Objective To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption.

Design A convergent, mixed-methods study using direct field observations, semi-structured templates, and summative content analysis.

Setting Ten neurorehabilitation units in a single health system.

Participants 3 research clinicians (1OT, 2PTs) observed ∼60 OTs and 70 PTs in inpatient; ∼18 OTs and 30 PTs in outpatient.

Interventions Not applicable

Main Outcome Measures Characteristics of RT, time spent setting up and using RT, and clinician behaviors.

Results 90 distinct devices across 15 different focus areas were inventoried. 329 RT-uses were documented over 44 hours with 42% of inventoried devices used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vitals (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately AC-powered (56%), actuated (57%), monitor-less (53%), multi-use (68%), and required little familiarization (57%). Set-up times were brief (mean ± SD = 3.8±4.21 and 0.8±1.3 for intervention and measurement, respectively); more time was spent with intervention RT (25.6±15) than measurement RT (7.3±11.2). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%). Therapists’ attention was split evenly between direct attention towards the patient during clinician treatment (49.7%) and completing other tasks such as documentation (50%).

Conclusions Even in a tech-friendly hospital, majority of available RT were observed un-used, but identifying these usage patterns is crucial to predict eventual adoption of new designs from earlier stages of RT development. An interactive data visualization page supplement is provided to facilitate this study.

David J. Reinkensmeyer has a financial interest in Hocoma A.G. and Flint Rehabilitation Devices LLC, companies that develop and sell rehabilitation devices. The terms of these arrangements have been reviewed and approved by the University of California, Irvine, in accordance with its conflict-of-interest policies. All other authors declare no competing interests.

This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research [90REGE005, 90REGE0010], the National Institute on Aging [P30AG059988], U.S. Department of Defense [W81XWH-20-1-0231], and the National Center for Advancing Translational Sciences [UL1TROO1414]. These contents, however, do not necessarily represent the policy or endorsement of any of the funding sources.

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