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Background:In-hospital fall prevention is a complex phenomenon most efficiently addressed via a wide range of multifactorial interventions. Technology may contribute, but research in this field has so far mainly focused on detecting falls. As a result, new knowledge from a system perspective is needed regarding when and how new technologies may support fall prevention among patients who have been hospitalized.

Objective:This study aimed to explore and describe clinical practices in an acute orthopedic hospital ward for fall prevention from a system perspective; determine the needs and possibilities related to support for clinical practices for fall prevention; and test whether a framework for studying interactions between people, activities, contexts, and technologies can be used to support observations of complex phenomena such as clinical fall prevention.

Methods:This qualitative study followed the principles of human-centered design while combining focused ethnography with a workshop. Eight health care professionals representing different staff categories in an acute hospital ward of an orthopedic clinic participated in on-site interviews or were observed in their clinical practice. Data from these events were subjected to qualitative content analysis to describe the clinical practices for fall prevention observed in terms of people, activities, context, and tools. In a workshop, a larger group of clinic personnel provided their views on fall prevention, described the activities and tools they observed to prevent falls, and discussed needs for further support.

Results:This study determined that health personnel considered fall prevention in all their interactions with patients, which included a wide range of activities for fall prevention wherein staff categories played complementary roles. These staff-patient meetings were goal oriented, responsive, and patient centered. The staff often served as key “tools” in assessment, communication, and coaching, while digital tools (mainly computer-based software programs) were used for information retrieval, documentation, and communication. The personnel worked to prevent patient falls both during hospitalization and after discharge. They believed that the long-term perspective was much more difficult to address in their clinical practice, and they expressed a need for more homelike environments in the hospital.

Background: In-hospital fall prevention is a complex phenomenon most efficiently addressed via a wide range of multifactorial interventions. Technology may contribute, but research in this field has so far mainly focused on detecting falls. As a result, new knowledge from a system perspective is needed regarding when and how new technologies may support fall prevention among patients who have been hospitalized. Objective: This study aimed to explore and describe clinical practices in an acute orthopedic hospital ward for fall prevention from a system perspective; determine the needs and possibilities related to support for clinical practices for fall prevention; and test whether a framework for studying interactions between people, activities, contexts, and technologies can be used to support observations of complex phenomena such as clinical fall prevention. Methods: This qualitative study followed the principles of human-centered design while combining focused ethnography with a workshop. Eight health care professionals representing different staff categories in an acute hospital ward of an orthopedic clinic participated in on-site interviews or were observed in their clinical practice. Data from these events were subjected to qualitative content analysis to describe the clinical practices for fall prevention observed in terms of people, activities, context, and tools. In a workshop, a larger group of clinic personnel provided their views on fall prevention, described the activities and tools they observed to prevent falls, and discussed needs for further support. Results: This study determined that health personnel considered fall prevention in all their interactions with patients, which included a wide range of activities for fall prevention wherein staff categories played complementary roles. These staff-patient meetings were goal oriented, responsive, and patient centered. The staff often served as key “tools” in assessment, communication, and coaching, while digital tools (mainly computer-based software programs) were used for information retrieval, documentation, and communication. The personnel worked to prevent patient falls both during hospitalization and after discharge. They believed that the long-term perspective was much more difficult to address in their clinical practice, and they expressed a need for more homelike environments in the hospital. Conclusions: The view on technology-based in-hospital fall prevention can be broadened not only to mainly include monitoring and alarm systems, information systems in general, or computer-based information in particular systems but also to support activities performed by health personnel that engage patients in fall prevention. For example, tools such as these can be implemented in training involving daily activities and mobility within safe yet more homelike clinical contexts. ©Maria Ehn, Åsa Revenäs, Helena Tobiasson.

Older adults are a heterogeneous population for which many e-health innovations are inaccessible. Involving older adults in user-centered design (UCD) with a specific focus on inclusive design is important to make e-health more accessible to this user group. This case study aimed to explore the feasibility of a new UCD approach aiming to minimize bias in the design phase of a digital support for older adults’ physical activity (PA). The study used mixed methods and applied UCD principles in a four-iteration design phase followed by an evaluation phase where 11 and 15 older adults participated, respectively. The users’ gender, PA level and technology experience (TE) were considered in recruitment, data analysis and prioritization of improvement efforts. In the design phase, users with different gender, PA level and TE participated and contributed with feedback, which was prioritized in the development. The adaptation included improving readability, simplifying layout and features, clarifying structure, and making the digital content more inclusive and relevant. The evaluation showed that the users had a positive experience of the prototype and could use it with some help. The study demonstrated that adopting e-health to assure digital inclusion among older adults must address several aspects. The UCD approach was feasible for amending user bias and for confirming that users of both genders and with varied PA- and TE level shaped the design. However, evaluation of the method with larger samples is needed. Moreover, further research on methods to involve digitally excluded populations in UCD is needed.

In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.

Background

Many seniors need to increase their physical activity (PA) and participation in fall prevention exercise. Therefore, digital systems have been developed to support fall-preventive PA. Most of them lack video coaching and PA monitoring, two functionalities that may be relevant for increasing PA.

Objective

To develop a prototype of a system to support seniors' fall-preventive PA, which includes also video coaching and PA monitoring, and to evaluate its feasibility and user experience.

Methods

A system prototype was conceived by integrating applications for step-monitoring, behavioural change support, personal calendar, video-coaching and a cloud service for data management and co-ordination. Its feasibility and user experience were evaluated in three consecutive test periods combined with technical development. In total, 11 seniors tested the system at home for four weeks with video coaching from health care professionals.

Results

Initially, the system's feasibility was non-satisfactory due to insufficient stability and usability. However, most problems could be addressed and amended. In the third (last) test period, both seniors and coaches experienced the system prototype to be fun, flexible and awareness-raising. Interestingly, the video coaching which made the system unique compared to similar systems was highly appreciated. Nonetheless, even the users in the last test period highlighted issues due to insufficient usability, stability and flexibility. Further improvements in these areas are needed.

Conclusions

Video coaching in fall-preventive PA can be valuable for both seniors and health care professionals. High reliability, usability and flexibility of systems supporting seniors are essential.

BACKGROUND: The need to assess the effectiveness and value of interventions involving digital health and health and welfare technologies is becoming increasingly important due to the rapidly growing development of these technologies and their areas of application. Systematic reviews of scientific literature are a mainstay of such assessment, but publications outside the realm of traditional scientific bibliographic databases-known as gray literature-are often not included. This is a disadvantage, particularly apparent in the health and welfare technology (HWT) domain. OBJECTIVE: The aim of this article is to investigate the significance of gray literature in digital health and HWT when reviewing literature. As an example, the impact of including gray literature to the result of two systematic reviews in HWT is examined. METHODS: In this paper, we identify, discuss, and suggest methods for including gray literature sources when evaluating effectiveness and appropriateness for different review types related to HWT. The analysis also includes established sources, search strategies, documentation, and reporting of searches, as well as bias and credibility assessment. The differences in comparison to scientific bibliographic databases are elucidated. We describe the results, challenges, and benefits of including gray literature in 2 examples of systematic reviews of HWT. RESULTS: In the 2 systematic reviews described in this paper, most included studies came from context-specific gray literature sources. Gray literature contributed to the overall result of the reviews and corresponded well with the reviews' aims. The assessed risk of bias of the included studies derived from gray literature was similar to the included studies from other types of sources. However, because of less standardized publication formats, assessing and extracting data from gray literature studies were more time-consuming and compiling statistical results was not possible. The search process for gray literature required more time and the reproducibility of gray literature searches were less certain due to more unstable publication platforms. CONCLUSIONS: Gray literature is particularly relevant for digital health and HWT but searches need to be conducted systematically and reported transparently. This way gray literature can broaden the range of studies, highlight context specificity, and decrease the publication bias of reviews of effectiveness of HWT. Thus, researchers conducting systematic reviews related to HWT should consider including gray literature based on a systematic approach.

BACKGROUND: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation.

OBJECTIVE: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non-GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom.

METHODS: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs.

RESULTS: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient.

CONCLUSIONS: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research.

Background Nocturnal digital surveillance technologies are being widely implemented as interventions for remotely monitoring elderly populations, and often replace person-based surveillance. Such interventions are often placed in care institutions or in the home, and monitored by qualified personnel or relatives, enabling more rapid and/or frequent assessment of the individual's need for assistance than through on-location visits. This systematic review summarized the effects of these surveillance technologies on health, welfare and social care provision outcomes in populations >= 50 years, compared to standard care. Method Primary studies published 2005-2020 that assessed these technologies were identified in 11 databases of peer-reviewed literature and numerous grey literature sources. Initial screening, full-text screening, and citation searching steps yielded the studies included in the review. The Risk of Bias and ROBINS-I tools were used for quality assessment of the included studies. Result Five studies out of 744 identified records met inclusion criteria. Health-related outcomes (e.g. accidents, 2 studies) and social care outcomes (e.g. staff burden, 4 studies) did not differ between interventions and standard care. Quality of life and affect showed improvement (1 study each), as did economic outcomes (1 study). The quality of studies was low however, with all studies possessing a high to critical risk of bias. Conclusions We found little evidence for the benefit of nocturnal digital surveillance interventions as compared to standard care in several key outcomes. Higher quality intervention studies should be prioritized in future research to provide more reliable evidence.

Sensor-based fall risk assessment (SFRA) utilizes wearable sensors for monitoring individuals’ motions in fall risk assessment tasks. Previous SFRA reviews recommend methodological improvements to better support the use of SFRA in clinical practice. This systematic review aimed to investigate the existing evidence of SFRA (discriminative capability, classification performance) and methodological factors (study design, samples, sensor features, and model validation) contributing to the risk of bias. The review was conducted according to recommended guidelines and 33 of 389 screened records were eligible for inclusion. Evidence of SFRA was identified: several sensor features and three classification models differed significantly between groups with different fall risk (mostly fallers/non-fallers). Moreover, classification performance corresponding the AUCs of at least 0.74 and/or accuracies of at least 84% were obtained from sensor features in six studies and from classification models in seven studies. Specificity was at least as high as sensitivity among studies reporting both values. Insufficient use of prospective design, small sample size, low in-sample inclusion of participants with elevated fall risk, high amounts and low degree of consensus in used features, and limited use of recommended model validation methods were identified in the included studies. Hence, future SFRA research should further reduce risk of bias by continuously improving methodology.