Smart Home Tech-Based Intervention to Enhance Functional Independence in Individuals with Complex Physical Disabilities: Single-Group Pre-Post Feasibility Study (Preprint)
Authors: Ding Dan , Morris Lindsey , Novario Gina , Fairman Andrea , Roehrich Kacey , Foschi Walko Palma , Boateng Jessica 
Published: January 2025

BACKGROUND

Mainstream smart home technology (MSHT), such as home automation devices and smart speakers, is becoming more powerful, affordable, and integrated into daily life. While not designed for individuals with disabilities, MSHT has the potential to serve as assistive technology (AT) to enhance their independence and participation.

OBJECTIVE

The study aims to describe a comprehensive MSHT-based intervention named ASSIST (Autonomy, Safety, and Social Integration via Smart Technologies) and evaluate its feasibility in enhancing the functional independence of individuals with complex physical disabilities.

METHODS

ASSIST is a time-limited intervention designed based on the Human Activity Assistive Technology (HAAT) model, emphasizing client-centered goals and prioritizing individual needs. The intervention follows a structured AT service delivery process, including two assessment sessions to determine technology recommendations, installation and setup of the recommended technology, and up to eight training sessions. An occupational therapist (OT) led the intervention, supported by a contractor and a technologist. Feasibility was evaluated through several measures: (1) the ASSIST Functional Performance Index, which quantifies the number of tasks transitioned from requiring assistance to independent completion and from higher levels of assistance or effort to lower levels; (2) pre- and post-intervention measures of perceived task performance and satisfaction using a 10-point scale; (3) the number and types of tasks successfully addressed, along with the costs of devices and installation services; (4) training effectiveness using the Goal Attainment Scale (GAS).

RESULTS

Seventeen power wheelchair users with complex physical disabilities completed the study with 100% session attendance. Across participants, 127 tasks were addressed, with 2 to 10 tasks at the cost of $3,308 (SD=$1,192) per participant. Of these tasks, 95 (74.8%) transitioned from requiring partial or complete assistance to independent completion, while 24 (18.9%) either improved from requiring complete to partial assistance or, if originally performed independently, required reduced effort. Only 8 tasks (6.3%) showed no changes. All training goals, except for two, were achieved at or above the expected level, with a baseline GAS score of 22.6 (SD = 3.5) and a post-training GAS score of 77.2 (SD = 4.5). Perceived task performance and satisfaction showed significant improvement, with performance score increasing from a baseline of 2.6 (SD = 1.2) to 8.8 (SD = 1.0) (P < .001) and satisfaction score rising from 2.9 (SD = 1.3) to 9.0 (SD = 0.9) (P < 0.001).

CONCLUSIONS

The ASSIST intervention demonstrated the immediate benefits of enhancing functional independence and satisfaction with MSHT among individuals with complex physical disabilities. While MSHT shows promise in addressing daily living needs at lower costs, barriers such as digital literacy, device setup, and caregiver involvement remain. Future work should focus on scalable models, caregiver engagement, and sustainable solutions for real-world implementation.