OT Research Article Spotlight: Safety evaluation using telehealth.

Article

Feasibility of telehealth-delivered home safety evaluations for caregivers of clients with dementia.

Authors

Megan E. Gately, Scott A. Trudeau, and Lauren R. Moo

Journal

OTJR: Occupation, Participation and Health

Research Design

Quasi-experimental, mixed methods, one group research design

Purpose

Examine the feasibility of using videoconferencing software for an occupational therapy home safety evaluation to address dementia-related home safety risks. Specifically, the researchers wanted to determine the feasibility of caregivers of the care recipient with dementia utilizing video conferencing software and technology to assist the occupational therapist complete the home safety assessment.

Specific Research Questions of the Study:

  1. What are the technological requirements—device, software, peripherals?
  2. What are the technological limitations—number and type of technical glitches or problems?
  3. What are the technical supports needs—type and source of support?
  4. What are the logistical factors—who operated technology and communicated with provider? What strategies optimized technical operability?
  5. What are the safety implications of the video format, as measured by the number of adverse events or unforeseen safety hazards?

Participants

Convenience sample of caregivers of veterans receiving services either in-person or via video telehealth dementia management clinics. The caregivers were the primary participants of this study.

Recruitment: 102 recruitment letters sent out; 43 opted out due to caregiver scheduling; 13 agreed to enroll and 3 more withdrew due to scheduling conflicts. 10 (9.8% return rate) caregivers participated in the study.

Caregivers demographics: 80% women, mean age: 62.8 years (54-71 years old), all 10 caregivers were White, 60% were spouses or partners, and 40% were adult children.

Materials Used

For participants with their own laptops and attached video cameras: Cisco Jabber, a HIPAA compliant video conferencing software was installed by the researchers.

For participants that did not have their own laptop, VA tablets with preinstalled video conferencing software were provided.

Methods

The caregiver navigated the home holding the laptop or tablet with directions provided by research assistants. Cues were used by the research assistant to navigate home to determine areas that were safety hazards. Visits took approximately 45-60 minutes.

Measures

Field notes were completed by research assistants to collect data during the safety evaluations assisted by the caregiver.

Data Analysis

Demographic data were summarized and reported as percentages and frequencies using Microsoft Excel.

Field notes were analyzed using conventional content analysis categories and field notes were refined in the following manner:

Technological glitches (Yes/No) were refined to identify problems with audio or video transmission.

Audio difficulty was refined to total or partial loss, and video issues resulted in two categories: Freezing (Y/N) and Pixilation/Blurry (Y/N).

Other categories included number of caregivers present, trouble logging on, device ownership, who initiated call, need for formal technical support and use of a second device.

Results

Specific Research Questions of the Study and Outcomes:

  1. What are the technological requirements—device, software, peripherals?

Hardware: Laptop with a webcam, tablet.  Cell phone is needed due to any issues with audio or visual technical issues. Software: Cisco Jabber video conferencing.2.

2. What are the technological limitations—number and type of technical glitches or problems?

Audio issues–either partial or total loss of audio. With audio loss, there were instances when a third individual in the household had to provide the caregiver assistance to complete the assessment.

Visual issues—pixilation or blurriness, especially when the device was in motion, which affected researchers seeing key details and spatial awareness. Freezing of video for brief moments. Complete loss of video transmission due to poor reception in specific areas of the home.

3. What are the technical supports needs—type and source of support?

Professional assistance of IT at the VA hospital due to visit link failure and proper use of hardware. Researcher assistance with logging into email to access visit link, positioning of devices for maximum visibility, cuing to decrease speed when moving devices.

4. What are the logistical factors—who operated technology and communicated with provider? What strategies optimized technical operability?

Caregivers were able to maneuver laptop and tablet to show researchers the household. Researchers were able to provide assistance with technological issues. Caregivers also required assistance from others in the household to operate the technology.

5. What are the safety implications of the video format, as measured by the number of adverse events or unforeseen safety hazards?

No adverse safety events occurred with participants during research study.

Discussion of Study

The small sample size, convenience sampling, and homogenous racial demographic limits generalization of results. With this being a feasibility study, the focus was on whether a safety evaluation could be completed using telehealth; and the results focused mainly on technological barriers to completing a home safety evaluation using telehealth with the assistance of the caregiver. Little information was provided on whether safety measures were implemented, or specifics on the criteria in the evaluation. For future studies, one area of focus could be what specific areas were assessed to allow for a more comprehensive view of the feasibility of completing a safety evaluation in a variety of home settings using telehealth.

Takeaway for students

With respect to research, a future direction for a study could be to look specifically at what areas are assessed during a telehealth evaluation with this population. This information will provide a better understanding of the feasibility not only from a technological standpoint, but also from a procedural standpoint in various settings. It may also allow for a more in-depth analysis of limitations based on specific community settings. Another area to research would be the implementation of the recommendations made by the therapists to look at the long-term outcomes on home safety using telehealth.

Takeaway for therapists

The findings of this study point to the feasibility of completing a home safety evaluation using the caregiver of a client with dementia. It is important to realize that if a telehealth model is used, there are some limitations that are expected such as audio, visual, and internet reception issues. This study reminds therapists of the importance of having some alternative modes of communication when utilizing technology for an evaluation session, in addition to having access to higher level technical assistance if software and hardware used is not working and the therapist cannot offer a solution. Also, there is time factor that must be included when using telehealth to address technical issues that arise.  

Citation

Gately, M. E., Trudeau, S. A., & Moo, L. R. (2019). Feasibility of telehealth-delivered home safety evaluations for caregivers of clients with Dementia. OTJR: Occupation, Participation and Health, 40(1), 42-49. doi:10.1177/1539449219859935

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