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Disability and Rehabilitation
ISSN: 0963-8288 (Print) 1464-5165 (Online) Journal homepage: https://www.tandfonline.com/loi/idre20
The use of information and communicationtechnology in healthcare to improve participationin everyday life: a scoping review
Michael Zonneveld, Ann-Helen Patomella, Eric Asaba & Susanne Guidetti
To cite this article: Michael Zonneveld, Ann-Helen Patomella, Eric Asaba & SusanneGuidetti (2019): The use of information and communication technology in healthcare toimprove participation in everyday life: a scoping review, Disability and Rehabilitation, DOI:10.1080/09638288.2019.1592246
To link to this article: https://doi.org/10.1080/09638288.2019.1592246
© 2019 The Author(s). Published by InformaUK Limited, trading as Taylor & FrancisGroup
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REVIEW ARTICLE
The use of information and communication technology in healthcare to improveparticipation in everyday life: a scoping review
Michael Zonnevelda , Ann-Helen Patomellab , Eric Asabab and Susanne Guidettib
aFaculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands; bDivision of Occupational Therapy, Department ofNeurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
ABSTRACTBackground and purpose: The increase in use of everyday information and communication technologiescan lead to the need for health professionals to incorporate technology use competencies in practice.Information and communication technologies has the potential to improve participation in daily lifeamong people with disability. The aim was to review and describe evidence of the use of informationand communication technology, including mobile technology, for improving participation in everyday life.A secondary aim was to describe how study outcomes were related to participation.Materials and methods: A scoping review methodology was used to identify studies through databasesas MEDLINE, CINAHL, Cochrane Library. Thereafter, the studies were screened and assessed for inclusion.Results: Eleven studies were included. The most commonly used technology were videoconferencingand the telephone. Ten of the 11 studies reported a change in participation in everyday life. Participationwas mainly described as involvement in a life situation or related to activities of daily living.Conclusion: Delivering an intervention to improve participation through information and communicationtechnology can be a valid option in rehabilitation. There is a need to measure and describe the interven-tion and its outcomes in relation to a definition of participation in future studies.
� IMPLICATIONS FOR REHABILITATION� The use of an information and communication technology application seems to be as good as the
face-to-face intervention.� There is a need for defining the concept of participation related to outcome measures in
future studies.
ARTICLE HISTORYReceived 31 August 2018Revised 4 March 2019Accepted 5 March 2019
KEYWORDSICT; telerehabilitation;eHealth;mHealth; telehealth
Introduction
Since 2005, the World Health Organization has urged memberstates, “to develop the infrastructure for information and communi-cation technologies (ICT) for health as deemed appropriate to pro-mote equitable, affordable, and universal access to their benefits,and to continue to work with information and telecommunicationagencies and other partners in order to reduce costs and makeeHealth successful” [1, p. 109]. The use of ICT can have greatpotential to support rehabilitation and it is consequently of interestto explore evidence as well as benefits and implications for clinicalpractice. There are many terms used to describe the use of ICT tosupport healthcare. These terms are often used interchangeably,which can contribute to misunderstanding or misconceptions.Terms include: eHealth, mHealth, telehealth, telerehabilitation andtelemedicine. For instance, the World Health Organization (WHO)uses the term eHealth to describe the use of ICT to support popu-lation health and in healthcare areas [1]. Within rehabilitation scien-ces, telerehabilitation is emerging [2–4], defined by the delivery ofrehabilitation services via ICT [2] to include a wide range of servicessuch as: assessment, intervention, supervision, education,
consultation and counseling [5,6]. To prevent confusion, ICT will beused in this study as a term to describe technologies used to sup-port and deliver healthcare services.
The use of ICT, specifically smartphones and tablets is rapidlygrowing [7]. It is estimated that the amount of smartphone sub-scriptions in Europe will reach 880 million by 2021 [8], and mobileapp markets will expand even more, with currently over 160,000mobile health apps available for download [9]. The use of ICT inhealthcare has shown great potential in improving the quality oflife among senior citizens [10], by facilitating support in independ-ent living for persons with conditions such as stroke andAlzheimer’s disease [11,12]. Moreover, ICT has demonstratedpotential in improving communication between patients andhealthcare providers [13]. Although it is still unclear how telereha-bilitation services can most appropriately be rendered, it has beensuggested that ICT can add value to current stroke rehabilitation[14,15]. For instance, White et al. [16] described how, among per-sons with stroke, the use of a tablet was experienced as contribu-ting to motivation, socialization, and was non-burdensome. This isalso in line with earlier research showing that people after astroke were using smartphones and tablets in their everyday life
CONTACT Susanne Guidetti susanne.guidetti@ki.se Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, KarolinskaInstitutet, Alfred Nobels All�e 23, B4, Huddinge, Stockholm 141 83, Sweden.� 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis GroupThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon inany way.
DISABILITY AND REHABILITATIONhttps://doi.org/10.1080/09638288.2019.1592246
[17,18]. Moreover, smartphones and tablets have been widelyintegrated in the performance of everyday activities [19,20]. Yetmany of the mobile applications available today lack expertinvolvement from health professionals or researchers, and do notadhere to relevant medical evidence [21]. It can be argued thatresearch to support evidence for the use of technologies in clin-ical practice is needed [15,22,23].
Participation is generally part of rehabilitation goals [24], andin some policy documents, participation is seen as the ultimategoal [25]. But the concept of participation takes on differentmeanings in the context of health and welfare services.Participation was recently described in the literature “as engage-ment in daily life and ‘everyday life’” [24]. While InternationalClassification of Functioning, Disability and Health define partici-pation as “involvement in a life situation” [26] which can be inter-preted as task performance in a person’s current environment[26]. This definition has been criticized for lacking a perspective ofthe individuals’ subjective experience of involvement in theirchoices [24]. Since participation is a multidimensional conceptwith different uses and meanings, it is being used imprecisely,leaving it up to the reader to infer how the concept is used [27].In a systematic review by Pinto-Bruno et al. investigating the useof ICT to increase participation [28] there was no evidence for theuse of ICT to increase participation among persons with dementia.Other systematic reviews found evidence for the use of ICT inpeople with stroke [14] and Multiple Sclerosis [29], but did notinvestigate the increase in participation as an outcome. In orderto understand the potential of ICT in rehabilitation there is aneed to create an overview of the available evidence, particularlyfocusing on the effect of ICT interventions on participation, inde-pendent of diagnosis.
There is still a knowledge gap between clinical practice andthe use of ICT applications to improve rehabilitation and partici-pation outcomes, which needs to be filled. Therefore, the aim ofthis article is to review and describe evidence of the use of ICT,including mobile technology, for improving participation in every-day life. A secondary aim was to describe how study outcomeswere related to measuring participation.
Method
A scoping review design was used to disseminate the field ofenquiry and supported the process to identify the knowledgegaps within the existing evidence [30]. This scoping review fol-lowed the five stages as described by the methodological frame-work of Arksey and O’Malley [30]; as a complement, therecommendations by Levac et al. [31] on the Arksey and O’Malleyframework have been used.
Stage 1: identifying the research question
The research question guiding the scoping review was, “what evi-dence is available for the use of ICT, including mobile technology,for improving participation in everyday life?”
Stage 2: identifying relevant studies
For inclusion in the review the following criteria were applied: a)contains use of an ICT based intervention, b) focuses on improv-ing participation (i.e., according to the International Classificationof Functioning, Disability and Health [26]) or increasing independ-ence in activities of daily living (ADL) as an outcome measure, c)
could be of any design, d) participants over 18 years old, and e)published in English.
Three electronic databases were used: MEDLINE, CINAHL, andthe Cochrane Library. This search was conducted betweenDecember 2017 and February 2018, without any restriction to pub-lication date. A combination of the following search terms wasused: ICT, information and communications technology, mHealth,m-Health, eHealth, e-Health, health informatics, telehealth, telereha-bilitation, mobile technology, participat�, activities of daily living,intervention and prevention. Based on the high relevance of thejournals scope all of the published issues (started 2009) of TheInternational Journal of Telerehabilitation were hand-searched.
Systematic reviews that were found during the search wereexcluded, but the reference lists were hand-searched for relevantstudies, as were the reference lists of the articles included in thisstudy. (Further details of the search strategy are availableupon request).
Stage 3: study selection
First, all titles were screened for relevance by MZ, and non-rele-vant titles were removed. Two of the authors (MZ and SG)reviewed the abstracts identified from the database searchesindependently. Abstracts were assessed on meeting the inclusioncriteria. Disagreements on inclusion or exclusion of an abstractwere resolved by reaching a consensus or by consulting a thirdreviewer (AHP). The full text of the included abstracts wereobtained to be read independently by the authors (MZ and SG)to determine studies to be included in the review. In the case ofa disagreement the third reviewer (AHP) was consulted.
Stage 4: charting the data
A data extraction form was developed in Microsoft Excel, basedon the research question. Data were collected on: a) the article’sauthors; b) year of publication; c) aims of the study; d) studydesign; e) study location; f) intervention used; g) technology used;h) participants’ characteristics; i) methods used to administer out-comes or the order of measurements; j) outcome measures; andk) key findings of relevance.
Stage 5: collating, summarizing and reporting the results
The studies were summarized descriptively and compared for sim-ilarities and differences [30]. More specifically, in the studies, theuse of the concept of participation (including opportunities toparticipate in everyday activities such as work, leisure and self-care [24]) was investigated and described.
Results
The search resulted in 701 records (without duplicates) of which140 records were considered relevant and selected for theirabstracts. Of those 140 abstracts, 33 full-text articles wereassessed for eligibility, which resulted in 11 articles with consen-sus by the authors (MZ, SG and A-H P), for inclusion in the quali-tative synthesis. The results of the identification process andselection phases of the study were described in detail based onthe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) [32] see Figure 1.
Key characteristics of the included studies are presented inTable 1. Most of the studies were conducted in the USA (n¼ 7)and the use of a randomized controlled trial (RCT) design was most
2 M. ZONNEVELD ET AL.
common (n¼ 7). Three pilot studies were included (n¼ 3) of whichone had a RCT design and two were case studies. Most of the stud-ies were published after 2012 (n¼ 8) and focused on stroke (n¼ 7).Multiple types of ICT were reported where video and telephonecommunications were the most commonly used ICT (both n¼ 5)and the use of email was reported in only one study. A combin-ation of two ICT applications occurred in four of the studies.
Participation was explicitly measured in three of the studies. Inthe remaining studies participation was a component to measureparticipation in everyday activities such as work, leisure and self-care [26]. Six studies showed significant improvements in partici-pation. The following results describe how ICT was used toimprove participation and how participation was related tothe outcomes.
ICT for improving participation in everyday life
Ten of the 11 included studies reported a change in participation,of which six studies showed a significant improvement betweenpre- and post-measurement. The main outcomes and the keyfindings of the studies are presented in Table 1. First the six sig-nificantly improved studies will be described, then the four non-significant but slightly improved studies and at last the studywhich found no improvement is described.
Pilutti et al. [33] performed a RCT in which a behavioral inter-vention for people with Multiple Sclerosis combined videoconferen-cing with information from a website about becoming morephysically active. The participants in the intervention groupincreased significantly in their self-reported physical activity in dailyactivities compared to the control group. Jones et al. [34] with a
single group design used a mobile phone in combination withemails to deliver the self-management program called myMoves.The participants improved significantly directly after the interven-tion, but the improvement did not remain significant at follow-up.It is noteworthy that the study by Jones et al. [34] is the only studythat asked the participants what their preference of contact was,email or telephone in order to ensure that the participants werecontacted to their satisfaction. Ng et al. [35] studied multiple caseswho used the existing Cognitive Orientation to daily OccupationalPerformance (CO-OP) approach and delivered it over a videoconfer-ence. Two of three participants improved significantly after theintervention, the third participant improved, although not enoughto be statistically significant. Hermann et al. [36] conducted a casestudy in which the participant was supervised in using an electricalmuscle activity stimulating device via videoconferencing. Thisresulted in significant improvement on the Canadian OccupationalPerformance Measure measuring participation in relation to dailyactivities. A pilot study by Forducey et al. [37] also used videocon-ference to deliver a combination of physiotherapy and occupa-tional therapy interventions for older people who had a strokewhere the control group received standard home care withoutvideoconferencing. A total of nine participants completed pre- andpost-measurements and both groups showed significant improve-ments but no significance was found between the groups. Linderet al. [38] used a combination of a telephone with a website in aRCT design investigating a robot-assisted therapy with a homeexercise program. Both of the groups improved significantly, butshowed no significant difference between the two groups.
In four of the 11 studies non-significant improvementsbetween pre- and post-measurement were found. One of these
Figure 1. PRISMA flowchart of search and inclusion.
ICT TO IMPROVE PARTICIPATION: A SCOPING REVIEW 3
Table1.
Maincharacteristicsandou
tcom
esof
theinclud
edstud
ies.
Firstauthor,year–coun
try
Design;
participants;age;sex
Diagn
osis
Mainou
tcom
e–techno
logy
Aim;key
finding
s
Boehm
[39],2
015–USA
Pilotstudy
Case
stud
y;N¼1;
70years
old;
male
Stroke
Occup
ationalp
erform
ance
and
satisfaction&fatig
ueimpact
–Teleph
one
Topilottest
theManagingFatig
uecourse
toprovidefortheoccupa-
tionaln
eeds
ofpeop
lewith
post-strokefatig
ue;
TheCO
PMaverageperformance
scoreimproved
by0.4po
ints,and
theaveragesatisfactionscoreimproved
by0.8po
ints.These
scores
arewellb
elow
meaning
fulchang
eon
theCO
PM.Fatigue
scores
lowered
from
47to
13ou
tof
160on
theFatig
ueImpact
Scale.
Chum
bler
[40],2
012–USA
RCT;Interventio
nGroup
:N¼25;
� xage67.1
(9.5);24
males,1
female
ControlG
roup
:N¼23;� x
age
67.7
(10.0);2
3males
Stroke
Basicactivities
ofdaily
living–
Video-conference
&Teleph
one
Tostud
ytheeffect
ofamultifaceted
stroke
telerehabilitationinterven-
tionusingfunctio
nally
basedexercisesandadaptivestrategies,o
nph
ysical
functio
n,andsecond
arily
ondisability;
TheSTeleR
(¼Stroke
TeleRehabilitation)
interventio
ndidimprove
participants’abilityto
perform
lifetasksanddecreasedthelim
ita-
tionin
activities
atho
me.Thediffe
rencewas
notsign
ificant
betweengrou
psas
measuredby
theLate-Life
Functio
nand
Disability
InstrumentFunctio
ntotalscore.
Forducey
[37],2
012–USA
Pilotstudy
RCT;Interventio
nGroup
N¼4,
ControlG
roup
N¼5;
� xage60
(47-75);sex
notrepo
rted
Stroke
Independ
ence
–Video-conference
Tocompare
theeffectsof
home-basedtelehealth
versus
standard
homecare
services
onchangesin
emotionala
ndph
ysical
health
status
forolderperson
swith
stroke;
Both
telerehabilitationandcontrolg
roup
sshow
edstatisticallysig-
nificantimprovem
entin
ADL.Nosign
ificant
diffe
rences
inimprove-
mentwerefoun
dbetweengrou
ps,h
owever
thenu
mberof
visits
requ
iredweresign
ificantlylower
inthetelehealth
basedtreatm
ent.
Hermann[36],2
010–USA
Case
stud
y;N¼1;
62years
old;
male
Stroke
Occup
ationalp
erform
ance
and
satisfaction
–Video-conference
Theprimarystud
yob
jectivewas
toexam
inetheefficacyof
thisinex-
pensive,remotelybasedrehabilitativeapproach
inastroke
patient
exhibitin
gstable,affe
cted,u
pper-extremity
impairm
ent;
TheCO
PMsatisfactionsign
ificantlyincreasedforallfiveof
the
COPM
tasksby
4to
6po
ints.The
participantshow
edno
tableper-
form
ance
changesin
oneCO
PMtask.
Jones[34],2
016–Au
stralia
Sing
legrou
p;N¼24;� x
age
51.13(16.52);10
males,
14females
Stroke
(N¼20)
Traumaticbraininjury
(N¼4)
Participation
–Teleph
one&em
ail
Theprimaryaim
ofthisstud
ywas
toexam
inethefeasibility
and
acceptability
ofaremotelydelivered
self-managem
entprog
ram,
themyM
oves
Prog
ram;
Asmeasuredby
themod
ified
Reintegrationto
Normal
Living
Index
therewas
astatisticallysign
ificant
improvem
entin
participation
immediatelyaftertheprog
ram,w
ithan
averageincrease
of2.8
points.The
improvem
entdidno
tremainsign
ificant
atthe3mon
thfollow-up,
althou
ghthemeanscores
forallp
articipationmeasures
remainedhigh
erthan
thoseat
baseline.
Lind
er[38],2
015–USA
RCT;Interventio
nGroup
N¼51;
� xage59.4
(13.6);3
1males,
20females.
ControlG
roup
N¼48;� x
age
55.5
(12.6);3
3males,
15females
Stroke
ADL&meaning
fula
ctivities
–Teleph
one&Website
Torepo
rttheno
nmotor
outcom
esof
twoho
me-basedrehabilitation
interventio
ns:(1)
aho
meexercise
prog
ram
and(2)robo
t-assisted
therapyþho
meexercise
prog
ram;
Theinterventio
ngrou
pdidno
thave
sign
ificantlybetter
results
comparedto
thecontrolg
roup
.Participants
inbo
thgrou
psimproved
sign
ificantlyon
theStroke
Impact
Scaledo
mainscores
except
for‘mem
ory’and‘mood’.
Makai[43],2
014–The
Netherland
sRC
T;Interventio
nGroup
N¼179;� xage81.69(5.38);
62males,1
17females.
ControlG
roup
N¼270;� xage
81.32(5.72);1
03males,
167females
Fraile
lderly
ADL,instrumentalA
DL&social
activity
–Onlinehealth
commun
ity
Toinvestigatetheeffectivenessof
anon
linehealth
commun
ityinter-
ventionforolderpeop
lewith
frailty
aimed
atfacilitatingmultid
is-
ciplinarycommun
ication;
Nosign
ificant
improvem
enton
ADL,instrumentalA
DL,or
social
activity
wereob
served
asmeasuredby
theKatz
ADL,Katz-15and
theShortForm
-36.
(continued)
4 M. ZONNEVELD ET AL.
Table1.
Continued.
Firstauthor,year–coun
try
Design;
participants;age;sex
Diagn
osis
Mainou
tcom
e–techno
logy
Aim;key
finding
s
Mayo[42],2
008–Canada
RCT;Interventio
nGroup
N¼96;
� xage70
(14.5);6
4males,3
2females.C
ontrol
Group
N¼94;� x
age72
(12.95);52
males,4
2females
Stroke
ADL&participation
–Teleph
one
Todeterm
inewhether
person
snewlydischarged
into
thecommun
ityfollowingan
acutestroke
wou
ldrepo
rtbetter
health
relatedqu
ality
oflifeandhave
fewer
emergencyroom
visits
andno
n-electiveho
s-pitalizations
ifassign
edto
astroke
case
manager
incomparison
tothosereceivingusualp
rocedu
resforpo
st-hospitalcare;
Thenu
rsingcase
managem
entinterventio
ndidno
thave
sign
ificant
effectson
anyof
thehealth
orfunctio
n-relatedou
tcom
es.O
nlya
small,no
n-sign
ificant,improvem
entwas
foun
don
thereintegration
tono
rmal
livingindexin
both
grou
psat
follow-up.
Ng[35],2
013–Canada
Pilotstudy
Case
stud
ies;N¼3;
age47,
34&55;m
ale
Traumaticbraininjury
Occup
ationalp
erform
ance
and
satisfaction&participation
–Video-conference
Toexplorethefeasibility
ofadministerin
gtheCO
-OPapproach
viaa
telerehabilitationform
at.A
ndto
exam
ineiftheCO
-OPapproach
inits
telerehabilitationform
atcanprom
otecommun
ityintegration
andhelp
managetheinfluence
ofexecutivedysfun
ctionin
every-
daylifeforadults
with
traumaticbraininjury;Significantimprove-
ments
inparticipationwererepo
rted
by2patientsand2
sign
ificant
others.The
otherpatient
also
improved
onthepartici-
patio
nmeasure
Mayo-Portland
AdaptabilityInventory-4,
ParticipationIndex.TheCO
-OPapproach
viatelerehabilitationwas
foun
dto
befeasible
andto
adhere
tothesevenkeyfeatures.
Results
ontheCO
PMshow
edthat
agreaternu
mberof
trainedand
untrainedgo
alsimproved
atfollow-upcomparedto
post-
interventio
n.Ngu
yen[41],2
008–USA
Pilotstudy
RCT;Interventio
nGroup
N¼20;� x
age70.9
(8.6);12
males,8
females.C
ontrol
Group
N¼19;� x
age68
(8.3);
10males,9
females
Chronicob
structivepu
lmon
-arydisease
ADL –Web-based
application
Tocompare
theefficacyof
theinternet-based
dyspneaself-manage-
mentprog
ram
with
aface-to-face
dyspneaself-managem
entpro-
gram
ontheprimaryou
tcom
eof
dyspneawith
ADLin
patients
with
mod
erateto
severe
Chronicob
structivepu
lmon
arydisease
over
along
erperio
dusingarand
omized
design
;Participants
inbo
thprog
ramsshow
edsimilarclinicallymeaning
ful
changesin
dyspneawith
ADLfrom
baselineto
3mon
thsandsus-
tained
theseimprovem
ents
forthemostpartat
6mon
ths.Thesus-
tained
improvem
ents
indyspneawith
ADLreflect
thespecificity
oftheinterventio
n.Pilutti[33],2014
–USA
RCT;Interventio
nGroup
N¼41;
� xage48.4
(9.1);11
males,3
0females.C
ontrol
Group
N¼41;� x
age49.5
(9.2);9
males,3
2females
Multip
lesclerosis
Physical
activity
–Website
&Videocon
ference
Toexam
inetheefficacyof
aninternet-delivered
behavioral
interven-
tionforimprovingsecond
aryou
tcom
esof
fatig
ue,d
epression,
anx-
iety,p
ain,
sleepqu
ality,and
health
relatedqu
ality
oflife.The
second
aryaim
isto
replicateprevious
results
regardingchange
inph
ysical
activity
usingself-repo
rted
andob
jectivelymeasures
outcom
es;Participants
intheinterventio
ngrou
pparticipated
insig-
nificantly
moreself-repo
rted
physical
activity
comparedwith
con-
trolspo
st-trial.Lifestyleph
ysical
activity
includ
esleisure,
occupatio
nal,andho
useholdactivities
asapartof
everyday
life.
ADL:Activities
ofDailyLiving
;COPM
:CanadianOccup
ationalP
erform
ance
Measure;C
O-OP:
Cogn
itive
Orientationto
daily
Occup
ationalP
erform
ance.
ICT TO IMPROVE PARTICIPATION: A SCOPING REVIEW 5
studies was the pilot case study by Boehm et al. [39], where atelephone was used to deliver the Managing Fatigue course butshowed non-significant improvements for the participants.Chumbler et al. [40] used a combination of videoconferencesand telephone calls within a stroke telerehabilitation interven-tion. Improvements were found in the intervention group(N¼ 25), but between-group improvements were non-significant.Nguyen et al. [41] compared the efficacy of the internet-baseddyspnea self-management program with a face-to-face dyspneaself-management program in a study for people with COPD.Both groups showed improvements, though non-significant butthey sustained these improvements at 6 months. Mayo et al.[42] showed no significant effects in relation to surveillance,information and education, and psycho-social support using aRCT design where case managers kept in touch over the tele-phone compared to the usual care. A small improvement wasmeasured by the Reintegration to Normal Living Index in bothgroups, but there was no significance within or between thegroups. The conclusion was that the interventions used by thecase managers were not sufficiently potent to alter the per-ceived health status.
No effect was observed in one study by Makai et al. [43] whodeveloped a web-based online health community to facilitatemultidisciplinary communication for frail elderly. The online healthcommunity was only used actively by 26.2% of the participantsand did not improve any of the outcomes.
Measurement of participation
In the included studies participation was measured in differentways and only three studies had participation as a primary out-come [34,35,42]. Jones et al. [34] reported that they used themodified Reintegration to Normal Living Index to measure partici-pation, which assesses how well people return to normal livingpatterns related to participation in daily activities, recreationalactivities, social activities, family roles, and relationships. Althoughthe participants improved in their participation during interven-tion but the effect was not sustained at the follow-up. TheReintegration to Normal Living Index (the non-modified version)was also used in a study by Mayo et al. [42], though it was usedwithout further explanation and with only a non-significantimprovement that was not further discussed. Ng et al. [35]described how they used Participation Index and indirectly theCanadian Occupational Performance Measure as their primary out-come and as a secondary outcome the Mayo-PortlandAdaptability Inventory-4 to measure participation.
Three studies have measured participation as a satisfaction ofperformance in self-chosen activities by using the CanadianOccupational Performance Measure [35,36,39]. In four studies[37,38,41,43] participation was used as an outcome for ADL inthe intervention. These studies used ADL measurements such asthe Functional Independence Measure, the Stroke Impact Scale,Katz-ADL and the Chronic Respiratory Questionnaire dys-pnea subscale.
Two studies have also used physical activity in the frame ofparticipation as an outcome measure [33,40]. First Chumbler et al.[40] connected physical activity to ADL, measured by the Late-LifeFunction and Disability Instrument. Secondly, a broader connec-tion was made by Pilutti et al. [33], who defined physical activityas leisure, occupational or household activities that are plannedor unplanned as a part of everyday life and showed significanteffects with a behavioral intervention on physical activity.
Discussion
The primary aim of this scoping review was to review anddescribe the evidence of the use of ICT, including mobile technol-ogy, for improving participation in everyday life. A total of 11studies were found on targeting participation as an outcome ofan ICT based intervention. The participants in the majority ofstudies had had a stroke (64%). Ten of 11 studies found a changein participation in daily life, of which six showed a significantimprovement. While many aspects of the results can be discussed,we will focus on three main findings: 1) the potential improve-ment’s in participation through using ICT, 2) the approach used inICT-based interventions and challenges in conducting researchpertaining to a rapidly changing technology landscape, and 3) thepossible gaps between how participation was used as an out-come and addressed in projects.
Firstly, the studies included in this scoping review show thatthere is potential in using ICT-based interventions to improve par-ticipation however the design of a study has different impact onthe level of evidence provided. Traditionally RCT designs areviewed as having a higher impact than for example case studies[44]. Case study design were used in three studies and a singlegroup pre-post design in one study. RCT design was used inseven of the included studies, only one showed significantimprovements in favor of the ICT-based intervention group com-pared to the control group [33], two studies found a non-signifi-cant improvement in favor of the intervention group [40,42], andone found no improvement [43]. The remaining three RCT’s foundimprovements in participation in both the intervention and thecontrol groups, with a non-significant difference between groups.Forducey et al. [37], compared the effects of home-based ICT ver-sus standard home care services. Even though both groupsimproved significantly, the amount of visits were significantlylower in the ICT group, which suggests it could be more cost-effective compared to the standard face-to-face home care serv-ices. The study by Nguyen et al. [41] aimed to develop an inter-vention that would be (equally) effective whether delivered viaICT or face-to-face, in order to reach a larger number of patientswith COPD. Both treatment groups had improved results, render-ing the study a success. Of these three studies only the study byLinder et al. [38] hypothesized that the ICT intervention group,who received the home exercise program together with the HandMentor Pro robotic device, would be significantly better than thecontrol group receiving only the home exercise program. Thesestudies show the potential of using ICT to deliver interventions asbeing equally efficient as face-to-face interventions and at thesame time beneficial for healthcare at distance and for cost-effect-iveness. Being able to provide healthcare services in the patient’sown environment increases the chances of improving the personsparticipation because of the contextual relevance the home envir-onment creates [45]. If there is an ICT option available, or moresuitable for a patient, it seems to be a viable option. The resultsindicate that there is still a need for studies with sufficient powerto investigating the effectiveness of ICT-based interventions.
Secondly, the approach in eight of the 11 studies showed thatICT was used as a tool for delivering an intervention. The inter-vention could either have been recently developed or be a cur-rently existing intervention. An example is Hermann et al. [36],they guided a patient using videoconferencing in the use of apreviously developed electrical muscle stimulating hand orthosis.The results suggested that it was the orthosis that caused most ofthe improvement, and not as much the therapy received overvideoconferencing since the therapist mainly had a counselingand supervising role. Three of the 11 studies have instead
6 M. ZONNEVELD ET AL.
developed an intervention to be based on ICT as an integratedplatform for the rehabilitation process; a web-based application[41], a website [33] and an online health community [43]. Thesethree studies used the potential of ICT as a form of rehabilitationintervention, rather than the other eight studies that used ICT asa tool for delivering an intervention that also could have beenface-to-face. The majority of the included studies used existinginterventions, which can be explained from a cost-effectivenesspoint of view, but also from the perspective of ICT interventionsbeing a young research area. One challenge in integrating newtechnologies is short utility period. The time from development toimplementation needs to be rapid in order to be competitive inrelation to how fast the development of ICT products is happen-ing. Nearly as soon as a new product is launched, there is a needfor of a new version or an update. Surprisingly no studies werefound on using smartphones targeting participation in everydaylife, even though the aim of this study included the use of mobiletechnology and the fact that there is already such a large amountof mobile applications available [9]. However, four of the 11 stud-ies used a website or web-based application to connect partici-pants with each other and the professionals [41,43], to trackprogress [38,41], or to communicate with participants [33,41]. Thewebsites that have been used might be convertible to a mobileapplication in the future. The current growth rate in technology[46,47] can be one reason for why there are few studies availablewith the latest smart phone technology.
At last a relevant finding was the analysis of how participationwas described, measured, and used as an outcome in theincluded studies. Interestingly, participation was mainly used asan outcome for involvement in a life situation as measured byusing assessment tools such as the Reintegration to NormalLiving Index, or as related to ADL. Only three studies included theoutcome of participation as a choice, by using the CanadianOccupational Performance Measure as an outcome [35,36,39].Participation demonstrated improvement as an outcome in threeof the studies [34,35,42], even though participation was notdescribed as a direct intervention target in any of the includedstudies nor as a primary aim. Instead participation was indirectlytargeted by improved ADL or physical activity. This suggests thatthere is a potential in the design of ICT-based interventions toalso target participation as an outcome measure in future studies.However, in most of the studies the concept of participation wasnot defined. A definition of participation would add to the gener-alisability of the studies and would make it more accessible toimplement in other locations [24]. By describing how participationwas measured in the included studies, this scoping review illumi-nates the potential of improving participation with the use of ICT-based interventions. As improving participation is a relevant goalfor rehabilitation and healthcare [24,25], there is also a need tomeasure and describe the intervention and its outcomes in rela-tion to a definition of participation.
Although the results from the current scoping review suggestthat ICT-based intervention could improve participation in relationto engagement in daily life and ‘everyday life” [26] and“involvement in a life situation” [27], there is still a need for morestudies focusing on healthcare supported applications of ICT inimproving participation in everyday life.
Methodological considerations
To our knowledge this is the first scoping review conducted witha focus on ICT and participation. There is a knowledge gapregarding how ICT is used in rehabilitation, therefore this scoping
review was performed in order to disseminate the evidence forimproving participation in everyday life using ICT. However, inthis study only studies written in English were included; thismight have limited the results, since the ICT interventions couldbe given in other languages and those results could’ve been pub-lished in the same language. This can be seen in the resultswhere only one of the 11 included studies is from a non-Englishspeaking country. The all-encompassing term ICT was used tocombine different terms within the review, the search howeverwas conducted with many terms that were found combined witha Boolean operator. In this search, some more unknown termscould have been missed.
Conclusion
This scoping review provides an overview of studies investigatingan intervention delivered by, or based on, ICT to improve partici-pation in everyday life. Ten of 11 included studies found a changewhen reported measuring participation, of which six showed asignificant improvement. Delivering an existing intervention viaICT could be a valid option and shows significant improvementjust as the face-to-face interventions. In future studies, there is aneed to measure, and describe the intervention and its outcomesin relation to a definition of participation.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
Michael Zonneveld http://orcid.org/0000-0001-8959-6717Ann-Helen Patomella http://orcid.org/0000-0003-2667-4073Eric Asaba http://orcid.org/0000-0002-6910-3468Susanne Guidetti http://orcid.org/0000-0001-6878-6394
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