Effects of a caregiver-inclusive assistive technology intervention: a randomized controlled trial

Technology-based interventions on burden of older adults' informal caregivers: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

An increasing number of technologies are provided to reduce the burden of older adults' informal caregivers. However, less is known about the effects and the mechanism of technology to work on burden. This review is to evaluate the effectiveness of technology-based interventions (TBI) in alleviating the burden of older adults' informal caregivers and to distinguish its effective mechanism via group disparities.

METHODS

A systematic review and meta-analysis of randomized controlled trials studies (RCTs) has been conducted. Web of Science, PubMed, EMBASE, Scopus, CINAHL, PsycINFO, WANFANG, CNKI, CQVIP databases, Cochrane Library Trials, and ClinicalTrials.gov were searched for trial studies and registry in both English and Chinese published from January 1990 to October 2022. Reviewers independently screened the articles and trials, conducted quality assessments, and extracted the data. All processes were guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias of the studies was evaluated by the Cochrane Systematic Review Handbook. The meta-analysis was conducted by RevMan 5.13. Subgroup analyses, sensitivity analyses, publication bias were also conducted.

RESULTS

A total of 11,095 RCTs were initially screened, and 14 trials representing 1010 informal caregivers were included finally. This review proved TBI effective in reducing caregiving burden older adults. Subgroup analysis showed effects of TBI differed by interventions on control group and medical conditions of care recipients.

CONCLUSION

TBI is an effective way to alleviate the burden on informal caregivers of aging people. Interventions for control groups and medical conditions of care-recipients are significant factors in effective interventions. Future researches could include more trials with high-quality or to explore more targeted aging groups, modalities of TBI, or caregiver outcomes.

TRIAL REGISTRATION

The review protocol was registered on PROSPERO [CRD42021277865].

Evaluation of a new assistive technology: the StandBar

PURPOSE

Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers.

MATERIALS AND METHODS

A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up.

RESULTS AND CONCLUSIONS

StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.

Reducing the Burdens of Paid Caregivers of Older Adults by Using Assistive Technology: A Scoping Review

BACKGROUND

Paid caregivers are needed to support older adults, but caregiver burden contributes to high turnover rates. Assistive technologies help perform activities of daily living (ADLs) and can reduce caregiver burden, but little is known about how they impact paid caregivers.

OBJECTIVE

This scoping review provides an overview of evidence on using assistive technology to reduce burdens on paid caregivers working with older adults.

DESIGN

The review was conducted from May to August 2022. The eligibility criteria included: (1) publication within 5 years in peer-reviewed journals, (2) investigation of assistive technology, (3) main participants include paid caregivers supporting older adults, and (4) describing impacts on caregiver burden. Searches were conducted in 6 databases, generating 702 articles. The charted data included (1) country of study, (2) participant care roles, (3) study design, (4) main outcomes, and (5) types of assistive technology. Numerical description and qualitative content analysis of themes were used.

RESULTS

Fifteen articles reporting on studies in 9 countries were retained for analysis. Studies used a variety of quantitative (8/15), qualitative (5/15), and mixed (2/15) methods. Technologies studied included grab bars and handrails, bidet seats, bed transfer devices, sensor and monitoring systems, social communication systems, and companion robots. Articles identified benefits for reducing stress and workload, while paid caregivers described both positive and negative impacts.

CONCLUSIONS

Literature describing the impact of assistive technology on paid caregivers who work with older adults is limited and uses varied methodologies. Additional research is needed to enable rigorous evaluation of specific technologies and impacts on worker turnover.

What works to support carers of older people and older carers? an international evidence map of interventions and outcomes

BACKGROUND

Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence.

METHODS

Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years).

FINDINGS

205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers' mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers' physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes.

CONCLUSION

Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers' physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.

Available Assistive Technology Outcome Measures: Systematic Review

BACKGROUND

The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments.

OBJECTIVE

This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice.

METHODS

We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023.

RESULTS

We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles.

CONCLUSIONS

Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.

Economic evaluation of wheelchairs interventions: a systematic review

OBJECTIVE

The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations.

METHODOLOGY

This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations.

RESULTS

Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations.

CONCLUSION

Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.Implication for RehabilitationSystematic reviews of health economic evaluation studies are useful for synthesising economic evidence about health interventions and provide insight in new research development.Organisations involved in the provision of wheelchairs should apply cost-effectiveness outcome measures to help raise the standard of provision, to support evidence-based practice, and to improve resource utilisation.

Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India

Background

Assistive technology (AT) is essential to minimize functional limitations. The current study aimed to estimate the prevalence of needs, met and unmet needs for AT, and barriers to accessing AT among a subnational population in India.

Methods

This cross-sectional study was conducted in eight districts, representing four zones of India, using the WHO Rapid Assistive Technology Assessment (rATA) tool. The tool was administered by trained staff using read aloud technique. Multi-stage cluster random sampling was used, as well as the probability proportional to size, to select smaller administrative units from the larger ones.

Findings

In total, 8486 participants were surveyed out of 8964 individuals enumerated with a response rate of 94.6%. The sample prevalence of at least one difficulty was 31.8% (2700), with 6.3% (532) having severe or total difficulties. The sample prevalence for AT need was 27.8% (2357) with an estimated population prevalence of 24.5% (95% CI: 23.5-25.4). Similarly, the sample prevalence of unmet needs was 9.7% (823) with an estimated population unmet needs of 8.0% (95% CI: 7.43-8.60). The unmet needs among persons with severe or total difficulties was 52.3% (278/532), and was higher among females, rural residents, and older persons. Spectacles were the most used products, followed by canes/sticks, tripods, and quadripods. Nearly two-thirds of AT users purchased assistive products at their own expense, particularly from the private sector. The inability to afford AT (36.9%) was the most common barrier.

Interpretation

The results show that the need for AT was substantial in the study population, the highest being for seeing difficulties. The unmet needs are higher in females, older population, rural residents, and persons having serious difficulties. While the majority of users have to make out-of-pocket payments to obtain AT, inability to afford and limited availability were the common barriers among those with unmet needs.

Funding

This research is non-commercial, and was conducted in the interest of public health. The authors have not declared any specific grant for this research.

Assistive technology: The current perspective in India

The world, today, recognizes the increasing importance of assistive technology (AT) that can reduce the functional limitations of persons with disabilities, individuals with chronic debilitating diseases, and elders. This indicates that at some point, everyone, either temporary or permanent, will require AT to improve their physical and functional abilities, thus contributing to independent living, social inclusion, and education. Besides this, the need for AT will be growing with a majority from low-middle-income countries. The same is true for India though we are not sure how many people have met a need, and unmet need for AT to date, but the requirement will continue to increase. There is a significant gap between needs and access to AT. Recently, the WHO has led many initiatives related to AT services after the 71^st World Health Assembly's resolution in 2018, to improve access to AT for its member states. The UN Sustainable Development Goals (SDGs) have pledged that no one should be left behind irrespective of personal characteristics. India, a ratified member state, needs to align with various initiatives undertaken by the WHO and the UN. Despite many challenges, India needs to formulate evidence-based AT policy, planning within the purview of the healthcare delivery system in collaboration with various government and nongovernment sectors, including industries. This article explores the need, access, and potential challenges associated with AT services in India. Finally, we discussed various initiatives on AT in the country and possible recommendations to improve AT services across.

Psychosocial vulnerability among carers of persons living with a chronic illness: A scoping review

AIMS

To outline and examine evidence related to the meaning of 'psychosocial vulnerability' among caregivers of persons with chronic illnesses.

BACKGROUND

The number of informal caregivers continues to rise globally. Their risk of psychosocial vulnerability is frequently overlooked, but understanding their psychosocial vulnerability may offer insights into meeting their needs.

DESIGN

Scoping review following the PRISMA 2020 extension guidelines.

DATA SOURCES

The databases CINAHL, Embase, Medline/Pubmed, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Lenus and ProQuest were systematically searched to identify original research. No date limit was set, and 23 studies were included.

REVIEW METHODS

A five-step approach using the Arksey and O'Malley framework. Thematic analysis guided data analysis.

RESULTS

Carers' psychosocial vulnerability occurs when they experience barriers to resources while access and use of supports reduce risk. Antecedents of psychosocial vulnerability include a carer's age and sex, socioeconomic status and their health and wellbeing. Psychosocial vulnerability affects carers' relationships and causes personal losses.

CONCLUSIONS

The concept of carers' psychosocial vulnerability is complex. Recognition of carers at risk for psychosocial vulnerability would help nurses direct relevant support and information to carers who need it most.

What support is beneficial for caregivers of individuals with vision impairment?

Previous studies and reviews have documented the stress and challenges that may be associated with providing informal care for individuals with vision impairment (IVI). This scoping review was therefore conducted in order to synthesise published literature about forms of support which may benefit the informal caregivers of both adults and children with vision impairment (VI), and to identify research gaps in the support available for this population. A systematic literature search was carried out using CINAHL, Medline, PsycINFO and PsycARTICLES, followed by citation tracking. A total of 23 published studies met the eligibility criteria and were included in the review. The included studies focused on: exploring caregiver support needs (8/23); novel interventions supporting caregivers of IVI (10/23); evaluating usual care (2/23); and exploring how treatment for IVI directly impacts the caregiver (3/23). Overall, support for caregivers of IVI is a relatively new research topic, with no eligible studies identified before 1999. Twelve of the 23 studies (52%) focused on support for caregivers of adults with VI, while 11 (48%) focused on support for caregivers of children with VI. The studies illustrate that support groups may generally help to improve caregivers' knowledge and awareness of VI, although benefits for emotional wellbeing are more modest. Support interventions for parents of children with VI appear to reduce stress effectively; however, evidence regarding the value of interventions for caregivers of adults with vision impairment is less clear, partly due to small samples and a lack of standardised, comparable outcome measures. Caregivers often express a need for better information about the condition of the IVI, even when information is apparently available. Further research is required comparing the benefits of different support modalities for caregivers of people with VI over longer follow-up periods.

The value of powered mobility scooters from the perspective of elderly spouses of the users - a qualitative study

PURPOSE

To explore spouses' experiences of the value of mobility scooters prescribed to their partner.

MATERIAL AND METHODS

A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65-86 years participated. Semi-structured interviews were conducted when the spouse's partner had had the mobility scooter for 4-6 months. The interviews were analysed using qualitative content analysis.

RESULTS

The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter's limitations. Three categories emerged: a sense of freedom related to the spouse's own activities, a sense of freedom related to shared activities and a somewhat restricted freedom.

CONCLUSION

Prescription of a powered mobility scooter was of value to the users' spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses' experiences is thus crucial, as this may influence the future rehabilitation outcome.IMPLICATIONS FOR REHABILITATIONA powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user.The spouses' perspectives on their partners' mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process.A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user.

Robotic assistance for people with dementia: a viable option for the future?

INTRODUCTION

Demographic changes in society and fewer personnel working in healthcare services have resulted in an increase in the speed of development of safe, reliable robotic assistance technologies for patients with neurological diseases. This paper aims to advocate for the frailty of patients in light of the economic need for robotic assistance, discuss potential hazards, and outline related factors that influence positive outcomes.

AREAS COVERED

This article reviews the state of the art and perspectives regarding the use of robotics in older adults with dementia. We focus on current trends in the development of robotic technologies for these patients and discuss the potential hazards associated with the implementation of such cutting-edge technology in daily practice.

EXPERT OPINION

We envisage a gradual increase in the usage of robot-based devices for the management and support of patients with cognitive deficits. In particular, the introduction of artificial intelligence will enhance the functionality of these technologies, but also increase potential hazards resulting from human-robot interactions. The development of such technology must consider whether neurological syndromes are static or progressive. Progressive syndromes pose the biggest challenge since the functionality of robotic devices must adapt to patients changing cognitive and motor performance profiles.

Technology Use among Family Caregivers of People with Dementia

This study explored family caregivers' use of technology to care for people with dementia living at home. Three questions were pursued: (1) what are the important, unmet needs of family caregivers, (2) how do they use technologies to assist in care tasks, and (3) what do health care providers know about caregivers' needs and technology use? Two comprehensive surveys were developed to answer these questions: one for family caregivers (n = 33), and one for health care providers (n = 60). Descriptive and quantitative analyses showed that caregivers' important, unmet needs were in the domains of information, formal services, and emotional support. Caregivers make limited use of technology but believe in its potential usefulness. Health care providers agree that technology is useful in dementia care; however, they underestimate caregivers' willingness to adopt technologies to communicate with providers. Findings prove caregiver willingness to use technology to support their care role and provide guidance regarding the caregiver needs that these technologies should address.

What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives

INTRODUCTION

With governments worldwide reducing their involvement in the provision of institutional long-term elder care, community-based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals.

METHODS

We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis.

RESULTS

Quality of care - as delivered by both FCs themselves, and formal health and social care systems - was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas.

CONCLUSIONS

Our findings suggest that the formal care system providers could be more caregiver-oriented in their communications by engaging FCs in the decision-making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications.

The effects of assistive technology service delivery processes and factors associated with positive outcomes - a systematic review

Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n ≥ 10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.Implications for rehabilitationAssistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.New digital technologies could be used to improve the AT-SDP and reduce costs.Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user's needs for training.

Recruitment of caregivers into health services research: lessons from a user-centred design study

BACKGROUND

With patient and public engagement in many aspects of the healthcare system becoming an imperative, the recruitment of patients and members of the public into service and research roles has emerged as a challenge. The existing literature carries few reports of the methods - successful and unsuccessful - that researchers engaged in user-centred design (UCD) projects are using to recruit participants as equal partners in co-design research. This paper uses the recruitment experiences of a specific UCD project to provide a road map for other investigators, and to make general recommendations for funding agencies interested in supporting co-design research.

METHODS

We used a case study methodology and employed Nominal Group Technique (NGT) and Focus Group discussions to collect data. We recruited 25 family caregivers.

RESULTS

Employing various strategies to recruit unpaid family caregivers in a UCD project aimed at co-designing an assistive technology for family caregivers, we found that recruitment through caregiver agencies is the most efficient (least costly) and effective mechanism. The nature of this recruitment work - the time and compromises it requires - has, we believe, implications for funding agencies who need to understand that working with caregivers agencies, requires a considerable amount of time for building relationships, aligning values, and establishing trust.

CONCLUSIONS

In addition to providing adaptable strategies, the paper contributes to discussions surrounding how projects seeking effective, meaningful, and ethical patient and public engagement are planned and funded. We call for more evidence to explore effective mechanisms to recruit family caregivers into qualitative research. We also call for reports of successful strategies that other researchers have employed to recruit and retain family caregivers in their research.