The first step in using a robot in brain injury rehabilitation: patients’ and health-care professionals’ perspective

The experiences and perceptions of health-care professionals regarding assistive technology training: A systematic review

Worldwide, there is an increasing demand for assistive technologies (ATs) that can support people to live independently for longer. Health-care professionals (HCPs) often recommend AT devices, however there exists a lack of availability of devices and appropriate training in the field. This systematic review aimed to synthesize the available evidence into the experiences and training needs of HCPs in relation to AT. Six electronic databases were searched without date restrictions: MEDLINE, PsycINFO, SPP, SSCI, CINAHL, and ASSIA. Journal handsearching, searching reference lists of included studies and relevant reviews, and contacting experts in the field of AT were also conducted. Findings were analyzed using narrative synthesis. Data from 7846 participants from 62 studies were synthesized, eliciting perceived challenges in access to and provision of training, resulting in knowledge gaps across disciplines and geographic locations. Mechanisms to mitigate these issues included ongoing support following training and tailoring education to meet individual needs since comprehensive training is essential to maintain and improve competence, knowledge, and confidence. Further research is required to explore the impact and effectiveness of AT training for HCPs to ensure that users of devices are supported to live independent and healthy lives.

Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q): development and implementation of an instrument to evaluate patients' perception during training

BACKGROUND

The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients' personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties.

METHODS

A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient's performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance.

RESULTS

Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach's alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded.

CONCLUSIONS

The TARPP-Q highlights the importance of patients' personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients' perception of training effectiveness, helping to customize devices and interventions.

Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study

BACKGROUND

There is a growing prevalence of loneliness and social isolation among older adults (OAs). These problems are often associated with depressive states, cognitive decline, sleep disorders, addictions, and increased mortality. To limit loneliness and social isolation in OAs, some authors recommend the use of new communication technologies to maintain a social link with family members as well as with health and social care professionals. Among these communication tools, telepresence robots (TRs) seem to be a promising solution. These robots offer users the possibility of making video calls with their relatives, social workers, and health care professionals, to maintain social contact and access to support services while living at home. Nevertheless, TRs have been relatively unstudied in real-life environments.

OBJECTIVE

The main objective of this study is to measure the impact of a 12-week intervention using a TR on the feeling of loneliness and on social isolation of OAs living at home. Its secondary objective is to establish recommendations for the implementation of TRs in the studied context.

METHODS

A nonrandomized study will be conducted among 60 OAs living at home who will participate in the study for 24 weeks. During this period, they will host a TR for 12 weeks to use it in their home. After the end of the intervention a 12-week follow-up ensues. In total, 4 evaluations will be performed over the entire experimental phase for each participant at weeks 0, 6, 12, and 24. A multidimensional assessment of the impact of the robot will be performed using a multimethod approach including standardized scales and a semistructured interview. This assessment will also help to identify the ergonomic aspects that influence the robot's usability and acceptability among OAs.

RESULTS

Data collection started in September 2020 and is expected to be completed in early 2023. In August 2022, 56 participants were recruited for the study. Data analysis will take place between August 2022 and is expected to be completed in early 2023.

CONCLUSIONS

The DOMIROB study will provide new knowledge on the impact of social TRs in OAs living at home. The results will make it possible to suggest technological, ethical, and organizational recommendations for the use and implementation of TRs for OAs in real-life settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04767100; https://clinicaltrials.gov/ct2/show/NCT04767100.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40528.

Social Telepresence Robots: A Narrative Review of Experiments Involving Older Adults before and during the COVID-19 Pandemic

Social isolation is a common phenomenon among the elderly. Retirement, widowhood, and increased prevalence of chronic diseases in this age group lead to a decline in social relationships, which in turn has adverse consequences on health and well-being. The coronavirus COVID-19 crisis worsened this situation, raising interest for mobile telepresence robots (MTR) that would help create, maintain, and strengthen social relationships. MTR are tools equipped with a camera, monitor, microphone, and speaker, with a body on wheels that allows for remote-controlled and sometimes autonomous movement aiming to provide easy access to assistance and networking services. We conducted a narrative review of literature describing experimental studies of MTR involving elderly people over the last 20 years, including during the COVID-19 period. The aim of this review was to examine whether MTR use was beneficial for reducing loneliness and social isolation among older adults at home and in health and care institutions and to examine the current benefits and barriers to their use and implementation. We screened 1754 references and included 24 research papers focusing on the usability, acceptability, and effectiveness of MTR. News reports on MTR use during the COVID-19 period were also examined. A qualitative, multidimensional analysis methodology inspired by a health technology assessment model was used to identify facilitating and limiting factors and investigate if and how MTR could reduce social isolation in elderly people. Reviewed studies provide encouraging evidence that MTR have potential in this regard, as experiments report positive feedback on MTR design and core functionalities. However, our analysis also points to specific technical, ergonomic, and ethical challenges that remain to be solved, highlighting the need for further multidimensional research on the design and impact of MTR interventions for older adults and building on new insights gained during the COVID-19 pandemic.

Usability Evaluations of Mobile Mental Health Technologies: Systematic Review

Background

Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice.

Objective

This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems.

Methods

We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Results

A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes.

Conclusions

This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.

Assistive technology for communication of older adults: a systematic review

OBJECTIVE

Describe the use of assistive technology to enhance communication opportunities for older adults.

METHODS

A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read.

RESULTS

Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication.

CONCLUSION

Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.

Care Personnel's Attitudes and Fears Toward Care Robots in Elderly Care: A Comparison of Data from the Care Personnel in Finland and Japan

PURPOSE

The aim of the study was to analyze and compare elderly care personnel attitudes toward care robots in Finland and Japan.

DESIGN

Cross-sectional survey in Finland and Japan.

METHODS

The Finnish sample was collected from care personnel in home care facilities in five municipalities in 2016. The Japanese sample was collected from personnel in two rehabilitative day centers and three residential care homes for the elderly in the north of Honshu Island in 2017. The data were analyzed using basic statistical methods and calculated descriptive statistics (frequencies). Differences between the Finnish and Japanese data have been analyzed using the Mann-Whitney U test.

FINDINGS

Overall, Japanese care personnel assessed the usefulness of robots more positively than did their Finnish counterparts. The data showed substantial national differences in the perceived importance of various potential tasks for care robots. The findings show that there are also certain fears related to the introduction of care robots, in particular among the Finnish care personnel.

DISCUSSION

The data from the Japanese care personnel bring new perspectives to the concept of a close human-robot relationship. The differences seen in the results between Finland and Japan can be partly explained by cultural dissimilarity, but it is also known that Japan is a more developed country with regard to the use of robotics in nursing care. The research highlights the importance of cultural factors when examining the issue of care robotics. The factors affecting fear are a concern that care robots would be used to replace people, the dehumanization of treatment, and an increased loneliness in the elderly. Thus, further research is required to demonstrate the relationship between different cultural factors, and attitudes and conceptions toward care robots.

CLINICAL RELEVANCE

Management plays a key role when implementing robotics. It is important to help care personnel accept care robots, and to diminish any fears that their introduction would make the treatment of elderly people inhumane or in some way add to their loneliness. As such, education is crucial in changing attitudes and making care personnel understand that care robots can perform routine tasks, allowing care personnel to focus on providing improved care and nursing.

First steps in designing an all-in-one ICT-based device for persons with cognitive impairment: evaluation of the first mock-up

Background

This project Smart Assisted Living involving Informal careGivers++ (SALIG) intends to develop an ICT-based device for persons with cognitive impairment combined with remote support possibilities for significant others and formal caregivers. This paper presents the identification of the target groups’ needs and requirements of such device and the evaluation of the first mock-up, demonstrated in a tablet.

Methods

The inclusive design method that includes end-users in the design process was chosen. First, a scoping review was conducted in order to examine the target group’s need of an ICT-based device, and to gather recommendations regarding its design and functionalities. In order to capture the users’ requirements of the design and functionalities of the device three targeted focus groups were conducted. Based on the findings from the publications and the focus groups a user requirement specification was developed. After that a design concept and a first mock-up was developed in an iterative process. The mock-up was evaluated through interviews with persons with cognitive impairment, health care professionals and significant others. Data were analysed using content analysis.

Results

Several useful recommendations of the design and functionalities of the SALIG device for persons with cognitive impairment were identified. The main benefit of the mock-up was that it was a single device with a set of functionalities installed on a tablet and designed for persons with cognitive impairment. An additional benefit was that it could be used remotely by significant others and formal caregivers.

Conclusion

The SALIG device has the potentials to facilitate everyday life for persons with cognitive impairment, their significant others and the work situation for formal caregivers. The results may provide guidance in the development of different types of technologies for the target population and for people with diverse disabilities. Further work will focus on developing a prototype to be empirically tested by persons with cognitive impairment, their significant others and formal caregivers.