Identifying healthcare and telehealth access for people with hand spasticity

Project Summary/Abstract The world we knew prior to the COVID-19 pandemic is unlikely ever to return. Structural and behavioral changes, such as remote working, socialization, and learning, are now part of everyday life. Telehealth has emerged as a solution for health care delivery, and social connections have been maintained through Zoom, Teams, and other software applications. These are good solutions for the general population, but people with hand spasticity may not be able to use electronic devices without assistance. Spasticity, a sequela of some neurological conditions, causes tight muscles, interferes with functional movements, affects activities of daily living (ADLs), and increases caregiver burden. Moderate to high levels of spasticity cause loss of independence and even institutionalization. The goal of spasticity care is to achieve optimal independence in all aspects of life, with the assistance of others and aid of technology only as needed; however, the degree to which individuals with moderate to high levels of hand spasticity can access and draw upon technology to maintain their independence is unknown. Therefore, this application responds to the notice of special interest to investigate the impact of COVID-19 on people with hand spasticity and identify current rehabilitation needs to inform future interventions. The long-term goal of this research is to support optimal independence for people with spasticity and good quality of life. The rationale for this exploratory sequential mixed-method study, which is guided by the socio-ecological model, is to determine the impact of telehealth access on the receipt of health care and the ability of adults with hand spasticity to maintain independence. Specific aims are to: Aim 1. Identify access to health care and telehealth for adults with moderate to high levels of hand spasticity in the community. Aim 2: Identify computer literacy and barriers and facilitators to accessing telehealth for adults living with moderate to high levels of hand spasticity in the community. Aim 3: Identify the extent to which telehealth access and computer literacy affect independence for adults living with moderate to high level of spasticity in the community. Approach. Thirty adults with moderate to high levels of hand spasticity living in the community will be recruited. NIH and PROMIS tools will assess Coronavirus Impact, access to technology, upper dexterity, physical functioning, ADLs and Instrumental ADLs, psychological impact, loneliness, and social and emotional health. Using the Coronavirus Impact and access to technology tools, we will first quantify the effect of the pandemic on health care, telehealth, and independence. Then we will conduct 45- to 60-minute semi- structured interviews that will offer greater insight into telehealth literacy, its barriers and facilitators, and its impact on maintaining independence. This study is significant because it pinpoints unaddressed Covid-related experiences and concerns affecting the ability of this population to maintain independence.