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Disability and Rehabilitation

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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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