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O
ri
g
i
na
l
P
ape
r
A
M
ob
il
e App
D
ir
ecto
r
y of Occupat
i
ona
l
T
he
r
ap
i
sts
W
ho P
r
ov
i
de
H
o
m
e
M
od
i
f
i
cat
i
ons:
D
eve
l
op
m
ent and P
r
e
li
m
i
na
r
y
U
sab
ili
ty
Eva
l
uat
i
on
An Th
i
Nguyen, OTD, OT
R
/
L
;
E
m
il
y K
li
ng
S
o
m
erv
ill
e, OTD, OT
R
/
L
;
S
andra
M
ar
ti
na E
s
p
í
n-Te
ll
o,
P
hD,
M
S
c
;
M
ar
i
an Keg
l
ov
it
s
, OTD,
M
S
C
I, OT
R
/
L
;
S
u
s
an Lynn
St
ark,
P
hD, OT
R
/
L
P
rogra
m
i
n Occupa
ti
ona
l
Therapy, Wa
s
h
i
ng
t
on Un
i
ver
s
it
y
S
choo
l
of
M
ed
i
c
i
ne,
St
. Lou
i
s
,
M
O, Un
it
ed
St
a
t
e
s
Corre
s
p
o
ndin
g A
u
t
h
or:
An Th
i
Nguyen, OTD, OT
R
/
L
P
rogra
m
i
n Occupa
ti
ona
l
Therapy
Wa
s
h
i
ng
t
on Un
i
ver
s
it
y
S
choo
l
of
M
ed
i
c
i
ne
4444
F
ore
s
t
P
ark Avenue,
CB
8505
St
. Lou
i
s
,
M
O, 63110
Un
it
ed
St
a
t
e
s
P
hone
:
1 2062443126
E
m
a
il:
an.nguyen@wu
s
tl
.edu
A
b
s
t
r
a
c
t
B
ac
k
gro
und
: Ho
m
e
m
od
i
f
i
ca
ti
on
s
prov
i
ded by occupa
ti
ona
l
t
herap
i
s
t
s
(OT
s
) are effec
ti
ve
i
n
i
m
prov
i
ng da
il
y ac
ti
v
it
y perfor
m
ance
and reduc
i
ng fa
ll
r
i
s
k a
m
ong co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
. However,
t
he preva
l
ence of ho
m
e
m
od
i
f
i
ca
ti
on
i
s
l
ow. One rea
s
on
i
s
t
he
l
ack of a cen
t
ra
li
zed da
t
aba
s
e of OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
.
O
b
ject
i
ve: Th
i
s
s
t
udy a
i
m
ed
t
o deve
l
op and
t
e
s
t
t
he u
s
ab
ilit
y of a
m
ob
il
e app d
i
rec
t
ory of OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
i
n
t
he Un
it
ed
St
a
t
e
s
.
Met
h
o
d
s
: In pha
s
e 1, a pro
t
o
t
ype wa
s
deve
l
oped by
i
den
ti
fy
i
ng OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
t
hrough keyword Web
s
earche
s
.
R
eferra
l
i
nfor
m
a
ti
on wa
s
conf
i
r
m
ed by phone or e
m
a
il
. In pha
s
e 2, co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
aged o
l
der
t
han
65 year
s
and OT
s
curren
tl
y work
i
ng
i
n
t
he Un
it
ed
St
a
t
e
s
were purpo
s
efu
ll
y recru
it
ed
t
o par
ti
c
i
pa
t
e
i
n a
s
i
ng
l
e u
s
ab
ilit
y
t
e
s
t
of
t
he
m
ob
il
e app, Ho
m
e
M
od
i
f
i
ca
ti
on
s
for Ag
i
ng and D
i
s
ab
ilit
y D
i
rec
t
ory of
R
eferra
l
s
(Ho
m
e
M
add
i
r
s
).
P
ar
ti
c
i
pan
t
s
co
m
p
l
e
t
ed
t
he
S
y
s
t
e
m
U
s
ab
ilit
y
S
ca
l
e (
S
U
S
) and
s
e
m
i
s
t
ruc
t
ured
i
n
t
erv
i
ew que
s
ti
on
s
. In
t
erv
i
ew da
t
a were coded, and
t
he
m
e
s
were der
i
ved u
s
i
ng
a grounded
t
heory approach.
Re
s
ul
t
s
: In pha
s
e 1, referra
l
i
nfor
m
a
ti
on for 101 OT
s
acro
ss
49
s
t
a
t
e
s
wa
s
conf
i
r
m
ed. In pha
s
e 2, 6 OT
s
(
m
ean c
li
n
i
ca
l
exper
i
ence
4.3 year
s
,
S
D 1.6 year
s
) and 6 o
l
der adu
lt
s
(
m
ean age 72.8 year
s
,
S
D 5.0 year
s
) par
ti
c
i
pa
t
ed. The
m
ean
S
U
S
s
core for OT
s
wa
s
91.7 (
S
D 8.0
;
ou
t
of 100),
i
nd
i
ca
ti
ng good u
s
ab
ilit
y. The
m
ean
S
U
S
s
core for o
l
der adu
lt
s
wa
s
71.7 (
S
D 27.1),
i
nd
i
ca
ti
ng
con
s
i
derab
l
e var
i
ab
ilit
y
i
n u
s
ab
ilit
y. In add
iti
on,
t
he
S
U
S
s
core
s
i
nd
i
ca
t
ed
t
ha
t
t
he app
i
s
accep
t
ab
l
e
t
o OT
s
and
m
ay be accep
t
ab
l
e
t
o
s
o
m
e o
l
der adu
lt
s
.
F
or OT
s
,
s
e
l
f-repor
t
ed barr
i
er
s
t
o accep
t
ab
ilit
y and u
s
ab
ilit
y
i
nc
l
uded
t
he need for
m
ore
i
nfor
m
a
ti
on on
t
he
s
cope of referra
l
s
erv
i
ce
s
.
F
or o
l
der adu
lt
s
, barr
i
er
s
i
nc
l
uded h
i
gh cogn
iti
ve
l
oad,
l
ack of opera
ti
ona
l
s
k
ill
s
, and
t
he need
t
o
acco
mm
oda
t
e
s
en
s
ory change
s
.
F
or bo
t
h group
s
, fac
ilit
a
t
or
s
of accep
t
ab
ilit
y and u
s
ab
ilit
y
i
nc
l
uded perce
i
ved u
s
efu
l
ne
ss
,
s
oc
i
a
l
s
uppor
t
, and
m
u
lti
p
l
e op
ti
on
s
t
o acce
ss
i
nfor
m
a
ti
on.
Co
n
c
lu
s
i
o
n
s
: Ho
m
e
M
add
i
r
s
de
m
on
s
t
ra
t
e
s
good pre
li
m
i
nary accep
t
ab
ilit
y and u
s
ab
ilit
y
t
o OT
s
. O
l
der adu
lt
s
’ percep
ti
on
s
regard
i
ng accep
t
ab
ilit
y and u
s
ab
ilit
y var
i
ed con
s
i
derab
l
y, par
tl
y ba
s
ed on pr
i
or exper
i
ence u
s
i
ng
m
ob
il
e app
s
.
R
e
s
u
lt
s
w
ill
be
u
s
ed
t
o
m
ake
i
m
prove
m
en
t
s
t
o
t
h
i
s
pro
m
i
s
i
ng new
t
oo
l
for
i
ncrea
s
i
ng o
l
der adu
lt
s
’ acce
ss
t
o ho
m
e
m
od
i
f
i
ca
ti
on
s
.
(J
M
I
R
R
e
h
ab
il
A
ss
i
s
t
Tec
hn
o
l
2020;7(1):e14465) do
i:
10.2196
/
14465
K
E
YW
O
RD
S
m
Hea
lt
h
;
m
ob
il
e app
;
occupa
ti
ona
l
t
herap
i
s
t;
occupa
ti
ona
l
t
herapy
;
o
l
der adu
lt;
u
s
er-co
m
pu
t
er
i
n
t
erface
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
Int
r
odu
c
t
i
on
B
ac
k
gro
und
D
i
ff
i
cu
lti
e
s
perfor
m
i
ng ac
ti
v
iti
e
s
of da
il
y
li
v
i
ng (ADL
s
),
s
uch
a
s
ba
t
h
i
ng, dre
ss
i
ng, or
t
o
il
e
ti
ng, p
l
ace o
l
der adu
lt
s
a
t
i
ncrea
s
ed
r
i
s
k for adver
s
e ou
t
co
m
e
s
,
i
nc
l
ud
i
ng poorer hea
lt
h and fra
ilt
y,
pre
m
a
t
ure
i
n
s
tit
u
ti
ona
li
za
ti
on, and
m
or
t
a
lit
y [1-4].
Approx
i
m
a
t
e
l
y 30% of co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
have
d
i
ff
i
cu
lt
y perfor
m
i
ng one or
m
ore ADL
s
[5,6]. W
it
h
t
he nu
m
ber
of A
m
er
i
can
s
aged o
l
der
t
han 65 year
s
pro
j
ec
t
ed
t
o r
i
s
e fro
m
49
m
illi
on
t
o 98
m
illi
on be
t
ween 2016 and 2060,
t
he nu
m
ber
of o
l
der adu
lt
s
li
v
i
ng w
it
h ADL
li
m
it
a
ti
on
s
i
s
expec
t
ed
t
o
s
urge
[7]. Accord
i
ng
l
y, Hea
lt
hy Peop
l
e 2020 ou
tli
ned an urgen
t
goa
l
t
o reduce
t
he adver
s
e ou
t
co
m
e
s
of da
il
y ac
ti
v
it
y
li
m
it
a
ti
on
s
a
m
ong o
l
der adu
lt
s
a
s
a na
ti
ona
l
hea
lt
h pr
i
or
it
y [8].
Ev
i
dence-ba
s
ed ho
m
e
m
od
i
f
i
ca
ti
on
s
de
li
vered by occupa
ti
ona
l
t
herap
i
s
t
s
(OT
s
) are an effec
ti
ve
i
n
t
erven
ti
on
t
o
i
m
prove o
l
der
adu
lt
’
s
s
afe
t
y and
i
ndependence when perfor
m
i
ng ADL
s
[9-16].
The goa
l
of ho
m
e
m
od
i
f
i
ca
ti
on
s
i
s
t
o reduce env
i
ron
m
en
t
a
l
barr
i
er
s
i
n an o
l
der adu
lt
’
s
ho
m
e
t
o
m
a
t
ch dec
li
n
i
ng
phy
s
i
o
l
og
i
ca
l
co
m
pe
t
enc
i
e
s
a
ss
oc
i
a
t
ed w
it
h
i
ncrea
s
i
ng age and
m
ed
i
ca
l
cond
iti
on
s
. Ho
m
e
m
od
i
f
i
ca
ti
on
i
n
t
erven
ti
on
s
m
ay
i
nc
l
ude
t
ra
i
n
i
ng o
l
der adu
lt
s
and careg
i
ver
s
t
o u
s
e co
m
pen
s
a
t
ory
s
t
ra
t
eg
i
e
s
and adap
ti
ve equ
i
p
m
en
t
t
o fac
ilit
a
t
e
s
afer perfor
m
ance
and
i
ncrea
s
ed
i
ndependence
i
n ADL
s
[9,11]. Ho
m
e
m
od
i
f
i
ca
ti
on
s
m
ay a
l
s
o
i
nc
l
ude reco
mm
enda
ti
on
s
for
m
a
j
or
s
t
ruc
t
ura
l
change
s
t
o a ho
m
e (eg, add
iti
on of grab bar
s
or a
curb
l
e
ss
s
hower) and
t
he re
m
ova
l
of env
i
ron
m
en
t
a
l
hazard
s
t
o
reduce
t
he r
i
s
k of fa
ll
s
and preven
t
s
er
i
ou
s
re
s
u
lti
ng
i
n
j
ur
i
e
s
[17]. OT
s
are e
ss
en
ti
a
l
t
o ev
i
dence-ba
s
ed eva
l
ua
ti
on and de
li
very
of ho
m
e
m
od
i
f
i
ca
ti
on
s
becau
s
e
t
hey po
ss
e
ss
t
he b
i
o
m
ed
i
ca
l
and
p
s
ycho
s
oc
i
a
l
know
l
edge,
s
k
ill
s
, and
t
ra
i
n
i
ng
t
o accura
t
e
l
y a
ss
e
ss
an o
l
der per
s
on’
s
phy
s
i
o
l
og
i
ca
l
co
m
pe
t
enc
i
e
s
(eg, cogn
iti
ve,
m
o
t
or, and
s
en
s
ory func
ti
on
s
), eva
l
ua
t
e
s
oc
i
a
l
and phy
s
i
ca
l
env
i
ron
m
en
t
a
l
barr
i
er
s
i
m
ped
i
ng ADL perfor
m
ance,
i
den
ti
fy
ho
m
e
m
od
i
f
i
ca
ti
on
s
t
ha
t
reduce
t
he
m
i
sm
a
t
ch be
t
ween per
s
ona
l
co
m
pe
t
enc
i
e
s
and env
i
ron
m
en
t
a
l
de
m
and
s
,
t
ra
i
n o
l
der adu
lt
s
and careg
i
ver
s
i
n
t
he correc
t
and
s
afe u
s
e of ho
m
e
m
od
i
f
i
ca
ti
on
s
,
and a
ss
e
ss
i
n
t
erven
ti
on ou
t
co
m
e
s
t
o en
s
ure ADL
li
m
it
a
ti
on
s
have been reduced [18]. In
t
he Un
it
ed
St
a
t
e
s
, ho
m
e
m
od
i
f
i
ca
ti
on
s
and
t
he acco
m
pany
i
ng
s
erv
i
ce
s
prov
i
ded by OT
s
are of
t
en pr
i
va
t
e
l
y funded, a
lt
hough gran
t
fund
i
ng
m
ay be
ava
il
ab
l
e fro
m
s
t
a
t
e or
l
oca
l
govern
m
en
t
s
, pub
li
c progra
ms
, or
nonprof
it
organ
i
za
ti
on
s
t
o he
l
p cover
t
he co
s
t
of ho
m
e
m
od
i
f
i
ca
ti
on
s
for
l
ow-
i
nco
m
e
i
nd
i
v
i
dua
l
s
[19].
However,
m
any o
l
der adu
lt
s
con
ti
nue
t
o
l
ack acce
ss
t
o
ev
i
dence-ba
s
ed ho
m
e
m
od
i
f
i
ca
ti
on
s
,
i
n par
t
, becau
s
e of
t
he
l
ack
of
i
nfor
m
a
ti
on on OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
[19-22].
O
l
der adu
lt
s
, fa
m
il
y
m
e
m
ber
s
, careg
i
ver
s
,
s
oc
i
a
l
s
erv
i
ce
coord
i
na
t
or
s
, and hea
lt
h care profe
ss
i
ona
l
s
m
ay
l
ack awarene
ss
of
l
oca
ll
y ava
il
ab
l
e OT
s
who can prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
t
o he
l
p fac
ilit
a
t
e an o
l
der adu
lt
’
s
s
afe re
t
urn ho
m
e af
t
er ho
s
p
it
a
l
d
i
s
charge or
t
o pro
m
o
t
e ag
i
ng
i
n p
l
ace [22]. Th
i
s
l
ack of
i
nfor
m
a
ti
on
m
ay de
l
ay and even prec
l
ude
t
he de
li
very of ho
m
e
m
od
i
f
i
ca
ti
on
s
when
t
hey are needed
m
o
s
t
t
o
i
m
prove
s
afe
t
y and
i
ndependence
i
n ADL perfor
m
ance and reduce
t
he r
i
s
k of
l
ong-
t
er
m
adver
s
e hea
lt
h ou
t
co
m
e
s
for o
l
der adu
lt
s
[12,19,22-24]. D
i
rec
t
or
i
e
s
of re
s
ource
s
for ho
m
e
m
od
i
f
i
ca
ti
on
s
ex
i
s
t
,
i
nc
l
ud
i
ng
t
he
N
a
ti
ona
l
D
i
r
ec
t
o
r
y o
f
Home Mod
ifi
ca
ti
on
and Repa
i
r
Re
s
ou
r
ce
s
and E
l
de
r
ca
r
e
L
oca
t
o
r
[25,26]. Ex
i
s
ti
ng
d
i
rec
t
or
i
e
s
, however,
l
ack co
m
prehen
s
i
ve referra
l
i
nfor
m
a
ti
on
on OT
s
who de
li
ver ho
m
e
m
od
i
f
i
ca
ti
on
s
a
s
par
t
of
t
he
i
r da
t
aba
s
e
of re
s
ource
s
. Therefore,
t
here
i
s
a need
t
o deve
l
op a cen
t
ra
li
zed,
pub
li
c
l
y acce
ss
i
b
l
e da
t
aba
s
e of
i
nfor
m
a
ti
on on OT
s
who prov
i
de
ho
m
e
m
od
i
f
i
ca
ti
on
s
t
o
i
ncrea
s
e
i
n
t
erven
ti
on acce
ss
,
i
m
prove
care coord
i
na
ti
on, and reduce care de
li
very de
l
ay
s
for o
l
der
adu
lt
s
who are d
i
s
charged fro
m
hea
lt
h care fac
iliti
e
s
back
t
o
i
ndependen
t
li
v
i
ng and for
t
ho
s
e
s
eek
i
ng
t
o
m
a
i
n
t
a
i
n
i
ndependen
t
li
v
i
ng or age
i
n p
l
ace.
O
b
ject
i
ve
s
To addre
ss
t
h
i
s
cha
ll
enge,
t
h
i
s
s
t
udy
s
ough
t
t
o deve
l
op a
m
ob
il
e
app a
s
a cen
t
ra
li
zed da
t
aba
s
e con
t
a
i
n
i
ng referra
l
i
nfor
m
a
ti
on
for OT
s
i
n
t
he Un
it
ed
St
a
t
e
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
and
t
o pre
li
m
i
nar
il
y eva
l
ua
t
e
it
s
accep
t
ab
ilit
y and u
s
ab
ilit
y for
OT
s
and o
l
der adu
lt
s
. In
t
h
i
s
paper, we pre
s
en
t
t
he
m
e
t
hod
s
and
re
s
u
lt
s
of deve
l
op
i
ng a pro
t
o
t
ype of
t
he
m
ob
il
e app (pha
s
e 1)
and u
s
ab
ilit
y
t
e
s
ti
ng
t
o
i
nfor
m
it
era
ti
ve
i
m
prove
m
en
t
s
t
o
t
he
pro
t
o
t
ype (pha
s
e 2). The ob
j
ec
ti
ve of
t
he
m
ob
il
e app, na
m
ed
Ho
m
e
M
od
i
f
i
ca
ti
on
s
for Ag
i
ng and D
i
s
ab
ilit
y D
i
rec
t
ory of
R
eferra
l
s
(Ho
m
e
M
add
i
r
s
),
i
s
t
o a
i
d o
l
der adu
lt
s
, fa
m
il
y
m
e
m
ber
s
, careg
i
ver
s
,
s
oc
i
a
l
s
erv
i
ce coord
i
na
t
or
s
, and hea
lt
h
care prov
i
der
s
i
n
i
den
ti
fy
i
ng
l
oca
l
OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
. We hypo
t
he
s
i
zed
t
ha
t
t
he
m
ob
il
e d
i
rec
t
ory wou
l
d
be accep
t
ab
l
e and u
s
ab
l
e
t
o OT
s
and co
mm
un
it
y-dwe
lli
ng o
l
der
adu
lt
s
.
M
ethod
s
P
h
a
s
e 1: Prototy
p
e Deve
l
o
p
me
n
t
A prev
i
ou
s
l
y pub
li
s
hed pro
t
oco
l
for hea
lt
h-re
l
a
t
ed d
i
rec
t
ory
deve
l
op
m
en
t
wa
s
adap
t
ed
t
o deve
l
op a pro
t
o
t
ype of
t
he
m
ob
il
e
app [27]. To
i
den
ti
fy OT
s
for
i
nc
l
u
s
i
on
i
n
t
he d
i
rec
t
ory, keyword
Web
s
earche
s
were conduc
t
ed be
t
ween Oc
t
ober 2018 and
M
arch
2019 u
s
i
ng Web
s
earch eng
i
ne
s
(Goog
l
e and L
i
nkedIn) for
t
he
fo
ll
ow
i
ng
t
er
ms
, where a
ll
50 U
S
s
t
a
t
e
s
and
P
uer
t
o
R
i
co were
i
nc
l
uded a
s
s
earch
t
er
ms
:
(“ho
m
e
m
od
i
f
i
ca
ti
on” O
R
“ho
m
e
a
ss
e
ssm
en
t
”) AND “occupa
ti
ona
l
t
herap
i
s
t
” AND
“[
s
t
a
t
e
/t
err
it
ory].”
F
or each
s
earch query,
t
he f
i
r
s
t
au
t
hor (AN) rev
i
ewed
t
he
t
op
300
s
earch re
s
u
lt
s
or
t
he
m
ax
i
m
u
m
nu
m
ber of
s
earch re
s
u
lt
s
re
t
urned, wh
i
chever wa
s
f
i
r
s
t
reached,
t
o
i
den
ti
fy OT
s
who
prov
i
ded ho
m
e
m
od
i
f
i
ca
ti
on
s
for
i
nc
l
u
s
i
on
i
n
t
he d
i
rec
t
ory.
S
nowba
ll
s
a
m
p
li
ng wa
s
u
s
ed
t
o
i
den
ti
fy add
iti
ona
l
OT
s
by
s
o
li
c
iti
ng referra
l
s
fro
m
(1) OT
s
prev
i
ou
s
l
y
i
den
ti
f
i
ed
t
hrough
Web
s
earche
s
;
(2) re
s
pon
s
e
s
t
o po
s
t
s
on Web co
mm
un
it
y foru
ms
be
l
ong
i
ng
t
o
t
he Ame
r
i
can Occupa
ti
ona
l
T
he
r
apy A
ss
oc
i
a
ti
on’
s
Home
&
C
ommun
it
y Spec
i
a
l
In
t
e
r
e
s
t
Sec
ti
on and
t
he Home
Mod
ifi
ca
ti
on Occupa
ti
ona
l
T
he
r
apy A
lli
ance (H
M
OTA)
;
and
(3) cro
ss
-referenc
i
ng
t
wo o
t
her ex
i
s
ti
ng re
s
ource da
t
aba
s
e
s
re
l
a
t
ed
t
o ho
m
e
m
od
i
f
i
ca
ti
on
s
,
t
he
N
a
ti
ona
l
D
i
r
ec
t
o
r
y o
f
Home
Mod
ifi
ca
ti
on and Repa
i
r
Re
s
ou
r
ce
s
and E
l
de
r
ca
r
e
L
oca
t
o
r
[25,26].
C
urren
t
c
li
n
i
ca
l
prac
ti
ce gu
i
de
li
ne
s
and a c
li
n
i
ca
l
rea
s
on
i
ng
gu
i
de
li
ne for
t
he de
li
very of ho
m
e
m
od
i
f
i
ca
ti
on
s
by OT
s
were
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
u
s
ed
t
o def
i
ne ba
s
i
c da
t
a f
i
e
l
d
s
and bu
il
d
s
earch f
ilt
er
s
i
n
t
o
t
he
m
ob
il
e app [28,29].
B
a
s
i
c da
t
a f
i
e
l
d
s
for referra
l
s
ource
s
i
nc
l
uded organ
i
za
ti
on or bu
s
i
ne
ss
na
m
e, addre
ss
,
t
e
l
ephone
nu
m
ber, e
m
a
il
, web
s
it
e,
s
pec
i
f
i
c popu
l
a
ti
on
s
s
erved (eg, ch
il
dren
and o
l
der adu
lt
s
), ho
m
e
m
od
i
f
i
ca
ti
on
s
erv
i
ce
s
prov
i
ded (eg,
ho
m
e eva
l
ua
ti
on, con
s
u
lt
a
ti
on, con
s
t
ruc
ti
on, pro
j
ec
t
m
anage
m
en
t
, and careg
i
ver
t
ra
i
n
i
ng), pay
m
en
t
m
e
t
hod
s
or
i
n
s
urance
s
accep
t
ed, and
l
anguage
s
ava
il
ab
l
e for
s
erv
i
ce
prov
i
s
i
on. The na
m
e
s
of bu
s
i
ne
ss
e
s
or organ
i
za
ti
on
s
were
i
ncorpora
t
ed,
i
n
s
t
ead of
t
he na
m
e
s
of
i
nd
i
v
i
dua
l
prov
i
der
s
,
t
o
i
m
prove
s
u
s
t
a
i
nab
ilit
y by reduc
i
ng
t
he
i
m
pac
t
of prov
i
der
t
urnover. A bu
ilt
-
i
n for
m
t
o co
ll
ec
t
s
ub
m
i
ss
i
on
s
fro
m
app u
s
er
s
for new da
t
aba
s
e en
t
r
i
e
s
and upda
t
e
s
t
o curren
t
en
t
r
i
e
s
wa
s
a
l
s
o
added
t
o fac
ilit
a
t
e fu
t
ure upda
t
e
s
t
o
t
he d
i
rec
t
ory. Infor
m
a
ti
on
for each da
t
a f
i
e
l
d wa
s
i
n
iti
a
ll
y re
t
r
i
eved fro
m
pub
li
c
l
y ava
il
ab
l
e
i
nfor
m
a
ti
on on
li
ne.
R
eferra
l
i
nfor
m
a
ti
on wa
s
conf
i
r
m
ed by
s
e
l
f-repor
t
over e
m
a
il
or phone ca
ll
w
it
h each
t
herap
i
s
t
.
P
h
a
s
e 2: U
s
a
bili
ty
T
e
s
t
in
g
Pa
r
ti
c
i
pa
nt
s
To eva
l
ua
t
e
t
he pre
li
m
i
nary accep
t
ab
ilit
y and u
s
ab
ilit
y of
t
he
m
ob
il
e app, u
s
ab
ilit
y
t
e
s
t
s
were conduc
t
ed w
it
h
co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
and OT
s
a
s
t
arge
t
ed end u
s
er
group
s
. O
l
der adu
lt
s
(n
=
6) and OT
s
(n
=
6) were recru
it
ed by
purpo
s
efu
l
s
a
m
p
li
ng fro
m
a
li
s
t
of
l
oca
l
con
t
ac
t
s
ob
t
a
i
ned fro
m
c
li
n
i
ca
l
re
s
earch coord
i
na
t
or
s
a
t
t
he
P
ar
ti
c
i
pa
ti
on, Env
i
ron
m
en
t
and
P
erfor
m
ance Labora
t
ory and
t
he
C
o
mm
un
it
y
P
rac
ti
ce
C
li
n
i
c
a
t
t
he Wa
s
h
i
ng
t
on Un
i
ver
s
it
y
S
choo
l
of
M
ed
i
c
i
ne (
St
Lou
i
s
,
M
i
ss
our
i
, U
S
A). A
s
a
m
p
l
e
s
i
ze of 8
t
o 10
i
s
reco
mm
ended
t
o
de
t
ec
t
80% of u
s
ab
ilit
y prob
l
e
ms
[30].
I
n
c
lu
s
i
o
n
C
r
it
e
r
i
a
C
o
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
were recru
it
ed
i
f
t
hey (1)
were aged 65 year
s
or o
l
der, (2) cou
l
d
s
peak Eng
li
s
h, (3) cou
l
d
li
ve
i
ndependen
tl
y
i
n a non
i
n
s
tit
u
ti
ona
li
zed
s
e
tti
ng, and (4)
s
e
l
f-repor
t
ed no hea
lt
h concern
s
abou
t
u
s
i
ng a
m
ob
il
e app o
t
her
t
han
l
ack of exper
i
ence. OT
s
were
i
nc
l
uded
i
f
t
hey (1) cou
l
d
s
peak Eng
li
s
h and (2) curren
tl
y worked a
s
a
li
cen
s
ed OT
i
n
t
he
Un
it
ed
St
a
t
e
s
(par
t
ti
m
e, fu
ll
ti
m
e, per d
i
e
m
, or
s
e
l
f-e
m
p
l
oyed).
E
xc
lu
s
i
o
n
C
r
it
e
r
i
a
OT
s
no
t
curren
tl
y work
i
ng were exc
l
uded
t
o re
t
r
i
eve feedback
regard
i
ng app accep
t
ab
ilit
y and u
s
ab
ilit
y
i
nfor
m
ed by curren
t
c
li
n
i
ca
l
prac
ti
ce exper
i
ence.
U
s
ab
ilit
y Te
s
tin
g P
r
oced
u
r
e
s
The au
t
hor
s
a
s
ked
t
he
i
n
s
tit
u
ti
ona
l
rev
i
ew board (I
RB
) a
t
t
he
Wa
s
h
i
ng
t
on Un
i
ver
s
it
y
S
choo
l
of
M
ed
i
c
i
ne
i
n
St
Lou
i
s
t
o rev
i
ew
a
ll
s
t
udy procedure
s
, and
t
he I
RB
ver
i
f
i
ed
t
ha
t
t
he
s
t
udy
qua
li
f
i
ed for I
RB
exe
m
p
ti
on a
s
a qua
lit
y
i
m
prove
m
en
t
i
n
iti
a
ti
ve
(I
RB
s
t
udy ID nu
m
ber
:
201901022).
P
ar
ti
c
i
pan
t
s
were
s
creened
by phone or e
m
a
il
t
o a
ss
e
ss
e
li
g
i
b
ilit
y and coord
i
na
t
e a
tt
endance
a
t
a
s
i
ng
l
e u
s
ab
ilit
y
t
e
s
ti
ng
s
e
ss
i
on. O
l
der adu
lt
s
and OT
s
par
ti
c
i
pa
t
ed
i
nd
i
v
i
dua
ll
y
i
n a
s
i
ng
l
e, 45-
m
i
n
t
e
s
t
s
e
ss
i
on. A
ll
u
s
ab
ilit
y
t
e
s
t
s
were perfor
m
ed
i
n a na
t
ura
li
s
ti
c
s
e
tti
ng [31].
O
l
der adu
lt
s
were v
i
s
it
ed
i
n
t
he
i
r ho
m
e, wherea
s
OT
s
were
v
i
s
it
ed
i
n
t
he
i
r c
li
n
i
ca
l
workp
l
ace
s
e
tti
ng
t
o conduc
t
a
ll
t
e
s
ti
ng
procedure
s
. Th
i
s
approach e
li
m
i
na
t
ed
t
he need for o
l
der adu
lt
s
t
o acce
ss
t
ran
s
por
t
a
ti
on (
s
uppor
ti
ng
i
nc
l
u
s
i
ve recru
it
m
en
t
of
o
l
der adu
lt
s
w
it
h a w
i
der range of phy
s
i
ca
l
capab
iliti
e
s
and
s
oc
i
oecono
m
i
c background
s
) and acco
mm
oda
t
ed c
li
n
i
c
i
an
s
’
bu
s
y work
s
chedu
l
e
s
.
Verba
l
con
s
en
t
wa
s
ob
t
a
i
ned fro
m
a
ll
par
ti
c
i
pan
t
s
a
t
t
he
s
t
ar
t
of each
s
e
ss
i
on af
t
er exp
l
a
i
n
i
ng
it
s
purpo
s
e and
s
t
ruc
t
ure. A
s
cr
i
p
t
wa
s
read a
l
oud
t
o de
s
cr
i
be
t
he genera
l
purpo
s
e of
t
he
m
ob
il
e app, bu
t
no fur
t
her
i
n
s
t
ruc
ti
on
s
were prov
i
ded on how
t
o u
s
e
t
he app.
P
ar
ti
c
i
pan
t
s
were
i
n
s
t
ruc
t
ed
t
o perfor
m
a
s
e
t
of
f
i
ve
t
a
s
k
s
cenar
i
o
s
u
s
i
ng
t
he app on a
m
ob
il
e
t
ab
l
e
t
dev
i
ce
(App
l
e
iP
ad 4). Ta
s
k
s
s
cenar
i
o
s
con
s
i
s
t
ed of repre
s
en
t
a
ti
ve
t
a
s
k
s
expec
t
ed
t
o be
t
yp
i
ca
ll
y perfor
m
ed by end u
s
er
s
. The
s
e
t
a
s
k
s
were
t
o (1)
i
den
ti
fy
t
he na
m
e of
t
he OT neare
s
t
t
o your curren
t
l
oca
ti
on who prov
i
de
s
ho
m
e
m
od
i
f
i
ca
ti
on
s
, (2)
i
den
ti
fy
t
he
na
m
e of
t
he ho
m
e
m
od
i
f
i
ca
ti
on fund
i
ng
s
ource neare
s
t
t
o your
curren
t
l
oca
ti
on, (3)
s
earch for
t
he
li
s
t
of a
ll
OT
s
w
it
h
i
n 200
m
il
e
s
of your curren
t
l
oca
ti
on who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
,
(4)
s
earch for
t
he
li
s
t
of a
ll
ho
m
e
m
od
i
f
i
ca
ti
on fund
i
ng
s
ource
s
w
it
h
i
n your
s
t
a
t
e, and (5)
s
earch for
t
he
li
s
t
of a
ll
ho
m
e
m
od
i
f
i
ca
ti
on fund
i
ng
s
ource
s
for peop
l
e w
it
h
l
ow
i
nco
m
e
i
n
your
s
t
a
t
e. In add
iti
on
t
o
i
den
ti
fy
i
ng OT
s
, referra
l
i
nfor
m
a
ti
on
for fund
i
ng
s
ource
s
t
o rece
i
ve f
i
nanc
i
a
l
a
ss
i
s
t
ance for ho
m
e
m
od
i
f
i
ca
ti
on
s
wa
s
a
l
s
o
i
ncorpora
t
ed
i
n
t
o
t
he d
i
rec
t
ory and wa
s
t
e
s
t
ed
i
n
t
ande
m
dur
i
ng u
s
ab
ilit
y
t
e
s
ti
ng. In
s
t
ruc
ti
on
s
for each
t
a
s
k were prov
i
ded ora
ll
y and
i
n wr
iti
ng.
A concurren
t
t
h
i
nk-a
l
oud pro
t
oco
l
wa
s
u
s
ed
t
o ob
t
a
i
n
i
n
s
i
gh
t
s
i
n
t
o u
s
ab
ilit
y prob
l
e
ms
t
ha
t
par
ti
c
i
pan
t
s
exper
i
enced [30,32-34].
P
ar
ti
c
i
pan
t
s
were
i
n
s
t
ruc
t
ed
t
o
s
i
m
u
lt
aneou
s
l
y verba
li
ze
t
he
i
r
m
en
t
a
l
t
hough
t
proce
ss
e
s
a
s
t
hey perfor
m
ed each
t
a
s
k
s
cenar
i
o.
The
t
e
s
t
ad
m
i
n
i
s
t
ra
t
or (AN) wa
s
no
t
a
ll
owed
t
o prov
i
de
a
ss
i
s
t
ance dur
i
ng
t
a
s
k
s
and wa
s
on
l
y a
ll
owed
t
o u
s
e one of
t
he
t
wo probe
s
dur
i
ng
t
he
t
e
s
t
s
e
ss
i
on
:
(1) “Keep
t
a
l
k
i
ng” af
t
er 15
s
econd
s
of
s
il
ence
t
o encourage par
ti
c
i
pan
t
s
t
o con
ti
nue
verba
li
z
i
ng
t
he
i
r
t
hough
t
s
and (2) “U
m
-hu
m
,” “oh,” or “okay,”
t
o aff
i
r
m
ac
ti
ve
li
s
t
en
i
ng [34]. The
m
ax
i
m
u
m
a
m
oun
t
of
ti
m
e
a
ll
owed for each
t
a
s
k
s
cenar
i
o wa
s
5
m
i
n, af
t
er wh
i
ch
t
he
par
ti
c
i
pan
t
wa
s
i
n
s
t
ruc
t
ed
t
o
m
ove on
t
o
t
he nex
t
t
a
s
k.
O
ut
co
m
e
M
ea
s
u
r
e
s
A
m
i
xed
m
e
t
hod approach wa
s
u
s
ed
t
o a
ss
e
ss
pr
i
m
ary ou
t
co
m
e
s
of accep
t
ab
ilit
y and u
s
ab
ilit
y of Ho
m
e
M
add
i
r
s
w
it
h
t
he
fo
ll
ow
i
ng ou
t
co
m
e
m
ea
s
ure
s
:
(1)
t
a
s
k accu
r
acy (
t
he ra
t
e of
s
ucce
ss
fu
l
t
a
s
k co
m
p
l
e
ti
on ca
l
cu
l
a
t
ed a
s
t
he nu
m
ber of
t
a
s
k
s
co
m
p
l
e
t
ed
s
ucce
ss
fu
ll
y d
i
v
i
ded by
t
he
t
o
t
a
l
nu
m
ber of
t
a
s
k
s
under
t
aken
×
100), (2)
t
a
s
k e
ffi
c
i
ency (
ti
m
e
t
o co
m
p
l
e
t
e each
t
a
s
k
i
n
s
econd
s
,
s
t
ar
ti
ng fro
m
t
he
ti
m
e
t
he par
ti
c
i
pan
t
f
i
n
i
s
he
s
rece
i
v
i
ng
i
n
s
t
ruc
ti
on
s
t
o
t
he
ti
m
e
t
hey found
t
he
i
r an
s
wer and
f
i
n
i
s
hed rev
i
ew
i
ng
it
), (3) e
rr
o
r
r
a
t
e (nu
m
ber of error
s
per
t
a
s
k,
where error
s
are def
i
ned a
s
un
i
n
t
ended ac
ti
on
s
,
s
uch a
s
m
i
ss
c
li
ck
s
), (4)
t
ype
s
o
f
e
rr
o
rs
(qua
lit
a
ti
ve de
s
cr
i
p
ti
on
s
of error
s
),
and (5) pe
r
ce
i
ved
t
a
s
k d
iffi
cu
lt
y (
i
mm
ed
i
a
t
e
l
y af
t
er each
t
a
s
k
s
cenar
i
o, par
ti
c
i
pan
t
s
were a
s
ked, “Overa
ll
, how d
i
ff
i
cu
lt
or
ea
s
y d
i
d you f
i
nd
t
h
i
s
t
a
s
k?”
;
t
hey re
s
ponded u
s
i
ng a 7-po
i
n
t
L
i
ker
t
s
ca
l
e, rang
i
ng fro
m
1
=
very d
i
ff
i
cu
lt
t
o 7
=
very ea
s
y) [35].
S
y
s
t
e
m
U
s
ab
ilit
y
S
ca
l
e
The
S
y
s
t
e
m
U
s
ab
ilit
y
S
ca
l
e (
S
U
S
)
i
s
a va
li
d and re
li
ab
l
e 10-
it
e
m
que
s
ti
onna
i
re
t
ha
t
ha
s
been u
s
ed ex
t
en
s
i
ve
l
y
t
o eva
l
ua
t
e
t
he
u
s
ab
ilit
y of a w
i
de range of
t
echno
l
og
i
e
s
,
s
y
s
t
e
ms
, and
s
erv
i
ce
s
,
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
i
nc
l
ud
i
ng
m
ob
il
e app
s
[36]. The
S
U
S
wa
s
fur
t
her
s
e
l
ec
t
ed a
s
a
u
s
ab
ilit
y
m
ea
s
ure becau
s
e of
t
he ea
s
e w
it
h wh
i
ch par
ti
c
i
pan
t
s
wou
l
d be ab
l
e
t
o under
s
t
and
it
s
que
s
ti
on
s
i
n
t
he con
t
ex
t
of
t
he
s
t
udy’
s
u
s
ab
ilit
y
t
e
s
ti
ng
s
cenar
i
o
s
. Que
s
ti
on
s
on
t
he
S
U
S
are
ra
t
ed on a 5-po
i
n
t
L
i
ker
t
s
ca
l
e, rang
i
ng fro
m
1
=
s
t
rong
l
y d
i
s
agree
t
o 5
=
s
t
rong
l
y agree, and
s
u
mm
ed
t
o genera
t
e a
t
o
t
a
l
u
s
ab
ilit
y
s
core. To
t
a
l
u
s
ab
ilit
y
s
core
s
on
t
he
S
U
S
range fro
m
0
t
o 100,
where h
i
gher
s
core
s
i
nd
i
ca
t
e grea
t
er accep
t
ab
ilit
y and u
s
ab
ilit
y
(
i
e, grea
t
er ea
s
e of u
s
e, ea
s
e of
l
earn
i
ng
t
o u
s
e, and
s
e
l
f-conf
i
dence
i
n u
s
i
ng
t
he
m
ob
il
e app).
S
U
S
s
core
s
be
l
ow 70
i
nd
i
ca
t
e a
m
ob
il
e app con
s
i
dered
t
o be unaccep
t
ab
l
e by
re
s
ponden
t
s
, wherea
s
s
core
s
above 70
i
nd
i
ca
t
e good
accep
t
ab
ilit
y and u
s
ab
ilit
y, and
s
core
s
above 90
i
nd
i
ca
t
e
exce
ll
en
t
u
s
ab
ilit
y [36,37].
Q
u
a
lit
a
ti
ve
I
nt
e
r
v
i
e
w
Da
t
a
O
l
der adu
lt
s
’ and OT
s
’
s
ub
j
ec
ti
ve eva
l
ua
ti
on
s
of accep
t
ab
ilit
y
and u
s
ab
ilit
y of
t
he
m
ob
il
e app were co
ll
ec
t
ed
t
hrough re
s
pon
s
e
s
t
o open-ended
i
n
t
erv
i
ew que
s
ti
on
s
. A
s
e
m
i
s
t
ruc
t
ured
i
n
t
erv
i
ew
gu
i
de wa
s
deve
l
oped by
t
he re
s
earch
t
ea
m
t
o ob
t
a
i
n qua
lit
a
ti
ve
feedback on barr
i
er
s
and fac
ilit
a
t
or
s
t
o accep
t
ab
ilit
y and
u
s
ab
ilit
y. In
t
erv
i
ew que
s
ti
on
s
i
nc
l
uded (1) “Wha
t
m
ade
it
ea
s
y
or d
i
ff
i
cu
lt
for you
t
o u
s
e
t
he app?,” (2) “Wha
t
d
i
d you
li
ke or
d
i
s
li
ke abou
t
t
he app de
s
i
gn?,” and (3) “Wha
t
cou
l
d be changed
t
o
m
ake
it
ea
s
i
er for you
t
o u
s
e
t
he app?.” OT
s
were add
iti
ona
ll
y
a
s
ked que
s
ti
on
s
t
o probe for barr
i
er
s
and fac
ilit
a
t
or
s
t
o adop
ti
on
of
t
he
m
ob
il
e app
i
n
t
he
i
r c
li
n
i
ca
l
prac
ti
ce
s
e
tti
ng. The
s
e
que
s
ti
on
s
i
nc
l
uded (1) “
C
ou
l
d you fore
s
ee your
s
e
l
f or o
t
her
s
u
s
i
ng
t
he app
i
n your prac
ti
ce
s
e
tti
ng?,” (2) “Wha
t
d
i
ff
i
cu
lti
e
s
do you fore
s
ee w
it
h u
s
i
ng
t
he app
i
n your prac
ti
ce
s
e
tti
ng?,”
and (3) “Wha
t
wou
l
d
m
ake
it
ea
s
i
er for profe
ss
i
ona
l
s
t
o u
s
e
t
he
app
i
n your prac
ti
ce
s
e
tti
ng?.”
De
m
og
r
ap
hi
c
s
O
l
der adu
lt
s
s
e
l
f-repor
t
ed
t
he
i
r age, gender,
m
ar
it
a
l
s
t
a
t
u
s
,
race
/
e
t
hn
i
c
it
y, and educa
ti
on. OT
s
s
e
l
f-repor
t
ed
t
he
i
r age,
gender, race
/
e
t
hn
i
c
it
y, educa
ti
on, curren
t
c
li
n
i
ca
l
prac
ti
ce
s
e
tti
ng, and year
s
of c
li
n
i
ca
l
work exper
i
ence.
B
o
t
h o
l
der adu
lt
s
and OT
s
were a
s
ked
t
o ra
t
e
t
he
i
r pr
i
or ex
t
en
t
of
m
ob
il
e app
u
s
age
m
ea
s
ured u
s
i
ng
t
hree
it
e
ms
adap
t
ed fro
m
t
he
sm
ar
t
phone
u
s
age
s
ub
s
ca
l
e of
t
he
M
ed
i
a and Techno
l
ogy U
s
age and
A
ttit
ude
s
S
ca
l
e and on a 6-po
i
n
t
s
ca
l
e w
it
h
t
he fo
ll
ow
i
ng
que
s
ti
on
:
“In
t
he
l
a
s
t
m
on
t
h, how
m
uch
ti
m
e d
i
d you
s
pend
u
s
i
ng
m
ob
il
e app
s
?,” wh
i
ch wa
s
ra
t
ed fro
m
1
=
l
e
ss
t
han 1 hour,
2
=
1
t
o 2 hour
s
, 3
=
2
t
o 4 hour
s
, 4
=
4
t
o 6 hour
s
, 5
=
6
t
o 10 hour
s
,
t
o 6
=
m
ore
t
han 10 hour
s
[38,39].
Da
t
a
A
n
a
l
y
s
i
s
A
ll
u
s
ab
ilit
y
t
e
s
t
s
e
ss
i
on
s
were aud
i
o
t
aped, and
m
ob
il
e dev
i
ce
s
creen
s
were
s
creen recorded
t
hroughou
t
t
e
s
ti
ng. A
ll
da
t
a were
de
i
den
ti
f
i
ed before
s
t
orage and ana
l
y
s
i
s
. De
s
cr
i
p
ti
ve
s
t
a
ti
s
ti
c
s
of par
ti
c
i
pan
t
de
m
ograph
i
c
s
and quan
tit
a
ti
ve
m
ea
s
ure
s
of
accep
t
ab
ilit
y and u
s
ab
ilit
y were ca
l
cu
l
a
t
ed u
s
i
ng
SPSS
ver
s
i
on
24.0 (I
B
M
, New York, U
S
A). Qua
lit
a
ti
ve
i
n
t
erv
i
ew re
s
pon
s
e
s
were
t
ran
s
cr
i
bed verba
ti
m
. The f
i
r
s
t
au
t
hor (AN) coded a
ll
qua
lit
a
ti
ve
i
n
t
erv
i
ew da
t
a u
s
i
ng con
t
en
t
cod
i
ng ana
l
y
s
i
s
. A
con
s
t
an
t
co
m
para
ti
ve
m
e
t
hod ba
s
ed on
t
he grounded
t
heory
approach wa
s
u
s
ed
s
o
t
ha
t
i
n
t
erv
i
ew
t
ran
s
cr
i
p
t
s
were con
ti
nua
ll
y
reeva
l
ua
t
ed for
t
he
m
e
s
e
m
erg
i
ng fro
m
con
s
i
s
t
enc
i
e
s
and
d
i
fference
s
i
n coded
t
er
ms
[40-44]. The
m
e
s
were c
l
u
s
t
ered
i
n
t
o
ca
t
egor
i
e
s
of barr
i
er
s
and fac
ilit
a
t
or
s
t
o accep
t
ab
ilit
y and
u
s
ab
ilit
y.
C
a
t
egor
i
e
s
,
t
he
m
e
s
, and
t
he
i
r a
ss
oc
i
a
t
ed code
s
were
deve
l
oped and docu
m
en
t
ed u
s
i
ng NV
i
vo ver
s
i
on 12.0 (Q
S
R
In
t
erna
ti
ona
l
,
M
e
l
bourne, Au
s
t
ra
li
a).
M
e
m
ber check
i
ng wa
s
u
s
ed
t
o enhance
t
he
t
ru
s
t
wor
t
h
i
ne
ss
of f
i
nd
i
ng
s
, whereby
t
he
m
e
s
were
s
hared w
it
h par
ti
c
i
pan
t
s
by phone or e
m
a
il
for re
s
ponden
t
va
li
da
ti
on [45,46].
R
e
s
u
l
t
s
P
h
a
s
e 1: Prototy
p
e Deve
l
o
p
me
n
t
In
t
o
t
a
l
, 148 pro
s
pec
ti
ve d
i
rec
t
ory en
t
r
i
e
s
were
i
den
ti
f
i
ed fro
m
keyword Web
s
earche
s
, re
s
pon
s
e
s
t
o on
li
ne co
mm
un
it
y foru
m
po
s
t
s
, and
s
nowba
ll
s
a
m
p
li
ng. Of
t
he
s
e, 118 pro
s
pec
ti
ve en
t
r
i
e
s
re
s
ponded
t
o ou
t
reach by e
m
a
il
or phone (80% re
s
pon
s
e ra
t
e).
R
eferra
l
i
nfor
m
a
ti
on for 101 OT
s
wa
s
conf
i
r
m
ed and
i
ncorpora
t
ed
i
n
t
o
t
he
m
ob
il
e d
i
rec
t
ory.
R
ea
s
on
s
for wh
i
ch
pro
s
pec
ti
ve en
t
r
i
e
s
re
s
ponded bu
t
were no
t
i
nc
l
uded
i
n
t
he
d
i
rec
t
ory were a
s
fo
ll
ow
s
:
s
even organ
i
za
ti
on
s
t
ha
t
e
m
p
l
oy OT
s
who do no
t
prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
, f
i
ve organ
i
za
ti
on
s
t
ha
t
do no
t
e
m
p
l
oy OT
s
(eg,
t
hey were
s
o
l
e
l
y ho
m
e bu
il
der
s
), 4 OT
s
who had re
ti
red fro
m
prov
i
d
i
ng ho
m
e
m
od
i
f
i
ca
ti
on
s
, and 1 OT
who had no
t
ye
t
s
t
ar
t
ed prov
i
d
i
ng ho
m
e
m
od
i
f
i
ca
ti
on
s
bu
t
wa
s
p
l
ann
i
ng
t
o do
s
o
i
n
t
he near fu
t
ure.
The app u
s
e
s
geo
l
oca
ti
on
s
erv
i
ce
s
on a
m
ob
il
e dev
i
ce
t
o cura
t
e
referra
l
i
nfor
m
a
ti
on ba
s
ed on geograph
i
c d
i
s
t
ance fro
m
t
he app
u
s
er and o
t
her re
l
evan
t
dec
i
s
i
on-
m
ak
i
ng fac
t
or
s
s
e
l
ec
t
ed,
s
uch
a
s
i
n
s
urance or pay
m
en
t
m
e
t
hod
s
accep
t
ed, pa
ti
en
t
popu
l
a
ti
on
s
s
erved, and
t
he
s
cope of ho
m
e
m
od
i
f
i
ca
ti
on
s
erv
i
ce
s
prov
i
ded.
Fi
gure 1
s
how
s
an exa
m
p
l
e of how an OT’
s
prov
i
der
i
nfor
m
a
ti
on
i
s
d
i
s
p
l
ayed a
s
an en
t
ry
i
n
t
he d
i
rec
t
ory, wh
i
ch
i
nc
l
ude
s
t
he
i
r
bu
s
i
ne
ss
na
m
e, bu
s
i
ne
ss
addre
ss
, bu
s
i
ne
ss
t
e
l
ephone nu
m
ber,
bu
s
i
ne
ss
e
m
a
il
, bu
s
i
ne
ss
web
s
it
e,
s
pec
i
f
i
c pa
ti
en
t
popu
l
a
ti
on
s
s
erved (eg, ch
il
dren, adu
lt
s
, or o
l
der adu
lt
s
),
i
n
s
urance
s
accep
t
ed,
ho
m
e
m
od
i
f
i
ca
ti
on
s
erv
i
ce
s
prov
i
ded (eg, con
s
u
lt
a
ti
on, ho
m
e
eva
l
ua
ti
on, coord
i
na
ti
on of con
t
rac
t
or
s
, and fo
ll
ow-up on
con
t
rac
t
or
s
’ work),
l
anguage
s
i
n wh
i
ch
s
erv
i
ce
s
are prov
i
ded,
and d
i
s
t
ance fro
m
t
he
l
oca
ti
on of
t
he
m
ob
il
e dev
i
ce
t
o
t
he
prov
i
der’
s
addre
ss
.
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
F
i
g
u
re 1. Ho
m
e
M
od
i
f
i
ca
ti
on
s
for Ag
i
ng and D
i
s
ab
ilit
y D
i
rec
t
ory of
R
eferra
l
s
u
s
er
i
n
t
erface d
i
s
p
l
ay
i
ng a
s
i
ng
l
e d
i
rec
t
ory en
t
ry.
P
h
a
s
e 2: U
s
a
bili
ty
T
e
s
t
in
g
De
m
og
r
ap
hi
c
s
De
m
ograph
i
c
s
of OT
s
and o
l
der adu
lt
s
who par
ti
c
i
pa
t
ed
i
n
u
s
ab
ilit
y
t
e
s
ti
ng are
s
hown
i
n Tab
l
e 1. OT
s
repor
t
ed curren
tl
y
work
i
ng
i
n a w
i
de range of c
li
n
i
ca
l
prac
ti
ce
s
e
tti
ng
s
,
i
nc
l
ud
i
ng
acu
t
e care (n
=
1),
i
npa
ti
en
t
rehab
ilit
a
ti
on (n
=
2),
ou
t
pa
ti
en
t/
co
mm
un
it
y prac
ti
ce c
li
n
i
c (n
=
2), and pr
i
va
t
e prac
ti
ce
s
pec
i
f
i
ca
ll
y prov
i
d
i
ng ho
m
e
m
od
i
f
i
ca
ti
on
s
(n
=
1). Therap
i
s
t
s
’
m
ean c
li
n
i
ca
l
exper
i
ence wa
s
4.3 (
S
D 1.6) year
s
.
P
ar
ti
c
i
pan
t
s
’
pr
i
or ex
t
en
t
of
m
ob
il
e app u
s
age
i
s
s
hown
i
n Tab
l
e 2.
T
a
bl
e 1. De
m
ograph
i
c
s
of par
ti
c
i
pan
t
s
who par
ti
c
i
pa
t
ed
i
n u
s
ab
ilit
y
t
e
s
ti
ng.
O
l
der adu
lt
s
(n
=
6)Occupa
ti
ona
l
t
herap
i
s
t
s
(n
=
6)
C
harac
t
er
i
s
ti
c
Age (year
s
)
72.8 (5.0)35.7 (9.8)
M
ean (
S
D)
67-8128-54
R
ange
G
e
nd
er,
n
(%)
6 (100)6 (100)
F
e
m
a
l
e
Race,
n
(%)
1 (17)6 (100)Wh
it
e
5 (83)0 (0)Afr
i
can A
m
er
i
can
E
du
cat
i
o
n
,
n
(%)
1 (17)0 (0)H
i
gh
s
choo
l/
genera
l
educa
ti
ona
l
deve
l
op
m
en
t
2 (33)0 (0)
S
o
m
e co
ll
ege
3 (50)6 (100)
C
o
ll
ege degree
Mar
i
ta
l
s
tat
u
s
,
n
(%)
1 (17)
N
/
A
a
M
arr
i
ed
3 (50)N
/
A
Si
ng
l
e
2 (33)N
/
AW
i
dowed
a
N
/
A
:
no
t
app
li
cab
l
e.
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
T
a
bl
e 2.
P
ar
ti
c
i
pan
t
s
’ ex
t
en
t
of pr
i
or
m
ob
il
e app u
s
age.
O
l
der adu
lt
s
(n
=
6)Occupa
ti
ona
l
t
herap
i
s
t
s
(n
=
6)
M
ed
i
a and Techno
l
ogy U
s
age and A
ttit
ude
s
S
ca
l
e que
s
ti
on
a
H
ow ofte
n
d
o yo
u
s
earc
h
for
in
format
i
o
n
o
n
a mo
bil
e
ph
o
n
e
/
ta
bl
et,
n
30Never
20
S
evera
l
ti
m
e
s
a week
04
S
evera
l
ti
m
e
s
a day
01Once an hour
11A
ll
t
he
ti
m
e
H
ow ofte
n
d
o yo
u
get
di
rect
i
o
n
s
or
u
s
e
G
P
S
o
n
a mo
bil
e
ph
o
n
e
/
ta
bl
et,
n
20Never
30Once a
m
on
t
h
10
S
evera
l
ti
m
e
s
a
m
on
t
h
01Once a week
03
S
evera
l
ti
m
e
s
a week
02A
ll
t
he
ti
m
e
H
ow ofte
n
d
o yo
u
u
s
e a
pp
s
for a
n
y
pu
r
p
o
s
e o
n
a mo
bil
e
ph
o
n
e
/
ta
bl
et,
n
20Never
10Once a week
10
S
evera
l
ti
m
e
s
a week
10Once a day
03
S
evera
l
ti
m
e
s
a day
01
S
evera
l
ti
m
e
s
an hour
12A
ll
t
he
ti
m
e
I
n
t
h
e
l
a
s
t mo
n
t
h
,
h
ow m
u
c
h
t
i
me
did
yo
u
s
p
e
nd
u
s
in
g a
pp
s
for a
n
y
pu
r
p
o
s
e o
n
a mo
bil
e
ph
o
n
e
/
ta
bl
et,
n
31
<
1 hour
102-4 hour
s
204-6 hour
s
05
>
10 hour
s
a
A
ll
re
s
pon
s
e ca
t
egor
i
e
s
for each que
s
ti
on are no
t
li
s
t
ed
;
on
l
y
t
ho
s
e
t
ha
t
rece
i
ved a
t
l
ea
s
t
one par
ti
c
i
pan
t
re
s
pon
s
e are
li
s
t
ed.
Q
u
a
ntit
a
ti
ve O
ut
co
m
e
s
Quan
tit
a
ti
ve u
s
ab
ilit
y
m
e
t
r
i
c
s
are
s
hown
i
n Tab
l
e 3.
P
ercen
t
t
a
s
k co
m
p
l
e
ti
on ranged fro
m
0%
t
o 100% for o
l
der adu
lt
s
.
S
pec
i
f
i
ca
ll
y, 2 o
l
der adu
lt
s
were unab
l
e
t
o
s
ucce
ss
fu
ll
y co
m
p
l
e
t
e
any
t
a
s
k
s
cenar
i
o
s
—one con
s
i
s
t
en
tl
y
t
ook
l
onger
t
han
t
he
a
ll
owed 5
m
i
n per
t
a
s
k, wherea
s
t
he o
t
her a
tt
e
m
p
t
ed bu
t
gave
up ear
l
y on
t
a
s
k
s
c
iti
ng
t
ha
t
it
wa
s
t
oo d
i
ff
i
cu
lt
.
C
o
m
pared w
it
h
o
t
her o
l
der adu
lt
par
ti
c
i
pan
t
s
,
t
he
s
e 2 o
l
der adu
lt
s
were ob
s
erved
t
o be o
l
der and had
l
e
ss
pr
i
or exper
i
ence u
s
i
ng
m
ob
il
e app
s
.
The
i
r da
t
a were exc
l
uded fro
m
t
he ca
l
cu
l
a
ti
on of o
l
der adu
lt
’
s
average
t
a
s
k eff
i
c
i
ency bu
t
i
nc
l
uded
i
n a
ll
o
t
her u
s
ab
ilit
y
m
ea
s
ure
s
.
T
a
bl
e 3. Quan
tit
a
ti
ve u
s
ab
ilit
y
m
e
t
r
i
c
s
.
O
l
der adu
lt
s
(n
=
6),
m
ean (
S
D)Occupa
ti
ona
l
t
herap
i
s
t
s
(n
=
6),
m
ean (
S
D)
M
ea
s
ure
71.7 (27.1)91.7 (8.0)
S
y
s
t
e
m
U
s
ab
ilit
y
S
ca
l
e
s
core
60 (49)93 (16)
P
ercen
t
t
a
s
k co
m
p
l
e
ti
on
97.5 (57.4)40.7 (32.2)
Average
t
a
s
k eff
i
c
i
ency
a
(
s
econd
s
per
t
a
s
k)
1.9 (1.9)0.7 (0.5)Average error ra
t
e (error
s
per
t
a
s
k)
4.6 (2.2)6.6 (0.4)Average
t
a
s
k perce
i
ved d
i
ff
i
cu
lt
y (1
=
very d
i
ff
i
cu
lt
and 7
=
very ea
s
y)
a
Exc
l
ude
s
i
n
s
t
ance
s
of
t
a
s
k
s
cenar
i
o
s
t
ha
t
were no
t
co
m
p
l
e
t
ed
s
ucce
ss
fu
ll
y.
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
Q
u
a
lit
a
ti
ve O
ut
co
m
e
s
Qua
lit
a
ti
ve
t
he
m
e
s
der
i
ved fro
m
s
creen record
i
ng
s
and
i
n
t
erv
i
ew
t
ran
s
cr
i
p
t
s
are
s
u
mm
ar
i
zed
i
n Tab
l
e 4.
E
rr
o
r
Type
s
Error
s
exper
i
enced by bo
t
h OT
s
and o
l
der adu
lt
s
i
nc
l
uded
m
i
ss
c
li
ck
s
on var
i
ou
s
app fea
t
ure
s
and
t
he add
iti
on of
s
earch f
ilt
er
s
t
ha
t
over
l
y
li
m
it
ed
s
earch re
s
u
lt
s
(eg,
s
e
l
ec
ti
ng
t
o f
ilt
er by bo
t
h
t
he
s
t
a
t
e and
t
he geograph
i
ca
l
d
i
s
t
ance fro
m
t
he u
s
er when a
s
ked
t
o
s
earch for a
ll
re
s
ource
s
i
n one’
s
s
t
a
t
e). O
l
der adu
lt
s
add
iti
ona
ll
y exper
i
enced
m
ore frequen
t
and d
i
ver
s
e
t
ype
s
of
error
s
,
i
nc
l
ud
i
ng d
i
ff
i
cu
lt
y under
s
t
and
i
ng how
t
o
i
n
iti
a
t
e
t
he
s
earch func
ti
on, d
i
ff
i
cu
lt
y accura
t
e
l
y
i
n
t
erpre
ti
ng
t
he
m
ean
i
ng
of
s
earch re
s
u
lt
s
(eg, no
t
know
i
ng wh
i
ch
s
earch re
s
u
lt
wa
s
geograph
i
ca
ll
y c
l
o
s
e
s
t
t
o
t
he
m
de
s
p
it
e d
i
s
t
ance
s
be
i
ng
l
abe
l
ed),
d
i
ff
i
cu
lt
y
s
cro
lli
ng on a
t
ouch
s
creen dev
i
ce, and d
i
ff
i
cu
lt
y
re
m
a
i
n
i
ng or
i
en
t
ed wh
il
e
s
cro
lli
ng or nav
i
ga
ti
ng be
t
ween v
i
ew
s
w
it
h
i
n
t
he app.
T
a
bl
e 4. Qua
lit
a
ti
ve
t
he
m
e
s
of error
s
, barr
i
er
s
, and fac
ilit
a
t
or
s
of accep
t
ab
ilit
y and u
s
ab
ilit
y.
O
l
der adu
lt
s
Occupa
ti
ona
l
t
herap
i
s
t
s
C
a
t
egory
Error
t
ype
s
••
M
i
ss
c
li
ck
s
w
it
h
i
n app
M
i
ss
c
li
ck
s
w
it
h
i
n app
• •
Ex
t
ra
s
earch f
ilt
er
s
added
t
o
s
earch query Ex
t
ra
s
earch f
ilt
er
s
added
t
o
s
earch query
•
D
i
ff
i
cu
lt
y
i
n
iti
a
ti
ng
s
earch func
ti
on
•
D
i
ff
i
cu
lt
y
i
n
t
erpre
ti
ng
s
earch re
s
u
lt
s
•
D
i
ff
i
cu
lt
y
s
cro
lli
ng u
s
i
ng
t
ouch
s
creen
•
D
i
ff
i
cu
lt
y nav
i
ga
ti
ng be
t
ween v
i
ew
s
w
it
h
i
n
t
he app
B
arr
i
er
s
t
o accep
t
ab
ilit
y
and u
s
ab
ilit
y
••
H
i
gh cogn
iti
ve
l
oad of u
s
er
i
n
t
erfaceNeed for
m
ore
i
nfor
m
a
ti
on on
s
cope of referra
l
s
erv
i
ce
s
•
Need
t
o reduce
j
argon
•
Lack of opera
ti
ona
l
s
k
ill
s
•
Need
t
o acco
mm
oda
t
e age-re
l
a
t
ed
s
en
s
ory change
s
F
ac
ilit
a
t
or
s
of accep
t
-
ab
ilit
y and u
s
ab
ilit
y
••
P
erce
i
ved u
s
efu
l
ne
ss
P
erce
i
ved u
s
efu
l
ne
ss
• •
S
oc
i
a
l
s
uppor
t
(
i
e,
t
echn
i
ca
l
s
uppor
t
gu
i
dance)
S
oc
i
a
l
s
uppor
t
(
i
e, a
ss
i
s
t
ance fro
m
fa
m
il
y, careg
i
ver
s
,
and hea
lt
h care prov
i
der
s
)
•
T
i
m
e
t
o prac
ti
ce
t
o ga
i
n fa
m
ili
ar
it
y
•
T
i
m
e
t
o prac
ti
ce
t
o ga
i
n fa
m
ili
ar
it
y
•
M
u
lti
p
l
e op
ti
on
s
t
o acce
ss
i
nfor
m
a
ti
on
•
M
u
lti
p
l
e op
ti
on
s
t
o acce
ss
i
nfor
m
a
ti
on
B
a
rr
i
e
rs
t
o
A
ccep
t
ab
ilit
y a
n
d U
s
ab
ilit
y
B
arr
i
er
s
t
o accep
t
ab
ilit
y and u
s
ab
ilit
y conveyed by OT
s
i
nc
l
uded
t
he need for
m
ore
i
nfor
m
a
ti
on regard
i
ng
t
he
s
cope of ho
m
e
m
od
i
f
i
ca
ti
on
s
erv
i
ce
s
prov
i
ded by referra
l
s
li
s
t
ed
i
n
t
he
d
i
rec
t
ory
:
I gue
ss
I can go
i
n and c
li
ck on
li
ne bu
t
if
it
had
j
u
s
t
a
littl
e
li
s
t
o
f
s
ome o
f
t
he
t
h
i
ng
s
t
ha
t
t
hey do
f
r
om
t
he
i
r
i
n
f
o
r
ma
ti
on page
s
o I can qu
i
ck
l
y dec
i
de
if
it
fit
s
.
[Occupa
ti
ona
l
t
herap
i
s
t
2]
B
arr
i
er
s
exper
i
enced by o
l
der adu
lt
s
i
nc
l
uded h
i
gh cogn
iti
ve
l
oad pre
s
en
t
ed by
t
he pro
t
o
t
ype’
s
u
s
er
i
n
t
erface.
F
or exa
m
p
l
e,
o
l
der adu
lt
s
co
mm
en
t
ed
t
ha
t
t
he pre
s
ence of a
m
ap
acco
m
pany
i
ng
s
earch re
s
u
lt
s
added unnece
ss
ary co
m
p
l
ex
it
y
:
I don’
t
m
i
nd
t
he map be
i
ng
t
he
r
e bu
t
I don’
t
s
ee
t
he
r
ea
s
on
f
o
r
t
he map be
i
ng
t
he
r
e...I
t
h
i
nk
t
he map
i
s
fi
ne, I
j
u
s
t
,
it
’
s
k
i
nd o
f
d
i
s
t
r
ac
ti
ng becau
s
e I’m
l
ook
i
ng
f
o
r
s
ome
t
h
i
ng on
t
he map
w
hen I cou
l
d have
j
u
s
t
gone
ove
r
he
r
e
[
t
o
t
he o
t
he
r
s
i
de o
f
t
he
s
c
r
een
]
. [O
l
der
adu
lt
1]
To reduce cogn
iti
ve
l
oad, o
l
der adu
lt
s
a
l
s
o po
i
n
t
ed
t
o
t
he need
t
o reduce
j
argon and u
s
e
t
er
m
i
no
l
ogy
t
ha
t
re
s
ona
t
e
s
w
it
h
con
s
u
m
er need
s
and
s
erv
i
ce
s
t
hey wou
l
d
s
eek
:
De
fi
n
it
e
l
y
t
he
s
e
r
v
i
ce
s
, you kno
w
, you have
t
o ph
r
a
s
e
t
hem
i
n
s
uch a
w
ay
t
ha
t
it
’
s
s
ome
t
h
i
ng
li
ke –
“
Oh
yeah, I
t
h
i
nk
t
ha
t
’
s
s
ome
t
h
i
ng I need.
”
[O
l
der adu
lt
5]
The
m
a
j
or
it
y of o
l
der adu
lt
s
po
i
n
t
ed
t
o
t
he
i
r
l
ack of exper
i
ence
u
s
i
ng
m
ob
il
e dev
i
ce
s
and app
s
a
s
a barr
i
er. They e
m
pha
s
i
zed
t
he
i
r
li
m
it
ed
s
k
ill
s
t
o opera
t
e
m
ob
il
e app
s
i
n genera
l
, d
i
ff
i
cu
lt
y
def
i
n
i
ng an eff
i
c
i
en
t
s
earch
s
t
ra
t
egy
t
o
s
earch
t
he d
i
rec
t
ory, and
need
i
ng
m
ore
i
n
s
t
ruc
ti
on on how
t
o u
s
e
t
he app
i
n
iti
a
ll
y
:
I
f
I had
[
a mob
il
e dev
i
ce
]
t
ha
t
I cou
l
d
j
u
s
t
ge
t
a
ll
t
o
my
s
e
lf
and maybe have
s
ome k
i
nd o
f
book
l
e
t
t
ha
t
I
cou
l
d
r
ead
t
o
l
ea
r
n, you kno
w
. Some
i
n
s
t
r
uc
ti
on, you
kno
w
. [O
l
der adu
lt
4]
O
l
der adu
lt
s
a
l
s
o
s
ugge
s
t
ed
t
he need for de
s
i
gn change
s
t
o
i
ncrea
s
i
ng
l
y acco
mm
oda
t
e age-re
l
a
t
ed
s
en
s
ory change
s
, for
exa
m
p
l
e,
i
ncrea
s
i
ng fon
t
s
i
ze
t
o acco
mm
oda
t
e decrea
s
ed near
v
i
s
ua
l
acu
it
y
:
T
he
w
r
iti
ng
w
a
s
t
oo
littl
e. I u
s
ua
ll
y have
t
o
i
nc
r
ea
s
e
t
he
s
i
z
e o
f
t
he
s
c
r
een.
T
h
i
s
i
s
t
oo
littl
e
f
o
r
me. [O
l
der
adu
lt
3]
F
ac
ilit
a
t
o
rs
of
A
ccep
t
ab
ilit
y a
n
d U
s
ab
ilit
y
M
o
s
t
OT
s
and o
l
der adu
lt
s
perce
i
ved
t
he
m
ob
il
e app
t
o be u
s
efu
l
a
s
a fac
ilit
a
t
or of accep
t
ab
ilit
y and u
s
ab
ilit
y
:
Y
eah,
li
ke
r
i
gh
t
no
w
, I
f
ee
l
li
ke
s
ome o
f
t
ho
s
e
r
e
f
e
rr
a
l
s
,
w
e neve
r
w
e
r
e mak
i
ng
t
hem.
Li
ke
w
e can
t
e
ll
pa
ti
en
t
s
t
o
f
o
ll
o
w
up on
t
hem o
r
w
e’
ll
t
e
ll
ca
s
e
managemen
t
and
t
hey’
ll
t
r
y
t
o ge
t
s
ome o
f
t
ha
t
s
e
t
up
f
o
r
t
he d
i
s
cha
r
ge p
r
oce
ss
, bu
t
I
t
h
i
nk becau
s
e o
f
t
he
l
ack o
f
kno
w
l
edge o
f
w
he
r
e
t
o
s
end
t
hem,
s
ome
ti
me
s
t
ho
s
e peop
l
e m
i
gh
t
un
i
n
t
en
ti
ona
ll
y
f
a
ll
t
h
r
ough
t
he
c
r
ack
s
,
s
o
t
h
i
s
w
ou
l
d be a
r
ea
ll
y n
i
ce
t
oo
l
f
o
r
t
hem
t
o
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
ea
s
il
y acce
ss
w
he
r
e
t
hey cou
l
d
s
end
t
hem o
r
i
nc
r
ea
s
e
t
he
i
r
acce
ss
i
b
ilit
y
t
o
t
ha
t
i
n
f
o
r
ma
ti
on
t
o po
t
en
ti
a
ll
y
he
l
p
f
o
r
d
i
s
cha
r
ge. [Occupa
ti
ona
l
t
herap
i
s
t
5]
T
he
i
n
f
o
r
ma
ti
on
t
ha
t
I
w
a
s
l
ook
i
ng
f
o
r
w
a
s
c
l
ea
r
i
n
o
r
de
r
t
o ge
t
t
o
w
he
r
e I
w
an
t
ed
t
o be, you kno
w
. So, I
f
ound
t
he occupa
ti
ona
l
t
he
r
ap
i
s
t
and
t
ha
t
’
s
w
ha
t
I
needed, and I
f
ound
it
, you kno
w
. And
t
he con
t
ac
t
w
a
s
r
i
gh
t
t
he
r
e, a
ll
I had
t
o do
w
a
s
ca
ll
. [O
l
der adu
lt
2]
B
o
t
h OT
s
and o
l
der adu
lt
s
c
it
ed
s
oc
i
a
l
s
uppor
t
and
ti
m
e
t
o
prac
ti
ce
t
o ga
i
n fa
m
ili
ar
it
y w
it
h
t
he app a
s
effec
ti
ve
m
ean
s
t
o
enhance accep
t
ab
ilit
y and u
s
ab
ilit
y.
F
or exa
m
p
l
e, OT
s
s
t
a
t
ed
t
ha
t
s
oc
i
a
l
s
uppor
t
i
n
t
he for
m
of add
iti
ona
l
t
echn
i
ca
l
s
uppor
t
wou
l
d be u
s
efu
l:
I
t
h
i
nk
t
he
“
He
l
p
”
s
ec
ti
on
s
hou
l
d be
li
ke
“
I’m
s
t
uck
w
ha
t
do I do?
”
T
ech
s
t
u
ff
li
ke
“
I’m
s
t
uck, I can’
t
fi
nd
w
ha
t
I’m
l
ook
i
ng
f
o
r
,
”
o
r
maybe add
i
ng
i
n
t
he
r
e
li
ke
w
ha
t
if
my
i
n
t
e
r
ne
t
connec
ti
on
i
s
n’
t
w
o
r
k
i
ng. I mean
you a
ss
ume
t
ha
t
t
hey
w
ou
l
d have
s
ome
i
dea o
f
ho
w
t
o u
s
e
t
he
t
ab
l
e
t
, bu
t
t
ho
s
e a
r
e
t
he
t
h
i
ng
s
I
w
ou
l
d
i
nc
l
ude
f
o
r
t
he u
s
e
r
maybe
t
h
i
ng
s
l
e
ss
abou
t
O
T
and
mo
r
e abou
t
ho
w
t
o u
s
e
t
he app o
r
t
r
oub
l
e
s
hoo
ti
ng
li
ke
t
o
t
u
r
n on you
r
“l
oca
ti
on
s
e
r
v
i
ce
s
”
on you
r
t
ab
l
e
t
o
r
phone
s
o
t
ha
t
w
ay you have a
w
ay
t
o
fi
x
t
he
p
r
ob
l
em
if
t
he
r
e’
s
s
ome
t
echn
i
ca
l
p
r
ob
l
em.
[Occupa
ti
ona
l
t
herap
i
s
t
2]
In con
t
ra
s
t
, o
l
der adu
lt
s
s
t
a
t
ed
t
ha
t
s
oc
i
a
l
s
uppor
t
fro
m
ano
t
her
per
s
on (eg, fa
m
il
y
m
e
m
ber, careg
i
ver, or hea
lt
h care
profe
ss
i
ona
l
) wou
l
d be benef
i
c
i
a
l:
I
w
ou
l
d have
t
o have a
t
eache
r
, you kno
w
...
t
hen each
day, I cou
l
d p
r
ac
ti
ce
w
ha
t
I
l
ea
r
ned
f
r
om my
i
n
s
t
r
uc
ti
on. [O
l
der adu
lt
4]
Fi
na
ll
y, bo
t
h OT
s
and o
l
der adu
lt
s
s
ugge
s
t
ed
t
ha
t
m
u
lti
p
l
e
op
ti
on
s
t
o acce
ss
i
nfor
m
a
ti
on (eg, on a
m
ob
il
e dev
i
ce or a
co
m
pu
t
er) wou
l
d fac
ilit
a
t
e accep
t
ab
ilit
y and u
s
ab
ilit
y. OT
s
s
pec
i
f
i
ca
ll
y
s
t
a
t
ed
t
ha
t
hav
i
ng op
ti
on
s
t
o acce
ss
i
nfor
m
a
ti
on on
e
it
her a
m
ob
il
e dev
i
ce or a co
m
pu
t
er wou
l
d
i
ncrea
s
e u
s
e by
offer
i
ng f
l
ex
i
b
ilit
y
t
o acco
mm
oda
t
e d
i
ver
s
e c
li
n
i
ca
l
env
i
ron
m
en
t
s
and workf
l
ow
s
:
We do have
i
Pad
s
a
t
ou
r
d
i
s
po
s
a
l
bu
t
I don’
t
kno
w
if
it
’
s
s
ome
t
h
i
ng
t
ha
t
can a
l
s
o be done – I mo
r
e o
ft
en
have my
l
ap
t
op
t
han my
i
Pad
s
o I don’
t
kno
w
if
it
’
s
s
ome
t
h
i
ng
t
ha
t
cou
l
d be acce
ss
i
b
l
e
t
h
r
ough bo
t
h.
[Occupa
ti
ona
l
t
herap
i
s
t
5]
In con
t
ra
s
t
, o
l
der adu
lt
s
s
t
a
t
ed
t
ha
t
acce
ss
i
ng
t
he d
i
rec
t
ory on
a web
s
it
e w
it
h a co
m
pu
t
er
m
ou
s
e and keyboard wou
l
d he
l
p
fac
ilit
a
t
e u
s
age becau
s
e of
t
he grea
t
er ea
s
e of nav
i
ga
ti
on u
s
i
ng
a
m
ou
s
e co
m
pared w
it
h
t
he
t
ouch
s
creen
:
Y
ou need a mou
s
e
r
ea
l
bad...
t
he
t
ouch
s
c
r
een
t
h
i
ng I
j
u
s
t
don’
t
li
ke
it
. [O
l
der adu
lt
3]
Disc
u
ssi
on
Pr
in
c
ip
a
l
F
indin
g
s
The pr
i
nc
i
pa
l
f
i
nd
i
ng
s
of
t
h
i
s
s
t
udy are
t
he deve
l
op
m
en
t
of a
cen
t
ra
li
zed da
t
aba
s
e of OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
t
ha
t
i
s
acce
ss
i
b
l
e a
s
a
m
ob
il
e app, Ho
m
e
M
add
i
r
s
, and
pre
li
m
i
nary ev
i
dence
t
o
s
ugge
s
t
t
ha
t
t
he
m
ob
il
e app
i
s
accep
t
ab
l
e
and u
s
ab
l
e
t
o OT
s
. OT
s
who par
ti
c
i
pa
t
ed
i
n
t
he
s
t
udy worked
i
n a w
i
de range of c
li
n
i
ca
l
prac
ti
ce
s
e
tti
ng
s
and genera
ll
y
perce
i
ved
t
he app
t
o be ea
s
y
t
o u
s
e and u
s
efu
l
for
i
ncrea
s
i
ng
acce
ss
t
o referra
l
i
nfor
m
a
ti
on.
M
ob
il
e hea
lt
h (
m
Hea
lt
h) app
s
are
i
ncrea
s
i
ng
l
y be
i
ng u
s
ed by hea
lt
h care prov
i
der
s
t
o
i
m
prove
c
li
n
i
ca
l
workf
l
ow eff
i
c
i
ency and a
s
nove
l
i
n
t
erven
ti
on
s
t
o
i
m
prove d
i
ver
s
e hea
lt
h ou
t
co
m
e
s
for pa
ti
en
t
s
[47-49].
P
rev
i
ou
s
s
t
ud
i
e
s
have exp
l
ored
t
he accep
t
ab
ilit
y and u
s
ab
ilit
y of
m
Hea
lt
h
app
s
for OT
s
t
o fac
ilit
a
t
e c
li
n
i
ca
l
dec
i
s
i
on
m
ak
i
ng for a
ss
i
s
ti
ve
equ
i
p
m
en
t
prov
i
s
i
on,
m
ove
m
en
t
ac
ti
v
iti
e
s
for ch
il
dren w
it
h
d
i
s
ab
iliti
e
s
, and whee
l
cha
i
r
t
ra
i
n
i
ng [50-52]. To
t
he au
t
hor
s
’
know
l
edge,
t
h
i
s
i
s
t
he f
i
r
s
t
s
t
udy
t
o deve
l
op and pre
li
m
i
nar
il
y
eva
l
ua
t
e an
m
Hea
lt
h
s
o
l
u
ti
on for
i
ncrea
s
i
ng acce
ss
t
o
occupa
ti
ona
l
t
herapy
s
erv
i
ce
s
re
l
a
t
ed
t
o ho
m
e
m
od
i
f
i
ca
ti
on
s
.
U
s
ab
ilit
y
t
e
s
ti
ng fur
t
her
s
ugge
s
t
ed
t
ha
t
t
he
m
ob
il
e app
m
ay be
accep
t
ab
l
e and u
s
ab
l
e
t
o
s
o
m
e o
l
der adu
lt
s
bu
t
t
ha
t
con
s
i
derab
l
e
var
i
a
ti
on ex
i
s
t
s
a
m
ong o
l
der adu
lt
s
’ percep
ti
on
s
. A
lt
hough
s
o
m
e
o
l
der adu
lt
s
found
t
he
m
ob
il
e app ea
s
y
t
o u
s
e, o
t
her
s
perce
i
ved
it
t
o be d
i
ff
i
cu
lt
t
o u
s
e, wh
i
ch appeared
t
o be
i
nf
l
uenced by
t
he
o
l
der adu
lt
’
s
pr
i
or exper
i
ence and co
m
for
t
w
it
h u
s
i
ng
m
ob
il
e
app
s
.
P
rev
i
ou
s
s
t
ud
i
e
s
have
s
hown pro
m
i
s
i
ng re
s
u
lt
s
de
m
on
s
t
ra
ti
ng
t
he accep
t
ab
ilit
y of
m
Hea
lt
h
i
n
t
erven
ti
on
s
a
m
ong
co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
[48,53]. Accep
t
ab
ilit
y and
u
s
ab
ilit
y of
m
Hea
lt
h
i
n
t
erven
ti
on
s
, however, are a
tt
enua
t
ed by
o
l
der adu
lt
s
’ pr
i
or exper
i
ence u
s
i
ng
m
ob
il
e app
s
, wh
i
ch
i
nf
l
uence
s
t
he
i
r
s
e
l
f-eff
i
cacy
t
oward u
s
i
ng
m
ob
il
e app
s
[54,55].
Qua
lit
a
ti
ve
t
he
m
e
s
ar
i
s
i
ng fro
m
our
i
n
t
erv
i
ew
s
of o
l
der adu
lt
s
are con
s
i
s
t
en
t
w
it
h
t
he
lit
era
t
ure
t
ha
t
s
ugge
s
t
s
o
l
der adu
lt
s
,
par
ti
cu
l
ar
l
y
t
ho
s
e w
it
h
l
e
ss
exper
i
ence u
s
i
ng
m
ob
il
e app
s
, wou
l
d
benef
it
fro
m
s
oc
i
a
l
s
uppor
t
fro
m
careg
i
ver
s
and hea
lt
h care
profe
ss
i
ona
l
s
t
o pro
m
o
t
e adop
ti
on and engage
m
en
t
w
it
h
m
Hea
lt
h
i
n
t
erven
ti
on
s
[54,56,57]. Qua
lit
a
ti
ve
t
he
m
e
s
fro
m
t
h
i
s
s
t
udy
fur
t
her
s
ugge
s
t
t
ha
t
hav
i
ng
m
u
lti
p
l
e op
ti
on
s
t
o acce
ss
referra
l
i
nfor
m
a
ti
on,
s
uch a
s
on a de
s
k
t
op co
m
pu
t
er’
s
i
n
t
erne
t
brow
s
er,
i
n add
iti
on
t
o
t
he curren
t
m
ob
il
e app p
l
a
t
for
m
, wou
l
d
i
ncrea
s
e
t
he u
tili
za
ti
on of referra
l
i
nfor
m
a
ti
on by bo
t
h o
l
der adu
lt
s
and
c
li
n
i
c
i
an
s
ba
s
ed on
i
nd
i
v
i
dua
l
preference
s
for u
s
i
ng e
it
her
i
n
t
erface dur
i
ng da
il
y
li
v
i
ng or work rou
ti
ne
s
. The cho
i
ce
t
o
deve
l
op a progre
ss
i
ve Web app
t
ha
t
i
s
de
li
vered
t
hrough
t
he
Web (wh
i
ch Ho
m
e
M
add
i
r
s
i
s
)
m
ay
t
hu
s
be an a
tt
rac
ti
ve op
ti
on
for o
t
her
m
Hea
lt
h
i
n
t
erven
ti
on
s
t
o f
l
ex
i
b
l
y a
ll
ow for
d
i
ss
e
m
i
na
ti
on
s
i
m
u
lt
aneou
s
l
y on
m
ob
il
e dev
i
ce
s
and
i
n
t
erne
t
brow
s
er
s
acce
ss
ed on de
s
k
t
op co
m
pu
t
er
s
.
When perfor
m
i
ng repre
s
en
t
a
ti
ve
t
a
s
k
s
u
s
i
ng
t
he
m
ob
il
e app,
o
l
der adu
lt
s
, on average, perce
i
ved
t
a
s
k
s
t
o be
m
ore d
i
ff
i
cu
lt
,
m
ade
m
ore error
s
, encoun
t
ered
m
ore d
i
ver
s
e
t
ype
s
of error
s
,
and were
l
e
ss
accura
t
e and eff
i
c
i
en
t
co
m
pared w
it
h OT
s
. The
s
e
ob
s
erva
ti
on
s
po
i
n
t
t
o
t
he need for de
s
i
gn
i
m
prove
m
en
t
s
t
o be
tt
er
acco
mm
oda
t
e age-re
l
a
t
ed change
s
;
t
he
s
e
i
nc
l
ude cogn
iti
ve
change
s
,
s
uch a
s
decrea
s
ed
i
nfor
m
a
ti
on proce
ss
i
ng
s
peed and
work
i
ng
m
e
m
ory capac
it
y a
m
ong o
l
der adu
lt
s
, and
s
en
s
ory
change
s
,
s
uch a
s
decrea
s
ed near v
i
s
ua
l
acu
it
y and eff
i
c
i
ency of
v
i
s
ua
l
i
nfor
m
a
ti
on proce
ss
i
ng [58-61]. The
s
e re
s
u
lt
s
m
ay a
l
s
o
be par
ti
a
ll
y exp
l
a
i
ned by
t
he
l
ack of a requ
i
re
m
en
t
for
par
ti
c
i
pan
t
s
t
o
s
e
l
f-repor
t
co
m
for
t
or co
m
pe
t
ency w
it
h u
s
i
ng
m
ob
il
e app
s
a
s
par
t
of
t
he
i
nc
l
u
s
i
on cr
it
er
i
a for u
s
ab
ilit
y
t
e
s
ti
ng.
The au
t
hor
s
cho
s
e
t
o e
m
brace an eco
l
og
i
ca
l
per
s
pec
ti
ve by
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
i
nc
l
ud
i
ng o
l
der adu
lt
s
w
it
h
l
e
ss
exper
i
ence u
s
i
ng
m
ob
il
e app
s
t
o
i
ncrea
s
e
t
he
li
ke
li
hood of uncover
i
ng u
s
ab
ilit
y prob
l
e
ms
t
ha
t
wou
l
d be encoun
t
ered
i
n
t
he genera
l
popu
l
a
ti
on of o
l
der adu
lt
s
,
who, on average, have
l
e
ss
exper
i
ence u
s
i
ng
m
ob
il
e app
s
co
m
pared w
it
h younger age group
s
[62].
L
i
m
i
tat
i
o
n
s
The
li
m
it
a
ti
on
s
of
t
he
s
t
udy
i
nc
l
uded a
sm
a
ll
s
a
m
p
l
e
s
i
ze and
l
ack of ob
j
ec
ti
ve hea
lt
h
s
creen
i
ng
t
ha
t
re
s
u
lt
ed
i
n
t
he recru
it
m
en
t
of a nonrepre
s
en
t
a
ti
ve
s
a
m
p
l
e of OT
s
and co
mm
un
it
y-dwe
lli
ng
o
l
der adu
lt
s
.
F
e
m
a
l
e
s
and
i
nd
i
v
i
dua
l
s
w
it
h a
m
i
n
i
m
u
m
of a h
i
gh
s
choo
l
educa
ti
on were overrepre
s
en
t
ed
i
n
t
he
s
a
m
p
l
e.
F
ur
t
her
m
ore, o
l
der adu
lt
par
ti
c
i
pan
t
s
s
e
l
f-repor
t
ed no hea
lt
h
concern
s
t
ha
t
wou
l
d
i
m
pa
i
r
t
he
i
r ab
ilit
y
t
o u
s
e
m
ob
il
e app
s
, bu
t
t
h
i
s
s
e
l
f-repor
t
m
ay have been
i
naccura
t
e, and
t
he re
s
u
lt
s
w
ill
no
t
genera
li
ze
t
o o
l
der adu
lt
s
w
it
h
m
ore
s
i
gn
i
f
i
can
t
hea
lt
h or
func
ti
ona
l
i
m
pa
i
r
m
en
t
s
.
C
on
s
equen
tl
y, re
s
u
lt
s
can be u
s
ed
t
o
prov
i
de
i
n
s
i
gh
t
s
t
o
m
ake
it
era
ti
ve
i
m
prove
m
en
t
s
t
o
t
he app bu
t
s
hou
l
d be
i
n
t
erpre
t
ed w
it
h cau
ti
on, a
s
t
hey are no
t
li
ke
l
y
t
o be
re
li
ab
l
e and genera
li
zab
l
e
t
o
t
he en
ti
re popu
l
a
ti
on under
s
t
udy.
O
t
her
li
m
it
a
ti
on
s
i
nc
l
uded
t
he u
s
e of a
s
i
ng
l
e coder
t
o
qua
lit
a
ti
ve
l
y code
t
ran
s
cr
i
p
t
s
of aud
i
o record
i
ng
s
of u
s
ab
ilit
y
t
e
s
t
s
e
ss
i
on
s
. A
m
i
n
i
m
u
m
of
t
wo coder
s
i
s
s
ugge
s
t
ed
t
o
i
m
prove
verac
it
y and
t
ru
s
t
wor
t
h
i
ne
ss
of
t
he
m
e
s
y
i
e
l
ded fro
m
con
t
en
t
cod
i
ng ana
l
y
s
e
s
[41,43]. The dec
i
s
i
on
t
o u
s
e a
s
i
ng
l
e coder wa
s
cho
s
en becau
s
e a pr
i
m
ar
il
y ob
j
ec
ti
ve of
t
h
i
s
pre
li
m
i
nary
u
s
ab
ilit
y eva
l
ua
ti
on wa
s
t
o ob
t
a
i
n
i
n
s
i
gh
t
s
t
o
m
ake
i
m
prove
m
en
t
s
t
o
t
he app.
F
u
t
ure
s
t
ud
i
e
s
s
hou
l
d u
s
e
t
wo coder
s
t
o
i
m
prove
t
he
s
t
reng
t
h of conf
i
dence
i
n qua
lit
a
ti
ve f
i
nd
i
ng
s
.
A
ll
u
s
ab
ilit
y
t
e
s
ti
ng
s
e
ss
i
on
s
were conduc
t
ed
i
n a na
t
ura
li
s
ti
c
s
e
tti
ng,
i
n
s
t
ead of a
s
t
andard
i
zed
l
abora
t
ory env
i
ron
m
en
t
. Th
i
s
m
ay have reduced
i
n
t
erna
l
va
li
d
it
y
t
hrough
t
he
i
nf
l
uence of
d
i
fference
s
i
n uncon
t
ro
ll
ed env
i
ron
m
en
t
a
l
var
i
ab
l
e
s
w
it
h
i
n each
un
i
que
t
e
s
ti
ng env
i
ron
m
en
t
. We a
tt
e
m
p
t
ed
t
o
s
t
andard
i
ze par
t
s
of
t
he
t
e
s
ti
ng env
i
ron
m
en
t
by hav
i
ng par
ti
c
i
pan
t
s
t
e
s
t
t
he app
on
t
he
s
a
m
e
m
ob
il
e
t
ab
l
e
t
dev
i
ce runn
i
ng on
t
he
s
a
m
e w
i
re
l
e
ss
i
n
t
erne
t
ho
t
s
po
t
. The cho
i
ce
t
o conduc
t
u
s
ab
ilit
y
t
e
s
t
s
e
ss
i
on
s
i
n a na
t
ura
li
s
ti
c env
i
ron
m
en
t
wa
s
cho
s
en becau
s
e of
t
he na
t
ure
of
t
arge
t
u
s
er
s
group
s
be
i
ng bu
s
y work
i
ng c
li
n
i
c
i
an
s
or o
l
der
adu
lt
s
,
t
he
l
a
tt
er of who
m
m
ay
l
ack re
li
ab
l
e
t
ran
s
por
t
a
ti
on or
t
he phy
s
i
ca
l
capac
it
y for
t
rave
l
.
Co
n
c
lu
s
i
o
n
s
Ho
m
e
M
add
i
r
s
i
s
a pro
m
i
s
i
ng new
m
ob
il
e d
i
rec
t
ory
t
oo
l
t
o he
l
p
i
ncrea
s
e o
l
der adu
lt
s
’ acce
ss
t
o OT
s
who prov
i
de ho
m
e
m
od
i
f
i
ca
ti
on
s
. Th
i
s
s
t
udy prov
i
de
s
pre
li
m
i
nary ev
i
dence
t
ha
t
t
he
m
ob
il
e app
i
s
accep
t
ab
l
e and u
s
ab
l
e
t
o OT
s
. The re
s
u
lt
s
of
t
h
i
s
s
t
udy w
ill
be u
s
ed
t
o
m
ake
i
m
prove
m
en
t
s
t
o
t
he app,
i
nc
l
ud
i
ng de
s
i
gn change
s
t
o acco
mm
oda
t
e age-re
l
a
t
ed cogn
iti
ve
and
s
en
s
ory change
s
and
t
o
i
ncrea
s
i
ng
l
y
t
a
il
or v
i
ew
s
of
i
nfor
m
a
ti
on by aud
i
ence (
i
e, con
s
u
m
er v
s
hea
lt
h care
profe
ss
i
ona
l
). O
l
der adu
lt
s
’ percep
ti
on
s
of accep
t
ab
ilit
y and
u
s
ab
ilit
y of
t
he
m
ob
il
e app var
i
ed con
s
i
derab
l
y. To
i
m
prove
o
l
der adu
lt
s
’ acce
ss
t
o
t
he
m
ob
il
e d
i
rec
t
ory
i
nfor
m
a
ti
on,
careg
i
ver
s
, hea
lt
h care profe
ss
i
ona
l
s
, and
s
oc
i
a
l
s
erv
i
ce
coord
i
na
t
or
s
s
hou
l
d
s
eek
t
o prov
i
de
s
oc
i
a
l
s
uppor
t
, and
m
u
lti
p
l
e
way
s
t
o acce
ss
i
nfor
m
a
ti
on
s
hou
l
d be
m
ade ava
il
ab
l
e for o
l
der
adu
lt
s
who
l
ack exper
i
ence u
s
i
ng
m
ob
il
e app
s
.
A work
i
ng pro
t
o
t
ype of
t
he
m
ob
il
e app
i
s
free
l
y ava
il
ab
l
e on
li
ne
for pub
li
c u
s
e [63].
F
u
t
ure work w
ill
s
eek
t
o be
tt
er under
s
t
and
t
he accep
t
ab
ilit
y and u
s
ab
ilit
y of Ho
m
e
M
add
i
r
s
for key
s
t
akeho
l
der group
s
,
i
nc
l
ud
i
ng a broader,
m
ore repre
s
en
t
a
ti
ve
s
a
m
p
l
e of o
l
der adu
lt
s
, careg
i
ver
s
,
s
oc
i
a
l
s
erv
i
ce coord
i
na
t
or
s
,
and
i
n
t
erd
i
s
c
i
p
li
nary
m
e
m
ber
s
of o
l
der adu
lt
s
’ hea
lt
h care
t
ea
ms
.
F
u
t
ure
s
t
ud
i
e
s
are fur
t
her needed
t
o exp
l
ore
t
he c
li
n
i
ca
l
u
tilit
y
of
t
he
m
ob
il
e app,
i
nc
l
ud
i
ng co
m
par
i
s
on
s
be
t
ween
t
he u
s
e of
t
he
m
ob
il
e app w
it
h o
t
her
m
e
t
hod
s
of acce
ss
i
ng
t
h
i
s
i
nfor
m
a
ti
on,
op
ti
m
u
m
i
n
t
egra
ti
on of
it
s
u
s
age
i
n
t
o c
li
n
i
ca
l
workf
l
ow
s
, and
eva
l
ua
ti
on of
it
s
i
m
pac
t
on
ti
m
e
l
y acce
ss
t
o ho
m
e
m
od
i
f
i
ca
ti
on
s
for o
l
der adu
lt
s
.
Ac
kn
ow
l
e
d
gme
n
t
s
AN rece
i
ved f
i
nanc
i
a
l
s
uppor
t
for predoc
t
ora
l
t
ra
i
n
i
ng fro
m
a Na
ti
ona
l
S
c
i
ence
F
ounda
ti
on Innova
ti
on
C
orp
s
Sit
e
s
P
rogra
m
Award fro
m
t
he
M
i
ss
our
i
Un
i
ver
s
it
y of
S
c
i
ence and Techno
l
ogy and a
S
pencer T and Ann W O
li
n
F
e
ll
ow
s
h
i
p fro
m
t
he Wa
s
h
i
ng
t
on
Un
i
ver
s
it
y
i
n
St
Lou
i
s
. The au
t
hor
s
wou
l
d
li
ke
t
o
t
hank T
i
ffany D
ill
, Ke
ll
y
M
onroy, and
m
e
m
ber
s
of
t
he H
M
OTA for
t
he
i
r
a
ss
i
s
t
ance
i
n
i
den
ti
fy
i
ng OT
s
for
i
nc
l
u
s
i
on
i
n
t
he
m
ob
il
e d
i
rec
t
ory. The au
t
hor
s
wou
l
d a
l
s
o
li
ke
t
o
t
hank
t
he o
l
der adu
lt
s
and OT
s
who par
ti
c
i
pa
t
ed
i
n
t
he
s
t
udy for
t
he
i
r
ti
m
e
t
o prov
i
de va
l
uab
l
e feedback.
A
u
t
h
or
s
'
Co
n
tr
ibu
t
i
o
n
s
AN conduc
t
ed u
s
ab
ilit
y
t
e
s
t
s
, perfor
m
ed da
t
a and
s
t
a
ti
s
ti
ca
l
ana
l
y
s
e
s
, and draf
t
ed
t
he
m
anu
s
cr
i
p
t
. A
ll
au
t
hor
s
rev
i
ewed and
approved
t
he f
i
na
l
m
anu
s
cr
i
p
t
.
Co
n
f
li
ct
s
of
I
n
tere
s
t
AN deve
l
oped
t
he
i
n
iti
a
l
pro
t
o
t
ype of
t
he
m
ob
il
e app under
t
he
s
uperv
i
s
i
on of
t
he au
t
hor
s
E
S
,
S
T,
M
K, and
SS
.
Refere
n
ce
s
1. Henne
ss
y
S
, Kur
i
ch
i
J
E,
P
an Q,
St
re
i
m
J
E,
B
ogner H
R
, X
i
e D, e
t
a
l
. D
i
s
ab
ilit
y
s
t
age
i
s
an
i
ndependen
t
r
i
s
k fac
t
or for
m
or
t
a
lit
y
i
n
m
ed
i
care benef
i
c
i
ar
i
e
s
aged 65 year
s
and o
l
der.
P
hy
s
M
ed
R
ehab
il
2015 Dec
;
7(12)
:
1215-1225 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.p
m
r
j
.2015.05.014] [
M
ed
li
ne
:
26003869]
2. Ha
j
ek A,
B
re
tt
s
chne
i
der
C
, Lange
C
,
P
o
ss
e
lt
T, W
i
e
s
e
B
,
St
e
i
n
m
ann
S
, Age
C
oDe
St
udy Group. Long
it
ud
i
na
l
pred
i
c
t
or
s
of
i
n
s
tit
u
ti
ona
li
za
ti
on
i
n o
l
d age.
P
Lo
S
One 2015
;
10(12)
:
e0144203 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1371
/j
ourna
l
.pone.0144203]
[
M
ed
li
ne
:
26658776]
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
3.
F
eng Z, Lug
t
enberg
M
,
F
ran
s
e
C
,
F
ang X, Hu
S
,
J
i
n
C
, e
t
a
l
.
R
i
s
k fac
t
or
s
and pro
t
ec
ti
ve fac
t
or
s
a
ss
oc
i
a
t
ed w
it
h
i
nc
i
den
t
or
i
ncrea
s
e of fra
ilt
y a
m
ong co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
:
A
s
y
s
t
e
m
a
ti
c rev
i
ew of
l
ong
it
ud
i
na
l
s
t
ud
i
e
s
.
P
Lo
S
One
2017
;
12(6)
:
e0178383 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1371
/j
ourna
l
.pone.0178383] [
M
ed
li
ne
:
28617837]
4. Ver
m
eu
l
en
J
, Neyen
s
J
C
, van
R
o
ss
u
m
E,
S
preeuwenberg
M
D, de W
itt
e L
P
.
P
red
i
c
ti
ng ADL d
i
s
ab
ilit
y
i
n co
mm
un
it
y-dwe
lli
ng
e
l
der
l
y peop
l
e u
s
i
ng phy
s
i
ca
l
fra
ilt
y
i
nd
i
ca
t
or
s
:
a
s
y
s
t
e
m
a
ti
c rev
i
ew.
B
M
C
Ger
i
a
t
r 2011
J
u
l
1
;
11
:
33 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1186
/
1471-2318-11-33] [
M
ed
li
ne
:
21722355]
5. He W, Lar
s
en L
J
.
C
en
s
u
s
B
ureau. Wa
s
h
i
ng
t
on, D
C
:
U
S
Govern
m
en
t
P
r
i
n
ti
ng Off
i
ce
;
2014. O
l
der A
m
er
i
can
s
W
it
h a
D
i
s
ab
ilit
y
:
2008
−
2012 U
R
L
:
h
tt
p
s
://
www2.cen
s
u
s
.gov
/li
brary
/
pub
li
ca
ti
on
s
/
2014
/
ac
s
/
ac
s
-29.pdf [acce
ss
ed 2020-01-31]
6.
F
edera
l
In
t
eragency
F
oru
m
on Ag
i
ng-
R
e
l
a
t
ed
St
a
ti
s
ti
c
s
. Ag
i
ng
St
a
t
s
. Wa
s
h
i
ng
t
on, D
C
:
F
edera
l
In
t
eragency
F
oru
m
on
Ag
i
ng-
R
e
l
a
t
ed
St
a
ti
s
ti
c
s
;
2016. O
l
der A
m
er
i
can
s
2016
:
Key Ind
i
ca
t
or
s
of We
ll
-
B
e
i
ng U
R
L
:
h
tt
p
s
://
ag
i
ng
s
t
a
t
s
.gov
/
doc
s
/
La
t
e
s
t
R
epor
t/
O
l
der-A
m
er
i
can
s
-2016-Key-Ind
i
ca
t
or
s
-of-We
ll
B
e
i
ng.pdf [acce
ss
ed 2020-01-31]
7. U
S
Ad
m
i
n
i
s
t
ra
ti
on on Ag
i
ng. A
C
L Ad
m
i
n
i
s
t
ra
ti
on for
C
o
mm
un
it
y L
i
v
i
ng. Wa
s
h
i
ng
t
on, D
C
:
U
S
Govern
m
en
t
P
r
i
n
ti
ng
Off
i
ce
;
2018 Apr. 2017
P
rof
il
e of O
l
der A
m
er
i
can
s
U
R
L
:
h
tt
p
s
://
ac
l
.gov
/
s
it
e
s
/
defau
lt/
f
il
e
s
/
Ag
i
ng%20and%20D
i
s
ab
ilit
y%20
i
n%20A
m
er
i
ca
/
2017O
l
derA
m
er
i
can
s
P
rof
il
e.pdf [acce
ss
ed 2020-01-31]
8. Hea
lt
hy
P
eop
l
e 2020. Wa
s
h
i
ng
t
on, D
C
:
Off
i
ce of D
i
s
ea
s
e
P
reven
ti
on and Hea
lt
h
P
ro
m
o
ti
on
;
2017. O
l
der Adu
lt
s
P
reven
ti
on
Ob
j
ec
ti
ve
s
U
R
L
:
h
tt
p
s
://
www.hea
lt
hypeop
l
e.gov
/
2020
/t
op
i
c
s
-ob
j
ec
ti
ve
s
/t
op
i
c
/
o
l
der-adu
lt
s
/
ob
j
ec
ti
ve
s
[acce
ss
ed 2020-01-31]
9.
St
ark
S
, Keg
l
ov
it
s
M
, Arbe
sm
an
M
, L
i
eber
m
an D. Effec
t
of ho
m
e
m
od
i
f
i
ca
ti
on
i
n
t
erven
ti
on
s
on
t
he par
ti
c
i
pa
ti
on of
co
mm
un
it
y-dwe
lli
ng adu
lt
s
w
it
h hea
lt
h cond
iti
on
s
:
a
s
y
s
t
e
m
a
ti
c rev
i
ew. A
m
J
Occup Ther
2017
;
71(2)
:
7102290010p1-710229001p11. [do
i:
10.5014
/
a
j
o
t
.2017.018887] [
M
ed
li
ne
:
28218595]
10.
Pi
gh
ill
s
A
C
, Torger
s
on D
J
,
S
he
l
don TA, Dru
mm
ond AE,
B
l
and
J
M
. Env
i
ron
m
en
t
a
l
a
ss
e
ssm
en
t
and
m
od
i
f
i
ca
ti
on
t
o preven
t
fa
ll
s
i
n o
l
der peop
l
e.
J
A
m
Ger
i
a
t
r
S
oc 2011
J
an
;
59(1)
:
26-33. [do
i:
10.1111
/j
.1532-5415.2010.03221.x] [
M
ed
li
ne
:
21226674]
11.
St
ark
S
, Land
s
bau
m
A,
P
a
l
m
er
J
L,
S
o
m
erv
ill
e EK,
M
orr
i
s
J
C
.
C
li
en
t
-cen
t
red ho
m
e
m
od
i
f
i
ca
ti
on
s
i
m
prove da
il
y ac
ti
v
it
y
perfor
m
ance of o
l
der adu
lt
s
.
C
an
J
Occup Ther 2009
J
u
l;
76
:
235-245 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1177
/
000841740907600
s
09]
[
M
ed
li
ne
:
19757729]
12.
P
e
t
er
ss
on I, Ko
tt
orp A,
B
erg
s
t
rö
m
J
, L
ilj
a
M
. Long
it
ud
i
na
l
change
s
i
n everyday
li
fe af
t
er ho
m
e
m
od
i
f
i
ca
ti
on
s
for peop
l
e
ag
i
ng w
it
h d
i
s
ab
iliti
e
s
.
S
cand
J
Occup Ther 2009
M
ay
;
16(2)
:
78-87. [do
i:
10.1080
/
11038120802409747] [
M
ed
li
ne
:
18821447]
13. G
ill
e
s
p
i
e LD,
R
ober
t
s
on
M
C
, G
ill
e
s
p
i
e W
J
,
S
herr
i
ng
t
on
C
, Ga
t
e
s
S
,
C
l
e
ms
on L
M
, e
t
a
l
. In
t
erven
ti
on
s
for preven
ti
ng fa
ll
s
i
n o
l
der peop
l
e
li
v
i
ng
i
n
t
he co
mm
un
it
y.
C
ochrane Da
t
aba
s
e
S
y
s
t
R
ev 2012
S
ep 12(9)
:
C
D007146. [do
i:
10.1002
/
14651858.
C
D007146.pub3] [
M
ed
li
ne
:
22972103]
14.
C
ha
s
e
C
A,
M
ann K, Wa
s
ek
S
, Arbe
sm
an
M
.
S
y
s
t
e
m
a
ti
c rev
i
ew of
t
he effec
t
of ho
m
e
m
od
i
f
i
ca
ti
on and fa
ll
preven
ti
on
progra
ms
on fa
ll
s
and
t
he perfor
m
ance of co
mm
un
it
y-dwe
lli
ng o
l
der adu
lt
s
. A
m
J
Occup Ther 2012
;
66(3)
:
284-291. [do
i:
10.5014
/
a
j
o
t
.2012.005017] [
M
ed
li
ne
:
22549593]
15.
S
zan
t
on
S
L, Leff
B
, Wo
l
ff
J
L,
R
ober
t
s
L, G
itli
n LN. Ho
m
e-ba
s
ed care progra
m
reduce
s
d
i
s
ab
ilit
y and pro
m
o
t
e
s
ag
i
ng
i
n
p
l
ace. Hea
lt
h Aff (
M
ill
wood) 2016
S
ep 1
;
35(9)
:
1558-1563. [do
i:
10.1377
/
h
lt
haff.2016.0140] [
M
ed
li
ne
:
27605633]
16.
P
e
t
er
ss
on I, L
ilj
a
M
, Ha
mm
e
l
J
, Ko
tt
orp A. I
m
pac
t
of ho
m
e
m
od
i
f
i
ca
ti
on
s
erv
i
ce
s
on ab
ilit
y
i
n everyday
li
fe for peop
l
e
age
i
ng w
it
h d
i
s
ab
iliti
e
s
.
J
R
ehab
il
M
ed 2008 Apr
;
40(4)
:
253-260 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.2340
/
16501977-0160] [
M
ed
li
ne
:
18382820]
17.
St
ark
S
,
S
o
m
erv
ill
e E, Keg
l
ov
it
s
M
,
C
on
t
e
J
, L
i
M
, Hu Y, e
t
a
l
.
P
ro
t
oco
l
for
t
he ho
m
e hazard
s
re
m
ova
l
progra
m
(HA
R
P
)
s
t
udy
:
a prag
m
a
ti
c, rando
m
i
zed c
li
n
i
ca
l
t
r
i
a
l
and
i
m
p
l
e
m
en
t
a
ti
on
s
t
udy.
B
M
C
Ger
i
a
t
r 2017 Apr 20
;
17(1)
:
90 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1186
/
s
12877-017-0478-4] [
M
ed
li
ne
:
28427336]
18.
S
o
m
erv
ill
e E,
S
m
a
ll
f
i
e
l
d
S
,
St
ark
S
,
S
e
i
ber
t
C
, Arbe
sm
an
M
, L
i
eber
m
an D. Occupa
ti
ona
l
t
herapy ho
m
e
m
od
i
f
i
ca
ti
on
a
ss
e
ssm
en
t
and
i
n
t
erven
ti
on. A
m
J
Occup Ther 2016
;
70(5)
:
7005395010p1-7005395010p3. [do
i:
10.5014
/
a
j
o
t
.2016.705002]
[
M
ed
li
ne
:
27548872]
19.
P
ynoo
s
J
. The fu
t
ure of hou
s
i
ng for
t
he e
l
der
l
y
:
four
s
t
ra
t
eg
i
e
s
t
ha
t
can
m
ake a d
i
fference.
P
ub
li
c
P
o
li
cy Ag
i
ng
R
ep
2018
;
28(1)
:
35-38. [do
i:
10.1093
/
ppar
/
pry006]
20. HUD U
S
E
R
. Wa
s
h
i
ng
t
on, D
C
:
Off
i
ce of
P
o
li
cy Deve
l
op
m
en
t
and
R
e
s
earch, Depar
t
m
en
t
of Hou
s
i
ng and Urban Deve
l
op
m
en
t;
2013. Ag
i
ng
i
n
Pl
ace
:
F
ac
ilit
a
ti
ng
C
ho
i
ce and Independence U
R
L
:
h
tt
p
s
://
www.hudu
s
er.gov
/
por
t
a
l/
per
i
od
i
ca
l
s
/
e
m
/
fa
ll
13
/
h
i
gh
li
gh
t
1.h
t
m
l
[acce
ss
ed 2020-01-31]
21. HUD U
S
E
R
. Wa
s
h
i
ng
t
on, D
C
:
Off
i
ce of
P
o
li
cy Deve
l
op
m
en
t
and
R
e
s
earch, Depar
t
m
en
t
of Hou
s
i
ng and Urban Deve
l
op
m
en
t;
2017. Hou
s
i
ng for
S
en
i
or
s
:
C
ha
ll
enge
s
and
S
o
l
u
ti
on
s
U
R
L
:
h
tt
p
s
://
www.hudu
s
er.gov
/
por
t
a
l/
per
i
od
i
ca
l
s
/
e
m
/
s
u
mm
er17
/
h
i
gh
li
gh
t
1.h
t
m
l
[acce
ss
ed 2020-01-31]
22.
R
enda
M
, Lape
J
E.
F
ea
s
i
b
ilit
y and effec
ti
vene
ss
of
t
e
l
ehea
lt
h occupa
ti
ona
l
t
herapy ho
m
e
m
od
i
f
i
ca
ti
on
i
n
t
erven
ti
on
s
. In
t
J
Te
l
erehab
il
2018
;
10(1)
:
3-14 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.5195
/ijt
.2018.6244] [
M
ed
li
ne
:
30147839]
23. New
P
W,
J
o
ll
ey D
J
,
C
a
m
eron
P
A, O
l
ver
J
H,
St
oe
l
w
i
nder
J
U. A pro
s
pec
ti
ve
m
u
lti
cen
t
re
s
t
udy of barr
i
er
s
t
o d
i
s
charge fro
m
i
npa
ti
en
t
rehab
ilit
a
ti
on.
M
ed
J
Au
s
t
2013
F
eb 4
;
198(2)
:
104-108. [do
i:
10.5694
/
m
j
a12.10340] [
M
ed
li
ne
:
23373502]
24. Nygård L, Grahn U,
R
udenha
mm
ar A, Hyd
li
ng
S
.
R
ef
l
ec
ti
ng on prac
ti
ce
:
are ho
m
e v
i
s
it
s
pr
i
or
t
o d
i
s
charge wor
t
hwh
il
e
i
n
ger
i
a
t
r
i
c
i
npa
ti
en
t
care?
S
cand
J
C
ar
i
ng
S
c
i
2004
J
un
;
18(2)
:
193-203. [do
i:
10.1111
/j
.1471-6712.2004.00270.x] [
M
ed
li
ne
:
15147483]
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
25. Un
i
ver
s
it
y of
S
ou
t
hern
C
a
li
forn
i
a. U
S
C
Ho
m
e
M
od
i
f
i
ca
ti
on. The Na
ti
ona
l
D
i
rec
t
ory of Ho
m
e
M
od
i
f
i
ca
ti
on and
R
epa
i
r
R
e
s
ource
s
U
R
L
:
h
tt
p
s
://
ho
m
e
m
od
s
.org
/
na
ti
ona
l
-d
i
rec
t
ory
/
[acce
ss
ed 2020-01-31]
26. U
S
Ad
m
i
n
i
s
t
ra
ti
on on Ag
i
ng. E
l
dercare Loca
t
or. U
R
L
:
h
tt
p
s
://
e
l
dercare.ac
l
.gov
/
[acce
ss
ed 2020-01-31]
27.
Si
eg
l
er A
J
, W
i
r
t
z
S
, Weber
S
,
S
u
lli
van
PS
. Deve
l
op
i
ng a web-ba
s
ed geo
l
oca
t
ed d
i
rec
t
ory of h
i
v pre-expo
s
ure
prophy
l
ax
i
s
-prov
i
d
i
ng c
li
n
i
c
s
:
The prep
l
oca
t
or pro
t
oco
l
and opera
ti
ng procedure
s
.
J
M
I
R
P
ub
li
c Hea
lt
h
S
urve
ill
2017
S
ep
6
;
3(3)
:
e58 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.2196
/
pub
li
chea
lt
h.7902] [
M
ed
li
ne
:
28877865]
28.
St
ark
S
L,
S
o
m
erv
ill
e E, Keg
l
ov
it
s
M
,
S
m
a
s
on A,
B
i
gha
m
K.
C
li
n
i
ca
l
rea
s
on
i
ng gu
i
de
li
ne for ho
m
e
m
od
i
f
i
ca
ti
on
i
n
t
erven
ti
on
s
.
A
m
J
Occup Ther 2015
;
69(2)
:
6902290030p1-6902290030p8. [do
i:
10.5014
/
a
j
o
t
.2015.014266] [
M
ed
li
ne
:
26122687]
29.
Si
eber
t
C
,
S
m
a
ll
f
i
e
l
d
S
,
St
ark
S
. Occupa
ti
ona
l
Therapy
P
rac
ti
ce Gu
i
de
li
ne
s
for Ho
m
e
M
od
i
f
i
ca
ti
on
s
.
B
e
t
he
s
da,
M
D
:
AOTA
P
re
ss
;
2014.
30.
J
ohn
s
on
C
M
,
J
ohn
s
on T
R
, Zhang
J
. A u
s
er-cen
t
ered fra
m
ework for rede
s
i
gn
i
ng hea
lt
h care
i
n
t
erface
s
.
J
B
i
o
m
ed Infor
m
2005
F
eb
;
38(1)
:
75-87 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.
j
b
i
.2004.11.005] [
M
ed
li
ne
:
15694887]
31.
B
oryck
i
E, Ku
s
hn
i
ruk A, Nohr
C
, Takeda H, Kuwa
t
a
S
,
C
arva
l
ho
C
, e
t
a
l
. U
s
ab
ilit
y
m
e
t
hod
s
for en
s
ur
i
ng hea
lt
h
i
nfor
m
a
ti
on
t
echno
l
ogy
s
afe
t
y
:
ev
i
dence-ba
s
ed approache
s
.
C
on
t
r
i
bu
ti
on of The I
M
IA Work
i
ng Group Hea
lt
h Infor
m
a
ti
c
s
for
P
a
ti
en
t
S
afe
t
y. Yearb
M
ed Infor
m
2013
;
8
:
20-27. [
M
ed
li
ne
:
23974544]
32. Er
i
c
ss
on KA,
Si
m
on HA. Verba
l
repor
t
s
a
s
da
t
a.
P
s
ycho
l
R
ev 1980
;
87(3)
:
215-251. [do
i:
10.1037
/
0033-295X.87.3.215]
33.
R
o
m
ano
B
J
, O
l
ms
t
ed-Hawa
l
a E. Th
i
nk-A
l
oud
P
ro
t
oco
l
s
:
Doe
s
Age
M
ake a D
i
fference? In
:
P
roceed
i
ng
s
of
t
he 59
t
h
S
oc
i
e
t
y
for Techn
i
ca
l
C
o
mm
un
i
ca
ti
on
S
u
mm
it
. 2012
P
re
s
en
t
ed a
t:
S
T
C
'12
;
M
ay 20-23, 2012
;
C
h
i
cago, IL.
34. O
l
ms
t
ed-Hawa
l
a E,
M
urphy E, Hawa
l
a
S
, A
s
henfe
lt
er K. Th
i
nk-A
l
oud
P
ro
t
oco
l
s
:
A
C
o
m
par
i
s
on of Three Th
i
nk-A
l
oud
P
ro
t
oco
l
s
for U
s
e
i
n Te
s
ti
ng Da
t
a-D
i
ss
e
m
i
na
ti
on Web
Sit
e
s
for U
s
ab
ilit
y. In
:
P
roceed
i
ng
s
of
t
he
S
IG
C
HI
C
onference on
Hu
m
an
F
ac
t
or
s
i
n
C
o
m
pu
ti
ng
S
y
s
t
e
ms
. 2010
P
re
s
en
t
ed a
t:
C
HI'10
;
Apr
il
25 - 30, 2020
;
A
tl
an
t
a, GA p. 2381-2390. [do
i:
10.1145
/
1753326.1753685]
35. Lew
i
s
J
, Erd
i
nc O. U
s
er Exper
i
ence
R
a
ti
ng
S
ca
l
e
s
W
it
h 7, 11, or 101
P
o
i
n
t
s
:
Doe
s
I
t
M
a
tt
er?
J
U
s
ab
ilit
y
St
ud
i
e
s
2017
;
12(2)
:
73-91 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1201
/
b11308-8]
36.
B
angor A, Kor
t
u
m
P
T,
M
ill
er
J
T. An e
m
p
i
r
i
ca
l
eva
l
ua
ti
on of
t
he
s
y
s
t
e
m
u
s
ab
ilit
y
s
ca
l
e. In
t
J
Hu
m
-
C
o
m
pu
t
In
t
erac
t
2008
;
24(6)
:
574-594. [do
i:
10.1080
/
10447310802205776]
37.
B
angor A, Kor
t
u
m
P
,
M
ill
er
J
. De
t
er
m
i
n
i
ng wha
t
i
nd
i
v
i
dua
l
S
U
S
s
core
s
m
ean
:
add
i
ng an ad
j
ec
ti
ve ra
ti
ng
s
ca
l
e.
J
U
s
ab
ilit
y
St
ud 2009
;
4(3)
:
114-123 [
F
R
EE
F
u
ll
t
ex
t
]
38.
C
ho
J
,
P
ark D, Lee HE.
C
ogn
iti
ve fac
t
or
s
of u
s
i
ng hea
lt
h app
s
:
s
y
s
t
e
m
a
ti
c ana
l
y
s
i
s
of re
l
a
ti
on
s
h
i
p
s
a
m
ong hea
lt
h
con
s
c
i
ou
s
ne
ss
, hea
lt
h
i
nfor
m
a
ti
on or
i
en
t
a
ti
on, eHea
lt
h
lit
eracy, and hea
lt
h app u
s
e eff
i
cacy.
J
M
ed In
t
erne
t
R
e
s
2014
M
ay
9
;
16(5)
:
e125 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.2196
/j
m
i
r.3283] [
M
ed
li
ne
:
24824062]
39.
R
o
s
en LD, Wha
li
ng K,
C
arr
i
er L
M
,
C
heever NA,
R
okku
m
J
. The
m
ed
i
a and
t
echno
l
ogy u
s
age and a
ttit
ude
s
s
ca
l
e
:
an
e
m
p
i
r
i
ca
l
i
nve
s
ti
ga
ti
on.
C
o
m
pu
t
Hu
m
an
B
ehav 2013 Nov 1
;
29(6)
:
2501-2511 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.chb.2013.06.006] [
M
ed
li
ne
:
25722534]
40. G
l
a
s
er
B
G,
St
rau
ss
AL. The D
i
s
covery of Grounded Theory
:
St
ra
t
eg
i
e
s
for Qua
lit
a
ti
ve
R
e
s
earch. New York, NY
:
A
l
d
i
ne
De Gruy
t
er
;
1967.
41. Ko
l
b
S
M
. Grounded
t
heory and
t
he con
s
t
an
t
co
m
para
ti
ve
m
e
t
hod
:
va
li
d re
s
earch
s
t
ra
t
eg
i
e
s
for educa
t
or
s
.
J
E
m
erg Trend
s
Educ
R
e
s
P
o
li
cy
St
ud 2012
;
3(1)
:
83-86 [
F
R
EE
F
u
ll
t
ex
t
]
42.
St
rau
ss
AL,
C
orb
i
n
J
. Grounded
t
heory
m
e
t
hodo
l
ogy. In
:
Denz
i
n NK, L
i
nco
l
n Y
S
, ed
it
or
s
. The
S
AGE Handbook of
Qua
lit
a
ti
ve
R
e
s
earch. Thou
s
and Oak
s
,
C
A
:
S
age
P
ub
li
ca
ti
on
s
;
1994.
43.
B
oe
ij
e H. A purpo
s
efu
l
approach
t
o
t
he con
s
t
an
t
co
m
para
ti
ve
m
e
t
hod
i
n
t
he ana
l
y
s
i
s
of qua
lit
a
ti
ve
i
n
t
erv
i
ew
s
. Qua
l
Quan
t
2002
;
36(4)
:
391-409. [do
i:
10.1023
/
a
:
1020909529486]
44.
C
har
m
az K.
C
on
s
t
ruc
ti
on
i
sm
and
t
he grounded
t
heory
m
e
t
hod. In
:
Ho
l
s
t
e
i
n
J
, Gubr
i
u
m
J
, ed
it
or
s
. Handbook of con
s
t
ruc
ti
on
i
s
t
re
s
earch. New York, NY
:
Gu
il
ford
P
re
ss
;
2008
:
397-412.
45. Tong A,
S
a
i
n
s
bury
P
,
C
ra
i
g
J
.
C
on
s
o
li
da
t
ed cr
it
er
i
a for repor
ti
ng qua
lit
a
ti
ve re
s
earch (
C
O
R
EQ)
:
a 32-
it
e
m
check
li
s
t
for
i
n
t
erv
i
ew
s
and focu
s
group
s
. In
t
J
Qua
l
Hea
lt
h
C
are 2007 Dec
;
19(6)
:
349-357. [do
i:
10.1093
/i
n
t
qhc
/
m
z
m
042] [
M
ed
li
ne
:
17872937]
46. O'
B
r
i
en
BC
, Harr
i
s
I
B
,
B
eck
m
an T
J
,
R
eed DA,
C
ook DA.
St
andard
s
for repor
ti
ng qua
lit
a
ti
ve re
s
earch
:
a
s
yn
t
he
s
i
s
of
reco
mm
enda
ti
on
s
. Acad
M
ed 2014
S
ep
;
89(9)
:
1245-1251 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1097
/
A
C
M
.0000000000000388]
[
M
ed
li
ne
:
24979285]
47.
Sil
va
B
M
,
R
odr
i
gue
s
JJ
, de
l
a Torre D
í
ez I, López-
C
oronado
M
,
S
a
l
ee
m
K.
M
ob
il
e-hea
lt
h
:
a rev
i
ew of curren
t
s
t
a
t
e
i
n
2015.
J
B
i
o
m
ed Infor
m
2015 Aug
;
56
:
265-272 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.
j
b
i
.2015.06.003] [
M
ed
li
ne
:
26071682]
48.
Fi
s
cher
S
H, Dav
i
d D,
C
ro
tt
y
B
H, D
i
erk
s
M
,
S
afran
C
. Accep
t
ance and u
s
e of hea
lt
h
i
nfor
m
a
ti
on
t
echno
l
ogy by
co
mm
un
it
y-dwe
lli
ng e
l
der
s
. In
t
J
M
ed Infor
m
2014
S
ep
;
83(9)
:
624-635 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.
ij
m
ed
i
nf.2014.06.005]
[
M
ed
li
ne
:
24996581]
49. Ka
m
p
m
e
ij
er
R
,
P
av
l
ova
M
, Ta
m
bor
M
, Go
li
now
s
ka
S
, Groo
t
W. The u
s
e of e-hea
lt
h and
m
-hea
lt
h
t
oo
l
s
i
n hea
lt
h pro
m
o
ti
on
and pr
i
m
ary preven
ti
on a
m
ong o
l
der adu
lt
s
:
a
s
y
s
t
e
m
a
ti
c
lit
era
t
ure rev
i
ew.
B
M
C
Hea
lt
h
S
erv
R
e
s
2016
S
ep 5
;
16(
S
upp
l
5)
:
290 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1186
/
s
12913-016-1522-3] [
M
ed
li
ne
:
27608677]
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
50. Levac D, Du
m
a
s
H
M
,
M
e
l
e
i
s
W. A
t
ab
l
e
t
-ba
s
ed
i
n
t
erac
ti
ve
m
ove
m
en
t
t
oo
l
for ped
i
a
t
r
i
c rehab
ilit
a
ti
on
:
deve
l
op
m
en
t
and
pre
li
m
i
nary u
s
ab
ilit
y eva
l
ua
ti
on.
J
M
I
R
R
ehab
il
A
ss
i
s
t
Techno
l
2018 Nov 26
;
5(2)
:
e10307 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.2196
/
10307] [
M
ed
li
ne
:
30478025]
51. G
i
e
s
brech
t
E
M
,
M
ill
er W
C
,
J
i
n
B
T,
M
it
che
ll
I
M
, Eng
JJ
.
R
ehab on whee
l
s
:
a p
il
o
t
s
t
udy of
t
ab
l
e
t
-ba
s
ed whee
l
cha
i
r
t
ra
i
n
i
ng
for o
l
der adu
lt
s
.
J
M
I
R
R
ehab
il
A
ss
i
s
t
Techno
l
2015 Apr 30
;
2(1)
:
e3 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.2196
/
rehab.4274] [
M
ed
li
ne
:
28582240]
52. Ha
mm
J
,
M
oney AG, A
t
wa
l
A, Gh
i
nea G.
M
ob
il
e
t
hree-d
i
m
en
s
i
ona
l
v
i
s
ua
li
s
a
ti
on
t
echno
l
og
i
e
s
for c
li
n
i
c
i
an-
l
ed fa
ll
preven
ti
on a
ss
e
ssm
en
t
s
. Hea
lt
h Infor
m
a
ti
c
s
J
2019
S
ep
;
25(3)
:
788-810 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1177
/
1460458217723170]
[
M
ed
li
ne
:
28816091]
53. Tho
m
p
s
on H
J
, De
m
i
r
i
s
G,
R
ue T,
S
ha
til
E, W
il
a
m
ow
s
ka K, Za
s
l
av
s
ky O, e
t
a
l
. A Ho
li
s
ti
c approach
t
o a
ss
e
ss
o
l
der adu
lt
s
'
we
ll
ne
ss
u
s
i
ng e-hea
lt
h
t
echno
l
og
i
e
s
. Te
l
e
m
ed
J
E Hea
lt
h 2011 Dec
;
17(10)
:
794-800 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1089
/t
m
j
.2011.0059] [
M
ed
li
ne
:
22011052]
54. Go
l
an
t
S
M
. A
t
heore
ti
ca
l
m
ode
l
t
o exp
l
a
i
n
t
he
sm
ar
t
t
echno
l
ogy adop
ti
on behav
i
or
s
of e
l
der con
s
u
m
er
s
(E
l
deradop
t
).
J
Ag
i
ng
St
ud 2017 Aug
;
42
:
56-73. [do
i:
10.1016
/j
.
j
ag
i
ng.2017.07.003] [
M
ed
li
ne
:
28918822]
55. Deng Z,
M
o X, L
i
u
S
.
C
o
m
par
i
s
on of
t
he
m
i
dd
l
e-aged and o
l
der u
s
er
s
' adop
ti
on of
m
ob
il
e hea
lt
h
s
erv
i
ce
s
i
n
C
h
i
na. In
t
J
M
ed Infor
m
2014
M
ar
;
83(3)
:
210-224. [do
i:
10.1016
/j
.
ij
m
ed
i
nf.2013.12.002] [
M
ed
li
ne
:
24388129]
56.
P
eek
S
T, Wou
t
er
s
E
J
, van Hoof
J
, Lu
ij
kx KG,
B
oe
ij
e H
R
, Vr
ij
hoef H
J
.
F
ac
t
or
s
i
nf
l
uenc
i
ng accep
t
ance of
t
echno
l
ogy for
ag
i
ng
i
n p
l
ace
:
a
s
y
s
t
e
m
a
ti
c rev
i
ew. In
t
J
M
ed Infor
m
2014 Apr
;
83(4)
:
235-248 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1016
/j
.
ij
m
ed
i
nf.2014.01.004] [
M
ed
li
ne
:
24529817]
57.
P
ee
t
er
s
J
M
, de Veer A
J
, van der Hoek L,
F
rancke AL.
F
ac
t
or
s
i
nf
l
uenc
i
ng
t
he adop
ti
on of ho
m
e
t
e
l
ecare by e
l
der
l
y or
chron
i
ca
ll
y
ill
peop
l
e
:
a na
ti
ona
l
s
urvey.
J
C
li
n Nur
s
2012 Nov
;
21(21-22)
:
3183-3193. [do
i:
10.1111
/j
.1365-2702.2012.04173.x] [
M
ed
li
ne
:
22827253]
58.
C
ha
i
W
J
, Abd Ha
m
i
d AI, Abdu
ll
ah
J
M
. Work
i
ng
m
e
m
ory fro
m
t
he p
s
ycho
l
og
i
ca
l
and neuro
s
c
i
ence
s
per
s
pec
ti
ve
s
:
a rev
i
ew.
F
ron
t
P
s
ycho
l
2018
;
9
:
401 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.3389
/
fp
s
yg.2018.00401] [
M
ed
li
ne
:
29636715]
59.
P
ark D
C
,
F
e
s
ti
n
i
S
B
. Theor
i
e
s
of
m
e
m
ory and ag
i
ng
:
a
l
ook a
t
t
he pa
s
t
and a g
li
m
p
s
e of
t
he fu
t
ure.
J
Geron
t
o
l
B
P
s
ycho
l
S
c
i
S
oc
S
c
i
2017
J
an
;
72(1)
:
82-90 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1093
/
geronb
/
gbw066] [
M
ed
li
ne
:
27257229]
60.
S
af
t
ar
i
LN, Kwon O. Age
i
ng v
i
s
i
on and fa
ll
s
:
a rev
i
ew.
J
P
hy
s
i
o
l
An
t
hropo
l
2018 Apr 23
;
37(1)
:
11 [
F
R
EE
F
u
ll
t
ex
t
] [do
i:
10.1186
/
s
40101-018-0170-1] [
M
ed
li
ne
:
29685171]
61.
B
awe
j
a H
S
, Kwon
M
, Onu
s
hko T, Wr
i
gh
t
DL,
C
orco
s
D
M
,
C
hr
i
s
t
ou EA.
P
roce
ss
i
ng of v
i
s
ua
l
i
nfor
m
a
ti
on co
m
pro
m
i
s
e
s
t
he ab
ilit
y of o
l
der adu
lt
s
t
o con
t
ro
l
nove
l
f
i
ne
m
o
t
or
t
a
s
k
s
. Exp
B
ra
i
n
R
e
s
2015 Dec
;
233(12)
:
3475-3488. [do
i:
10.1007
/
s
00221-015-4408-4] [
M
ed
li
ne
:
26298044]
62. Kon
t
o
s
E,
B
l
ake KD,
C
hou W
S
,
P
re
s
ti
n A.
P
red
i
c
t
or
s
of eHea
lt
h u
s
age
:
i
n
s
i
gh
t
s
on
t
he d
i
g
it
a
l
d
i
v
i
de fro
m
t
he Hea
lt
h
Infor
m
a
ti
on Na
ti
ona
l
Trend
s
S
urvey 2012.
J
M
ed In
t
erne
t
R
e
s
2014
J
u
l
16
;
16(7)
:
e172 [
F
R
EE
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10.2196
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:
25048379]
63. Nguyen A. Ho
m
e
M
add
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s
- Ho
m
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f
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s
for Ag
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ab
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rec
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R
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s
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R
L
:
h
tt
p
s
://
ho
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add
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s
.
co
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/
[acce
ss
ed 2020-02-04]
A
bb
rev
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s
AD
L
: ac
ti
v
it
y of da
il
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li
v
i
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H
M
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T
A: Ho
m
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M
od
i
f
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ca
ti
on Occupa
ti
ona
l
Therapy A
lli
ance
H
ome Ma
ddi
r
s
: Ho
m
e
M
od
i
f
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ca
ti
on
s
for Ag
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ng and D
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s
ab
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y D
i
rec
t
ory of
R
eferra
l
s
I
R
B
:
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n
s
tit
u
ti
ona
l
rev
i
ew board
m
H
ea
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:
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ob
il
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lt
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O
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: occupa
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ona
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herap
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S
U
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:
S
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m
U
s
ab
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ca
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Ed
it
ed by G Ey
s
enbach;
s
ubm
itt
ed 02.05.19; pee
r
-
r
ev
i
e
w
ed by
Z
Deng, M S
t
e
i
n, I de
l
a
T
o
rr
e; commen
t
s
t
o au
t
ho
r
29.09.19;
r
ev
i
s
ed
ve
rs
i
on
r
ece
i
ved 21.11.19; accep
t
ed 22.01.20; pub
li
s
hed 30.03.20
P
l
ea
s
e c
it
e a
s
:
N
guyen A
T
, Some
r
v
ill
e E
K
, E
s
p
í
n-
T
e
ll
o SM,
K
eg
l
ov
it
s
M, S
t
a
r
k S
L
A Mob
il
e App D
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r
ec
t
o
r
y o
f
Occupa
ti
ona
l
T
he
r
ap
i
s
t
s
Who P
r
ov
i
de Home Mod
ifi
ca
ti
on
s
: Deve
l
opmen
t
and P
r
e
li
m
i
na
r
y U
s
ab
ilit
y
Eva
l
ua
ti
on
JMIR Rehab
il
A
ss
i
s
t
T
echno
l
2020;7(1):e14465
UR
L
: h
tt
p:
//
r
ehab.
j
m
i
r
.o
r
g
/
2020
/
1
/
e14465
/
do
i
: 10.2196
/
14465
PMID:
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
©An Th
i
Nguyen, E
m
il
y K
li
ng
S
o
m
erv
ill
e,
S
andra
M
ar
ti
na E
s
p
í
n-Te
ll
o,
M
ar
i
an Keg
l
ov
it
s
,
S
u
s
an Lynn
St
ark. Or
i
g
i
na
ll
y pub
li
s
hed
i
n
J
M
I
R
R
ehab
ilit
a
ti
on and A
ss
i
s
ti
ve Techno
l
ogy (h
tt
p
://
rehab.
j
m
i
r.org), 30.03.2020. Th
i
s
i
s
an open-acce
ss
ar
ti
c
l
e d
i
s
t
r
i
bu
t
ed
under
t
he
t
er
ms
of
t
he
C
rea
ti
ve
C
o
mm
on
s
A
tt
r
i
bu
ti
on L
i
cen
s
e (h
tt
p
s
://
crea
ti
veco
mm
on
s
.org
/li
cen
s
e
s
/
by
/
4.0
/
), wh
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ch per
m
it
s
unre
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t
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i
c
t
ed u
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n any
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work, f
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r
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t
pub
li
s
hed
i
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J
M
I
R
R
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on
and A
ss
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s
proper
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ed. The co
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p
l
e
t
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i
b
li
ograph
i
c
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pub
li
ca
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on on
h
tt
p
://
rehab.
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r.org
/
, a
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we
ll
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and
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cen
s
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i
nfor
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a
ti
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m
u
s
t
be
i
nc
l
uded.
Nguyen e
t
a
l
J
M
I
R
R
EHA
B
ILITATION AND A
SS
I
S
TIVE TE
C
HNOLOGIE
S
