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[Ongoing study] The effects of personalizing assistive technology

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By:

Shannon Code
This is a summary of a study being conducted with ICORD researcher Dr. Ben Mortenson. The study focuses on the impact of a tailored assistive technology intervention on both the assistance user and the family caregiver. The study is anticipated to end in March 2017.

You can find the original paper here.


 What is assistive technology?

With today’s aging population, there is a significant increase in the number of older adults experiencing physical disabilities and limitations in mobility. Assistive technology (AT) can be very beneficial to these individuals in promoting participation in daily life. Common AT includes items related to mobility, such as walkers, canes, and wheelchairs, as well as environmental modifications, such as raised toilet seats and grab bars. Researchers in this study noted that Gitlin and colleagues outlined many positive outcomes of the use of AT, such as a greater ability to perform daily tasks, enhanced belief in one’s ability to succeed (self-efficacy), less fear of falling, better use of adaptive strategies, and decreased home hazards. Common barriers to the use of AT that were mentioned included limited information about AT use and availability, as well as cost.

What is this study about?

This study focuses on the family caregivers, who are most often either spouses or adult children, who provide unpaid assistance to the family member with a disability. Caregivers often experience a great amount of stress while providing assistance, and this can lead to potential emotional and physical burnout. A major goal of AT is to decrease or possibly eliminate reliance on this personal assistance. This study’s goal is to examine whether a home-based, individually customized AT approach can decrease the family caregiver’s perceived burden and increase the older adult’s independence when compared to a customary care (commonly used) approach.

In order to be eligible for the study, assistance users must be (a) 50 years old or older; (b) be living at home; (c) have a mobility issue that requires home-care services; and (d) require assistance with social participation or daily activities for four or more hours per week. The family caregiver must be (a) 18 years old or older and (b) providing unpaid assistance for a total of four hours or more per week at least once a month with daily activities or social participation. Study participants are randomly assigned into either an experimental group, in which they will receive the AT Provision, Updating, and Tune-Up (ATPUT) intervention, or a control group, in which participants will receive customary care from the medical site where they were originally recruited for the study.

 The Customary Intervention:

Participants in the control group receive customary intervention from registered occupational therapists. Participants are given equipment based on local funding policies, and may have minimal practice with the devices.

 The Experimental Intervention:

The experimental intervention begins with an in-home assessment of the participant’s current AT use, as well as the design of a personalized plan for AT use, which is developed with the help of the care recipient and the family caregiver. The ATPUT intervention consists of five steps:

1)  Identify and assess the problematic activities with involvement of both the family caregiver and recipient.
2)  Explore possible strategies to address the problematic activities.
3)  Choose most appropriate AT solution.
4)  Conduct training.
5)  Evaluate effectiveness of the AT-related strategy.

When compared to customary care, the ATPUT intervention will:
1)  Follow a consistent procedure that will be documented with every visit.
2)  Incorporate added follow-up visits that are not necessarily included in customary care.
3)  Create collaboration among the AT user and the family caregiver.
4)  Supply AT and funding efficiently, as well as provide financial assistance to repair or obtain new equipment, and for training.

With these guidelines, the frequency and intensity of the experimental intervention is anticipated to be greater than customary care.

Data collection for both groups will occur at baseline, 6, 22, and 59 weeks. The primary outcome of interest for caregivers is caregiver burden. The primary outcome for assistance users if functional autonomy. A sub-sample of participants will be interviewed to collect additional data about the content of treatment sessions, components that appear to be working well in the intervention, aspects that need improvement, and other general impressions.

How will this study influence AT users and their caregivers?

The researchers believe that when compared to the users in the customary care group, the older adults in the experimental group who receive the intervention plan will become more independent in daily life. Additionally, the caregivers in the experimental group will experience a decrease in perceived burden, as well as lowered psychological and physical demands. They hope that positive findings from this study will encourage clinicians to include caregivers better in the prescription process and to provide recommendations for AT use that takes into account both the needs of the care recipient and the care provider. The family caregiver in many instances is aging themselves, and this study highlights the importance of their inclusion in an AT intervention.