No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Experiences among older persons using mobility devices
Disability and Rehabilitation: Assistive Technology
Abstract
The aim of the study was to investigate older persons' experiences of using mobility devices.
In this qualitative study, focus group interviews were carried out with participants living in two municipalities in the south of Sweden. Occupational therapists and physiotherapists identified interested participants, 65 years or older. A total of 22 persons participated once in the seven focus group interviews that were arranged.
Five main categories of participant experiences emerged from the data: 'Municipal supply and non-supply of devices', 'Acceptance or non-acceptance of mobility devices', 'Different use of mobility devices supports everyday and social activities', 'Different kinds of obstacles constrain everyday and social activities' and 'Adaptive strategies in order to use mobility devices'.
Since the participants experienced non-acceptance and obstacles related to the use of mobility devices, this highlights the needs for quality development concerning more efficient data-collecting in community-based rehabilitation.
... How comfortable a device was to use and wear was identified as another barrier. Issues with device discomfort included pain which limited the use of the device [56,57,62,69,76,81,84]. ...
... Examples included equipment being provided too late after the user's condition had deteriorated past the point it was useful. Long wait times for appointments and/or delivery of the equipment were regularly mentioned in relation to this theme [49,52,53,59,60,63,64,67,68,70,79,80,83,84,86]. A lack of equipment trialling to test if the equipment will work in a user's real-life context prior to equipment provision was another barrier. ...
... A lack of equipment trialling to test if the equipment will work in a user's real-life context prior to equipment provision was another barrier. Many user's wanted but did not get a period of time to try out equipment in different environments before choosing if the equipment was appropriate for them [55,57,59,62,66,78,79,84]. ...
Purpose
Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions.
Materials and methods
A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research.
Results
Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers.
Conclusions
The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology.
•
Implications for rehabilitation
• Individuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers.
• The provision of assistive technology needs to change away from the traditional medical model of the “expert” clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences.
• Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology.
... Mobility refers to movement in all of its forms, including basic ambulation, transferring from a bed to a chair, walking for leisure and the completion of daily tasks, engaging in activities associated with work and play, exercising, driving a car, and using various forms of public transport. [158] (Satariano et al. p. 1508) Reasons for using mobility aids, related to functional impairments, are often a need and desire to continue to be active and to continue performing everyday activities, including the potential to take part in social activities [159]. La Grow et al. [160] showed that mobility was directly related to quality of life and this relation was mediated by the satisfaction with functional capacity. ...
... Value-based design can therefore be considered a means to prevent product from failing when it is not accepted while fulfilling the potential end-users' needs after applying a human-centered design focus, an occurrence we have seen often among mobility devices [173]. Nonetheless, many factors have been identified to explain this phenomenon, such as financing, as well as more person-based barriers regarding attitudes and beliefs [164,174,175], such as a personal unwillingness to display dependence on mobility aids [159]. Therefore, besides identifying and designing for end-user values, a strong focus on determining why a specific (prototypical) mobility device is accepted or not during the design process is crucial [159,175]. ...
... Nonetheless, many factors have been identified to explain this phenomenon, such as financing, as well as more person-based barriers regarding attitudes and beliefs [164,174,175], such as a personal unwillingness to display dependence on mobility aids [159]. Therefore, besides identifying and designing for end-user values, a strong focus on determining why a specific (prototypical) mobility device is accepted or not during the design process is crucial [159,175]. Two of the most critical factors that explain this acceptance include coping style and subjective norm [176]. Coping style determines for an important part how one acts in times of difficult situations (e.g., not being able to walk as well as one used to) and how one goes about solving this situation [177]. ...
Recent public health campaigns often communicate the alarming phrase: “Sitting is the new smoking”. Sitting is related to all-cause mortality, cardiovascular disease, type 2 diabetes, and metabolic syndrome. Sedentary behavior is generally understood as “sitting or reclining while expending ≤1.5 metabolic equivalents” and the interesting aspect of sedentary behavior is that it is a modifiable health risk. The health risk can be reduced if a person changes his or her behavior towards a healthier one; to sit less and to become more physically active.
Research focusing on patterns of sedentary behavior has taken off since the rise of both wearable technologies and activity sensors. They provide opportunities for uncovering sedentary patterns within the context of daily life. As a consequence, the sedentary research field moved forward towards fine-grained, objective monitoring of sedentary behavior in free-living conditions for substantial time frames. Current wearable activity sensors are, however, not flawless in measuring sedentary behavior. It is therefore important to understand the effects of possible measurement bias, in order to deal with it in the best way.
People are often unaware of their sedentary behavior, making it difficult to change the behavior. mHealth interventions can improve awareness and trigger behavior change by tailoring the intervention to the user’s needs by providing direct feedback and coaching on physical activity and sedentary behavior together with real-time information on the context. Context information can be gathered by integrating relevant data sources or by posing questions about the here-and-now. Further increase of acceptance of mHealth interventions can be achieved by tailoring to individual values, and barriers and facilitators to these values.
The aim of this thesis is to determine how wearable activity sensors can be applied successfully in health interventions focused on sedentary behavior.
This thesis follows an expanding scope: starting from the level of the activity sensor up to the level of public health. The first part of this thesis focuses on the measurement of sedentary behavior and its patterns by means of wearable activity sensors (Chapter 2, 3 and 4). The second part of this thesis focuses on the development and evaluation of mHealth interventions that utilize these wearable activity sensors (Chapter 5 and 6).
The pattern of sedentary behavior during the day is an independent health risk. Prolonged sedentary time affects cardio-metabolic and inflammatory biomarkers, independent of the total sedentary time. Since the rise of both wearable technologies and activity sensors, there is however, no consensus among researchers on the best outcome measures for representing the sedentary pattern during the day, based on wearable activity sensors. Chapter 2 provides an overview of current pattern measures of sedentary behavior in adults, by means of a literature review. Simple measures of sedentary behavior were most often reported, like the number of bouts, the medium or median bout length. More complex pattern measures, such as the GINI index or the W50 were reported sparsely. Due to the differences among measurement devices, data analysis protocols and a lack of basic outcome parameters such as total wear-time and total sedentary time, the sedentary patterns, reported in the various studies, were difficult to compare. The simple and complex measures of sedentary time accumulation serve different goals, varying from a quick overview to in-depth analysis and prediction of behavior. The answer to which measures are most suitable to report, is therefore strongly dependent on the research question. From this overview in Chapter 2 we conclude that the reported measures were dependent on 1) the sensing method, 2) the classification method, 3) the experimental and data cleaning protocol, and 4) the applied definitions of bouts and breaks. Based on these findings, we recommend to always report total wear-time, total sedentary time, number of bouts and at least one measure describing the diversity of bout lengths in the sedentary behavior such as the W50. Additionally, we recommend to report the measurement conditions and data processing steps.
One of the factors influencing the output of activity sensors mentioned above is the experimental protocol (Chapter 2). This was studied in more depth in Chapter 3 in which we focused on optimal sensor placement for measuring physical activity. Subjects walked at various speeds on a treadmill, performed a deskwork protocol, and walked on level ground, while simultaneously wearing five activity sensors with a snug fit on an elastic waist belt. We found that sensor location, type of activity, and their interaction-effect affected sensor output. The most lateral positions on the waist belt were the least sensitive for interference. Additionally, the effect of mounting was explored by repeating the experimental protocol with sensors more loosely fitted to the elastic belt. The loose fit resulted in lower sensor output, except for the deskwork protocol, where output was higher. We conclude that, in order to increase the reliability and to reduce the variability of sensor output, researchers should place activity sensors on the most lateral position of a participant‘s waist belt. If the sensor hampers free movement, it may be positioned slightly more forward on the belt. Finally, we recommend to wear sensors tightly fitted to the body.
Another factor influencing the output of activity sensors mentioned above (Chapter 2) is the classification method. Currently, the most applied method to distinguish sedentary from active time is by applying a cut-point to accelerometry-based data. This means that the intensity of the measured behavior is classified as being sedentary when below this cut-point. The effect of the classification method on sedentary pattern measures was studied in detail in laboratory and free-living conditions with office workers (Chapter 4). In this study we found that the outcome measures are robust – meaning that the outcome measures do not change –, when cut-points for classifying sedentary behavior are within the boundaries of ±10-20% of the optimal cut-point. This conclusion implies that results from studies analyzing sedentary patterns based on different cut-points, can only be compared if the cut-points are within these boundaries.
In Chapter 5, we combined the knowledge on sensor use, data processing steps and outcome measures with context-aware technology in an intervention for older office workers towards sitting less and breaking up sitting time. Office workers spend a high percentage of their time sitting, often in long periods of time. Research suggests that it is healthier to break these long bouts into shorter periods by being physically active. In order to promote breaking up long sedentary bouts, we developed an innovative, context-aware activity coach for older office workers. This coach provides activity suggestions, based on a physical activity prediction model, consisting of past and current physical activity (measured by a wearable activity sensor) and digital agendas. The total sedentary time in the intervention week, was not reduced compared to the baseline week. However, the pattern of the sedentary behaviour did change – the office workers reduced their total time spent in long sitting bouts (≥45 minutes). Additionally, the office workers indicated that the main added value of the intervention resided in creating awareness about their personal sedentary behaviour pattern. Finally, the participants were compliant to 53% of the suggestions; a number that could be increased by improving the timing of suggestions. We conclude that the mobile intervention (using an activity sensor, smartphone application and context information) has the potential to improve the sedentary behaviour of older office workers. The gain can especially be found in breaking up long sedentary periods by being physically active. Older office workers value that it makes them aware of their sedentary behaviour. We also found that focusing on total sedentary time as an outcome of a public health intervention, aimed at reducing sedentary behaviour, is too simplistic. Rather, one should take into account both the duration and the number of bouts when determining the effect of the intervention. We conclude this article by summarizing our design recommendations for eHealth interventions that aim to improve sedentary behaviour.
In Chapter 6 we focused on a design approach to further increase acceptance of mHealth interventions – by tailoring to individual values, and barriers and facilitators to these values. In this study, we demonstrated how value-based design can contribute to the design of a product or service that addresses real needs and thus, lead to high acceptance. We described the methods and application of value-based design. We elicited values, facilitators and barriers of their reduced mobility – meaning difficulty with walking, biking, and/or activities of daily living – of older adults via in-depth interviews. These interviews resulted in a myriad of key values, such as ‘independence from family’ and ‘doing their own groceries’. Co-creation design sessions resulted in innovative mobility aids from which three designs for a wheeled walker were selected for evaluation on acceptance, again via in-depth interviews. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offered designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit the actual needs. However, mobility is related to physical capacity and not being sedentary. In-depth understanding of the values of life to be mobile, can therefore directly inspire designers focused on mobility aids. Nevertheless, this understanding can as well tap into the context and personal goals needed to tailor health interventions on sedentary behavior.
In Chapter 7, the general discussion, we discuss the rapid development of sensors and analysis methods, as well as gathering rich context information by means Experience Sampling. Cut-point-based analyses make only very limited use of the wealth of data that can be measured by activity sensors and has various challenges which hinders generalization of the current body of knowledge (Chapter 2, 3 and 4). It seems to make more sense to express the measured behavior in terms of the actual behavior, such as bicycling and climbing stairs, rather than expressing physical activity in counts or metric units representing its intensity. Machine learning techniques are very capable of this with higher accuracy, and their application seems to be a logical step forwards. And when expressed as behavior, machine learning output will be easier to adopt in interventions, as total sitting time and active breaks are better understandable than for example counts – matching the real-world knowledge of users. The Experience Sampling Method (ESM) incorporated in the developed intervention (Chapter 5) provided in-depth understanding of the context of sedentary behavior – the where, when, why, with whom and experienced emotions. Future interventions should incorporate this type of context-awareness in real-time tailored coaching strategies to increase awareness and behavior change.
The studies in this thesis have shown that activity sensors can provide valuable information on the pattern of sedentary behavior, and that these can be useful for health interventions. We have shown the strengths of current practice and opportunities for improvement, by applying a broad scope with a focus on measuring sedentary behavior and developing and evaluating mHealth interventions. Based on the study we conclude that:
The combination of the bottom-up approach (from sensor, to data to information levels) and the top-down approach (from user values related to public health to interventions and its specific feedback and coaching strategies), contribute to diverse, strongly connected and interdependent domains of applying wearable activity sensors in health interventions focused on sedentary behavior.
... For the qualitative studies, the sample size varied from six (Hjelle and Vik 2011) to 35 participants (Rosenberg et al. 2013). All studies used semi-structured or in-depth interviews for their data collection methods except for two, which used focus groups (Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hjelle and Vik 2011). For the mixed-methods studies, the sample size varied from three (Kylberg et al. 2013;Löfqvist et al. 2009) to 6578 participants (Clarke 2014). ...
... Twelve studies focused on mobility (Bromley, Matthews, and Thomas 2007;Clarke 2014;Gell et al. 2015;Gonzalez and Lord 2015;Harris, Yang, and Sanford 2015;Hoenig et al. 2007;Kirchner, Gerber, and Smith 2008;Korotchenko and Hurd Clarke 2014;LaPlante and Kaye 2010;Löfqvist et al. 2009;Matthews et al. 2003;Meyers et al. 2002) and seven studies focused on social participation (Botticello, Rohrbach, and Cobbold 2014;Cooper et al. 2011;Karmarkar et al. 2011;Kylberg et al. 2013;Pettersson et al. 2015;Tolerico et al. 2007;Wee and Lysaght 2009). The remaining 11 studies focused on both mobility and social participation (Auger et al. 2010;Barker, Reid, and Cott 2006;Brandt, Iwarsson, and Ståhle 2004;Carlson and Myklebust 2002;Fomiatti et al. 2014;Gibson et al. 2012;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hjelle and Vik 2011;Hoenig et al. 2003;Liang et al. 2008;Rosenberg et al. 2013). ...
... Twelve of the 30 articles reported 'weather conditions' as a barrier to mobility among people using MAT. More precisely, nine studies identified 'weather conditions' as barriers for manual and power wheelchairs (Barker, Reid, and Cott 2006;Brandt, Iwarsson, and Ståhle 2004;Gibson et al. 2012;Gonzalez and Lord 2015;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Kirchner, Gerber, and Smith 2008;Meyers et al. 2002;Rosenberg et al. 2013;Wee and Lysaght 2009), three for scooters (Fomiatti et al. 2014;Gonzalez and Lord 2015;Hoenig et al. 2007), and six for canes, walkers, and crutches (Gonzalez and Lord 2015;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hoenig et al. 2007;Kylberg et al. 2013; Löfqvist et al. Rosenberg et al. 2013). ...
This paper presents a systematic literature review on the impact of the neighborhood physical environment on mobility and social participation among people using mobility assistive technology (MAT). Peer-reviewed articles from eight databases published in French or English from 1990 to 2016 were searched. Thirty studies were included in this review. Factors related to neighborhood environmental features, mobility in transit, and accessibility of homes and public buildings influenced mobility and social participation of MAT users. The majority of reviewed studies combined different types of MAT, which made the interpretation of the results challenging. Few studies included walker, cane, and crutch users. Definitions of mobility and social participation lacked consistency and were often simplistic. Future empirical research needs to examine the impact of neighborhood physical environment factors separately for different MAT users. Causality and links between mobility and social participation of different MAT users at the neighborhood level should be further explored.
... como las relaciones sociales, lo que se traduce en sentimientos de control de la rutina personal, identidad y autoestima (55) . Diversos estudios cualitativos concluyen que la utilización de PA aumenta la independencia, la seguridad y disminuye la dificultad en el desempeño de las AVD (104,157,158) . ...
... Las opciones son múltiples: subvenciones para la adquisición, el préstamo, el alquiler o la cesión. Las ayudas son heterogéneas y existen diferencias importantes entre países, en cuanto a la dotación presupuestaria y el alcance de las actuaciones incluidas (157,182) . ...
... En los últimos años se observó un crecimiento importante de la demanda de AH y PA en Europa (100,157,190) . Las diferencias entre los países, con respecto a las características del sistema sanitario y social, la variedad en las Tabla 15. ...
En el modelo biopsicosocial, productos y tecnología (adaptaciones del hogar y productos de apoyo) son facilitadores contextuales del funcionamiento. Objetivo general: determinar la prevalencia de necesidades no cubiertas de productos y tecnología, en personas dependientes. Objetivos específicos: identificar adaptaciones del hogar; analizar la participación del terapeuta ocupacional y del sistema sanitario y social; conocer los factores explicativos de las adaptaciones y de la cobertura de productos. Metodología: revisión de 221 valoraciones de dependencia consecutivas. Resultados: 69,7% mujeres; mediana 84 años. En movilidad o autocuidado, 99% encuentra alguna barrera arquitectónica, intervalo confianza 95% (IC) = 96,6% a 99,9%; 97,7% precisa y no utiliza algún producto de apoyo (IC = 94,8% a 99,3%). Se adaptó el 29,3% de hogares. El terapeuta ocupacional indicó adaptaciones en el 14,8% de los domicilios en los que se removieron barreras y productos al 6,1% de usuarios. Los servicios públicos financiaron el 89,2% de sillas de ruedas. Hospitalización y situación social explican las adaptaciones. Estado civil y número de hijos determinan la cobertura de productos. Conclusión: la existencia generalizada de barreras y el empleo insuficiente de productos de apoyo argumentan la necesidad de favorecer la utilización de productos y tecnología, para promover autonomía, salud y bienestar.
... For the qualitative studies, the sample size varied from six (Hjelle and Vik 2011) to 35 participants (Rosenberg et al. 2013). All studies used semi-structured or in-depth interviews for their data collection methods except for two, which used focus groups (Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hjelle and Vik 2011). For the mixed-methods studies, the sample size varied from three (Kylberg et al. 2013;Löfqvist et al. 2009) to 6578 participants (Clarke 2014). ...
... Twelve studies focused on mobility (Bromley, Matthews, and Thomas 2007;Clarke 2014;Gell et al. 2015;Gonzalez and Lord 2015;Harris, Yang, and Sanford 2015;Hoenig et al. 2007;Kirchner, Gerber, and Smith 2008;Korotchenko and Hurd Clarke 2014;LaPlante and Kaye 2010;Löfqvist et al. 2009;Matthews et al. 2003;Meyers et al. 2002) and seven studies focused on social participation (Botticello, Rohrbach, and Cobbold 2014;Cooper et al. 2011;Karmarkar et al. 2011;Kylberg et al. 2013;Pettersson et al. 2015;Tolerico et al. 2007;Wee and Lysaght 2009). The remaining 11 studies focused on both mobility and social participation (Auger et al. 2010;Barker, Reid, and Cott 2006;Brandt, Iwarsson, and Ståhle 2004;Carlson and Myklebust 2002;Fomiatti et al. 2014;Gibson et al. 2012;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hjelle and Vik 2011;Hoenig et al. 2003;Liang et al. 2008;Rosenberg et al. 2013). ...
... Twelve of the 30 articles reported 'weather conditions' as a barrier to mobility among people using MAT. More precisely, nine studies identified 'weather conditions' as barriers for manual and power wheelchairs (Barker, Reid, and Cott 2006;Brandt, Iwarsson, and Ståhle 2004;Gibson et al. 2012;Gonzalez and Lord 2015;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Kirchner, Gerber, and Smith 2008;Meyers et al. 2002;Rosenberg et al. 2013;Wee and Lysaght 2009), three for scooters (Fomiatti et al. 2014;Gonzalez and Lord 2015;Hoenig et al. 2007), and six for canes, walkers, and crutches (Gonzalez and Lord 2015;Hedberg-Kristensson, Ivanoff, and Iwarsson 2007;Hoenig et al. 2007;Kylberg et al. 2013; Löfqvist et al. Rosenberg et al. 2013). ...
Context: Over three million Canadians have a mobility disability and a significant portion of these individuals are older adults. The majority of them rely on assistive technology (such as, cane, walkers and wheelchairs) to get from place to place. Research on the impact of the physical environment on mobility and participation among people with disability across the life course is limited. Objectives: This paper presents a systematic literature review on the impact of neighbourhood physical environment on mobility and social participation among people using assistive technology. This review was conducted as a part of multiphasic SSHRC-community partnership Canadian Disability Participation project. Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Nine databases (i.e., Academic Search Premier, AgeLine, CINAHL, Humanities & Social Sciences, MedLine, Social Sciences, Sport Discuss, Geo Ref and Web of Science) were searched for articles on this topic published in French or English from 1990 to 2015. Results and Conclusion: Forty-seven relevant articles were included in the review. Mobility is influenced by a variety of environmental and personal factors. Neighbourhood environment factors included mixed land use, density, connectivity, building accessibility, neighbourhood safety, and adapted transit systems. Individual characteristics included gender, age, user ability and the type of mobility device. In turn, mobility impacts social participation of adults with disabilities using assistive devices. Empirical studies demonstrated indirect and direct associations among physical environment, mobility and participation among this population. A conceptual framework is proposed based on the findings of the review.
... A recent study demonstrates that cost is the most common reason for unmet needs regarding mobility devices, such as canes [27]. If the cane is easy to set up and use that means the user can assemble the product quickly, or it already comes assembled within an adequate package, learns how to correctly use the device faster, or with less training required [28]. At the same time, the device can be transported and operated in different locations. ...
... The handle should be personalised to accommodate different hands with different conditions, such as arthritis, using different shapes, sizes, and textures [30]. Furthermore, the device should be light to facilitate its use throughout the user's daily routine and to avoid possible injuries [28]. The cane needs to be safe to use and offer support to the user [31]. ...
... Obwohl Nutzer*innen in aller Regel von Rollstühlen profitieren (Bates et al., 1993;Furnham & Thompson, 1994;Hedberg-Kristensson et al., 2007;Pettersson et al., 2006) -sei es durch eine verbessere Mobilität, soziale Partizipation oder ein gesteigertes Sicherheitsgefühl -überwiegen dem Rollstuhl gegenüber besonders zu Anfang der Nutzung ambivalente bis kritische Gefühle. Die Auseinandersetzung mit dem Rollstuhl erzeugt Scham, Fremdheit, Angst und Irritation (Bates et al., 1993;Gitlin et al., 1998;Hedberg-Kristensson et al., 2007). ...
... Obwohl Nutzer*innen in aller Regel von Rollstühlen profitieren (Bates et al., 1993;Furnham & Thompson, 1994;Hedberg-Kristensson et al., 2007;Pettersson et al., 2006) -sei es durch eine verbessere Mobilität, soziale Partizipation oder ein gesteigertes Sicherheitsgefühl -überwiegen dem Rollstuhl gegenüber besonders zu Anfang der Nutzung ambivalente bis kritische Gefühle. Die Auseinandersetzung mit dem Rollstuhl erzeugt Scham, Fremdheit, Angst und Irritation (Bates et al., 1993;Gitlin et al., 1998;Hedberg-Kristensson et al., 2007). Einige Autor*innen beschreiben eine anfangs große Abwehr dem Rollstuhl gegenüber, der als Symbol von Abhängigkeit, Asexualität und nicht-lebenswertem Leben wahrgenommen wird (Bates et al., 1993 (Müller, 2009, S. 206). ...
Rollstühle sind Fortbewegungsmittel. Sie haben vier Räder, einen Metallrahmen und einen Stoffbezug mit Polster. Rollstühle sind praktisch und nützlich – eigentlich. Doch in dominanten Diskursen zu Behinderung umgibt Rollstühle ein Nimbus des Problems, der Angst, des sozial Alarmierenden. Rollstühle signalisieren etwas, z.B. Passivität, Gefangensein und Abhängigkeit. Demgegenüber stehen Diskurse, die Rollstühle als befreiende, alltägliche und einverleibte Hilfsmittel sehen, die ein selbstbestimmtes Leben (wieder) ermöglichen. Dennoch zögern viele stark gehbeeinträchtigte Menschen Jahre, bevor sie sich für die Nutzung eines Rollstuhls entscheiden. Dieser Beitrag beschäftigt sich mit Prozessen der Aneignung von Rollstühlen und ihren gesellschaftlichen Rahmenbedingungen. Er schließt vorläufige Ergebnisse einer qualitativen Befragung gehbeeinträchtigter Menschen mit ein und geht Diskursen im Kontext von Disziplinierung und einer Verinnerlichung von Stigma und »ableism« nach.
... Kraskowsky and Finlayson (2001) in a review of the literature, identified addressing user needs, providing sufficient training, and evaluation in the context of use as the key elements in promoting acceptance and continued use of AT such as a MWC among older adults. A qualitative study exploring the willingness of older adults to use an assistive mobility device reported that the opportunity to learn how to use the device, particularly during the early stages of acquisition, was a precondition to acceptance (Hedberg-Kristensson, Ivanoff, & Iwarsson, 2007). The World Health ...
... Reluctance among older adults to adopt technology is often related to concern over their capacity for skilled operation; older adults are reported to have lower self-efficacy and higher anxiety around technology (Laguna & Babcock, 2000). Conversely, acceptance of a mobility device can generate feelings of independence, security and confidence, which in turn may facilitate greater engagement in and performance of everyday activities (Hedberg-Kristensson, Ivanoff, & Iwarsson, 2007). ...
Many older adults rely on a manual wheelchair (MWC) for mobility but are not provided with
skills for independent and effective use. Access to wheelchair skills training is constrained by the
logistics, expense and limited availability of rehabilitation services. A supervised, home-based
program specifically designed for older adults and delivered via a mobile computer tablet
(mHealth) could potentially be a useful and efficient strategy to provide skills training.
Purpose: To explore the experience and needs of older adults transitioning to MWC use (Chapter 2);
collaboratively develop, refine and pilot test an mHealth training program (Chapter 3); evaluate
the program’s feasibility (Chapter 4); estimate impact on skill capacity and clinical outcomes
(Chapter 5); and explore user-perceived benefits (Chapter 6).
Methods: Qualitative methods were used to understand the MWC transition experience. A mixed-methods
Participatory Action Design and pre-post pilot trial were used for program development. A
feasibility randomized controlled trial (RCT) assessed feasibility and clinical indicators, and
follow-up interviews explored participants’ experiences.
Results: Older adult MWC users identified a lack of supports during transition to MWC use, particularly
with skills training, often resulting in compromised community participation and increased care
provider burden. The Participatory Action Design approach proved useful in constructing a
viable prototype tablet-based home-training program that incorporated self-efficacy strategies
and promoted principles of adult learning. In the feasibility RCT, the program was delivered
safely and consistently, achieving most of the feasibility indicators; recruitment proved
challenging but participants demonstrated good adherence with only one health-related dropout.
There was a statistically significant difference and large effect size for measures of self-efficacy
(p = 0.06; ηp = 0.28) and performance of outdoor wheelchair activities (p = 0.02; ηp = 0.40),
but not for the primary outcome of skill capacity. Participants and care providers identified
substantial clinical benefits in terms of confidence with wheelchair use, engagement in activities
of life, and reduced care provider demands.
Conclusions: The mHealth program shows promise as a potentially effective and appealing
wheelchair skills training program for older adult MWC users. Future evaluation should enhance
recruitment strategies, facilitating a larger RCT for more robust evaluation of clinical benefits.
... For older people the use of MDs can be related to positive as well as negative aspects. On the positive side there are expressions of satisfaction when being able to participate in activities and not having to rely on the help of others; however, older people also have to overcome a threshold to accept being a user (2). Experiences of ambivalence in getting used to assistive devices (ADs) are also expressed (3); even if the devices provide security and create opportunities for performing activities in everyday life, they also cause limitations and raise concerns. ...
... Research on activities in everyday life show that old people strive for continuity in their lives, and the performance of activities in everyday life gives feelings of independence and self-confidence (2,9,17). Changes occur, however, as part of the ageing process, in relation to the variety, frequency, and time spent on these activities (18). ...
Aim: The aim of this study was to explore experiences of mobility device (MD) use among very old single-living Swedish men. Methods: A multiple case study of three men, involving quantitative and qualitative data, was used in an embedded mixed methods design and presented in three narrative stories. To capture differences and similarities in the use of MDs a cross-case analysis was conducted. Results: The findings show that the devices were important for retaining independence in everyday life and for participation in social activities. Use of MDs impacted on everyday activities by enabling, restricting, or changing the performance. Planning and careful thinking were new strategies developed for managing everyday life. The devices were purchased, received from relatives, or prescribed by professionals at a time point when there was a need. The function and form of the devices and a supportive environment were considered important for optimal use. Conclusions: These narrative stories nurture our understanding of complex and multifaceted aspects impacting on MD use in everyday life for very old men. To support active ageing, occupational therapists and other health professionals need to seek information on personal needs and expectations, in order to understand individual perspectives on MD use.
... Some studies report to what extent devices actually are used (19) and how satisfied older people are with their devices (20). Others reveal the importance of a professional prescription process in order to achieve a good personÁenvironment fit (21,22). Several studies focus on the safety or meaning of the devices for the person or spouse, mainly from the perspective of having a certain functional condition or a specific device (23Á27). ...
... At the same time, it seems to be crucial to supply the same model as the one once introduced to and trained with, since older people, women in particular (20), tend to be sensitive to the design and technical performance of the device. In addition, our findings suggest that prescriptions and follow-up should be performed by professionals, in the older person's familiar environment, taking into consideration the complex transactions of all factors impacting on the disablement process (20,21,43). These findings put demands on the provision and distribution system of MDs, posing a challenge to the diversity of countries engaged in social development for the ageing population (19). ...
The use of mobility devices, such as walking sticks and rollators, increases during the ageing process. Our aim was to explore how very old single-living Swedish women experience the use of mobility devices over time, in relation to everyday occupation. A multiple case study strategy involving quantitative and qualitative data was used. The findings indicate that the use of mobility devices, rollators in particular, starts off as support for walking but over time becomes more involved in occupational performance, resulting in complex transactions between personal, environmental, and task components. Personal factors such as ability to adjust and adapt to different situations seem to be crucial for optimal mobility device use. Strategies and adaptive behavior were developed over the years while striving for maintained independence and participation. The use of mobility devices was described as something one has to accept, but also a constant reminder of your limitations, or as a possibility to remain active and to manage everyday occupation. The findings stress the need to adopt a comprehensive view when trying to facilitate everyday occupations in very old age. Physical, social, psychological aspects, combinations among assistive devices, and home modification all need to be reflected on and monitored over time.
... In the Assistive Technology literature many terms are used interchangeably to describe the decision of not using ATDs. These terms include device non-use (de Boer et al., 2009;Edwards & Jones, 1998;Hass et al., 1996;Ishigami et al., 2021;Luz et al., 2017;Roelands et al., 2002;Skymne et al., 2012), discontinuance (Lauer et al., 2015;Petrie et al., 2018; -Reiss & Wacker, 2000), abandonment (Chen, 2020;Cruz et al., 2016;Federici & Borsci, 2016;Haggblom-Kronlöf & Sonn, 2007;Orellano-Colón et al., 2016;Phillips & Zhao, 1993;Sawadogo et al., 2022;Spiteri, 2018;Verza et al., 2006), rejection (Aminzadeh & Edwards, 1998), disuse (Gooberman-Hill & Ebrahim, 2007;Yeh, 2009), non-acceptance (Barker et al., 2004;Hedberg-Kristensson et al., 2007), or avoidance (Lilja et al., 2003). All of these terms are discussed in the following section. ...
For individuals with disabilities, failure to use prescribed assistive technology devices (ATDs) according to professional recommendations can have detrimental health consequences. The literature has employed various terms to describe this phenomenon such as nonuse, abandonment, and non-adherence to characterize this behavior, lacking clear and standardized definitions. Consistent use of a standardized language is critical for advancing research in this area. This study aims to identify and describe the concepts related to the failure to use prescribed ATDs, along with the associated contexts, and proposes a framework for standardizing terminology in this domain. A narrative literature review encompassing studies from inception to June 2023 was conducted to elucidate these concepts. Out of 1029 initially identified articles, 27 were retained for in-depth analysis. The review unveiled a significant inconsistency in the use of terms like nonuse, abandonment, noncompliance, and non-adherence. Some articles even employed these terms interchangeably without clear definitions. Only 10 of the 27 reviewed articles provided definitions for the terminology they used. This highlights the crucial need for adopting valid conceptual models to select appropriate terms. Researchers are strongly encouraged to furnish operational definitions aligned with theoretical models and relevant to their research context to advance this field consistently.
... These functional limitations of mobility aids can be summarized by limiting use of upper extremities, impairing balance in some instances, increasing energy to move, and having strength requirements that make them unsuitable for some patients [9]. One significant reason that older adults reject mobility aids is stigma [14]. No matter how effective the device is when it is used, if the potential user rejects it, the device will not assist them. ...
Exoskeletons are a burgeoning technology with many possible applications to improve human life; focusing the effort of exoskeleton research and development on the most important features is essential for facilitating adoption and maximizing positive societal impact. To identify important focus areas for exoskeleton research and development, we conducted a survey with 154 potential users (older adults) and another survey with 152 clinicians. The surveys were conducted online and to ensure a consistent concept of an exoskeleton across respondents, an image of a hip exoskeleton was shown during exoskeleton-related prompts. The survey responses indicate that both older adults and clinicians are open to using exoskeletons, fall prevention and joint pain reduction are especially important features, and users are likely to wear an exoskeleton in the scenarios when it has the greatest opportunity to help prevent a fall. These findings can help inform future exoskeleton research and guide the development of devices that are accepted, used, and provide meaningful benefit to users.
... 163). Barriers to environmental supports for older women with disabilities that were identified included a reluctance to use technology (Scherer, 1993) and mobility devices (Hedberg-Kristensson, Dahlin-Ivanoff, & Iwarsson, 2007). Scherer and Dicowden recommended the practice of highlighting ways to improve the functioning of older females with disabilities by exploring preferences for other environmental supports. ...
The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework that was developed by the World Health Organization (WHO). The framework offers a new perspective from which to view a condition or disability in terms of components such as body functions and structures, activities, participation, environmental factors, and personal factors. In an effort to explore the experiences of women with post-traumatic stress disorder (PTSD), risk factors for them will be explored using the ICF as a conceptual framework. The environmental factors and personal factors on the ICF will be matched in order to tailor support services and resources for women with PTSD in counseling settings.
... Research shows that some people do not accept using assistive technology due to fear of being stigmatised, for example, looking old or ill (Hedberg-Kristensson et al. 2007;La Cour et al., 2020;Porter et al., 2011). One could argue that to Peter maintaining his daily walks was more important than keeping integrity by not using the rollator. ...
Introduction: For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention.
Methods: In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied.
Results: 148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy.
Conclusion: This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.
... For some participants, an assistive technology was just the help they needed, while for others it caused negative associations. Negative perceptions of assistive technology are not uncommon 35,36 and might be considered a barrier for achieving desired effects with this population. 37 The study showed that some participants experienced insufficient time to adopt the use of assistive technologies. ...
Background
The Cancer Home-Life Intervention showed no significant effects, and examination of the processes affecting or inhibiting outcomes is relevant.
Aim
To evaluate the Cancer Home-Life Intervention for its processes of implementation, mechanisms of impact and contextual factors.
Design
Process evaluation conducted alongside the randomised controlled trial, using quantitative and qualitative methods (ClinicalTrials.gov NCT02356627). The Cancer Home-Life Intervention is a tailored, occupational therapy–based programme.
Setting/participants
This study took place in participants’ homes and at hospital. A total of 113 home-dwelling adults (⩾18 years) with advanced cancer who had received the Cancer Home-Life Intervention were included, together with five intervention-therapists.
Results
All 113 participants (100%) received a first home visit; 32 participants (26%) received a second visit; and 4 participants (3%) received a third visit. Median number of delivered intervention components were 3 (interquartile range: 2; 4). Identified barriers for effect included unclear decision process for intervention dosage; participants’ low expectations; participants’ lack of energy; and insufficient time to adopt new strategies. The trial design constituted a barrier as the intervention could only be provided within a specific short period of time and not when relevant. Intervention components working to solve practical everyday problems, enhance enjoyment and increase a sense of safety were perceived as useful.
Conclusion
Future interventions can benefit from inclusion criteria closely related to the intervention focus and clear procedures for when to continue, follow-up and terminate intervention. Decisions about dose and timing may benefit from learning theory by taking into account the time and practice needed to acquire new skills.
... Similar findings have been discussed in other studies, 3,25 where AT could actually be disabling due to the negative emotions surrounding the aesthetics of AT. 11 Resistance and negative emotions were often the outcome of AT clinical Can't say look, a lack of colour and pattern choices because they reflected personal identity, and AT that looked similar to that used by parents and grandparents [see also Ref. 26]. ...
Objective
To understand mobility issues not adequately serviced by assistive technology (AT).
Methods
A two‐stage mixed‐methods research project that forms the basis of future AT design and manufacture. Stage 1: a focus group comprising 46 participants (people aged 55 years or older with mobility issue/s) and their support networks. Stage 2: a sample of 413 people over 55 completed a purpose‐designed survey informed by stage 1, regarding mobility issues and perceived desirability of suggested AT mobility aids.
Results
Two core themes emerged: (a) functionality issues relating to existing AT designs and (b) identified mobility issues encountered during activities of daily living that could potentially be resolved by developing new AT. Importance was placed on certain features of AT mobility aids with cost, transportability and aesthetics being primary issues.
Conclusion
Consulting end‐users and their networks ensures valuable insight into how future AT can better address and target mobility needs.
... Besides showing that MDs are one of the most commonly used devices in very old age, [13,14] these studies explored outcomes for using MDs [15,16] as well as changes in the use of MDs over time during the ageing process. [17][18][19][20] Some studies highlight individuals' experiences with the MD prescription process [8,21] and users' attitudes towards the devices. [8,20,22] These findings suggest that the use of MDs can be highly variable depending on a person's abilities, the activities performed, and the environmental factors. ...
Aim: To explore the experiences over time of using mobility devices (MDs) among very old women in the context of everyday life in Latvia. Methods: This study utilized a multiple case-study design that employed an explanatory mixed-methods approach. A combination of quantitative survey data on home and health and qualitative interview data for each participant were used to create three narratives to describe the experiences of MD use in everyday life over time, followed by a cross-case analysis. Results: The three cases illustrate that very old women accept and use MDs due to walking difficulties and related needs. Over time, functional decline combined with physical environmental barriers and changes in their social networks limited the supportive role that available MDs could offer these women. Conclusions: The findings contribute to the understanding of the complexity of MD use in everyday life among very old women in Latvia and the need for different kinds of MDs. These findings illustrate the importance of considering the interaction between people’s everyday life situation and their physical environment for their optimal use of MDs. This is important information for policy-makers who can optimize the services for old people in Latvia and support the need for occupational therapists’ professional competence for the planning and development of MD provision.
... Furthermore, ET and AT might be viewed in different ways such as in what they communicate or symbolize to the user and others. An AT could on the one hand promote independence, security, and confidence to the user in everyday life (Hedberg-Kristensson, Dahlin Ivanoff & Iwarsson, 2007). However, on the other hand it could pose a threat to the person's self-image or be experienced as stigmatizing and therefore not be used (Gitlin, 2002;Larsson Lund & Nygård, 2003;Rosenberg, Kottorp & Nygård, 2011). ...
... As far as the authors know, this is the first study to consider facility variables as predictors of seating need. The facility-wide issue of poorly fitting wheelchairs appears to be mediated through access to occupational therapy, which is a primary provider of wheelchair seating assessment and prescription [23] . Prevalence of need for assessment followed a very consistent decline with higher OT staffing ratios. ...
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.
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.
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.
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 (r(p) = -0.684, CI -0.143 to -0.910) was found.
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.
... Focusing on the use of mobility devices, researchers in Sweden interviewed 22 males and females 65 years or older and found that the non-acceptance of mobility devices was associated with 'negative feelings' such as irritation and shame and that this was influenced by listening to and thinking about other peoples' opinions [15]. Environmental obstacles also played a key role in non-acceptance and this included lack of training in use of the device, physical/architectural barriers, and insufficient clearance of snow and ice. ...
The International Classification of Functioning, Disability and Health (ICF) is discussed as being relevant to research and service delivery for women with disabilities. The personal meaning a disability has for a woman is shaped largely by Personal Factors. These, in turn, have historically been affected strongly by Environmental Factors such as culture and attitudes. Too often both Personal Factors, and how they are shaped by Environmental Factors, are not adequately addressed in our intervention programs. The interaction of Personal and Environmental Factors is illustrated by examples from the technology use and non-use literature.
The well-being of older adults relies significantly on maintaining balance and mobility. As physical ability declines, older adults often accept the need for assistive devices. However, existing walkers frequently fail to consider user preferences, leading to perceptions of imposition and reduced acceptance. This research explores the challenges faced by older adults, caregivers, and healthcare professionals when using walkers, assesses their perceptions, and identifies their needs and preferences. A holistic approach was employed, using tailored perception questionnaires for older adults (24 participants), caregivers (30 participants), and healthcare professionals (27 participants), all of whom completed the survey. Over 50% of caregivers and healthcare professionals displayed good knowledge, positive attitudes, and effective practices regarding walkers. However, over 30% of participants perceived current designs as fall risks, citing the need for significant upper body strength, potentially affecting safety and movement. More than 50% highlighted the importance of incorporating fall detection, ergonomic designs, noise reduction, and walker ramps to better meet user needs and preferences.
Mobility devices are crucial in enhancing activities and participation for individuals with mobility disability, particularly among the rapidly expanding population of older adults worldwide. This paper explores patterns of mobility device use among a nationally representative cohort of community‐dwelling older adults in the United States, using data from the National Health and Aging Trends Study (NHATS) waves 1–9 (2011–2019). Our descriptive analysis focuses on the characteristics of incident mobility device use, its influencing factors, and related user experiences, aligning with the NHATS late‐life disability framework. Mobility devices were categorized into walking aids (WAs), wheeled and seated mobility devices (WSMDs), and mixed use of both. We identified 2,943 incidents of mobility device use among 2,591 participants, spanning 47,722 person‐years in community settings, yielding an incidence rate of 61.7 per 1,000 person‐years. Over half (51.3%) of mobility device use ended in 1 year, with WAs being the predominantly used (63.8%). About one‐third (30.5%) of these incidents involved a change in device combinations, with a notable shift towards WSMDs and mixed use over time. We found that older adults using WSMDs or changing their device combinations were in a more vulnerable state, while those using mixed devices or changing their device combinations experienced poorer user experiences. This study advocates for the implementation of rental and recycling programs, the involvement of NGOs and professional associations, and the adoption of flexible policies responding to the dynamic patterns of mobility device use among community‐dwelling older adults. It also recommends expanding services to better serve vulnerable subgroups.
L’article présente les résultats de la recherche « Accès-communauté : un objectif partagé », une recherche-action participative qui a exploré le thème de l’inclusion sociale des personnes aînées ayant des incapacités. L’objectif de cette recherche était de comprendre ce qui facilite ou freine les déplacements et l’accès aux milieux de participation sociale dans le groupe concerné. Dans cet article, nous nous sommes concentrés sur l’environnement social des personnes participantes. Ce dernier peut être défini comme la manière dont la société est organisée notamment sur le plan du fonctionnement de la gouverne de l’État, des services aux citoyens et aux citoyennes, et des relations entre les individus.
Introduction
Knowledge about how mobility devices are integrated into occupational performance is important to improve participation in daily life among users and assistive technology provision. This study aimed to identify and synthesise literature on how mobility device users integrate their devices into occupational performance.
Methods
A narrative review was conducted with a systematic search in PubMed, CINAHL, PsycINFO and SocINDEX for scientific, original, peer-reviewed journal publications in the English or Scandinavian languages. Following search terms were used: mobility devices, occupational performance and synonyms. Publications were screened and read, and data were extracted by two authors independently.
Results
A total of 4088 hits led to the identification of six publications. Two categories were identified: (1) how mobility devices are integrated into occupational performance and (2) for what types of occupations beyond mobility are mobility devices used for; seven types were revealed.
Conclusion
Mobility devices are integrated into occupations in unique ways to the individual users, shaping how occupations are performed and are used for different types of occupations beyond mobility. Since mobility device use is situational, it is suggested to investigate assistive technology use, applying a transactional perspective to improve assistive technology provision to increase fulfilment of users’ needs and preferences.
El envejecimiento de la población plantea retos para la salud y la planificación de las ciudades en el siglo XXI. Las personas adultas mayores con discapacidad requieren espacios urbanos adaptados e inclusivos, lo que demanda la mejora de la accesibilidad objetiva y percibida de las infraestructuras, equipamientos y servicios. Sin embargo, existe un limitado conocimiento de los efectos adversos de las presiones del espacio público (barreras arquitectónicas, inseguridad, contaminación) sobre este colectivo vulnerable, como los riesgos físicos y psicosociales vinculados al aislamiento social y el deterioro de su salud y calidad de vida. La obra ofrece un abordaje novedoso para conocer y desentrañar algunas claves de las relaciones entre el ambiente urbano y una sociedad que envejece con y sin discapacidad, desde el enfoque interdisciplinar de la gerontología ambiental. Su contenido y el examen de las evidencias empíricas propiciarán nuevas reflexiones y acciones para promover el envejecimiento activo y saludable, a partir del diseño y la culminación de ciudades y comunidades amigables con las personas de edad.
The population ageing poses challenges for the health and planning of cities in the 21st century. Older adults with disabilities require adapted and inclusive urban spaces, which demands the improvement of the objective and perceived accessibility of infrastructures, equipment, and services. However, there is limited knowledge of the adverse effects of the pressures of public space (architectural barriers, insecurity, pollution) on this vulnerable group, such as the physical and psychosocial risks linked to social isolation and the deterioration of their health and quality of life. The work offers a novel approach to discover and unravel some keys to the relationships between the urban environment and an aging society with and without disabilities, from the interdisciplinary approach of environmental gerontology. Its content and the examination of the empirical evidence will promote new reflections and actions to promote active and healthy aging, based on the design and completion of Age-friendly Cities and Communities.
BACKGROUND: Only a few studies have investigated the effects of assistive devices (ADs) from the user’s perspective. This knowledge is important for clinical and policy decision-making. OBJECTIVE: The aim was to determine to what extent older people experience less difficulty in performing daily activities after having received uncomplicated ADs such as bath chairs and rollators. METHODS: The study had a pretest – post-test intervention design where the outcomes were evaluated using the Individually Prioritized Problem Assessment (IPPA) and analyzed with paired t-tests. Effect sizes (ES) were interpreted according to Cohen’s d. People aged ⩾ 67 years with sufficient cognitive or hearing functioning necessary to participate in an interview were included. RESULTS: This study enrolled 52 home-dwelling persons aged 69–93 years. Baseline IPPA score was 17.29 ± 4.27 points (mean ± standard deviation), follow-up score 9.29 ± 4.47 points, indicating a significant reduction in the mean difficulty score of 8.64 points (95% confidence interval: 7.37–9.81 points) (p⩽ 0.001). The ES at the group level was 1.57 and varied from no to large effect. CONCLUSIONS: Receiving uncomplicated ADs significantly reduced the difficulties experienced by older people. However, the large variations in the ES highlight the importance of providing individually tailored training programs for mobility ADs, which should be considered in further outcome studies.
The study aims to explore the barriers and facilitators related to the use of mobility devices among older adults. A total of 815 studies conducted between 2000–2020 were retrieved from Scopus. Eight primary research studies met the eligibility criteria for the scoping review. Systematic processes of study identification, data extraction, and data synthesis were used. The barriers and facilitators were identified in terms of three aspects: environment, user, and device. The environmental barriers comprised external and internal environmental factors that hinder use, including limited indoor and outdoor accessibility, limited transportation options, and weather. External environmental factors such as curb ramps and amenities for anti-fatigue were identified as the environmental facilitators. The negative perceptions of older adults and related stigma prevented them from using mobility devices, particularly when they considered them a sign of disability and dependence. However, users’ adoption of mobility devices was facilitated if the devices were perceived as an aid for balancing and preventing older adults from falling or if recommended by a physician. In addition, the design of the devices influenced the positive or negative acceptance of older adults. The issue of cost was identified as a device-related barrier, and it can be improved with a government support system. In addition, the design and functions of mobility devices need to meet the needs and preferences of older adults while preserving their self-image and dignity.
Rolling walkers are popular mobility aids for older adults. A rolling walker usually has two swivel front wheels and two non-swivel rear wheels. It is designed to improve stability while walking and reduce the risk of falling. However, a considerable number of users have come close to or experienced falling. We developed a user-adaptive brake assist system for the walker. In the system, the usage of a walker is modeled in combination with the walking speed and the distance from the walker to the user. A brake pattern is generated based on usage data interpolated using the inverse distance weighting method. The pattern is referenced to activate brakes with the corresponding strength while walking. The applicability was confirmed by analyzing the walking data of two older adults, and the usability was positively evaluated in experiments with seven young adults wearing elderly simulation suits.
This chapter integrates resilience frameworks (Richardson, J Clin Psychol 58:307–321, 2002; Wister et al., Int J Aging Hum Dev 82:290–313, 2016) with processes of adaptation articulated in the Selective Optimization and Compensation (SOC) model (Baltes and Baltes, Successful aging: perspectives from the behavioral sciences. Cambridge University Press, New York, 1990) to understand mobility challenges among older adults, termed mobility resilience. Forty-one studies were reviewed to identify the range of adaptive processes employed by older adults with mobility limitations in order to explore how these strategies are associated with the different classes of reintegration in the resilience model. The linking of models of resilience and adaption helps to (i) explain why some older adults adapt to or recover from mobility limitations better than others and (ii) understand the factors and processes involved in building mobility resilience, which in turn can guide the development of programs that enhance older adults’ health and well-being.
Introduction: Previous studies have suggested that, in addition to factors such as sociocultural and physical contexts, the incorporation of assistive technology (AT) into everyday life is influenced by acceptance. Less seems to be known about the actual process by which the AT becomes incorporated. Purpose: To investigate older adults’ experiences of the process of incorporating ATs into occupations. Method and material: A qualitative longitudinal approach using ethnographically inspired fieldwork with repeated interviews and participant observations was taken to explore experiences related to eight older adults’ incorporation of an AT into occupations. A phenomenological-hermeneutical approach was used to interpret the data. Findings: Through the analysis, one main theme, “Becoming acquainted” and six related subthemes, “Acquaintance through use”, “Drawing on previous experiences”, “Engaging in valued occupations”, “Encounters with others”, “Regaining control over everyday life” and “Challenges in using the AT” were identified. Conclusion: Active use of the AT – or “doing” – was experienced as important to the process of, first, learning the AT’s different functions and, later, engaging or re-engaging in valued occupations. Using the AT to engage in occupations had a positive impact on the participants’ minds and inner selves, i.e. it influenced their “being” and enabled a connection to people and places and thereby enhanced the feeling of “belonging”. All these elements contributed to a successful incorporation of the AT into occupations or to the older adults “becoming” users of AT.
Purpose:
To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT).
Method:
A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation.
Results:
Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E.
Conclusion:
The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older adult's social context; healthcare professionals should consider involving the client's social network in the AT delivery process.
Background:
Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist.
Purpose:
This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF).
Method:
Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data.
Findings:
The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject.
Implications:
Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.
Background
Social anxiety disorder (SAD) (formerly called social phobia ) is among the most common mental health diagnoses among older adults; however, the research on late-life social anxiety is scarce. A limited number of studies have examined the assessment and diagnosis of social anxiety disorder in this population, and there are few social anxiety measures that are validated for use with older adults. One such measure, the Older Adult Social Evaluative Scale (OASES), was designed for use with this population, but until now has lacked validation against a gold-standard diagnostic interview.
Methods
Using a sample of 47 community-dwelling older adults (aged 60 years and over) with anxiety, the present study compared OASES performance to that of the Structured Clinical Interview for DSM-5 Disorders (SCID-5), as well as other measures of anxiety and depression.
Results
The OASES demonstrated convergent validity with other measures of anxiety, and demonstrated discriminant validity on other measures (e.g. depression, somatic symptoms). Receiver operating characteristic (ROC) analysis revealed that a cut-point of ≥76 optimized sensitivity and specificity compared to SCID-5 derived diagnoses of social anxiety disorder.
Conclusions
This study is the first study to provide psychometric validation for the OASES and one of the first to administer the SCID-5 to an older adult sample. In addition to establishing a clinically significant cut-off, this study also describes the clinical utility of the OASES, which can be used to identify distressing situations, track anxiety severity, and monitor behavioral avoidance across a variety of social situations.
In this systematic literature review, we examined whether and how walking aids (i.e., canes, crutches, walkers, and rollators) enable activity and participation among adults with physical disabilities. Medline, Embase, all EBM reviews, PsychInfo, CINAHL, and Web of Science databases were used to identify studies published since 2008. Quantitative and qualitative designs were included. Data regarding participants, assistive device use, outcome measures, and domains of participation were extracted. Two reviewers independently rated the level of evidence and methodological quality of the studies. Outcomes were categorized per types of walking aids and activity and participation domains. Thirteen studies were included. Two studies involved canes, four pertained to rollators, and seven dealt with multiple types of walking aids. Mobility was the most frequently examined domain of activity and participation. Both negative and positive results were found. Negative outcomes were linked to the physical characteristics of the device, the use, environment, and personal reluctance. When incorporated in daily life, walking aids were found to enable several domains of activity and participation. Whether walking aids facilitate activity and participation may depend on the user's ability to overcome obstacles and integrate them in daily life. More high-quality research is needed to draw conclusions about their effectiveness.
Purpose:
Although it has been well documented that the progressive exercise limitation associated with chronic obstructive pulmonary disease can be helped with an assistive device, such as a rollator, many individuals use it infrequently. This study seeks to explore the views of individuals with chronic obstructive pulmonary disease regarding the use of rollators.
Methods:
A qualitative study design was used. Twelve individuals with moderate to very severe chronic obstructive pulmonary disease were recruited from an outpatient pulmonary rehabilitation program to participate in semistructured interviews. Inductive thematic analysis was applied.
Results:
Analysis revealed 5 themes: (1) "acquiring a rollator" reflecting the process of obtaining a device either via a health care professional or self-referral; (2) "acceptance versus resistance" describing opposing views regarding rollator usage; (3) "rollator roadblocks" describing practical barriers to use; (4) "participation" reflecting how rollators can promote reintegration into society; and (5) "revising perceptions" whereby participants embodied an eventual acceptance of rollators.
Conclusion:
Rollator acquisition appeared to be a unilateral, prescriptive process. Individuals described initial resistance to use, although in the long-term, negative perceptions were outweighed by the functional and social benefits of rollator use. Encouraging users to participate in deciding whether to use a rollator and providing adequate education on its indications, benefits, barriers, and facilitators are likely to promote optimal use of a rollator.
Background:
In our aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance.
Aim:
The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance.
Material and methods:
We elicited values, facilitators and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews.
Results:
The interviews resulted in a myriad of key values, such as 'independence from family' and 'doing their own groceries'. Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users.
Conclusion:
The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.
In this descriptive qualitative research, we examined older women's responses and decisions after experiencing a fall. Falls were unexpected, sudden events that heightened these women's awareness of their physical, emotional, spiritual, and social independence. Interviewees reported assessing personal physical and emotional needs; feeling burdened by the extra work; trying to get back to normal; seeking and obtaining assistance and spiritual support; avoiding specific people, objects, and places; planning ahead; and putting the fall out of mind. Consideration of older women's post-fall responses and decisions should be incorporated into falls prevention and management programs, services, and clinical recommendations.
This thesis contributes to our understanding of the moral dimensions of using self-management technologies in general practice. Through qualitative interviews with general practitioners (GPs) and patients with experience in home blood pressure monitoring (HBPM) utilization, it examines the influences of HBPM on the general practitioner-patient relationship, patient responsibility for their health and patient autonomy. The first part of this thesis provides an account of the ethical implications of self-management technologies and their related practices for the doctor-patient relationship (DPR), patients’ responsibility for their health and patient autonomy. This account is contrasted with models of the DPR drawn from the bioethics and clinical literature, and with the conceptions of patient responsibility and patient autonomy that inform these models. Self-management technologies and their related practices have the potential to be more ethically robust than ordinary care. They may be able to influence patients’ health agency by promoting their cognitive and emotional abilities and, through this, change health outcomes for chronically-ill patients. However, there are a number of pertinent ethical issues concerning mutual trust in the DPR, patient responsibility and patient autonomy that need further empirical clarification. Building upon the theoretical material covered in the first part of the thesis, the second half describes an empirical study, which consisted of a series of interviews with GPs (n = 13) and patients (n = 19). HBPM was used as a case study for self-management technologies. The interviews focused on participants’ experiences with HBPM as a means to collect experiential narrative material relevant to answer the research questions. The findings are presented across two domains: the GP-patient relationship and patients’ responsibility for their health. GPs’ and patients’ views of these ethical notions are presented comparatively. Mutual trust in the DPR plays an important role in promoting patients’ motivation to maintain their health, which in turn, underpins all dimensions of patients’ responsibility for their health. In the final part of the thesis, these two themes from the empirical findings are drawn together with the theoretical material. I emphasize the significance of these findings for the bioethics literature concerning the DPR, patient responsibility and patient autonomy and for the conceptual base of self-management technologies. The implications of these conclusions for bioethics, general practice and public health are then considered.
Background
Ageing in place refers to the practice of older adults continuing to live in their own homes. Existing research has highlighted both the importance and complexity of ageing in place for older people, however limited attention has been paid to the associated processes. This study explored these processes among a sample of older people living in Ireland.
Methodology
This study used a two-phase mixed methods exploratory design. In phase one a cross sectional survey design was used to explore older adults' (N=159) beliefs regarding control over their home environment. Sequential multiple regression analysis was used to identify how housing related control beliefs could be predicted by selected demographic, housing and health related characteristics. Phase two of the research used a case study design. Nine cases were purposively selected from participants who were involved in phase one of the study. Data in the form of in-depth interviews, diary entries and photo elicitation text were collected over a period of 12 months. These data were analysed using the principles of constructive grounded theory. The findings of phase one and phase two were integrated using a three-step inference process.
Results
Housing related control beliefs do not appear to influence the nature of practices of ageing in place. A substantive theory of practices of ageing in place was developed suggesting that ageing in place is an (in)visible process made up of maintaining (an independent) self and (re) constructing space to (re) create home.
Conclusions
Practices of ageing in place are embedded in everyday life and are often rendered invisible. Research and intervention to support ageing in place must recognise the on-going character of older people's lives and should attempt to build upon existing practices.
Unlabelled:
Researching the outcomes of assistive technology devices (ATDs) for older clients is important to facilitate clinical decision-making. However, to understand the outcomes associated with ATDs, one must investigate the users' experiences and acknowledge the user as an active participant in diverse social contexts.
Purpose:
To enhance understanding of the users' perspective regarding ATDs, this study aimed to investigate the meaning of the ATD for older individuals still living in their home environment.
Methods:
To provide descriptions of ATD experiences, older individuals who received a new ATD to compensate for their challenges in moving around, assist in self-care or both were recruited for the study. Participants were interviewed twice, with a few months between interviews, about their experience in using their new ATD. The interview transcripts were analyzed in a hermeneutical-phenomenological research approach.
Results:
The analysis revealed three recurring themes associated with the description of ATD experiences: "enabling performance and choice", "transformation from requiring assistance to assisting others", and "preparing for the future".
Conclusion:
The results show that ATDs are used to enhance competence, mastery, control, self-worth, hope, and preparedness. The ATD service delivery should be client-centered and the client should be acknowledged as an active participant in producing change.
Purpose:
This study explored therapists' attitudes to and strategies for developing client-centred approaches in relation to the provision of mobility devices.
Method:
Four physiotherapists and eight occupational therapists in a Swedish municipality context were interviewed according to a semi-structured interview guide. Data collection and analysis were guided by a qualitative approach, applying manifest content analysis.
Results:
The analysis resulted in a main theme: "Awareness and positive attitudes towards a client-centred approach" and two sub-themes: "Challenges to a client-centred approach" and "Strategies for developing a client-centred approach".
Conclusions:
Therapists in municipality-based geriatric rehabilitations are aware of and have ambitions to apply a client-centred approach in mobility device provision, despite different kinds of obstacles for client interaction. The examples of different strategies they suggested to facilitate a client-centred approach can be used to improve clinical practice. While more research is needed in this field, the results can be used as a basis for practice development which may increase activity among older clients. Implications for Rehabilitation The fact that therapists seem aware of the client's legal right to interact with them in the rehabilitation process, in relation to the provision of mobility devices, is promising and an important prerequisite for the development of more client-centred practices. The identification of different types of obstacles that could interfere with applying a client-centred approach has the potential to increase the therapists' attention to such aspects. The results show that it is necessary for practitioners to develop strategies to be successful in applying a client-centred approach. The examples provided can serve as a basis for continuing discussions among practitioners, increasing their awareness of strategies and opportunities for client interaction.
Purpose:
To investigate the characteristics and change in use among very old Swedish users and non-users of assistive devices (ADs) for mobility and personal care, over a six-year period, and to investigate factors predicting AD use over a six-year period.
Method:
Descriptive statistics and logistic regression were used to analyse quantitative data from a subsample from the Swedish part of the ENABLE-AGE Survey Study, n = 154. Variables according to socio-demographics, environment and health were utilized.
Results:
The number of users increased over time, particularly those using both types of ADs (mobility and personal care). There were differences in health between users and non-users, while no such differences were seen regarding socio-demographics or environmental factors. Health factors most prominent predicted AD use after six years, but also variables within socio-demographics and the environment had an impact on the use; income for ADs for personal care and aspects in the outdoor environment for ADs for mobility.
Conclusions:
As ADs increases over time, it is important, to pay attention to health as well as other factors, among users and non-users of ADs, to provide important information in planning for and supporting healthy and active ageing. [Box: see text].
To explore home care staff experiences in relation to assistive devices and the use of assistive device at work.
Individual conversational interviews with 14 home care staff were used. Qualitative content analysis was used to analyse the data.
A broad meaning attached to the use of assistive devices at work emerged in three themes. In 'staff's role at work in relation to assistive devices', their different roles emerged in relation to knowledge and instruction as well as safeguarding the user. 'Assistive devices as a product and their significance for staff' showed that devices were an integrated part of staff work in the users' home. Devices influenced staff cooperation, feelings and were significant in relation to time and finance. Regarding 'assistive devices and their significance for the user from the staff's perspective', the staff felt that devices were a prerequisite for the user coping with everyday life and they also had an emotional significance.
Assistive devices play a significant and important role for home care staff. An increased understanding among prescribers and other health care staff about home care staff knowledge about, work with and experience from assistive devices could contribute to a better care and rehabilitation for home care recipients.
Mobility devices (MDs) such as walking sticks, rollators and wheelchairs, often play an important role for older people living at home, striving to remain independent in everyday activities. The aim of this study was to explore how the use of MDs changes over time among very old people in five European countries.
Empirical data from the ENABLE-AGE Survey Study, part of a major interdisciplinary research project carried out in Sweden (n=314), Germany (n=322), the United Kingdom (n=316), Hungary (n=179), and Latvia (n=225), were used.
The use of MDs in the Swedish, German and UK samples showed a significant increase between the first occasion of data collection (T1) and the second (T2), 12 months later. A walking stick was the most common MD on both occasions, with the exception that the number of users of rollators outdoors exceeded the number of users of walking sticks in the Swedish sample at T2. Among non-users of MDs at T1, 12-21% became new users at T2. Continued use was seen between T1 and T2 (80-94%) in the various samples, but the type of MD used changed. In the Swedish, German and UK samples, significant changes were seen in the use of MDs with greater assistive potential over the year.
This study shows that the pattern of MD use changes over a short period of time. More research is needed to determine outcomes of MD use in very old age, focusing on the extent to which MDs decrease disability during the aging process, not least in a European perspective.
The purpose of this study was to enhance the understanding of how people with disabilities experience the meaning of their assistive devices in their occupations and how they act on their experiences. Seventeen participants were interviewed and data were analyzed using a qualitative approach. The participants' experiences showed that they reacted differently to the manifold and often contradictory meaning of assistive devices. The analysts organized the participants' reactions into three categories: pragmatic users, ambivalent users, and reluctant users. The differences between the participants were understood as representing different adaptive approaches to achieve desired occupational self-images. Thus, the assistive devices were not in themselves important, but were merely a means to achieve a desired self-image. The findings reflect that the participants' experiences of using assistive devices reveal meanings about their use that go beyond the traditional medical perspective that focuses on the role of assistive devices as compensation for physical impairment.
Objective. The objective of this study was to describe how elderly users of assistive devices perceive and relate to their assistive devices in occupational performance. Study design. The research approach used was phenomenography, which endeavours to describe different ways of peoples experience. Result. User attitude is described as: the assistive devices are well incorporated; the elderly are forced to accept; the necessity of using the device gives the feeling of inadequacy. Accommodation to the use of assistive devices in daily activities are described as: modification and resignation. The Support of assistive device is perceived in three different ways; external safety, internal security and respect. Conclusion. Elderly women's experience of what it is like to rely on an artificial device is important when planing for support. The main feature that appears is an endeavour to gain control of, or a feeling of being able to take control of, one's occupational performance.
The provision of equipment and adaptations is a major part of the social services occupational therapist's role and is, therefore, an area that needs investigation to ensure that assessed needs are being met effectively and cost-efficiently. This study was an audit that investigated the longer-term usefulness of equipment and adaptations, provided by social services occupational therapists, in enabling service users to perform daily living tasks. The focus of the audit was whether the service users were still using the equipment and/or adaptations provided, and how useful they were finding them, 18 months to 2 years after provision.
This was a retrospective audit of a random sample of 100 service users during a specified time scale, using a telephone survey for data collection. Fifty-seven telephone questionnaires were completed.
The clearest finding was that the majority (83%) of the equipment and adaptations issued between 18 months and 2 years previously were still being used at the time of this audit, with 69% being used on a daily basis. This suggested that the equipment and adaptations provided were being used as an integral part of daily life and that they had been prescribed appropriately. It was also interesting to note that the satisfaction with the equipment and adaptations being used independently was higher than the satisfaction with the equipment and adaptations used with help from others.
Conclusion
The audit found that 83% of the equipment and adaptations were still being used 18 months after provision, which suggests accurate and appropriate prescription by the occupational therapy service. Small low-cost items, such as grab rails, were seen by the service users to be very useful in helping them to perform activities of daily living, frequently on their own. The audit suggests that people rate equipment or an adaptation as more useful if they are able to use it alone. This link between independent use and satisfaction is an area for further study, because it suggests that equipment can be very important to a person's sense of independence and wellbeing in the community.
The reasons for non-use of equipment were mainly changes in functional ability or personal circumstances, not poor instruction or fitting. This suggests a more appropriate assessment process or more suitable equipment being issued than in the studies reviewed by Mountain (2000).
There was a very high proportion of respondents who would recommend the occupational therapy service to others with similar difficulties; however, most needed prompting to remember that it was occupational therapy staff who had provided the equipment and/or adaptations. Even when prompted, they could remember the staff member but not the name of the service; publicity and clearer information provided to service users at the point of contact may resolve this issue.
Recommendations
Further study is needed to provide more evidence that the provision of equipment and/or adaptations can be effective in enabling independent living in the community. The expertise of community occupational therapists in enabling people to perform daily living tasks is not widely recognised because there has been little or no research in this specialist field. The process of issuing equipment follows a holistic assessment and a practical step-by-step analysis of the problems identified by users and carers. It continues with training and support to use the equipment, with constant re-evaluation of the whole process.
It is interesting to note that although there was a high level of satisfaction with the service provided, there was a lack of clarity over who had provided it. This suggests that more signposting is needed to help service users and the general public to identify occupational therapy as a profession working within social services.
Following on from this audit, there will be a review of systems to ensure that service users and carers are competent in using the equipment issued to them and are aware of how to contact the service if reassessment, repair or return of equipment is needed. This will complement the standard equipment review systems and ensure that as much unused equipment as possible is recovered for recycling. More investigation is also needed to find out how service users are using the equipment and adaptations: are they following the instructions and using them safely? There is some anecdotal evidence that whilst a service user may be using a piece of equipment to perform daily living tasks, this might not be in the manner intended by the manufacturer or demonstrated by occupational therapy staff.
It would be invaluable to introduce a standardised outcome measure for social services occupational therapy staff to use with all service users. Heaton and Bamford (2001) stated that outcomes are increasingly important in the current policy context, with emphasis on quality, national standards, best value and evidence-based practice. If information could be routinely collected and analysed, it would provide continual statistical data to ensure a strong evidence base to the service. The appraisal of existing outcome measures and their suitability to be used as a tool for community occupational therapy will be a continuing task for the service.
A future audit using the same methodology would enable performance to be measured and reviewed again, ensuring that standards are maintained, and would ascertain whether improvements in service provision have been achieved. The results of this and subsequent audits are vital to ensure that the occupational therapy service meets the challenge of using evidence to underpin practice.
In Sweden, the most common assistive devices are related to mobility. A study was undertaken to evaluate users’ opinions on prescription of mobility devices and their satisfaction with devices and services using a cross-sectional design. A random sample of adult users of mobility assistive devices living in three county councils of Sweden was selected. A postal package comprising a questionnaire and QUEST 2.0 was sent out to 400 users of manual wheelchairs, powered wheelchairs, or walkers. Included in the analysis were 208 questionnaires, a response rate of 52%. Most devices were used on a daily basis and satisfaction with the device was high. Satisfaction with the service was scored lower than satisfaction with the device. Follow-up was the single item with the lowest mean score, and 69% of the users reported that they had not received any follow-up. A positive effect especially on users’ ability to be active, transport oneself, feel secure, and to take part in social activities was found. Owing to the low response rate the results have to be interpreted with caution. However, follow-up seems to be an area that needs to be improved. The majority of users are satisfied with the device but not with service.
In order to plan for and implement research on the outcome of the technical aid prescription process, more knowledge about the documentation of the process is imperative. The overarching aim of this study was to survey documentation quality aspects in patient records in community-based OT, with a particular focus on the technical aid prescription process. An additional aim was to compare the quality of patient record documentation in two municipalities with different documentation routines. The study was accomplished in two Swedish municipalities. By means of an extensive, structured survey protocol, 182 community OT patient records were examined, covering a two-year period. The comparison between two municipalities with different kinds of documentation routines demonstrated differences but as neither of them showed higher documentation quality there was no clear evidence that either of them is superior to the other. In conclusion, the results of this study show a considerable need for quality development in occupational therapy documentation, targeting documentation in general but also concerning the specific aspect of documenting the technical aid prescription process.
This paper introduces focus group methodology, gives advice on group composition, running the groups, and analysing the results. Focus groups have advantages for researchers in the field of health and medicine: they do not discriminate against people who cannot read or write and they can encourage participation from people reluctant to be interviewed on their own or who feel they have nothing to say.
Objectives:This article examines the use of assistive devices as a part of the long-term care arrangements of community-dwelling older Americans. It examines the potential for assistive devices to substitute for and supplement personal care assistance. Methods:Data from the Phase 2 Disability Supplements to the 1994-1995 National Health Interview Surveys are used to compare the use of personal care and equipment among persons reporting difficulty with a given activity of daily living. Results:The capacity of equipment to substitute for or supplement personal care is highly task-specific and depends on the characteristics of the devices and the personal care providers. In general, those using simple devices are less likely to use informal care, whereas those using complex devices are more likely to use formal care services. Discussion:Technology has the potential to confer quality of life enhancements for older persons and their caregivers and cost savings for payers.
Consecutive male patients studied with photographic measurement of a combination of clinical methods.
To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods.
Spinalis SCI unit, Stockholm, Sweden.
Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement.
Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting.
Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.
This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained. DESIGN, METHODS AND SUBJECTS: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison.
One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively.
The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.
The aim of this study was to investigate the use and need of assistive devices (ADs) in a cross-national European sample of very old persons, focusing on national similarities and differences as well as similarities and differences according to age and level of health status. Data from the ENABLE-AGE research project were utilized involving very old persons in Sweden, Germany, Latvia, Hungary, and the United Kingdom (UK). Personal interviews with single-living old persons were conducted (n=1 918). Of the total sample 65% reported that they had and used one or more ADs, and 24% reported unfilled need. The most commonly used ADs were devices for communication, followed by devices for mobility. Participants in Hungary and Latvia used a lower total number of ADs. Comparisons among sub-groups according to age between the Western and the Eastern European national samples showed significant differences. The result can to some extent be explained by different welfare systems and presumably differences in knowledge and awareness of ADs, and further research is called for. However, the result can serve as input for future planning and development of information, services, and community-based occupational therapy, to improve healthcare and social services for older people.
The article describes action research strategies that can help vocational rehabilitation professionals develop skills in scientific reasoning and self-reflection. An overview of action research methodology is followed by specific applications of action research techniques to clinical supervision of graduate students and practicing professionals.
The provision of assistive devices to improve functional independence is a well established component of occupational therapy practice. Recent research efforts in relation to assistive devices have indicated high levels of abandonment of devices in some client groups and for particular devices. Recommendations to address abandonment have focused primarily on training and follow-up of clients, apparently assuming abandonment relates to clients' skill levels and confidence in using devices. This article argues that abandonment also relates to people's perception of themselves as disabled, and to broader issues of identity. Factors for therapists to consider when working with persons who may benefit from assistive devices are suggested, based on concepts drawn from psychology, the social sciences, and consumer research.
The aim of this study was to explore older patients' experiences of participation in the prescription process of mobility devices.
The study was conducted in two Swedish municipalities and was a qualitative study, based on the focus group interview methodology of Merton et al (1990). In order to recruit a sample fulfilling both homogeneity and heterogeneity criteria, occupational therapists and physiotherapists in the municipalities identified potential participants, all aged 65 years or older. Twenty-two patients participated in focus group interviews. Each patient participated once in the seven focus group interviews that were arranged.
The participants reported passive participation in the prescription process of mobility devices as the most frequently occurring experience. They also reported non-participation, for example, in discussion about alternative solutions to activity problems.
The study concluded that it was necessary to develop a more client-centred approach in community-based rehabilitation, challenging occupational therapists and physiotherapists to encourage patient participation in the prescription process of mobility devices. The study also highlighted the importance of inviting the patient to discuss alternative solutions to activity problems.
What are focus groups? How are they distinct from ordinary group discussions and what use are they anyway? This article introduces focus group methodology, explores ways of conducting such groups and examines what this technique of data collection can offer researchers in general and medical sociologists in particular. It concentrates on the one feature which inevitably distinguishes focus groups from one-to-one interviews or questionnaires – namely the interaction between research participants - and argues for the overt exploration and exploitation of such interaction in the research process.
SummaryInteractions between patients and physiotherapists have been studied by various researchers. Some results indicate that physiotherapists have an awareness of underlying emotions, but often respond only on an intellectual level. It seems that verbally expressed emotions may be important for interaction between physiotherapists and patients during treatment.AimThe aim of this study was to investigate how many and what verbally expressed emotions physiotherapists state during interviews between physiotherapists and patients.MethodThe study was a qualitative case study with cross-case analysis according to Shepard et al (1993) and Merriam (1988). Ten informants participated, all of them 'experts in interaction with patients', women, Swedish-speaking, and with at least five years' experience in primary health care. The physiotherapists' emotions were categorised according to Tomkins (1984) and Izard (1977) in the categories of interest/excitement, surprise/startle, enjoyment/joy, sadness, anger/rage, fear/terror, shame/humiliation, contempt and disgust.ResultsPositive emotions such as interest and joy were expressed most often in the interviews, in situations where physiotherapy had been successful, as joyful contacts with colleagues, or in situations where humour was used as a therapeutic instrument. Surprise, sadness and anger were expressed more seldom and contempt or disgust were not expressed at all in the interviews.ConclusionVerbal expressions of emotions in treatment situations in physiotherapy practice should be promoted more emphatically. This may start a reflective process in both patients and physiotherapists and deepen the understanding of the interaction.
Includes bibliographical references, index
The proportion of the population over the age of 65 is increasing, and this includes persons with developmental disabilities. For this population, impaired mobility is often the result of the combined effects of the aging process, chronic diseases, and developmental disability. Unfortunately, there has been virtually no research on the interaction of these factors on mobility. Neither has there been a focus on mobility related assistive devices that might increase independence and safety, and improve quality of life for older persons with developmental disabilities. This study investigated the types of ambulation problems experienced by older persons with developmental disabilities and their use of mobility devices. The sample included 27 participants over the age of 60 with developmental disabilities living in community residences in Western New York. All but one participant used a walker and all had difficulty in walking. Participants and their caregivers were interviewed. Videotapes of participants' performance using their walkers were reviewed by an occupational therapist and a physical therapist. The assistive device most used by participants was the walker and 92.59% of participant reported satisfaction with their walker. Reasons for using a walker included skeletal problems, muscle weakness, balance problems and prevention of injuries to lower extremities. In most cases the physical therapist recommended the device, and provided training and follow-up. Caregivers in both the home and day program played important roles in ensuring correct use of the device. No accessibility problems were found in the community residences. These residences provided a social environment that fostered the use of walkers. The high level of consumer satisfaction with the walkers suggests effective service delivery for this population.
Focus group methodology was used with the aim of learning how persons with the diagnosis of age-related macular degeneration perceived and described their disease, and how the disease had changed their activities of daily living (ADL). This information is seen as critical in designing a health education programme. The focus group participants described problems in performing ADL. Factors contributing to the ADL problems were categorized as functional limitations in, and feelings about performing, ADL. The participants used a number of ADL strategies to adapt to new situations. The participants expressed uncertainty regarding whether senile macular degeneration, age-related macular degeneration and 'yellow spot' were the same disease. They expressed a desire to know more about the disease and its consequences. They particularly requested time for receiving information, and the opportunity to discuss it, as in the focus groups. This target group need a health education programme based on their own perceptions. The main issues in such a programme should be to convey information, teach ADL strategies, provide support and foster problem-solving.
Falls are a common barrier to independent living among elderly persons. In recent years, growing awareness of the incidence of falls has led to the development of many community-based fall prevention programs for older adults. However, the potential impact of these programs is diminished by the lack of research on factors that may influence older persons' decisions to adopt or reject fall prevention behaviors. This exploratory descriptive study employed a focus group approach to elicit qualitative data on seniors' views on the use of assistive devices in fall prevention. Four focus group interviews were conducted with a convenience sample of 30 community-living older adults from Italian- and British-Canadian backgrounds in Ottawa, Canada. The interviews documented personal experiences with and the meaning of falls, aging, and assistive device use for older adults. The findings have important implications for the public health nursing practice in the realms of individual counseling, social marketing, and policy change to prevent falls among elderly persons. The study also provides direction for future research on this topic.
The purpose of this review was to identify the major findings of published research on the factors influencing older adults' use of adaptive equipment.
Fourteen studies involving an older adult sample were selected from major electronic bibliographic databases searched with a series of key words related to aging and equipment use. Results of these studies were compared to determine the most common factors influencing the use of adaptive equipment among older adults.
Although the reviewed studies varied in their sampling strategies and designs, many results were similar. Between 47% and 82% of prescribed equipment continues to be used by older adults, with use decreasing over time. Findings from published studies show that equipment suitability, adequate training, and pre-prescription home visits contribute to these rates of use. Lack of fit among the person, his or her environment, and the equipment was the primary reason identified for nonuse.
The results of the published research provide practicing occupational therapists with a range of factors to consider when prescribing adaptive equipment to older adults. Although the findings of this review demonstrate remarkable consistency across existing research findings, future research is needed to identify what constitutes optimal device use, what factors provide personal motivation for using assistive devices, and how home visits influence use.
Community physiotherapy is often prescribed for stroke patients with long-term mobility problems. We aimed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke.
We screened 359 patients older than 50 years for a single-masked, randomised controlled trial to assess the effects of community physiotherapy. Assessments were made at baseline, 3, 6, and 9 months in 170 eligible patients assigned treatment or no intervention. The primary outcome measure was mobility measured by the Rivermead mobility index. Secondary outcome measures were gait speed, number of falls, daily activity (Barthel index scores), social activity (Frenchay activities index), hospital anxiety and depression scale, and emotional stress of carers (general health questionnaire 28). Analyses were by intention to treat.
Follow-up was available for 146 patients (86%). Changes in scores on the Rivermead mobility index (score range 0-15) differed significantly between treatment and control groups at 3 months (p=0.018), but only by a median of 1 point (95% CI 0-1), with an interpolated value of 0.55 (0.08-1.04). Gait speed was 2.6 m/min (0.30-4.95) higher in the treatment group at 3 months. Neither treatment effect persisted at 6-months' and 9-months' follow-up. Treatment had no effect on patients' daily activity, social activity, anxiety, depression, and number of falls, or on emotional stress of carers.
Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant, but clinically small, improvements in mobility and gait speed that are not sustained after treatment ends.
This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls.
Eighty-two older people (> or = 65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants (n = 57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge.
Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome.
Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.
The aims of this study were to investigate outcomes of older people's use of powered wheelchairs and risk factors for negative outcomes.
The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age.
All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified.
The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration.
In societies with an increasing proportion of elderly active people it is valuable to gain knowledge about what elderly people actually do and want to do in relation to activity arenas in the public environment. The main aim of this study was to investigate elderly people's preferences and frequencies of visits to public facilities in a Swedish town center. A further aim was to gather information on elderly people's subjective perception of problematic and favorable environmental conditions in public environments. The study was conducted using a previously developed questionnaire, "My visit preferences to the public environment". The sample comprised 39 persons aged 75-84 years, living in a defined geographic area. The results of this study provide an overview of the public facilities elderly people rate as important to visit. There are public facilities preferred by most elderly people but with varying frequencies of visits. The study also generated information about elderly people's subjective perceptions of problematic and favorable environmental conditions in public environments, demonstrating that more problems were perceived along walking routes in the public outdoor environment than in the public facilities per se. The results are indicative for community planning supporting elderly people's activities in the public environment, but the questionnaire used should be further validated.
Rättvisa prioriteringar i äldreomsorgen-dokumentation av ett pilotprojekt, Linkö ping: The National Centre for Priority Setting in Health Care
- P Rosén
Rosén P. Rättvisa prioriteringar i äldreomsorgen-dokumentation av ett pilotprojekt, Linkö ping: The National Centre for
Priority Setting in Health Care; 2005.
Choosing assistive devices: A guide for users and professionals
- H Pain
- L Mclellan
- S Gore
Pain H, McLellan L, Gore S. Choosing assistive devices: A
guide for users and professionals. UK: Jessica Kingsley
Publishers Ltd; 2004.
Assistive technology: Potential and preconditions of useful applications
- H Mollenkopf
Mollenkopf H. Assistive technology: Potential and preconditions of useful applications. In: Charness N, Schaie KW,
editors. Impact of technology on successful aging. New York:
Springer Publishing; 2003. pp 203 -214.
Healthy aging: Beyond exercise
- R D Marinelli
- O K Plummer
Marinelli RD, Plummer OK. Healthy aging: Beyond exercise.
Activ, Adaptat Aging 1999;23(4):1 -11.
Ask the user: User perspective in the assessment of assistive technology. [dissertation], Maastricht (OH): University Maastricht; 2004. 143 p. Available from
- R Wessels
Wessels R. Ask the user: User perspective in the assessment of
assistive technology. [dissertation], Maastricht (OH): University Maastricht; 2004. 143 p. Available from: ISBN 90-
5278-404-3.
The prescription process of assistive devices. Vällingby: The Swedish Handicap Institute
- U-B Blomquist
- I Nicolaou
Blomquist U-B, Nicolaou I. The prescription process of
assistive devices. Vällingby: The Swedish Handicap Institute;
2003.
Constitution Handbook
- K Willow
Willow K. Constitution Handbook. Stockholm: Liber; 2004.
Nursing research -Principles and methods
- D Polit
- C T Beck
Polit D, Beck CT. Nursing research -Principles and
methods. 7th ed. USA: Lippincott, Williams & Wilkins; 2004.