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Over 1.1 million older Canadians use assistive technologies (ATs) defined as devices that help to improve or maintain the functional capacity or participation of an individual. Rising demands, geographic spread of potential users, and the lack of community rehabilitation services (e.g., occupational therapy) are problematic factors for the provision of ATs. New approaches have to be developed to empower older adults and their caregivers in the self-selection of ATs. Information and communication technologies represent a promising avenue to address this gap. An online decision support system (DSS) for the self-selection of ATs called SmartAssist (available on platforms such as desktop computers, tablets, and smartphones) was developed in the United Kingdom. A study is currently underway to adapt this tool to the Canadian context, validate it and explore its acceptability by potential users and by other stakeholders. This paper will present how the test-retest reliability and the usability of this DSS will be assessed and how its acceptability will be explored.

Informal caregivers are a critical yet frequently unacknowledged part of the healthcare system. It is commonly presumed that providing assistive technology will decrease the burden of their care provision; however, no review has evaluated the evidence behind this assumption. Therefore, a systematic review was undertaken to evaluate evidence of the impact of assistive technology use by care recipients on their informal caregivers. Data sources included EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area. Twenty-two studies met the specified inclusion criteria. Collectively, the findings suggest that assistive technology use helps caregivers by diminishing some of the physical and emotional effort entailed in supporting individuals with disability. However, confidence in this causal connection is limited because of the study designs that were used. This undermines the understanding of the impacts of assistive technology use on the users' informal caregivers.

Objectives: To explore how wheelchair-related factors, mobility, and participation are associated in a sample of long-term care residents who use wheelchairs as their primary means of mobility. Design: Cross-sectional survey. Setting: Eleven residential care facilities in the lower mainland of British Columbia, Canada. Participants: One hundred forty-six self-responding residents and 118 proxy respondents: mean age 84 (range 60-103). Most were female (69%), and a small proportion (9%) drove a power wheelchair. Measurements: The Nursing Home Life Space Diameter Assessment was used to measure resident mobility, and the Late Life Function and Disability Instrument: Disability Component was used to measure participation frequency in daily activities. Results: Path analysis indicated that wheelchair-related factors were associated with participation frequency directly and indirectly through their relationship with mobility. The final model explained 46% of the variance in resident mobility and 53% of the variance in resident participation frequency. Wheelchair skills, which include the ability to transfer in and out of and propel a wheelchair, were important predictors of life-space mobility and frequency of participation, and life space mobility was a significant predictor of frequency of participation. Depression was associated with poorer wheelchair skills and mobility and less-frequent participation. Counterintuitively, perceived environmental barriers were positively associated with frequency of participation. Conclusion: The findings suggest that, by addressing wheelchair-related factors, resident's mobility and participation may be improved, but the efficacy of this approach needs to be confirmed experimentally.

Background: Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. Objective: To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. Methods: Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. Results: The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6–64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (rp = –0.684, CI –0.143 to –0.910) was found. Conclusion: Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.

Internet-based interventions helping caregivers of older adults to cope with caregiving tasks can offer an efficient and accessible alternative to traditional face-to-face interventions. However, little is known about the existing links between intervention components and outcomes. A systematic review was conducted in databases with keywords relevant to internet, caregivers and self-management interventions. Studies had to report on an intervention delivered mainly using the Internet and on caregiver specific outcomes, include at least one care recipient older than 50 years and score high level of evidence. A narrative synthesis of components (e.g. content, multimedia use, interactive online activities and provision of support), caregiver outcomes (e.g. on stressors, mediators and psychological health) and behavior change techniques was conducted. A total of 2338 articles were screened. 12 randomized controlled trials were included covering 10 internet-based interventions. 5 interventions led to statistically significant results on caregiver outcomes, mostly reporting impacts on depression or anxiety (n=4). From these interventions, 4 incorporated remote professional support with either synchronous (e.g. videoconference, n=1) or asynchronous (e.g. email, n=3) components and all were highly interactive with quizzes on educational content (n=3) or online questionnaires on health status (n=2). All 5 interventions provided instructions for behavior change, 4 provided social support and 3 used modeling techniques. In sum, internet-based interventions that are interactive, model appropriate behavior, incorporate professional support and provide instructions and social support can lead to better outcomes in caregivers. More studies isolating the specific effect of components are needed to better understand the underlying mechanism of action.

Family caregivers provide 75% of care needed for individuals with disabilities to remain in their communities. Many family caregivers in Canada experience negative health, social and financial outcomes. Innovative solutions (or interventions) are needed that can ameliorate the deleterious aspects of caregiving and foster positive ones. Therefore, we conducted a study with the following objectives: (i) to identify the specific needs of family caregivers, especially aspects of caregiving situations that caregivers find most difficult to manage or would like improved; and (ii) to identify preferences and priorities of caregivers for the development of technological solutions to address these areas. We conducted qualitative interviews with a purposive sample of 47 family caregivers of older adults or older adults who are family caregivers. Participant age ranged from 43 to 76, with a mean age of 63, and 75% were women. Our analysis identified three main themes: i) caregiver responsibilities explored their day-to-day caregiving activities; ii) strategies to address identified technologies that could potentially help caregiver needs; and iii) caregiver challenges revealed the physical and psychological struggles associated with caregiving. These findings emphasize the complexity of care provision, problems identifying and accessing solutions, and the need to develop effective and innovative approaches. This study offers a framework for future user-centred design research that involves caregivers as active partners. Our findings will inform the development of novel interventions and support policy changes to make care provision easier.

Mortenson WB, Miller WC, Backman CL, Oliffe JL. Predictors of mobility among wheelchair using residents in long-term care. Objective To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility. Design Cross-sectional study. Setting Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada. Participants Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119). Interventions Not applicable. Main Outcome Measures Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables. Results Independent mobility decreased as the distance from the resident's room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores. Conclusions Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.

The neighbourhood environment influences mobility and participation of older adults especially those using mobility assistive technology (AT). Documentation of environmental barriers/facilitators in neighbourhoods by AT users can enable them to vocalize and advocate their needs for mobility and participation. Twenty-four AT users collected observational and photographic data on neighbourhood environments in three municipalities in Metro Vancouver, British Columbia using the “Stakeholders Walkability/Wheelability Audit in Neighbourhoods” (SWAN) tool. Selected participants from each municipality participated in the development of a series of videos, showcasing key findings from SWAN data through vignettes of their daily mobility. The audit data, photographs and videos where later used to engage other stakeholders through community forums. This participatory process is a resource for diverse groups of older adults to become informed and engaged partners in neighbourhood physical planning and decision-making processes and initiate environmental changes in their communities.

Mixed qualitative and quantitative studies are becoming popular in social sciences research and are recognized as legitimate project designs. However, diverse definitions and applications are common and little consensus exists about exactly what constitutes a mixed methods approach. In this article, the authors provide an overview of various approaches to mixed methods and present the findings derived from a survey of mixed methods research published between 2000 and 2005 in nine occupational therapy journals. The results from this survey indicate that, although the use of mixed methods is relatively common (14% of all research articles published), there are several methodological issues to be considered. These include the subordinate positioning of qualitative findings and lack of justification for using mixed methods. Recommendations are offered to conceptually advance future applications and guide occupational therapy researchers considering the use of mixed methods.

Single-subject research design using 4 consecutive patients.To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin.Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients.This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention.All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain.Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

Specialized dementia care units (DCUs) house individuals whose behaviors cannot be managed in other settings. To ensure environmental fit, admission/discharge criteria are recommended for DCUs; however, there is no consensus about what criteria should be used. This study aimed to describe, in a random sample of DCUs, the current admission criteria, current/recommended discharge criteria, and services to support discharge. Usable surveys were returned by 23 of 30 facilities. Residents were most frequently admitted because they had a diagnosis of dementia and exhibited cognitive/behavioral problems. The four most common discharge criteria in place/recommended were resident ability to manage in a non-specialized long-term care environment, lack of socially inappropriate behaviors, dependency in activities of daily living, and inability to participate in dementia care activities. These findings suggest that discharge from DCUs is relatively ad hoc. The study lays the groundwork for future research to evaluate the use/appropriateness of these criteria.

Background: Exoskeleton technology has potential benefits for wheelchair users’ health and mobility. However, there are practical barriers to their everyday use as a mobility device. To further understand potential exoskeleton use, and facilitate the development of new technologies, a study was undertaken to explore perspectives of wheelchair users and healthcare professionals on reasons for use of exoskeleton technology, and the importance of a variety of device characteristics. Methods: An online survey with quantitative and qualitative components was conducted with wheelchair users and healthcare professionals working directly with individuals with mobility impairments. Respondents rated whether they would use or recommend an exoskeleton for four potential reasons. Seventeen design features were rated and compared in terms of their importance. An exploratory factor analysis was conducted to categorize the 17 design features into meaningful groupings. Content analysis was used to identify themes for the open ended questions regarding reasons for use of an exoskeleton. Results: 481 survey responses were analyzed, 354 from wheelchair users and 127 from healthcare professionals. The most highly rated reason for potential use or recommendation of an exoskeleton was health benefits. Of the design features, 4 had a median rating of very important: minimization of falls risk, comfort, putting on/taking off the device, and purchase cost. Factor analysis identified two main categories of design features: Functional Activities and Technology Characteristics. Qualitative findings indicated that health and physical benefits, use for activity and access reasons, and psychosocial benefits were important considerations in whether to use or recommend an exoskeleton. Conclusions: This study emphasizes the importance of developing future exoskeletons that are comfortable, affordable, minimize fall risk, and enable functional activities. Findings from this study can be utilized to inform the priorities for future development of this technology.

The aim of this study was to demonstrate experimentally that an assistive technology (AT) intervention improves older AT users' activity performance and satisfaction with activity performance and decreases their caregivers' sense of burden.This study was a delayed intervention, randomized control trial. Baseline data were collected on 44 community-dwelling AT user-caregiver dyads in Vancouver, British Columbia, and Montreal, Quebec. The primary outcome measures for AT users were the satisfaction and accomplishment scales from the Assessment of Life Habits. The primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure, which assessed burden associated with dyad-identified problematic activities.After the intervention, assistance users in the immediate intervention group reported significantly increased satisfaction with activity performance (P0.001) and improved accomplishment scores (P = 0.014). Informal caregivers in the immediate intervention group experienced significantly decreased burden with the dyad-identified problematic activity (P = 0.013). Participants in the delayed intervention group experienced similar benefits after the intervention. Improvements for both groups were mostly maintained 4 mos after the conclusion of the intervention.This is the first experimental study to demonstrate that the provision of AT decreases caregiver burden. If confirmed and extended by subsequent research, the findings have significant policy and practice implications and may enable health care providers to advocate for improved access to AT provision and the related follow-up services.

To support an aging population there has been a move towards developing surveillance technologies that observe the movements, behaviours and health status of older people. These technologies are meant to support health and independence within the context of limited resources. Although there have been studies about the development of new devices and systems, there has been less research examining the impact of surveillance technologies that monitor those residing and working in care facilities. This paper reports the findings from a qualitative study of a residential care facility that instituted video surveillance. The findings revealed how surveillance was used as a care management tool – to provide access to real-time data, to preserve the safety of older people and to monitor the working practices of formal carers. However, there may also be some unintended consequences of the implementation of video surveillance in residential care.

Despite the potential benefits of powered mobility, many older adults do not have access to this technology. To date, few studies have explored how prescribers make decisions regarding provision of powered mobility. Therefore, we undertook a qualitative study to develop a better understanding of prescribers’ attitudes toward and practices with older adult candidates for powered mobility devices. Our analysis of 10 in-depth interviews identified three main themes: (1) “Deciding who should be entitled” explored how therapists decided who should have access to powered mobility, (2) “power wheelchair negotiation” described the discord between clients and therapists that became apparent during this process, and (3) “practical considerations” revealed how contextual factors shaped the provision of powered mobility. The findings suggest that the ways in which powered mobility is funded, provided, and accommodated should be improved so that more older adults have access to these devices and can use them to their full potential.

Collision avoidance technology has the capacity to facilitate safer mobility among older power mobility users with physical, sensory and cognitive impairments, thus enabling independence for more potential users. However, little is known about consumers’ perceptions of collision avoidance. This article draws on interviews with 29 users, five caregivers, and 10 prescribers to examine views on the design and utilization of this technology. Data analysis identified three themes: “useful situations or contexts”, “technology design issues and real life application”, and “appropriateness of collision avoidance technology for a variety of users”. Findings support the ongoing development of collision avoidance for older adult users. The majority of participants were supportive of the technology, and felt that it might benefit current power mobility users and users with visual impairments, but might be unsuitable for people with significant cognitive impairments. Some participants voiced concerns regarding the risk for injury with power mobility use and some identified situations where collision avoidance might be beneficial (driving backwards, avoiding dynamic obstacles, negotiating outdoor barriers, and learning power mobility use). Design issues include the need for context awareness, reliability, and user interface specifications. Furthermore, user desire to maintain driving autonomy indicates the need to develop collaboratively-controlled systems. This research lays the groundwork for future development by identifying and illustrating consumer needs for this technology.

Many individuals living in residential care use a wheelchair as their primary means of mobility. Although studies have documented challenges encountered by residents in these facilities, few have addressed the role that wheelchairs, as potential enablers and barriers to mobility and participation, play in their lives. To better understand residents' experiences, an ethnographic study was conducted drawing on Bourdieu's theoretical constructs of capital, field, and habitus. Participant observations were conducted at two facilities, and residents, family members and staff took part in in-depth individual interviews. Our analysis revealed three themes. Ready to roll detailed how residents used wheelchairs as a source of comfort and means for expanding their social space, while staff could use them as a means to move and control some residents. Squeaky wheels described how residents solicited assistance from staff and family amid having to wait to perform activities of daily living. In, out and about revealed diversity in the places residents went, spaces they shared and the social activities in which they engaged inside and outside their residential facilities. The study findings emphasise how wheelchairs constitute capital that governs many fields of practice for residents and staff and suggest how practice and policy might be adjusted.

Background. Increasing choices in assistive technology have made the process of procuring a wheelchair more complex and challenging. Purpose. To explore the intricacies of the procurement process from the perspectives of clients and therapists. Methods. Thirty-four participants were interviewed, including 13 wheelchair prescribers, 14 wheelchair users, and 7 wheelchair associates (family members and caregivers). Findings. Analysis revealed five main themes. “Who decides? ” described varying degrees of client involvement in the procurement process. “Expert knowledge” reflected the expert knowledge that all parties possessed. “Form versus function” captured the primary and, at times, conflicting outcomes that participants wanted to achieve. “Fitting in” depicted the environmental factors that affected wheelchair procurement. “(Re)solutions” illustrated strategies that participants felt improved the process. Implications. This study reveals clients' experiences with wheelchair procurement, identifies potential issues therapists may encounter, and suggests possible remedies they might consider when prescribing wheelchairs within a client-centred framework.

Tilt-in-space (TIS) wheelchairs are common in residential care, but little empirical evidence exists regarding how they are used by residents and staff in these settings. As part of a larger study exploring the use of wheeled mobility in these facilities, we conducted a substudy to examine how TIS wheelchairs are used in practice and to explore the experiences of the residents who use them. We conducted a series of three participant observations and interviews with 6 residents or their family members and interviewed 10 staff. Our analysis identified taking control as the main overarching theme, subsuming two subthemes: promoting comfort and mobilizing to participate. Findings suggest that power TIS wheelchairs enable user control, whereas manual TIS wheelchairs promote staff control. These findings illustrate how TIS wheelchairs may enable or inhibit occupational engagement and suggest that vigilance is necessary to prevent their use as a restraint.

This letter to the editor is in response to the article by Pettersson, Pettersson and Frisk entitled, "ICF from an occupational therapy perspective in adult care: an integrative literature review". Given the breadth of this topic, the authors have done an admirable job in their survey of the topic. One area we felt deserved additional attention was the inadequate way the ICF classification system codes mobility assistive technology use. We also offer a point of clarification about the Wheelchair Outcome Measure, which was identified incorrectly as the only wheelchair specific measure that could measure activity and participation.

Background: The principal aim of this study was to investigate whether a caregiver-inclusive assistive technology intervention improved older care recipients’ functional autonomy and decreased the perceived burden of their family caregivers compared to customary care. Methods: The study was a single-blind, mixed-methods, randomized controlled trial with baseline data collection and follow-ups at 6-, 22-, and 58-weeks after baseline evaluation, which was prospectively registered (ClinicalTrials.gov Identifier: NCT01640470. Registered 11/21/2011). Dyads comprising a care recipient and family caregiver were randomly assigned to either a caregiver-inclusive experimental group (N = 44) or a customary-care comparison group (N = 46). Eligible care recipients were aged ≥55 years and had one or more limitations with mobility or daily activities, and family caregivers provided at least four hours per week of assistance. Outcome measures were administered to both groups at baseline and at the three follow-up time points. The data collectors were blinded regarding participants’ intervention group. The primary outcome measures were the Functional Autonomy Measurement System to assess care recipients’ functional performance, and the Caregiver Assistive Technology Outcome Measure to assess caregivers’ burden. Qualitative interviews examined participants’ perceptions of the caregiver-inclusive and customary care interventions. Results: The experimental intervention addressed significantly more dyad-identified problematic activities, but caregiver involvement was evident in both groups and outcomes were not significantly different over time. In both groups, care recipients’ functional autonomy declined significantly (P