Occupational therapists’ perceptions of the feasibility of using tele-assessment for remote prescription of assistive devices in Singapore: A qualitative study

Abstract

BACKGROUND:

Occupational therapists (OT) assess and prescribe assistive devices to older adults with limitations in performing daily living activities. Timely prescription of assistive devices to accommodate the rising demand has been affected by the COVID-19 pandemic. Tele-assessment allows for continuity of care, but its success depends on therapists’ acceptance.

OBJECTIVE:

This study examined OTs’ perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore.

METHODS:

Eligible OTs were recruited from purposive sampling. Semi-structured interviews were conducted via a virtual platform (Zoom). Audio recordings were transcribed verbatim. Inductive thematic analysis using a line-by-line coding method was used to identify common trends.

RESULTS:

Interviews with 10 participants revealed three main themes: (1) therapists’ perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate prescription of assistive devices via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. Participants felt that tele-assessment increases efficiency with more older adults being more receptive towards technology. They also raised suggestions to address OTs’ concerns regarding the safety and accuracy prescription of assistive devices following tele-assessment. This included establishing the client’s suitability for assistive device prescription, characteristics of assistive devices, resources required, and considering the preferences of stakeholders involved.

CONCLUSION:

Tele-assessment for assistive device prescription by OTs appears feasible in Singapore. OTs should consider collaborating with other stakeholders to develop a tele-assessment clinical practice guideline for assistive device prescription. Further studies testing its clinical effectiveness during and/or post-pandemic are warranted.

Keywords

Feasibility study occupational therapy telehealth remote consultation needs assessment prescriptions assistive devices qualitative research

1 Introduction

Singapore faces an ageing population where 16% of the population in 2021 was aged 65 and above [1]. It was projected that 14.7% and 31.9% of the older adult population will require assistance in activities of daily living (ADLs) and instrumental activities of daily living respectively by 2050 [2]. Occupational therapists enable older adults to participate in meaningful daily activities by maximising their abilities to engage in valued occupations and making environmental or activity modifications [3].

The prevalence of functional limitations in older adults suggests a rise in demand for assistive devices such as wheelchairs, commodes, and hospital beds. However, the COVID-19 pandemic had resulted in the implementation of stringent measures to curb the extent of local viral transmission, including the cessation of face-to-face outpatient services such as clinics in hospitals and day rehabilitation centres. This necessitated the adoption of alternative service delivery - telehealth, which World Federation of Occupational Therapists (WFOT) defines as “the use of information and communication technologies to deliver health-related services when the provider and client are in different physical locations” [4]. A recent study reported that 96% of service users agreed that telehealth should be integrated as part of service delivery, including home safety screening, assistive device prescription, and follow-up evaluations [5].

The use of tele-assessment as part of telehealth has been well supported in occupational therapy practice. This includes wheelchair prescription [6], ADLs assessment and adaptive equipment prescription alongside home modification [7]. Findings from these studies documented a high level of client satisfaction in tele-assessment. Furthermore, musculoskeletal assessments and physical measurements obtained through tele-assessment also demonstrated high reliability that was comparable to face-to-face assessments [8]. A recent pilot randomised controlled trial on conducting tele-assessment to collect functional outcomes post-stroke rehabilitation showed that Modified Barthel Index scores from videoconferencing were similar to those collected by in-person assessments at a 2-week and 3-month follow-up with acceptable levels of reliability [9].

Despite receiving largely positive feedback from clients and therapists, the adoption of telehealth remains slow [10]. Common barriers that require addressing include technical challenges, inadequate organisational support, and mixed results when determining both clients’ and therapists’ levels of acceptance of telehealth [11 –13]. In particular, Serwe [14] found that therapists’ acceptance is pivotal for the success of telehealth. Therapists found it difficult to determine the physical functions of clients accurately when conducting tele-assessment [15]. A scoping review conducted by Graham et al. [16] involving the remote assessment of wheelchair and seating needs also highlighted concerns raised by expert assessors regarding the adequacy of tele-assessment training and accuracy in measurements of the biomechanics of the client during wheelchair prescription. Similarly, Serwe [14] discussed that providers tended to view telehealth less positively and had more concerns than users.

Studies suggested that adopting tele-assessment allowed for continuity of care amidst restrictions imposed by the COVID-19 pandemic [17, 18]. To minimise barriers and maximise the feasibility of telehealth for therapists and clients from the COVID-19 restrictions, organisations and researchers worldwide have recognised the need to develop clinical practice guidelines for telehealth [19]. Although WFOT published a position statement on telehealth [4], it did not include telehealth guidelines on facilitating tele-assessment for assistive device prescription. Additionally, there are limited practical recommendations available to guide therapists in conducting physical assessments over videoconferencing platforms. Hence, feasibility studies are useful to consider the practicalities of developing a tele-assessment guide and identify the need for a definitive trial of the guideline through the reconciliation of positive outcomes outlined in current literature with therapists’ perceived experience in using tele-assessment.

Since older adults are the most vulnerable group being affected by the COVID-19 pandemic in Singapore [20], this study aimed to examine local occupational therapists’ perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore.

2 Methods

2.1 Study design

A qualitative approach with semi-structured interviews was used in this study. The approach framed by a contextual constructivist epistemology was used to understand the factors and circumstances contributing to remote assistive device prescription through the experiences of occupational therapists. The constructivist perspective has congruence with the study’s aims as it seeks to make meaning of therapists’ experiences and applies them to real-life clinical contexts [21]. The Consolidated criteria for Reporting Qualitative research (COREQ) checklist (Supplementary File A) was used as a guide in reporting the study findings [22].

2.2 Participant recruitment

Participants were recruited through purposive sampling. The inclusion criteria were: (1) fully registered occupational therapists accredited by the Allied Health Professions Council in Singapore, (2) have at least one year of relevant working experience in physical rehabilitation or community settings, and (3) have prescribed assistive devices to older adults aged 65 years or above. A recruitment poster was disseminated to personal contacts of all researchers and members of the Singapore Association of Occupational Therapists (SAOT) through email blasts and social media platforms (Facebook, Instagram) between March and October 2021. Interested therapists could sign up through a link and express their interest in the interview. Eligible therapists were then contacted by researchers through email or WhatsApp.

2.3 Data collection

A semi-structured interview guide consisting of 21 open-ended questions (Supplementary File B) was developed after reviewing literature with similar research aims [23]. The guide was reviewed with one researcher (TX) who is a fully registered occupational therapist with more than 20 years of experience working with older adults in local community settings. All participants provided written informed consent prior to the interview. Interviews were conducted by four occupational therapy student researchers (JP, KH, ST, SF) in English via an end-to-end encrypted secured videoconferencing platform (Zoom) with participants’ video on. One researcher facilitated the discussion while the other researchers took field notes and probed for additional clarifications if needed, to ensure consistency and overall credibility of the study. Each interview lasted approximately 40 minutes and was recorded with permission. Only audio recordings were saved on a password-protected hard disk to maintain confidentiality. Data saturation was reached after 10 occupational therapists (4 from acute settings and 6 from community settings) were interviewed.

2.4 Data analysis

Interviews were transcribed verbatim by four researchers (JP, KH, ST, SF) independently and cross-checked by another researcher to ensure accuracy. Participants were allocated a unique identifier to ensure anonymity.

Analysis of transcripts was guided by Braun and Clarke’s [24] six-step approach to thematic analysis by two researchers (JP, KH) using NVivo software Release 1.51. Inductive thematic analysis was used to make sense of participants’ experiences and form emerging codes and themes to provide indications of potential theoretical relationships [24]. Transcripts were read by the researchers independently to note initial ideas and generate codes through line-by-line coding. Connections were drawn between the codes for emerging themes and sub-themes. They were further refined to reflect the narrative of the overall content before relating the analysis to research aims and literature. Each step of analysis involved a process of going back and forth to re-examine codes and themes between the researchers.

Methodological rigour of findings was strengthened using the following methods: 1) an iterative reflective process; 2) a coding check with randomly selected transcripts (n = 3) by researcher TX; 3) regular discussions of final themes, sub-themes, and codes to reach consensus among all researchers; 4) using field notes on the meaning and overall implications of data [21].

3 Results

Ten occupational therapists were interviewed via a virtual platform (Zoom). The demographics of participants are presented in Table 1. The mean working experience of all participants was 10.0 years (SD = 7.0). Participants prescribed assistive devices for clients with general deconditioning, orthopaedic, neurological conditions, and cardiovascular diseases. Eight participants had experience in prescribing assistive devices via phone call and two participants had experience in prescribing assistive devices over videoconferencing platforms (Zoom).

Table 1
Demographics of participants

Participant code Gender Years of experience Area(s) of practice

Current Previous

P1 Female 6 Comm Hospital Comm Hospital

P2 Male 6 Nursing Home, Day Rehab Centre Acute Hospital

P3 Female 12 Comm Hospital Comm Hospital

P4^# Female 2.5 Acute Hospital Comm Hospital

P5 Male 16.5 Day Rehab Centre, Dementia Day Care Centre Comm Hospital

P6 Female 10 Comm Mental Health Not Applicable

P7 Male 3 Comm Hospital Acute Hospital

P8 Male 25 Acute Hospital Not Applicable

P9^# Female 13 Acute Hospital Not Applicable

P10 Female 5.5 Acute Hospital Not Applicable

Participant code	Gender	Years of experience	Area(s) of practice
P1	Female	6	Comm Hospital	Comm Hospital
P2	Male	6	Nursing Home, Day Rehab Centre	Acute Hospital
P3	Female	12	Comm Hospital	Comm Hospital
P4^#	Female	2.5	Acute Hospital	Comm Hospital
P5	Male	16.5	Day Rehab Centre, Dementia Day Care Centre	Comm Hospital
P6	Female	10	Comm Mental Health	Not Applicable
P7	Male	3	Comm Hospital	Acute Hospital
P8	Male	25	Acute Hospital	Not Applicable
P9^#	Female	13	Acute Hospital	Not Applicable
P10	Female	5.5	Acute Hospital	Not Applicable

^#Had prior experience in conducting formal tele-assessments for assistive device prescription. Comm: Community; Rehab: Rehabilitation.

Table 2

Main themes and sub-themes derived from thematic analysis

Themes	Sub-themes
Therapists’ perceptions on the feasibility of tele-assessment	Perceived facilitators
	Perceived barriers
Criteria for safe and appropriate assistive device prescription via tele-assessment	Clients’ inclusion criteria
	Clients’ exclusion criteria
	Characteristics of assistive devices suitable for tele-assessment
	Characteristics of assistive devices unsuitable for tele-assessment
Practical considerations for the implementation of tele-assessment	Support from stakeholders
	Videoconferencing technology
	Therapists’ clinical and communication competence
	Clients’ and caregivers’ preferences
	Integration of a clinical practice guide into current workflows

Three themes emerged from the interviews: (1) therapists’ perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate assistive device prescription via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. The themes and sub-themes shown in Table 2 illustrate how participants evaluate facilitators and barriers, before establishing criteria and identifying practical considerations for the successful implementation of tele-assessment. As most participants worked in hospitals, the term ‘patient’ and ‘client’ were used interchangeably to identify clients.

3.1 Therapists’ perceptions of the feasibility of tele-assessment

The majority of participants were receptive toward tele-assessment as a supplement to in-person assessments. Particularly, those with experience in conducting tele-assessment reported higher confidence in conducting tele-assessment. Participants cited several facilitators outweighing the barriers of tele-assessment.

3.1.1 Perceived facilitators

A few participants recognised that tele-assessment would allow therapists to provide recommendations contextualised to clients’ natural environment as they could “look into the home environment a bit better and see its setup” (P4). Therapists could “see how clients perform different tasks and provide advice on fall prevention and home modifications” (P10). Additionally, most felt that tele-assessment would “save time and energy” (P2) as therapists “do not have to travel down” (P3) and were able to update and address queries from family members on the same call.

3.1.2 Perceived benefits to clients

Similarly, tele-assessment was perceived to be beneficial for OTs as clients and caregivers “do not have to come down [to the hospital]” (P8) resulting in “cost-savings and resource-savings” (P8). Younger clients and caregivers “might value tele-assessment” as “they generally want to be more informed” (P1) and are “tech-savvy” (P6). This included the working population who used videoconferencing platforms for work purposes during the pandemic. Hence, tele-assessment may face “less[er] resistance” (P4).

3.1.3 Perceived barriers

Apart from facilitators in supporting tele-assessment, participants recognised the value of identifying barriers as they would provide insights to facilitate integration into practice. Most expressed the need to assess clients accurately while ensuring their safety without the therapist’s physical presence when compared to traditionally in-person evaluations. Participants acknowledged that assessment components affecting safety and accuracy during assistive device prescription such as “cognition, sensation, and physical function are very hard to assess remotely” (P9). Particularly for assessments of physical function, “there might be a lot of fear and apprehension, around safety especially if someone is mobilising the patient without [the] therapist’s presence” (P4). Additionally, participants reported that both setting up and the need to navigate videoconferencing platforms would be challenging for seniors including caregivers who were digitally illiterate as “they may not be familiar with the functions [of videoconferencing platforms]” (P10) and were “not used to it” (P9).

3.2 Criteria for safe and appropriate assistive device prescription via tele-assessment

To overcome barriers of tele-assessment, participants extensively described establishing inclusion and exclusion criteria and identifying characteristics of assistive devices for a safe and appropriate prescription. Determination of client suitability for tele-assessment is dependent on clients’ needs and could be influenced by a myriad of factors, including their current statuses, familiarity with and characteristics of the assistive devices prescribed.

3.2.1 Clients’ inclusion criteria

Participants decisively acknowledged that cognitively intact clients should be included as they were able to “understand and follow therapist’s instructions” (P2). Clients who required minimal physical assistance like “contact-guard assist (steadying assistance)” (P7) and have “straightforward physical conditions” (P6) such as “orthopaedic cases or geriatric functional decline” (P7) would benefit from tele-assessment. As defined by one participant, “the criteria include patient[s] [requiring] minimal assistance” or “maintenance [cases]” (P4). Two participants also suggested that tele-assessment would greatly reduce inconvenience for clients requiring maximum assistance as “they already have difficulties coming back to the hospital because they are chairbound [or] bedbound” (P9).

Tele-assessment was feasible for clients who had prior access to occupational therapy services, such as those referred for a replacement of their assistive device as “they already know their needs” (P9). Participants also felt more comfortable introducing tele-assessment to clients for subsequent review sessions: “From a physical visit to a teleconsultation, then we can try to offer them. They are patients that we already know” (P8).

3.2.2 Clients’ exclusion criteria

Besides establishing inclusion criteria, participants recognised that setting exclusion criteria was pivotal to circumventing potential risks of tele-assessment. Clients with impaired cognition were unsuitable for tele-assessment as elaborated by one participant, “dementia patients can sometimes be quite impulsive and do not have safety awareness” (P1). Participants were apprehensive about conducting tele-assessment for clients with “fluctuating conditions” (P7), or those “who were discharged long ago” (P9) due to drastic changes in function. A few participants commented that clients who were unfamiliar with using assistive devices such as “new users and [those who] do not know [about its] functions” (P9) would require an in-person assessment. Similarly, “a physical visit is warranted” (P4) for clients without caregivers.

3.2.3 Characteristics of assistive devices suitable for tele-assessment

Simple and low-tech assistive devices could be prescribed remotely as participants did not find a need for “a physical assessment of clients’ current functional status” (P6). For example, “simple assistive devices like commode, floor mat, and long-handled reacher” (P1) would be suitable for tele-assessment. The participant (P1) added that the above-mentioned devices were of “standard sizes” (P5) and thus, do not require specific adjustments. This would minimise the risks of getting inaccurate measurements when assessed remotely.

3.2.4 Characteristics of assistive devices unsuitable for tele-assessment

Conversely, there was an agreement among most participants that “devices requiring customisations, for example, customised wheelchairs requiring adjustments to the patient’s posture, might be difficult to do a tele-equipment prescription” (P10). Additionally, high-tech and multi-feature assistive devices that “patient[s] must learn how to set up” or were “hard to learn on their own” (P8) may require an in-person assessment.

3.3 Practical considerations for the implementation of tele-assessment

Apart from establishing criteria that must be addressed to conduct tele-assessment for assistive device prescription, participants also cited several practical considerations which included (1) support from other stakeholders, (2) videoconferencing technology, (3) therapist’s clinical and communication competence, (4) client’s and caregiver’s preferences and (5) integration of a clinical practice guide into current workflows.

3.3.1 Support from stakeholders

All participants agreed that caregivers must demonstrate competency in client care and literacy for a seamless tele-assessment. Caregivers should be able to “communicate and ascertain what the patient is trying to express” (P10). Half of them also suggested exploring the potential collaboration between therapists and vendors in tele-assessment where both parties have a “shared responsibility” (P9) when prescribing assistive devices. As explained by one participant with experience in conducting tele-assessment, “home visits were done remotely, and we had a ‘Zoom’ session with the vendor”. Hence, the lack of digital literacy among clients was negligible as therapists “do not need patients to set up their devices” (P9).

3.3.2 Videoconferencing technology

Most participants identified that requirements for videoconferencing include having “good computer systems and online access” (P8). They felt that “technology needs to be optimised” and both clients and therapists “cannot have any problems [with] audio, video, and other technical-related issues” (P2). Additionally, a few emphasised the importance of having secured platforms to prevent data breaches: “A secured [videoconferencing] account will ensure that whatever information that was being shared, is held within the cloud system” (P6).

3.3.3 Therapists’ clinical and communication competence

The importance of clinical reasoning skills required for tele-assessment influenced by therapists’ experience was voiced among participants as “experienced therapists might be able to pick up the signs easier” (P6). The success of tele-assessment also “depends on how therapists facilitate patients through instruction-giving and set-up of the session” (P10), thus highlighting the additional need for effective communication skills.

3.3.4 Clients’ and caregivers’ preferences

Participants discussed how the preferences of clients and caregivers might influence the feasibility of conducting tele-assessment. Clients who “just need something that works” (P5), had no preference for the delivery mode of assessment. However, half also cautioned about the possible resistance against tele-assessment from clients and caregivers who had particular needs or are used to the “traditional way of doing things” (P8), which involves an in-person trial of the assistive device: “Some family members would want to go down [to the hospital] and measure the size [of the assistive device]” (P7).

3.3.5 Integration of a clinical practice guide into current workflows

Participants generally welcomed the idea of developing a tele-assessment guideline for assistive device prescription based on facilitators, barriers, criteria, and considerations discussed. A majority saw tele-assessment as a complement to in-person assessments due to the potential implications on the safety and accuracy of the prescription process. Hence, a guide developed according to a hybrid approach involving both modes of assessments was suggested as “once therapists ascertain the patient’s physical needs [in-person], they could follow up with tele-assessment to see how the [assistive] device could help them” (P10). Additionally, participants felt that guidelines should be relevant to specific settings to accommodate for varying workflows: “Guidelines have to tailor [to specific settings]. If you’re in a community-based or hospital-based centre, your operations and procedures can be quite different based on different settings.” (P8)

To ensure the guideline adequately supports tele-assessment in practice, almost half indicated the need for a pilot trial. As explained by one participant, “if it has been well researched and after that, trialled and tested that [its] quite good, we’ll [therapists would] all just follow [the guideline]” (P3). While organising training as a supplement to the guide “would be beneficial in orienting or introducing OTs to the existence of a new guideline” (P10) and “clarify any doubts” (P7), most participants felt it should be dependent on therapists’ needs.

4 Discussion

This is the first study to examine the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices in Singapore. Overall, participants viewed tele-assessment positively, however, practical concerns pertaining to safety and risk management need to be addressed to increase the feasibility of tele-assessment.

4.1 Therapists’ perceptions of the feasibility of tele-assessment

Consistent with a recent systematic review [17], most participants considered tele-assessment to overcome existing challenges of in-person assessments such as reducing cost and waiting times for clients, as well as increasing therapists’ productivity. Notably, tele-assessment allowed therapists to observe client-environment interactions and provide more contextualised interventions as supported by Cottrell et al. [25]. Currently, home environment assessments conducted by most therapists in Singapore are limited to caregiver reports through phone calls and photographs of clients’ homes. Therefore, tele-assessment may be particularly helpful for therapists who are unable to conduct home visits. Such benefits identified in this study contribute to evidence of the feasibility of tele-assessment implementation.

The lack of digital literacy among older clients and caregivers which adversely impacts participants’ acceptance of tele-assessment was recognised in literature [10 , 26]. Despite this, participants believed that tele-assessment would be embraced in the near future with a growing number of clients and caregivers being adept at using technology as part of post-pandemic norms. The proportion of internet users aged 50 years and above in Singapore also increased from 3% to 6% between 2018 and 2019 [27]. This promising trend is expected to continue with the introduction of nationwide initiatives by the Infocomm Media Development Authority (Singapore) such as the “Seniors Go Digital” programme and the “Digital for Life” movement to bridge the age-related digital divide. This will support the wider implementation of tele-assessment in the community.

Participants’ concerns surrounding the safety and accuracy of remote physical and cognitive assessments due to the lack of physical contact align with studies reported among clinicians [15, 28]. However, there is research demonstrating good validity and safety of such assessments [8]. It appears that therapists’ concerns could stem from inadequate support for tele-assessment [28]. Recommendations from some participants to address this could potentially include establishing collaboration between therapists and stakeholders during tele-assessment for a hybrid approach involving both tele-assessment and in-person assessment and also having reliable technological support in place. Findings from Cottrell et al. [29] showed negative correlations between practitioners’ perceived barriers and confidence when using telehealth. This reinforces the need to explore other practical considerations to address perceived barriers to tele-assessment such as clients’ suitability.

4.2 Criteria for safe and appropriate assistive device prescription via tele-assessment

This study recommended client inclusion criteria such as higher levels of independence, less complicated conditions and review cases for safe delivery of tele-assessment which aligns with the findings from other studies [12, 13]. Additionally, it could be implied that clients requiring maximum assistance are suitable as they should have some form of social support in place to manage their day-to-day care. It may be assumed that these supports would be present to facilitate tele-assessment, as noted in a study where a large proportion of homebound patients had a caregiver to assist them during tele-assessment [30]. Another study [31] identified patient factors as key features influencing the sustainability of telehealth services such as the lack of social support and poor functional statuses which supported the experiences of participants in this study. Exclusion criteria identified in this study were also consistent with research citing challenges of tele-assessment due to cognitive and communication difficulties, lack of competent caregivers [9, 30], and complex conditions [15]. Hence, pre-assessment screenings should be conducted to manage potential risks.

This study also provided novel insights into the characteristics of assistive devices suitable for prescription via tele-assessment. Simple and uncomplicated assistive devices such as commodes, floor mats, and accessory equipment were deemed suitable as such devices do not require adjustments. Conversely, assistive devices such as mobility aids (e.g., wheelchairs, mobility scooters) requiring customisations for clients with complex needs were perceived as less feasible for tele-assessment. Khoja et al. [32] shared similar views among assessors, highlighting the lack of ‘hands-on’ fitting to ensure an accurate tele-wheelchair assessment. However, existing evidence found contrasting findings on how tele-assessment might be as effective as in-person assessments for wheelchair prescription [33]. The presence of trained support staff on-site to provide clients with assistance was common in these studies and could have contributed to the effectiveness of tele-assessment. Apart from having competent caregivers to assist in tele-assessment as discussed earlier, considerations such as support from trained care staff should be explored to enhance the facilitation of tele-assessment.

4.3 Practical considerations for the implementation of tele-assessment

Half of the participants suggested tapping on the expertise of vendors in the prescription process. These vendors may mitigate limitations of tele-assessment surrounding accessibility, safety, and accuracy as they assist therapists in facilitating assessments at clients’ homes while therapists communicate through videoconferencing platforms. The results from another study [33] on the feasibility of remote wheelchair seating were comparable with in-person assessments without adverse events with the facilitation of trained care staff. Hence, close collaboration between the key stakeholders, such as providing structured training to care staff and vendors, and defining roles and responsibilities is necessary to determine the success of tele-assessment for assistive device prescription.

Consistent with the literature [34], most participants, regardless of experience with tele-assessment, expressed the need for clients and therapists to be equipped with reliable technology meeting the minimum specification requirements of secured videoconferencing platforms. Failing to meet such requirements often translates to inaccuracies in assessment findings [34], privacy breaches [18], frustrations, and decreased acceptance of tele-assessment [10, 31]. Other considerations such as service users’ preferences [31] and therapists’ competence influenced by experience in conducting tele-assessment [29] were key enablers for successful implementation. Participants in this study may value such experiences due to the additional demands required of tele-assessment, where the clinical and communication skills of therapists must be adapted while navigating videoconferencing platforms. Furthermore, the study’s findings align with the literature which found that experienced therapists who conducted tele-assessment reported higher confidence and acceptance [29]. Collectively, these findings highlighted the need for institutions to support clients and therapists with optimised and secured technology and provide relevant resources for therapists to achieve competence in conducting tele-assessment.

All participants felt that having clinical practice guidelines would be a valuable resource to conduct tele-assessment. Drawing parallels from literature, guidelines should be relevant to specific organisational workflows across settings [35] and complement in-person assessments [34]. As there are no guidelines for the remote prescription of assistive devices apart from wheelchair and seating assessments, existing in-person [36] and telehealth guidelines [37] could act as a basis for its development. Findings from this study exploring factors that would affect the feasibility of tele-assessment should also be considered when developing a guideline to be incorporated into clinical practice. Almost half of the study’s participants indicated that a pilot trial is warranted to ascertain the feasibility and relevance of clinical practice guidelines in practice. This is especially relevant in the current context of the COVID-19 pandemic or post-pandemic phase to ensure equitable and timely access to assistive device prescription for the ageing population. As research in this area expands, gathering perspectives from clients, caregivers, vendors, and institutions can support the development of a culturally relevant clinical practice guideline for occupational therapists.

4.4 Clinical implications

Given the prevalence of functional limitations amongst older adults in Singapore, accessibility offered by tele-assessment could address the growing demand for assistive device prescription, consequently allowing them to maintain functional independence and age in place. To achieve this outcome, therapists need to be equipped with reliable technology and knowledge to conduct tele-assessment [35]. Supports from institutions, such as establishing inclusion and exclusion criteria to ensure safety, providing optimal videoconferencing technology, preference for in-person or tele-assessment, and choice to attend training appear necessary to facilitate the integration of tele-assessment into therapists’ workflow and should be included as a core consideration [33]. Training should be made available to therapists who are unfamiliar with tele-assessment and protected time should be allocated for them to undergo training [15, 34]. Moreover, collaboration among stakeholders, such as clinicians, vendors, community care staff and caregivers can be explored for the implementation of tele-assessment. For instance, a joint tele-assessment by both OTs and vendors can be conducted when vendors deliver trial equipment to clients’ homes. Such arrangements may increase therapists’ productivity to meet the client’s needs and ensure safety. However, safety measures must be discussed and established to ensure vendors are competent in facilitating assessments during the product trial.

4.5 Limitations

The study’s limitations should be acknowledged. Given the online nature of participant recruitment and interviews conducted limited by the pandemic, non-verbal cues from participants may not be fully accounted for during virtual interviews. Findings from this study should be interpreted with caution as therapists who were less technologically inclined, coupled with participants with experience, may reveal different insights and challenges of tele-assessment which could have been omitted from the study. While these limits generalisability, it is imperative to study as OTs are directly involved in the prescription process and to ensure therapist acceptance for the uptake of tele-assessment into practice.

5 Conclusion

The study sheds a positive light on the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices from OTs perspectives. It explored barriers and facilitators, established key criteria and highlighted considerations addressing barriers of tele-assessment to facilitate implementation into clinical practice. Findings from the study can be used to inform the development of a clinical practice guideline for the prescription of assistive devices via tele-assessment and its reliability and effectiveness should be evaluated through a pilot trial.

Ethical approval

Ethics approval for the study was obtained from the Singapore Institute of Technology Institutional Review Board (Approval number: 2021012).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

None to report.

Footnotes

Acknowledgments

The authors wish to thank all participants for their time in sharing insights into the feasibility of using tele-assessment for remote prescription of assistive devices and contributing to the qualitative data. They would also like to thank See Sher Fen (SF) for her kind assistance in conducting and transcribing the interviews.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The supplementary material is available in the electronic version of this article: .

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