Daily time management and influence of environmental factors on use of electronic planning devices in adults with mental disability

Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists

PURPOSE

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs).

METHODS

The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed.

RESULTS

Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education).

CONCLUSIONS

The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.

Use of Assistive Technology for Persons with Psychosocial Disability: Systematic Review

BACKGROUND

Assistive technology (AT) refers to assistive products (AP) and associated systems and services that are relevant for function, independence, well-being, and quality of life for individuals with disabilities. There is a high unmet need for AT for persons with disabilities and this is worse for persons with cognitive and mental or psychosocial disabilities (PDs). Further, information and knowledge on AT for PDs is limited.

OBJECTIVE

The aim of this review was to explore the pattern of AT use among persons with PDs and its associated socioeconomic and health benefits.

METHODS

The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), and we conducted systematic searches in the 4 databases: PubMed, Embase.com, APA PsycInfo (Ebsco), and Web of Science (Core Collection) with the following index terms: "Assistive Technology," "Self-Help Devices," "Quality of Life," "Activities of Daily Living," "Mental Disorders." We included only AT individuals with PDs can independently use without reliance on a provider. Identified papers were exported to EndNote (Clarivate) and we undertook a narrative synthesis of the included studies.

RESULTS

In total, 5 studies were included in the review which reported use of different AT for schizophrenia, bipolar disorder, depression and anxiety disorders. The APs described in the included studies are Palm tungsten T3 handheld computer, MOBUS, personal digital assistant, automated pill cap, weighted chain blankets, and smartphone function. All the AT products identified in the studies were found to be easily usable by individuals with PDs. The APs reported in the included studies have broad impact and influence on social function, productivity, and treatment or management. The studies were heterogeneous and were all conducted in high-income countries.

CONCLUSIONS

Our study contributes to and strengthens existing evidence on the relevance of AT for PDs and its potential to support socioeconomic participation and health. Although AT has the potential to improve function and participation for individuals with PDs; this review highlights that research on the subject is limited. Further research and health policy changes are needed to improve research and AT service provision for individuals with PDs especially in low-income settings.

TRIAL REGISTRATION

PROSPERO CRD42022343735; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343735.

Cross-cultural adaptation of assessments for time-related abilities of Indian older adults and evaluation of their reliability and validity

BACKGROUND

Older adults may have difficulties in daily time management due to age-related or disease-related cognitive impairment. Standardised assessments for time-related abilities are currently unavailable in India.

AIM

The study aimed to adapt the Kit for Assessing Time-processing Ability-Senior (KaTid-Senior) and Time-Self rating, Senior (Time-S Senior) for daily time management of Indian older adults, translate these into an Indian language, and evaluate the reliability and validity of the adapted assessments.

MATERIALS AND METHODS

The two Swedish-origin assessments were reviewed, adapted for linguistic and cultural relevance into English, and translated into Kannada language. Older adults (n = 128) were conveniently selected, assessed with the Montreal Cognitive Assessment, and assigned to age and gender-matched groups: cognitively-impaired and cognitively-normal. Data was then collected with the adapted assessments.

RESULTS

Both adapted assessments demonstrated acceptable reliability (internal consistency) in this sample (α =0.89 - 0.90). The cognitively-impaired group had significantly (p < 0.001) lower scores on the assessments as compared to the cognitively-normal group. There was a strong to moderate correlation between the assessments supporting their convergent validity.

CONCLUSIONS

The adapted assessments are reliable and valid in the Indian context.

SIGNIFICANCE

The study would facilitate contextually-relevant assessment and management of time-related abilities in Indian older adults.

How Implementation of Cognitive Assistive Technology in Home-Based Services for Young Adults with Intellectual Disabilities Influences Support Staff`s Professional Practice

The implementation of technology in home-based services takes place in contextualised socio-material practices negotiated through interactions between a diversity of actors. Prerequisites for succeeding in this process are time and competence, and that use of the technology is experienced as meaningful, for both the support staff and the resident. In this article, we investigate how implementation of cognitive assistive technology (CAT) in home-based services for young adults with intellectual disabilities influences the support staff`s professional practice. The participants are eight support staff members, five women and three men. Data were collected through two group interviews, the second one 8 months after the first one. The data were analysed according to a systematic text condensation (STC) approach. Implementation of CAT is a demanding process, revealing different perspectives on professionalism and changing power relations, and entails a new way of working for the support staff.

Assessing time processing ability and daily time management in persons with dementia: Psychometric properties of three instruments

INTRODUCTION

Persons with dementia experience time-related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®-Senior measuring time processing ability, and Time-S© Senior and Time-Proxy© measuring daily time management for persons with dementia.

METHODS

Persons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person-response validity; unidimensionality; person-separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated.

RESULTS

Overall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid-Senior for better targeting of persons with mild dementia. Person-response validity issues in Time-S Senior need to be addressed.

CONCLUSION

The instruments can validly and reliably be used to assess time processing ability and daily time management in persons with dementia in clinical research and healthcare settings. In turn, this can contribute to the development of methods to compensate for impaired time processing ability and daily time management. The assessments can also increase the possibility of early detection of impaired time processing ability and daily time management, thereby facilitating adequate timing of interventions and enhanced occupational performance.

Associations between Time Processing Ability, Daily Time Management, and Dementia Severity

This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs' own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA and DTM, objective measures should be used in combination with self-ratings and proxy-ratings. The findings can be used in clinical research and healthcare settings to develop methods to compensate for impaired TPA and support DTM in PwDs.

The Psychometric Properties of the Original Version of Assessment of Time Management Skills (ATMS)

Background

To perform daily activities, time management and organizational skills are essential and therefore also important intervention focus in occupational therapy. To guide and evaluate intervention, valid and reliable instruments that measure time management and organization skills are necessary. The aim of this study was to evaluate the psychometric properties of the Assessment of Time Management Skills (ATMS).

Methods

Eligible participants were volunteer adults from the general population who were aged between 18 and 65 years, had a good understanding of English, and were not currently involved in any training or education to improve time management. The ATMS was filled out as a computer-administered survey. Rasch measurement analysis was used to evaluate the validity and aspects of reliability of the ATMS.

Results

In total, 241 adults (112 male and 129 female, mean age = 40) participated. The analysis of principal components of residuals (PCA) and the item goodness-of-fit indicated that the 30-item scale does not measure only one single trait. Three subscales, time management (11 items), organization and planning (11 items), and regulation of emotion (5 items), were detected. One item each on the 11-item subscale showed misfit, but they were kept due to high relevance. All three subscales showed excellent results on analyses of PCA, local independence, and reliability. Conclusions and Relevance. ATMS can provide valid measures of time management, organization and planning skills, and regulation of emotion in a general population and presumably also in a population with cognitive impairment. The measure is useful for occupational therapists in assessing patients' strengths and barriers in time management skills. It can also be useful in identifying the necessity of training time management skills, to guide OT intervention programs and to evaluate interventions. What This Article Adds. Knowledge about the psychometric properties and usefulness of the ATMS in English-speaking countries.

Assessment of time-related deficits in older adults: a scoping review protocol

INTRODUCTION

People with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected.

METHOD AND ANALYSIS

This protocol follows the Joanna Briggs Institute Reviewer's Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis.

ETHICS AND DISSEMINATION

As secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.

Evaluation of the "Let's Get Organized" group intervention to improve time management: protocol for a multi-centre randomised controlled trial

BACKGROUND

Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. "Let's Get Organized" (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation.

METHODS

The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years.

DISCUSSION

A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.

One-year follow-up after the time management group intervention Let's Get Organized

BACKGROUND

Time management skills are essential to maintain occupations in everyday life. People with neurodevelopmental or mental disorders often experience persistent difficulties with managing time and organizing daily life, consequently, there is a need to establish interventions with sustainable results.

AIM

The aim was to perform a one-year post-intervention follow-up after the intervention Let's Get Organized (LGO-S) for people with neurodevelopmental or mental disorders.

METHODS

The study is a one-year follow-up of a single group pre-test-post-test design. Thirty-eight persons with difficulties in time management due to neurodevelopmental or mental disorders participated. Instruments to collect data were Assessment of Time Management Skills; Weekly Calendar Planning Activity and the Satisfaction with Daily Occupations instrument. Wilcoxons's signed-rank test was used to compare data over time.

RESULTS

There were no significant differences in the participants' outcomes between post-intervention and one-year follow-up in time management skills and regulation of emotions, satisfaction with daily occupations, and global satisfaction. A significant improvement could be seen in the subscale organization and planning at the one-year follow-up compared to post-intervention.

CONCLUSIONS

Improvements in time management skills, organization, and planning, regulation of emotions, and satisfaction with daily occupations after the LGO-S can be maintained in the long term.

How using assistive technology for cognitive impairments improves the participation and self-determination of young adults with intellectual developmental disabilities

In Norway, where all citizens are entitled to live in their own homes in their local communities, people with intellectual disabilities receive community-based home care services that aim to promote their ability to live on their own. In our study, we investigated how using an assistive device for cognitive impairment - namely, a memo planner (MP) - in community-based home care services affected the everyday lives of people with intellectual developmental disabilities (IDD). Our sample consisted of seven young adults with IDD and their support staff. Data were collected during field observations and group interviews and analysed via systematic text condensation. The findings illuminate how using an MP can structure the daily lives of young adults with IDD and afford them opportunities to participate in everyday activities. In this article, we discuss how using an MP shapes interactions between people with IDD and their support staff.

Parents act as intermediary users for their children when using assistive technology for cognition in everyday planning: Results from a parental survey

Assistive Technology for Cognition (ATC) is employed by children with and without disabilities. However, how the ATC is used in everyday life has not been studied. The current study investigated ATC-usage in everyday planning in three groups: 1) children qualifying for Swedish habilitation centers (ID/ASD), 2) children with disability not qualifying for habilitation service (ADHD), and 3) children with typical development (TD). A parental survey was conducted (n = 192) and answers were analyzed with statistical tests and inductive thematic text analysis. Results showed that all groups used ATC, most in the Habilitation group and least in the TD group. According to parents, ATC supported cognitive functions in all groups, but it became evident that the parents were responsible for planning by setting up the ATC, whilst the children merely executed the plans. This was linked to several limitations, for example the design was not appropriately adapted for these groups. The implications for the practitioners are 1) evaluate the users' cognitive abilities and choose an ATC suitable for that individual rather focusing on the diagnosis, and 2) follow up usage to see if it is the parent or the child that are using the ATC.

Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management

IMPORTANCE

There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties.

OBJECTIVE

To pilot test the first part of the Let's Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders.

DESIGN

One-group pretest-posttest design with 3-mo follow-up.

SETTING

Outpatient psychiatric and habilitation settings.

PARTICIPANTS

Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life.

INTERVENTION

Swedish version of Let's Get Organized (LGO-S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr.

OUTCOMES AND MEASURES

Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS-S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure.

RESULTS

Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS-S results were sustained at 3-mo follow-up.

CONCLUSION AND RELEVANCE

LGO-S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further.

WHAT THIS ARTICLE ADDS

This study shows that LGO-S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.

Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized controlled study

Specific problems with time and timing that affect daily routines, homework, school work, and social relations have been recognized in children with ADHD. The primary treatments for children with ADHD do not specifically focus on time-related difficulties. The aim of this randomized controlled study (RCT) was to investigate how multimodal interventions, consisting of training in time-processing ability (TPA) and compensation with time-assistive devices (TAD), affect TPA and daily time management (DTM) in children with ADHD and time difficulties, compared with only educational intervention. Thirty-eight children on stable medication for ADHD in the 9-15-year age range were randomly allocated to an intervention or a control group. The children's TPA was measured with a structured assessment (KaTid), and the children's DTM was rated by a parent questionnaire (Time-Parent scale) and by children's self-reporting (Time-Self-rating). The intervention consisted of time-skill training and compensation with TAD. Data were analysed for differences in TPA and in DTM between the control and intervention groups in the 24-week follow-up. Children in the intervention group increased their TPA significantly (p = 0.019) more compared to the control group. The largest increase was in orientation to time. In addition, the parents in the intervention group rated their children's DTM as significantly (p = 0.01) improved compared with the parents in the control group. According to the children, their DTM was not significantly changed. In conclusion, a multimodal intervention consisting of time-skill training and TAD improved TPA and DTM in children with ADHD aged 9-15 years.

Drafting standards on cognitive accessibility: a global collaboration

PURPOSE

The International Organization for Standardization (ISO) is working on accessibility of products to support people with cognitive impairment. Working Group 10, within the technical committee 173 (assistive products for persons with disability) was formed in 2014 to draft standards for assistive products that support people with cognitive impairment.

METHOD

This article explains the scope and purpose of the working group and the context for its formation, and describes the plans and process for drafting and publishing new international standards.

RESULTS

The proposed suite of standards is presented, with examples from a draft standard on daily time management. It draws on international research evidence for the effectiveness of assistive products designed to support time management in people with cognitive impairment. Examples of assistive products and their key features are provided based on domains of time as defined in the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY).

CONCLUSIONS

The proposed standards will provide design recommendations for features and functions that increase the accessibility of products used by people with cognitive impairment. They are intended to be used by designers, manufactures, educators and services providers, to facilitate their commitment to inclusion and demonstrate their willingness to work with accessibility regulation. Implications for Rehabilitation New standards based on universal design (UD) principles can guide the design of more user-friendly assistive products for people with cognitive impairment. Greater usability of assistive products, whether mainstream or specially-designed, will make it easier for practitioners to find and introduce assistive solutions to individuals with cognitive impairment. Greater usability of assistive products for daily time management can decrease the need for user training and support and enable participation.