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Background: Occupational therapists who work in hospitals need to assess patients’ home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients’ home environments could be an innovative solution to allow better and more appropriate recommendations. Objective: The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients’ home environments. Methods: Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients’ homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient’s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results: Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions: The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID): RR2-10.2196/11674 (JMIR Aging 2022;5(3):e24376) doi: 10.2196/24376 KEYWORDS caregivers; feasibility; mixed methods; mobile videoconferencing; mobile phone; occupational therapy; discharge planning; home assessment Based on a growing body of literature, the use of mobile Introduction videoconferencing for remote rehabilitation interventions has potential clinical benefits [10,13,14]. By providing a detailed When planning hospital discharge, it is important to ensure that and real-time view of the home environment, mobile patients have optimal conditions for a safe return home and that conferencing may help occupational therapists to improve the patients’ care and services needs are met . The occupational reliability of the data collected, which in turn guarantees therapist can play an important role in achieving this objective appropriate recommendations. The occupational therapist,  by providing recommendations (eg, technical aids, site therefore, gives instructions to the caregiver who, using the planning, care services) to promote the patient’s autonomy and electronic tablet, shows the facilities in the home for which safety upon returning home. The home visit is a way for more information is needed. However, empirical evidence is occupational therapists to obtain reliable information about the lacking to clinically support its use [15,16]. The aim of this environment , which is essential for making recommendations study is (1) to explore the added value of using mobile that support the best fit between the person, their activities, and videoconferencing compared with the standard procedure and their environment. A randomized controlled trial  found that (2) to document the clinical feasibility of using an electronic home predischarge assessment decreased the risk of falls, tablet to assess the patient’s home environment through reduced the number of rehospitalizations, and increased the videoconferencing. level of functional independence in patients with hip fractures. However, clinical (eg, patient fatigue or anxiety), organizational Methods (eg, time available), and financial (eg, travel time and costs) constraints limit the implementation of home visits, despite their Design relevance [1-5]. The methods used for this study are detailed in a published Alternative means are currently used to assess the home protocol . We conducted a concurrent mixed methods environment when planning hospital discharge, such as feasibility study to compare 2 home assessment methods (Figure interviews , consultation of home photos taken by caregivers 1). In method A, information about the home environment was , video , and virtual reality . Interviews quickly give collected during an interview with the patient. In method B, an idea of the environmental constraints perceived by the patient evaluation of the home was carried out through mobile and caregivers. The interpretation of the occupational therapist videoconferencing using an electronic tablet. For the is then based on this self-reported information, without having videoconferencing evaluation, some occupational therapists the opportunity to confirm it through direct observation . used their work computer (when the facility allowed the Photos provided by the caregivers allow the occupational installation of Skype for Business and a webcam was available), therapist to observe the patient’s environment ; however, others, as well as the patients, used an HP elite pad and iPad this observation is dependent on the choice of photos and the tablet with a 3G mobile connection. An electronic tablet was angle used by the caregiver. Video also makes it possible to provided to each caregiver with the exception of one caregiver observe the environment ; however, similar to photos, it is who chose to use her own smartphone. Skype for Business was an asynchronous means, and the occupational therapist’s used for videoconferencing. The home assessment was observation is contingent upon what the relatives choose to conducted from the hospital center. The 2 assessment methods show. Other methods such as virtual reality  and 3D were compared to highlight the contribution of mobile photography [11,12] are currently being explored and are in the videoconferencing to the standard evaluation (A versus A and experimental stage . B). https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al Figure 1. Study flowchart. OT: occupational therapist. was estimated by the occupational therapist; (3) major events Sampling and Recruitment after discharge, which were documented with the Social A purposeful sampling strategy was used in 2 regional hospitals Readjustment Rating Questionnaire ; and (4) patient in the province of Quebec, Canada. A triad consisted of (1) an occupational performance and satisfaction was measured using adult patient with a loss of functional autonomy mainly due to the Canadian Professional Performance Measurement . physical disability, (2) their caregiver, and (3) the occupational Qualitative Data therapist who conducted the assessment. The eligibility criteria for patients were (1) being hospitalized at the time of recruitment We also collected data on (1) the advantages and disadvantages and (2) having a return home (including retirement homes) of using mobile videoconferencing (the individual and planned. Caregivers had to be able to (1) clearly express semistructured interview guides—occupational therapists and themselves orally (in French or English) and (2) walk without caregivers’ versions—addressed previous and current experience technical assistance. The occupational therapist had to have at with mobile videoconferencing use, the barriers and problems least one year of clinical experience. Patients were excluded if encountered with the use of mobile videoconferencing in the they (1) had regular home monitoring by an occupational study, and the perceived benefits of adding this method); (2) therapist in the community prior to hospitalization and (2) were occupational therapist’s professional recommendations, unable to express themselves in a functional manner. The initial intervention plan, and the follow-up, which were charted using target sample was 18 triads (8 occupational therapists and 18 a pretested grid; and (3) the relevance and application of the patient-related dyads). recommendations, which were documented using a monitoring grid during an interview with the patient, with questions Data Collection Methods regarding the level of appreciation and barriers to Qualitative and quantitative data were collected in parallel. implementation of the recommendations (approximately 20 minutes). Quantitative Data Study Process We collected data on (1) occupational therapists’ receptivity to the use of mobile videoconferencing, using the French-Canadian A participant’s guide was developed for the research assistant version of the practitioner and organizational telehealth readiness and occupational therapists. First, a research assistant invited assessment tools, for which a score >80 indicates that the occupational therapists (in person or by telephone) to sign practitioners are well positioned to use telehealth, a score from the consent form and to complete the French-Canadian version 60 to 80 indicates that there are factors or elements that may of the practitioner and organizational telehealth readiness negatively affect telehealth use, and a score <60 indicates that assessment tools  and sociodemographic data form. there are barriers to successful telehealth use by practitioners Second, the health care teams and occupational therapists ; (2) the time spent evaluating the environment at the time identified patients who would potentially benefit from a home of discharge (discussions, making an appointment with the assessment prior to hospital discharge. These patients were caregiver, explanations prior to the assessment) using each offered the opportunity to participate in the study, and method (with and without mobile videoconferencing), which https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al occupational therapists made sure to specify that a refusal would type and number of unplanned events (confounding variables). affect neither access to nor the quality of their assessment. If We compared the recommendations from method A with those patients decided to participate in the study, the research assistant from the combination of methods A and B by identifying the made an appointment with the patient and their caregiver to differences and the nature of the differences (addition, discuss the study in order to obtain informed consent and verify modification). Finally, the application of the occupational that the inclusion and exclusion criteria were met. Subsequently, therapist’s recommendations (methods A and B) by the patient the research assistant (who also has background in occupational was also evaluated 6 weeks after hospital discharge. therapy) conducted the Canadian Professional Performance Semistructured interviews were conducted, in which the Measurement  and collected sociodemographic data. perceived benefits and barriers of mobile videoconferencing were discussed, recorded, and transcribed verbatim. Using The occupational therapist conducted the home assessment by analytical questioning , the transcriptions were categorized interviewing the patient and caregiver (method A). The by theme and analyzed by group (interview with occupational occupational therapist recorded the time (direct, when the patient therapists, interview with caregivers, and occupational and the caregiver were physically or remotely present, and therapist’s professional recommendations). We used MAXQDA indirect, when the patient and the caregiver were not present) software (version 2018.1; Verbi GmbH) for analyses. that it took to complete method A and documented any problems Quantitative and qualitative data were integrated based on 2 identified and recommendations (the first draft of intervention analytical questions related to the study objectives: Which plan). results inform us about the added value (or absence thereof) of Next, the occupational therapist made an appointment with the mobile videoconferencing? Which results inform us about the caregiver for the home assessment via mobile videoconferencing clinical feasibility of using mobile videoconferencing for the (method B), which included the time necessary to pick up the purpose of home environment assessment before hospital electronic tablet and to teach the caregiver how to use the device. discharge? The occupational therapist recorded the time (direct and indirect) Ethics Approval that it took to complete method B and modified the intervention The project was approved by the Research Ethics Committee plan where relevant. of the Centre intégré universitaire de santé et de services sociaux Finally, the research assistant conducted a semistructured de l’Estrie – Centre hospitalier universitaire de Sherbrooke interview with the occupational therapist to identify prior and (MP-31-2017-1485) and the Research Ethics Committee of the current experience with mobile videoconferencing, the barriers Quebec University Hospital – Université Laval (2017-3047). and problems encountered with the use of mobile Mobile videoconferences were not recorded. Aside from the videoconferencing in the study, and the perceived benefit of occupational therapists who performed the home assessment, incorporating this method. The occupational therapist also no one could observe the patient’s home. completed the French-Canadian version of the practitioner and organizational telehealth readiness assessment tools  a Results second time. Six weeks after hospital discharge, the research assistant went to the patient's home. In the presence of the Participants caregiver, the research assistant completed the Canadian Eight triads (6 occupational therapists, 8 patients, and 8 Professional Performance Measurement  again, as well as caregivers) were enrolled between April 2017 and April 2019 the Social Readjustment Rating Scale . She also conducted (Table 1). a semistructured interview related to the patient's satisfaction and the applicability of the recommendations that had been The number of triads originally targeted was not reached. To given at the time of discharge. better understand the issues surrounding patient recruitment and the feasibility of using mobile videoconferencing for home Training assessment, the research team decided to add open questions to Occupational therapists were not formally trained in the study the receptivity questionnaire (1) for occupational therapists who procedure; however, a step-by-step guide was provided on how used mobile videoconferencing with at least one patient (n=6) to use the electronic tablet and videoconferencing app. A and (2) for occupational therapists who participated in the research assistant was available to answer questions and provide project but who did not recruit patients (n=7) (Multimedia further guidance as needed. Appendix 1). In 1 instance, the mobile videoconferencing could not be used due to the absence of internet coverage in the Analysis municipality; the occupational therapist used video as an Descriptive analyses were conducted for the receptivity scores alternative. In addition, 1 patient could not be reached 6 weeks collected from occupational therapists at the beginning (before after discharge. (The occupational therapist who followed this the first patient) and at the end of the study (after the last patient thinks that he may have relocated to a different province.) patient), patient satisfaction and performance, as well as the https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al Table 1. Participant characteristics. Group and characteristic Value (n=8) Participants (n=8) Age (years) Mean 79.5 Range 68-90 Sex, n (%) Female 4 (50) Male 4 (50) In-hospital stay (days) Mean 39 Range 10-96 Principal diagnosis leading to hospitalization, n Infectious 1 Orthopedics 6 Neurology 1 Medical complications, n Delirium 1 Postop shock 1 Comorbidities, n 8 Caregivers (n=8) Age (years) Mean 58 Range 36-80 Sex, n (%) Female 7 (88) Male 1 (12) Relationship to the patient, n Spouse 3 Child 3 Sibling 1 Familiarity level with technology, n Poor 5 Average 1 Good 2 Occupational therapists (n=6) Sex, n (%) Female 6 (100) Male 0 (0) Overall work experience (years) Mean 8 Range 1-13 Program work experience (years) Mean 6 https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 5 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al Group and characteristic Value (n=8) Range 0.5-12 n=7, one value is missing. the risk of falling, offering a cheaper or simpler solution than Difference Between Recommendations Before and the one initially planned, and revising the initial recommendation After Mobile Videoconferencing in light of new information about the home environment that The majority of recommendations made before mobile was not discussed during the interview. Occupational therapists videoconferencing (n=28) remained applicable afterward (n=25), also revised their recommendations for a better fit between the except for 3 recommendations. Observation of the home patient, their occupation, and the environment. Finally, 4 environment through mobile videoconferencing made it possible recommendations were completely modified as a result of to identify the lack of space required in the room to implement videoconferencing—in 3 instances because the initial the planned recommendation and some incorrect information recommendation was not applicable and, in a fourth instance, gathered during the interview (taps on the right side of the because observing the environment made it possible to consider bathtub rather than on the left). These observations led to a return home following rehabilitation at an intensive functional changes in the intervention plan. rehabilitation unit instead of relocating the patient to a seniors’ residence, as recommended initially. In one instance, the Of the 8 patients, 7 patients’ initial intervention plans were intervention plan was not modified after mobile modified after videoconferencing (Table 2). The changes were videoconferencing. aimed at improving the person’s autonomy and safety, reducing Table 2. Modifications of initial intervention plans after mobile videoconferencing. Type and reason Changes Example (n=18), n Adding recommendations Optimizing the person’s autonomy 1 The installation of a support bar allowed the patient to transfer on her own rather than accompanied as in the initial recommendation Optimizing safety and reducing the risk of falling 2 Adding a grab bar and stool in the shower to maximize safety Offering a cheaper and simpler solution 1 Adding a grab bar to the wall instead of a toilet support frame as in the original recommendation. Adjusting to new information that was not discussed at the interview 6 Observation of the environment identified 2 potential places for taking meals (a high table with stools and a standard table and chairs in the dining room); due to physical diffi- culties, using a stool was not recommended Precision of recommendations Ensuring a better match between the patient, the patient’s occupation, 4 Precision about the orientation of the shower bench and and the environment support bars initially recommended Change of recommendations The original recommendation was not applicable 3 The safety support on the righthand side is irrelevant given the countertop at an adequate height to the right of the toilet and the lack of space to install the grab bar on that side Viewing the environment led to a return home 1 Once the environment is seen, there appeared to be no major architectural barrier to a return home if the patient manages to regain autonomy in her transfers and travel with the help of accessories According to participants, data collected from interviews can Perceived Benefits of Using Mobile Videoconferencing be wrong or incomplete because the caregiver neglects to take to Conduct a Remote Home Assessment into consideration certain aspects. In fact, mobile Overall, participants appreciated the use of the tablet and felt videoconferencing induced modification of recommendations, that “it adds something” (occupational therapist 6) to the such as correcting the provision for assistive devices to match standard evaluation. Specifically, caregivers perceived that the the patient’s environment. use of mobile videoconferencing allowed occupational therapists Yes, in fact the lady had given me inaccurate to obtain more precise information (Table 3). information about where the bath faucet was located, it was on the opposite side. I recommended a transfer https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al bench with the handle on the wrong side. So, I environment was] but since I was watching her, I was adjusted that. [Occupational therapist 3] able to ask her to measure this and that. It’s great, I made a diagram. Seeing what she was doing was of Another advantage of videoconferencing perceived by great help to me. [Occupational therapist 4] participants and occupational therapists was the opportunity for therapists to ask questions and provide feedback to the caregiver Mobile videoconferencing was useful for estimating distances in real time. Caregivers felt guided in the assessment and between various elements in the home environment. In addition, identification of measures required, and the occupational caregivers said that the videoconference visit reassured them. therapists were able to document patients’ lifestyles and which All caregivers mentioned that the mobile videoconferencing elements of the environment they wanted to see. experience had been positive despite the fact that some encountered a few technical glitches. I watched her take some measurements, some of which I may not have thought of not knowing [what the Table 3. Main advantages and disadvantages associated with the use of mobile videoconferencing by occupational therapists and caregivers. Characteristic Description Advantages Common to occupational therapists and Ability to make comments or provide feedback in real time caregivers Confirming the information obtained by the patient and caregivers Providing additional information on the patient’s lifestyle Ensuring the best choice of equipment Making sure that the caregiver is taking the right measurements and reassuring them about how they are doing Seeing the general condition of the environment (eg, cleanliness) Avoiding travel expenses and time For occupational therapists Discovering unanticipated barriers Dissipating remaining doubt and avoiding mistakes The involvement of the caregiver helps the patient to remember the recommendations Improving communication between the occupational therapist and the caregiver Promoting discussion between the occupational therapist and the patient if the latter participates in mobile videoconferencing For patients transferred to the intensive functional rehabilitation unit, mobile videoconferencing makes it possible to specify the rehabilitation objectives Seeing details and offering more specific recommendations Determining the pertinence of a home visit by the CLSC occupational therapist For caregivers Allowing the occupational therapist to identify problems that the caregiver had not thought of Feeling guided in the return home process Allowing patients to reconnect with their home and reflect on their return home Avoiding the need to explain everything Providing recommendations that don’t need tweaking Reassuring the caregiver Disadvantages Common to occupational therapists and Videoconferencing requires being comfortable with technology caregivers Videoconferencing requires additional time and availability of caregivers Videoconferencing constitutes additional stress for caregivers who are uncomfortable with taking measurements or using the tablet For occupational therapists Inability to observe the interaction between person, occupation, and environment No overview such as during a home visit in person Inaccessible if there is no Internet coverage in the municipality More time consuming than an interview For caregivers CLSC: centres locaux de services communautaires (local community service centers). There were no other perceived disadvantages. https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 7 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al when the occupational therapist has doubts about Disadvantages of Using Mobile Videoconferencing to what the patient said. [Occupational therapist 4] Conduct a Remote Home Assessment Another occupational therapist, who was part of 2 triads, also One occupational therapist reported that mobile failed to perceive any added value associated with the use of videoconferencing does not show the interaction between the mobile videoconferencing. person, the environment, and the person’s activities. In addition, mobile videoconferencing requires more time than interview The changes that the mobile videoconferencing made assessment. Five caregivers mentioned that there were no to the intervention plan were not essential to leave. disadvantages to mobile videoconferencing. The concerns They were aimed more at optimizing safety and could brought up by caregivers were the same as those identified by have been done by the occupational therapist at home. occupational therapists (ie, stress of having to take Although the mobile videoconferencing is more measurements or use a tablet, especially if they are not concrete than the interview and interesting, the time comfortable with the device). Caregivers also highlighted the invested, and the minor changes made to the extra time that it took to pick up the equipment, undergo intervention plan mean that there is no added value. training, and conduct the videoconference. [Occupational therapist 5] Perception of the Added Value of Mobile Changes in Satisfaction and Occupational Performance Videoconferencing There was a clinical difference between hospital stay and Mobile videoconferencing provided added value according to postdischarge patient performance scores (hospital: mean 4.0, 3 of 5 occupational therapists. These 3 occupational therapists SD 2.7; postdischarge: mean 6.2, SD 2.8) and satisfaction scores expressed readiness to promote the use of mobile (hospital: mean 4.1, SD 3.1; postdischarge: mean 7.1, SD 2.1). videoconferencing to their peers. A change of 2 points is considered a clinically relevant improvement or deterioration . Mobile videoconferencing takes longer to complete, but the recommendations are more specific. The ratio Time Required for Mobile Videoconferencing of time to what mobile videoconferencing requires in The mean direct time that occupational therapists reported terms of logistics versus what it provides in terms of having spent evaluating the environment through intervention offers added value. [Occupational videoconferencing at the time of discharge (discussions, making therapist 3] an appointment with the caregiver, providing explanations prior For (another) patient, it helped define specific goals to the assessment) was 104 minutes (SD 74). The mean indirect for her rehabilitation. It ensures that the time (environment evaluation) was 64 minutes (SD 87). recommendations are correct and feasible. Occupational Therapists’ Receptivity to Mobile Occupational therapists are often told that Videoconferencing recommendations don’t work. Mobile videoconferencing is not pertinent in all cases but Assessment of the receptivity of occupational therapists who when it applies, it really offers added value. It applies had recruited at least one patient indicated that there were barriers to successful telehealth use by practitioners (Table 4). Table 4. Receptivity of occupational therapists who recruited at least one patient. French-Canadian version of the Practitioner and Organizational Telehealth Readiness Score, mean (SD) Assessment section Before intervention (n=6) Postdischarge (n=5) Total score (out of 85) 51 (10) 56 (9) In order to meet the requirements for core readiness (out of 15) 7 (1) 8 (2) In order to meet the requirements for engagement readiness (out of 35) 25 (3) 26 (3) In order to meet the requirements for structural readiness (out of 35) 20 (7) 22 (5) the time constraints associated with this method. Consequently, Factors Influencing the Choice to Use Mobile the occupational therapist’s perception of the time that training Videoconferencing would take, dependent on whether or not the caregiver was Several factors appeared to influence whether or not mobile comfortable with the technology, influenced their choice. videoconferencing was used by occupational therapists who According to the occupational therapists, meetings with recruited at least one participant. caregivers to introduce mobile videoconferencing, scheduling virtual visits, and material recovery added to their workload, as One occupational therapist mentioned that, due to her workload, well as, that of caregivers. Some occupational therapists doubted she could not always prioritize mobile videoconferencing over their ability to teach caregivers how to use mobile other tasks and did not always have time to do it. The necessary videoconferencing, insofar as this required availability, caregiver training on mobile videoconferencing also added to motivation, and collaboration. As reported by occupational https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 8 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al therapists, a number of families refused to engage in mobile However, 2 occupational therapists believed that it was the videoconferencing because the process seemed too cumbersome. community occupational therapist and not the hospital However, for 6 of the caregivers, logistics were not a problem. occupational therapist’s role to do the home assessment. In addition, some of the occupational therapists felt that I think it’s the role of the occupational therapist at meetings with caregivers involved discussions that went beyond the CLSC [centres locaux de services communautaires mobile videoconferencing and therefore, in a context of limited (local community service center)] to do the home time, this aspect is a challenge in terms of feasibility. assessment because she has that expertise. Sometimes it’s harder to get someone to go film or [Occupational therapist D] have a caregiver who is in step with current Trust in the Interview as a Home Assessment Method technologies. [Occupational therapist 3] According to most occupational therapists, the amount of trust You see the person, you do not just fix it and then that can be placed in an interview method depends on the move on to something else … she told me a lot of patient. If the patient has no cognitive impairments and the things and then they also have difficult things to do family confirms the information, then it can be relied upon. with them personally. [Occupational therapist 1] Conversely, the method cannot be used with patients who have Occupational therapists sometimes anticipated the fact that the impaired memory or difficulty expressing themselves. The patient would be discharged from hospital before they had time method is even less reliable if a caregiver is not present, which to do the mobile videoconferencing or that it is not pertinent in was mentioned by one occupational therapist, who also stressed view of the patient’s transfer to a rehabilitation unit. Finally, the possible discrepancy between patient, patient family, and occupational therapists’ daytime work schedule did not match professional perceptions. the availability of some caregivers, in which case, mobile We are confused by the patient’s speech. For example, videoconferencing was not considered. the patient considers that his home allows to circulate Caregiver Level of Comfort With Technology and with a walker while a professional would judge the Mobile Videoconferencing Training opposite following assessment. [Occupational therapist C] Based on their own perceptions, caregivers’ comfort level with technology was poor (n=2), moderate (n=4), and good (n=2). In the opinion of some occupational therapists, when doubt Most felt that the training offered by the occupational therapist exists, photos can be requested from the family or a referral sent and the 2-page instruction booklet they were given helped them to the CLSC occupational therapist. However, there may be a to learn how to use the tablet. significant delay if the home assessment is done by the CLSC occupational therapist due to their own workload. I was afraid I might not to be able to do it, but with that short training, it seemed simple enough and I Prerequisites for the Use of Mobile Videoconferencing enjoyed trying to help. [Caregiver 5] by Occupational Therapists For one caregiver, however, the training was not sufficient. This Many occupational therapists (n=3) commented that they did caregiver used help from a third party (siblings) during the not have the necessary prerequisites to use mobile videoconference. Two other caregivers received help from a videoconferencing (ie, good knowledge of how to use the tablet, third, although their levels of comfort with the technology were ability to solve technical contingencies, and ability to teach the moderate and high. family how to use it). One occupational therapist believed that with good training she could manage. The others felt It didn’t take long; the hardest part was to learn how comfortable using mobile videoconferencing (n=3). to operate the tablet and finally it was my sister who turned it on because I had already forgotten how it Profile of Patients Who Could Benefit From Mobile worked...I’m not used to that myself. [Caregiver 2] Videoconferencing Perceptions of the Relevance of Home Assessment, According to occupational therapists, the patients who would Mobile Videoconferencing, and Recruitment benefit from mobile videoconferencing are patients who have Difficulties permanent motor disorders, who are already known to the therapist, who are young adults, who are alone, who need a Relevance of Home Assessment in Hospital Discharge walker in the home, who have cognitive impairments and need Of the occupational therapists who participated in the project to be tested in conditions that are similar to what they are used but did not recruit patients, 5 occupational therapists considered to, or whose entourage is comfortable with technology and home assessment prior to hospital discharge to be pertinent. available. Some occupational therapists said that this patient profile is quite common in practical settings, while others It’s important for the safety of the patient and in the disagreed. prevention of falls, in the maintenance of autonomy also. [Occupational therapist G] Reasons for Nonrecruitment It’s an integral part of my job. [Occupational therapist Finally, in order to explain the reasons why they were unable B] to recruit patients in the context of the project, occupational therapists mentioned the movement of staff, the impression that https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 9 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al it would be asking too much of the caregiver, the lack of time, instead. This is a clinically important point. Unimplementable the difficulty of coordinating the availability of caregivers with recommendations (such as the 3 assistive devices mentioned their own, having caregivers at ease with technology, the above) can interfere with older adults’ ability to age in their perception of duplicating work with the CLSC, thinking of homes, and a change in home environment is no small matter recruiting patients, having patients who correspond to the in a person’s life. inclusion criteria, and work overload. Overall, the perceived advantages of mobile videoconferencing for occupational therapists and caregivers exceeded the Problems Encountered With the Use of Mobile disadvantages; however, the nature of the disadvantages—time Videoconferencing required to conduct mobile videoconferencing (meeting Some technical problems were encountered during the study. planning, tablet training, equipment loan, virtual visit) combined Communication with the clinician was generally adequate. The with the increased workload perceived by occupational sound and the image were judged to be clear by all the therapists, intervention priorities such as pressure injury, participants. With the exception of the lack of internet coverage availability of caregivers on working hours, and the short length in the municipality where one patient resided, the technical of stay—do not support its use. More specifically, the perceived problems did not prevent the use of mobile videoconferencing reliability of data collected through interviews and the short or the home evaluation and were not raised as being time required for interviews led occupational therapists to prefer inconvenient for patients using mobile videoconferencing. interviews as an evaluation method. This is consistent with the Participant Suggestions on Improving Home conclusions from a scoping review  on the use of information and communication technology for home Assessment Using Mobile Videoconferencing assessment. Our study highlighted that mobile One occupational therapist suggested that it would be useful to videoconferencing is considered beneficial by occupational record the videoconference visit and subsequently review the therapists when the patient has a cognitive impairment and a assessment (as needed or depending on the patient’s progress). caregiver is not available, both of which reduce the reliability A caregiver also recommended that the videoconference visit of data collected through interviews. However, for individuals be recorded and available to other professionals. She was again with cognitive impairment, it is very important to observe their asked about her environment in the rehabilitation unit following interaction with their home environment, and mobile her stay at the unit where the initial assessment took place and videoconferencing used in the manner described in this study felt that she was duplicating what had already been done. does not allow for this interaction to be seen . Also, in our Another occupational therapist suggested that the study, availability and motivation of caregivers were identified interdisciplinary team should be involved in the as prerequisites for the use of mobile videoconferencing by videoconference. First responders, often the social worker, could occupational therapists. explore the possibility of doing the mobile videoconferencing with the patient’s family even before the occupational therapist Another clinically relevant finding was that mobile receives the referral in order to address the time constraints of videoconferencing required increased involvement on the part short stay. In addition, it may be pertinent for the physiotherapist of caregivers in discharge planning. This appears to be an to see the walking distances between the home and the parking advantage for improving communication between the clinician lot and inside the home, and for the social worker to verify the and caregivers, thereby increasing the probability that the safety and cleanliness of the home environment. Finally, one caregiver will implement the occupational therapist's occupational therapist conducted the mobile videoconference recommendations. In contrast, some occupational therapists, together with the patient. She explained that the patient was including those who did not recruit a patient, felt uncomfortable able to provide details of her lifestyle and this experience burdening caregivers with this task. In fact, some eligible motivated her in her rehabilitation because she was able to patients were not part of the study because the caregiver declined visualize what her return home would be like. This occupational to participate due to their busy schedule. Knowing that therapist recommended patient participation in mobile caregivers are at risk of exhaustion , clinicians may have videoconferencing. been reluctant to add to their burden of care. The family caregivers enrolled in the study, who may arguably be more Discussion available and interested in the project, commented that the logistics surrounding mobile videoconferencing had not been Principal Results a problem. They said that the mobile videoconferencing had reassured them and that they appreciated being guided by the The use of mobile videoconferencing after the interview occupational therapist to make the measurements. Holland and generally led occupational therapists to modify their initial colleagues  reported that seeing the clinicians on video made intervention plan. Most changes were considered by caregivers feel as if they were at home with them, which occupational therapists to be minor inasmuch as they were facilitated interactions. Chi and Dimiris  also found that expected to have little impact on a safe return home. However, caregivers felt more involved in the process. Therefore, mobile 3 assistive devices recommended after the interview raised some videoconferencing can be perceived as a burden by some issues after discharge. In addition, based on mobile caregivers and as a facilitator by others. videoconferencing, the decision of the interdisciplinary team and that of the patient himself to transfer to a seniors' residence Some feasibility issues may explain recruitment difficulties and, was modified, and the patient returned home upon discharge therefore, will have an impact on the choice to use mobile https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 10 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al videoconferencing or not. Based on the Telehealth Readiness of the home environment with the patient in terms of benefits Assessment questionnaire , there was a degree of reluctance and clinical, ethical, and financial issues [32,33]. It would also with respect to telehealth. These findings are not consistent with be of interest to document the clinical reasoning behind the those of a study  in which clinicians were reported to be decision whether or not to assess the home environment, through supportive of more frequent use of the telecommunication mobile videoconferencing or otherwise, in order to guide system. However, our results may be influenced by clinicians’ occupational therapists on the best methods to use for this and perceived openness of their workplace to telehealth. Indeed, in on how to best use their time . the Telehealth Readiness Assessment questionnaire , almost Limitations half of the points (40 out of 100) pertain to how clinicians This study has some limitations. First, we had fewer participants perceived the receptivity of the institution. In one study , than desired. The recruitment difficulties encountered during occupational therapists reported that they needed more training the study underscore the need to make organizational changes in communication technology use but organizational constraints to support the use of mobile videoconferencing in routine care. were a barrier . This is consistent with our finding that many Nevertheless, the added value perceived by participants as well occupational therapists did not have the skills to use mobile as the opportunity to obtain additional and more appropriate videoconferencing or to show caregivers how to use the recommendations suggest the relevance of using mobile technology. This perception of a lack of technological skills, videoconferencing. Second, it would have been relevant to combined with occupational therapists’ perceptions that further document the occupational therapists’ and caregivers’ caregivers who are less familiar with technology would require level of comfort with technology use in order to better more time, may explain why they favored the involvement of understand how it influenced occupational therapists’ receptivity caregivers who are familiar with the technology. Our and participant recruitment. Occupational therapists were not conclusions are consistent with those of Ninnis and al , who asked to recruit the ideal candidate, but a participant selection suggested that therapists consider the use of mobile apps to be bias cannot be excluded because of workload concerns. To appropriate for some patients but not those who are less reduce their workload, they may have been inclined to select confident or less able to use new technologies. However, in our patients with family caregivers who were comfortable with the study. it does not appear that the caregivers’ level of comfort technology or who were motivated to use videoconferencing. with the technology affected its use. Moreover, the analysis was performed by one person (KL). Future Directions However, the interviews were transcribed verbatim, and 2 Some occupational therapists and caregivers suggested that the co-authors who participated in the interviews (KB, MG) attested use of caregivers' own smartphones, despite potential to the consistency between themes and interviews. Finally, the confidentiality issues, would allow for a better start of the COVID-19 pandemic occurred in the period between videoconferencing experience. Smartphones are becoming more the study’s completion and its publication, which may also and more popular among people aged 65 and over . In impact the results as the pandemic forced occupational therapists addition to precluding the need for mobile videoconferencing and the general population to learn about, if not improve, their training, the use of their own device would eliminate the need technological proficiency and to use mobile video conferencing for caregivers to come to the hospital to pick up equipment. We more frequently. are currently working with engineers on making personal Conclusions smartphones safe and simple to use (only one button to press), Clinical feasibility issues were found when using mobile with options to measure distances between home facilities videoconferencing to support hospital discharge planning. through screenshots. Another suggestion made by one Although mobile videoconferencing provides multiple benefits, occupational therapist was to involve patients in the such as more appropriate occupational therapist videoconference, which is in line with shared decision-making recommendations, the inconveniences, such as time constraints, and patient-centered approaches [29-31]. The involvement of make it difficult to perceive the added value of this method. a social worker and physiotherapist could also help to gather However, it was suggested that having caregivers use their own further information (presence of an interior and exterior staircase smartphone, involvement of the interdisciplinary team, and for example) during the virtual visit and thus optimize hospital patient participation in the videoconference would mitigate discharge planning (such as planning the need for assistance these inconveniences. with mobility). We suggest that future studies compare standard assessment (interview), videoconference, and in-person visits Acknowledgments We would like to thank the patients, the caregivers, and the occupational therapists who participated in the study. The contributions of the students from the School of Rehabilitation at the University of Sherbrooke (G Fortin, F Gagnon, M Bruneau-Cossette, P Prince) in drafting this manuscript were much appreciated. We also thank the Quebec Network for Research on Aging and Rehabilitation Research Network for their financial contribution to this multicenter project. Conflicts of Interest None declared. https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 11 (page number not for citation purposes) XSL FO RenderX JMIR AGING Latulippe et al Multimedia Appendix 1 Added open questions to the receptivity questionnaire for occupational therapists who did not recruit a patient. 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[doi: 10.1177/0308022616650898] Abbreviations CLSC: centres locaux de services communautaires (local community service centers) Edited by J Wang; submitted 16.09.20; peer-reviewed by K Laver, M Naeemabadi; comments to author 03.11.20; revised version received 29.01.21; accepted 25.03.22; published 05.07.22 Please cite as: Latulippe K, Giroux D, Guay M, Kairy D, Vincent C, Boivin K, Morales E, Obradovic N, Provencher V Mobile Videoconferencing for Occupational Therapists’ Assessments of Patients’ Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study JMIR Aging 2022;5(3):e24376 URL: https://aging.jmir.org/2022/3/e24376 doi: 10.2196/24376 PMID: ©Karine Latulippe, Dominique Giroux, Manon Guay, Dahlia Kairy, Claude Vincent, Katia Boivin, Ernesto Morales, Natasa Obradovic, Véronique Provencher. Originally published in JMIR Aging (https://aging.jmir.org), 05.07.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included. https://aging.jmir.org/2022/3/e24376 JMIR Aging 2022 | vol. 5 | iss. 3 | e24376 | p. 13 (page number not for citation purposes) XSL FO RenderX
JMIR Aging – JMIR Publications
Published: Jul 5, 2022
Keywords: caregivers; feasibility; mixed methods; mobile videoconferencing; mobile phone; occupational therapy; discharge planning; home assessment
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