Mainstream Smart Home Technology-Based Intervention to Enhance Functional Independence in Individuals With Complex Physical Disabilities: Single-Group Pre-Post Feasibility Study.

Abstract

Background: Mainstream smart home technologies (MSHTs), such as home automation devices and smart speakers, are becoming more powerful, affordable, and integrated into daily life. While not designed for individuals with disabilities, MSHT has the potential to serve as assistive technology to enhance their independence and participation.

Objective: The study aims to describe a comprehensive MSHT-based intervention named ASSIST (Autonomy, Safety, and Social Integration via Smart Technologies) and evaluate its feasibility in enhancing the functional independence of individuals with complex physical disabilities.

Methods: ASSIST is a time-limited intervention with a design based on the human activity assistive technology model, emphasizing client-centered goals and prioritizing individual needs. The intervention follows a structured assistive technology service delivery process that includes 2 assessment sessions to determine technology recommendations, installation and setup of the recommended technology, and up to 8 training sessions. An occupational therapist led the intervention, supported by a contractor and a technologist. Feasibility was evaluated through several measures: (1) the ASSIST Functional Performance Index, which quantifies the number of tasks transitioned from requiring assistance to independent completion and from higher levels of assistance or effort to lower levels; (2) pre- and postintervention measures of perceived task performance and satisfaction using a 10-point scale; (3) the number and types of tasks successfully addressed, along with the costs of devices and installation services; and (4) training effectiveness using the Goal Attainment Scale (GAS).

Results: In total, 17 powered wheelchair users with complex physical disabilities completed the study with 100% session attendance. Across participants, 127 tasks were addressed, with 2 to 10 tasks at an average cost of US $3308 (SD US $1192) per participant. Of these tasks, 95 (74.8%) transitioned from requiring partial or complete assistance to independent completion, while 24 (18.9%) either improved from requiring complete to partial assistance or, if originally performed independently, required reduced effort. Only 8 (6.3%) tasks showed no changes. All training goals, except for 2, were achieved at or above the expected level, with a baseline average GAS score of 22.6 (SD 3.5) and a posttraining average GAS score of 77.2 (SD 4.5). Perceived task performance and satisfaction showed significant improvement, with performance score increasing from a baseline mean of 2.6 (SD 1.2) to 8.8 (SD 1.0; P<.001) and satisfaction score rising from an average of 2.9 (SD 1.3) to 9.0 (SD 0.9; P<.001).

Conclusions: The ASSIST intervention demonstrated the immediate benefits of enhancing functional independence and satisfaction with MSHT among individuals with complex physical disabilities. While MSHT shows promise in addressing daily living needs at lower costs, barriers such as digital literacy, device setup, and caregiver involvement remain. Future work should focus on scalable models, caregiver engagement, and sustainable solutions for real-world implementation.