Use of Technology in the Rehabilitation Setting: Therapy Observations, Mixed Methods Analysis, and Data Visualization

Objective

To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption.

Design

A convergent, mixed-methods study using therapy observations, semistructured templates, and summative content analysis.

Setting

Ten neurorehabilitation units in a single health system.

Participants

Three research clinicians (1 occupational therapist [OT], 2 physical therapists [PTs]) observed approximately 78 OTs and 100 PTs (N=178).

Interventions

Not applicable.

Main Outcome Measures

Characteristics of RT, time spent setting up and using RT, and clinician behaviors.

Results

Ninety distinct devices across 15 different focus areas were inventoried. Three hundred twenty-nine RT uses were documented over 44 hours, with only 42% of inventoried devices observed used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were associated with balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vital signs (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately electrically powered (56%), actuated (57%), monitor-less (53%), multiuse (68%), and required little familiarization (57%). Setup times were brief (mean ± SD = 3.8±4.2 and 0.8±1.3min for intervention and measurement, respectively); more time was spent with intervention RT (25.6±15min) than measurement RT (7.3±11.2min). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%) to their patients. Clinicians were evenly divided between providing one-on-one direct attention (49.7%) and multitasking (50.3%), such as completing documentation, when using RT with patients.

Conclusions

Even in a tech-friendly hospital, most available RTs were observed unused, especially measurement technologies. We discuss how the identified characteristics of used RT, as well as the observations about how therapists used RT, may be useful in guiding new designs. An interactive data visualization page supplement is also provided to facilitate further exploration with this dataset.