1339 - Clinician Perspectives on Barriers and Opportunities for Mainstream Smart Technology Intervention in Inpatient Rehabilitation

Voice-activated smart technology offers people with paralysis an alternative means of interacting with their environment, helping to increase independence and reduce caregiver demand. A pilot study (Smart Stay) was conducted in an inpatient rehabilitation hospital to provide mainstream smart technology and associated training and tech support to patients with paralysis. Clinicians were interviewed to explore their perspectives on the intervention implementation.

Design:

Guided by the Consolidated Framework for Implementation Research (CFIR), a qualitative study with semi-structured clinician interviews was conducted. Questions were selected based on input from researchers, clinicians, and individuals with paralysis. Responses were summarized into CFIR constructs (Relative Advantage, Complexity, Patient Needs and Resources, Implementation Climate, Readiness for Implementation, Evidence Strength and Quality) across three CFIR domains and analyzed using rapid qualitative analysis.

Results:

Rehabilitation therapists, physicians, and nursing clinicians with exposure to the intervention participated, and eight clinicians completed the interviews. Seven clinicians mentioned intervention benefits that increased patients’ independence, confidence, self-efficacy, and engagement in rehabilitation. Additional benefits included reduced nursing workflow interruptions and transferability of the technology to the home setting after hospital discharge. Key barriers centered around patients' abilities to interact with the technology; clinicians cited low-volume or dysarthric voices, cognitive impairments, and elderly patients' unfamiliarity with technology as key challenges. Multiple clinicians requested additional training to better integrate the technology into patient care. Physicians and therapists were more likely than other clinicians to recommend collecting functional outcome data to demonstrate the intervention’s effectiveness and support its expansion.

Conclusions: Using the CFIR, this study offers insights into benefits and barriers when integrating mainstream smart technology for patients with paralysis in inpatient rehabilitation. Overall, clinicians approved of the intervention, citing enhanced patient experience, but noted implementation barriers. Future studies will analyze a larger sample with the goal of providing recommendations for effective technology implementation in rehabilitation settings.