A scoping review of the use of intelligent assistive technologies in rehabilitation practice with older adults

Figures & data

Figure 1. Article selection process.

The article selection process for the overall scoping review represented in a flow diagram.

Table 1. Extracted data.

First Author, Country (Year)	Population Studied	Description of Technology	Study Type	Barriers	Facilitators
Various IAT Devices
Alqahtani (2019), The United States [61]	Older adults (but included 18+) and people with dementia with mobility impairments using AT.	Various assistive technologies reviewed: Powered/smart wheelchairs, exoskeletons, robots.	Literature review.	-Cost (smart wheelchair, exoskeleton, robot). -Privacy concerns. -Difficult to use. -Ease of use/don and doffing (exoskeleton). -Cumbersome technologies (weight, speed, size). -Personnel and resources in the AT sectors. -Negative attitudes towards mobility IAT.	-Addressing priorities of users (co-design). -Knowledge/ awareness of brain machine interface improved acceptance.
Bharucha (2009), The United States [45]	Older adults with dementia	Cognitive aids, physiological sensors, environmental sensors, advanced integrated sensor systems, wearable radiofrequency transmitters, proactive activity toolkit.	Review	-Most are still in the design or trial phase and not commercially available yet. -Prototype devices still have a significant failure rate. -Most AT are developed for younger people with non-progressive brain injuries. -Older adults minimize personal need when offered devices. -Health monitoring technologies raise ethical and privacy considerations.	-Cognitive aids possess customizable multimodal display and prompt delivery systems. -Physiological sensors can catch deviations from normal before it’s too late. -Unobstructed, passive devices are easy to accommodate in everyday life. -Low-cost environmental sensors for a single factor are widely available. -integrated sensor systems can provide peace of mind to caregivers.
Garçon (2016), Low-and Middle-Income Countries [26]	WHO conducted a survey on assistive and medical devices for older people (defined as older than 60 years) in six countries—China, Malaysia, Japan, the Philippines, the Republic of Korea, and Viet Nam.	Assistive health technology (AHT) and medical devices (MD).	Literature review of expert consultations.	-Lack of financial schemes for purchasing these must be addressed. -ATs fail to respond to a growing demand for innovative devices affordable devices for home-based care and for settings where no specialized human resources are available. -One size fits all approach. -Legislation has focused only on individuals with disabilities, excluding nondisabled older adults. -Being able to successfully use some AT may necessitate adaptations of the home and other environments. -Although AT for vision, hearing, and mobility are reasonably available and utilized, many of the other product categories (speech, mental, environment) are limited in their availability, not available at all in certain countries/settings, and access to AHT advice is variable. -Technology (including AHT) for older people has often been simply “overlaid” on existing systems and care approaches. -Older people may need more than one AD, for example, a hearing aid in addition to a pair of spectacles, or vice versa. But these Ats are seldom available in one place, thus creating avoidable difficulties in accessing them. -Concerns of autonomy. -Concerns of privacy. -Lack of personnel who are appropriately trained to provide AD to older people. -Many countries need much greater official awareness of older adults’ needs and preferences.	-Reduced informal/formal caregiver time. -Adaptable to increasing declines in function/capacity. -Easily integrated into daily living. -Ensure that appropriate policies that incorporate AHT and MD are adopted and implemented. -Affordability. -Products and services must meet stringent criteria to respond to the needs and preferences of older populations. These criteria are availability, accessibility, adaptability, acceptability, affordability, safety, and quality of both products and related services. -AHT services are accessible to OA, in terms of both geographical location and physical accessibility. -Having options for AT. -Promoting low-cost devices. -Education and training of health personnel are critical to deliver the best outcomes from AHT for older people. -Robust evidence of the most effective utilization of new assistive technologies for older people to provide balance to the aggressive marketing in some countries for this rapidly growing sector.
Halvorsrud (2021), Norway [92]	83 older adults, average age 85.	Various AT and IAT devices: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers.	Survey and qualitative interviews.	-Fear of causing false alarm limited the use of an embedded social alarm. -Concerns over privacy and surveillance.	-Presence of a social alarm IAT lead to a greater sense of safety.
Holthe (2018), Norway [52]	13 family caregivers of people with young onset dementia.	4 Categories of AT and IAT devices: Safety and security (Sensor technology, GPS tracker), simple user interfaces (Automatic Calender), visual reminders (Digital calender), auditive reminders (talking wrist watch, medicine dispenser with alarm).	Qualitative repeating semi-structured interviews.	-Little caregiver knowledge regarding available AT/IAT. -Process of acquiring IAT was confusing, too much information. -Some IAT too complicated.	-Good timing of provision would increase the success of incorporating AT/IAT into everyday life.
Khanuja (2018), The United States [56]	Comprehensive review of all adults over 65 then community-dwelling elderly adults who are found to be at risk for but have no previous history of falls, finally, adults who have experienced falls in the past.	Tools utilized in improving balance and gait.	Database searches.	-Cost of devices. -Underreporting of falls can delay interventions.	-Reduces the fear of falling. -Decrease incidents of falls. -Improved mobility. -Wearables and smartphone applications can provide clinicians with current and continuous assessments of gait, balance, and fall symptoms. -More precise prescribing based on data obtained through technology. -Technology allows more precise and effective screening measurements for individuals with neurological disorders or with mobility problems.
Krishnaswami (2020), The United States [4]	Older adults with cardiovascular disease.	Various IAT devices: mobile health, remote patient monitoring.	Literature review.	-Declines in cognition can limit older adults understanding of devices. -Benefits of offsite rehab through digital medians is still not well known.
Nauha (2016), Finland [107]	5 participants in an assisted living facility, average age 78, and 4 participants in a home setting, average age 78. All with memory impairment.	Various IAT devices: Smart flower stand, safety phone, GPS tracking bracelet, web chat computer, short range audio alarm connected to devices, motion sensor reminder.	Questionnaires, diaries, and logged data.	-Smart flower stand was too sensitive, several false alarms lead to abandonment. -Safety phone encountered several false alarms. -GPS tracker suffered from connectivity issues. -Battery drains quickly when smart phone/tablet devices were used.
Peek (2017), Netherlands [58]	33 community-dwelling seniors.	Various devices: personal alarm, electronic chair lift, home and personal care devices, remote controlled power socket, motorized rolling shutters, home fitness equipment, laptops, tablets, transportation devices.	Semi-structured interviews.	-Individual’s concerns about reliability, lifespan, power consumption and cost of technology. -Fear using assistive technology would make them appear old or frail.	-Family members and peers advising and supporting the adoption of technology.
Robinson (2013), United Kingdom [60]	The oldest old.	Assistive technology.	Review of current practice.	-Ethical issues around mental capacity to make decisions when prescribing devices. -Privacy concerns. -Lack of information for oldest old on available assistive devices. -Cost of device.	-Reduce accidents. -Enable independence. -Enhance quality of life following hospital discharge. -Limit need for personal assistance. -Aging in place reduces cost. -Low cost technologies proven beneficial for individuals with dementia. -Resources have been developed to help professionals disseminate information on AT.
Scott (2018), Australia [59]	Patients with sarcopenia.	Traditional devices and emerging technologies.	Review.	-Lack of access to AT. -Cost of AT. -Security concerns regarding sensitive personal health data. -Poor self-efficacy and perceptions that AT is too challenging. -Environmental factors such as poor street conditions are barriers to older adults using a walking aid. -Limited shelf life of 3D food printer materials. -Ongoing use of AT especially devices like electronic let chairs may accelerate muscle atrophy. -Mobility aids may increase falls through misuse. -High abandonment rates for using AT which may be minimized by appropriate training and monitoring of use.	-Can help minimize functional decline. -Smart home technology allows older adults to continue living independently through voice activation. -Wearables and device applications allow clinicians to access activity data remotely and monitor patient adherence. -Video gaming and virtual reality can make exercise more enjoyable. -3D food printers allow patients to make food at home and can change the texture to make it more appealing. -Regular follow-up and training can decrease abandonment, 37% to 10% abandonment.
Sriram (2019), United Kingdom [65]	2016 Informal caregivers for people with dementia ranging from 19 to 91 from 56 studies.	IAT devices for people with dementia: Assistive robots, wearable sensors, social robot, smartphone, tablets, smart calendar, smart watch, smart home management system, motion sensors, trackers.	Systematic review.	-IAT could replace the personal component of caring. -Technical familiarity. -Security concerns. -Cost.	-Safety of person with dementia is more important than their autonomy for caregivers. -IAT devices for safety, such as trackers, were most appreciated by caregivers. -IAT removes burden from caregivers. -Promotes independence for people living with dementia. -Caregiver disposition to continuously use IAT with their loved one.
Tangcharoensathien (2018), Thailand [27]	Low- and middle-income countries.	Assistive technology.	Perspectives paper.	-Lack of accessibility in low- and middle-income countries due to low demand and low supply. -High costs and lack of government funding. -Lack of trained personnel in LMIC. -Use is hindered by effectiveness and suitability; social stigma and privacy; usability and computer literacy. -Culture and language.	-Provides independence.
Tomšič (2018), Slovenia [100]	6 participants between 75-85, have had a stroke and use AT paid for by health insurance.	Assistive devices and technologies that: enabled mobility, supported social contacts and social participation, facilitated personal care, and facilitated kitchen-based activities.	In-depth qualitative interviews.	-Ageism and myths about older adults and technology. -Reduced physical abilities after stroke causing AT to be “forced” on people. -Use of devices and technologies cause stress. -Interrupts daily routine. -Causes discomfort. -Low digital literacy causing skepticism and distrust. -Poor esthetic properties.	-A social network to inspire and support learning new AT. -Assistance from a family member or caregiver when using AT. -Leads to increase independence. -Improved physical and mental well-being. -Preserved and trained cognitive abilities.
van der Cammen (2017), The Netherlands [99]	Older adults.	Assistive technology.	Information Article.	-Fear that a practitioner’s job will be replaced by technology.	-Reduce stigma around new devices and technology→ can be overcome by an inclusive design which can be used for younger and older people. -Iterative engagement with stakeholders in the design and delivery of services. -Identifying a common need and set of outcomes across care settings and with patient. -Collaboration between clinicians and designers, academia and industry.
Wang (2018), The United States [68]	Older adults who wish to age in place.	Smartphone enabled IAT (sensor, applications, wearable trackers, monitoring, tele-health) and remote monitoring.	Editorial.	-Safety. -Security. -Privacy. -Cost of the device. -Many technologies designed for younger audience and adopted to older adults. -Some IAT too complex. -Physician information overload due to the amount of data captured by monitoring/mobile/wearable IAT. -Lack of evidence for some technologies.	-Data transfer for more integrated care of older adults in multiple settings. -Interoperability of the system to receive data -ease of use. -Iterative design must be conducted, but systematically.
Xiong (2018), Canada [69]	40 Chinese family caregivers for persons with dementia, average age 62.	Various IAT and AT devices: Medication dispenser, GPS tracker.	Cross-sectional survey.	-Cost of the technology.	-Ease of installation. -Easy to learn to use. -Pleasing aesthetics. -Clear operating instructions. -Reliability. -Customizability.
Wearable IAT devices
Cherniack (2011), The United States [43]	Elderly with cognitive or neurologic disorders.	Virtual Reality.	Review of literature.	-Limited evidence that VR results in improvement of task in cognitively impaired. -Most technologies are only in the trial phase and not commercially available. -Not tested enough to prove more beneficial than other methods of assessment. -Simulators can cause motion sickness. -Head-mounted display potentially causing cataracts, eye strain, auditory injury and injury to spine/neck/head. -Cost of device. -Time to set up the device.	-VR offers greater safety than conventional testing or treatment. -Improves ADLs -Robotic animals can provide comfort and relieve agitation. -Ease of use by trainer and patient.
Hall (2019), United Kingdom [63]	146 Older adults and 10 long-term care sector staff.	Wearable garment-based fall protection device with embedded mobile connectivity, emergency alert, and data recording.	Group consultation with participants, Patient and public involvement (PPI).	-Older adults felt the IAT was unnecessary, felt they had not yet reached the point of concern. -Older adults felt the IAT was a visible sign of aging, stigma. -Aesthetic concerns override desire for protection. -People with cognitive impairments may not be able to wear the IAT. -Bulky/uncomfortable IAT limiting desire to use. -Poor connectivity to wireless networks may limit the useability of the IAT. -IAT and required accessories were expensive.	-For people with prior falls, IAT may provide reassurance/safety. -Ability to independently select garment for the IAT.
Jie (2019), The Netherlands [111]	15 people with cognitive and or physical limitations as a result of stroke, 2/3 of which were over 65.	Sensor biofeedback system to promote independence and practice gait.	Case report.		-Reminders and extra information beneficial to tester/participants. -Personalization of the device. -Font and aesthetics of the app. -Feedback from the app would provide motivation to continue rehab through the app.
Olsson (2016), Sweden [72]	11 persons with mild dementia living in their homes.	Passive positioning alarm.	Informal conversational interviews.	-Small battery limits the possibility to constant send the position. -Sense of being surveilled: ‘Big brother is watching you’. -Cost of device and who should pay. -Uncertainty as to when the “right” time is to introduce the alarm.	-Retaining autonomy. -SMS was sent to the receiver if the transmitter battery was low. -Loudspeaker function to get in contact with PwMD. -Increase relatives perceived feeling of safety and security. -Can assist if PwMD fell and needed to contact relative. -Ability to remain connected in community which increases well-being.
Rupal (2017), Canada [55]	Older adults.	Assistive exoskeletons.	Analysis of different assistive exoskeletons.	-Lack of options. -Costs. -Weight of AT. -Heavy battery when used outdoors. -Lack of comfort. -Cost concerns. -Size of exoskeleton. -Movements look robot-like (don’t want to wear in public). -General purpose or multi-purpose devices are not likely to be effective.	-Ease of equipping/taking off the exoskeleton. -Customizable for each patient (adjust amount of resistance). -Feelings of safety. -Minimal changes to home environment. -Easily integrated into lifestyle. -Feelings of independence. -Encourages physical activity. -Supports daily activities. -Ability to wear suit without help. -Testable by users before adoption. -Rent/lease options available for each exoskeleton. -Certified exoskeletons. -Long-term power supply. -Noise-free. -Durability of the device.
Thilo (2018), Switzerland [104]	15 community dwelling adults who could walk with or without aids, average age 81.	Wearable sensor enabled fall detector.	Field testing followed by qualitative focus group interviews.	-Battery life was too short: desire for a several days/weeks rather than a couple days. -Smartphone battery too short. -Connectivity between sensor and smartphone limiting: too short of a range.	-Comfort of the device when in use: size, weight and material. -Individualize color, font size and contrast of the app. -Application content was clear, comprehensible, and readable.
Sejunaite (2017), Germany [106]	Female and male patients with dementia of any kind or depressive disorder with subjective cognitive deficits were included.	The navigational device Google Glass.	Observation and questionnaire.	-Limited battery power. -Screen turns dark after 8 seconds ad needs to be double tapped.	-Easy to use. -Provide autonomy and ability to perform ADLs. -Sufficient training sessions.
Handhelds
Amlani (2019), The United States [102]	Older adults (50-80) with hearing loss and no history of middle ear pathology and passed a cognitive screening test. 15 who hadn’t used hearing device in a year, and 15 who had never used.	Smartphone based hearing amplification device.	Pre-post assessment and questionnaire.	-Bulkiness of the IAT perceived as a limitation to use.	-Trial period with the IAT produced reductions in perceived barriers and improvements in perceived benefits from the use of amplification devices in people who had stopped using amplification devices and those who never had. -Increased motivation to participate in social settings.
Arthanat (2019), The United States [62]	3 Stakeholder groups. Older adults being trained to use information communication technology (ICT), Care providers, and ICT trainers.	Handheld information communication technologies for tele-rehab delivery.	Semi-structured interviews.	-Older adult reluctance to accept innovations in technology. -Fears about competency and capacity, anxiety around privacy and abuse/scams. -Fear of breaking the device. -Lack of means to purchase. -Information overload when teaching (patience required).	-Previous experience with tech enabled current use. -Social participation with family motivated and reinforced use of ICT.
Cajita (2017), The United States [124]	65 or older and had a history of heart failure.	Mobile technology.	Survey.		-Perceived ease and usefulness of mHealth. -Easy to use, to the degree that untrained consumers could use them. -Doctor recommendation to use mHealth. -Participatory approach with older adult when designing mHealth intervention and collaborate with experts in human factors engineering.
Cinini (2019), Italy [94]	Adults aged over 65 (65-81/87) in Italy.	ICTs and caregiver robots.	Structured interviews.		-Active user engagement during the development of new technology to support OAs is beneficial to the acceptance of the tool. -Aesthetically pleasing (cute) devices more acceptable to older adults.
Emmerson (2018), Australia [123]	10 stroke patients who participated in a RCT testing an exercise program using tablet devices in upper limb rehab.	Touch screen tablet computer for upper limb rehab.	Semi-structured interviews.	-Older adults anxious when using the tablet. -New technology was difficult to use.	-Removed some caregiver burden as less supervision was required. -Use of IAT provided motivation to continue rehab. -Caregiver provision of technical support aided use.
Gélinas-Bronsard (2018), Canada [51]	10 participants. 5 AT users average age 75 and 5 caregivers average age 63.	Internet-based intervention mediated through handheld devices.	Qualitative semi-structured interviews within a needs assessment.	-Lack of ICT in healthcare institutions. -May increase physician burden, increased demand for follow-up with the same amount of personnel time.	-ICT IAT allowed participants to choose their access to interventions, easier access than conventional AT. -Physician data access, otherwise only available in person. -Remote communication through smartphone would remove transportation barriers. -Reduced caregiver burden by lowering the need for transportation.
Hawley-Hague (2020), United Kingdom [96]	Phase 1. 12 older adults, Phase 2. 5 health professionals and 8 older adults Phase 3. 7 older adults at risk of fall enrolled in a rehab center.	Motivational smart-phone app to support patient exercise.	3 phase design: 1. Analyze necessary components for app. 2. co-design app with patients and providers. 3. implement app with older adults at risk of fall.	-Smartphones may cause fear in older adults. -Arthritic patients may struggle to use smartphones. -Physicians had little experience with smart-phone based rehab.	-Personalization of exercise programs is important to patients. -Including users in designing apps encourages use. -Family support is important for building patient confidence using IAT. -App could be used to monitor activity, and physicians could provide encouragement based on this.
Imbeault (2018), Canada [54]	65-year-old woman with Alzheimer’s disease.	Calendar application on tablet.	Observations and participant journal logs.	-Choosing device as vast selection is overwhelming. -Initial intimidation/frustration using tablet. -Adoption of a new technology can be complex and multidimensional. -Tablets require an investment in time during the rehabilitation process.	-Role playing exercises to simulate using device in daily living situations. -Improvement in memory and ability to perform memory-related tasks. -Tablets are easily available.
Inskip (2017), Canada [49]	26 patients, average age 71.5, undergoing pulmonary rehabilitation and 26 healthcare providers, average age 43.	Smartphone mediated telehealthcare for pulmonary rehabilitation.	Focus groups.	-Professionals fear technology enabled communication can increase workload. -Professionals may lack expertise in using tele-rehab.	-Biosensors can provide feedback to patients about rehab and exercise progression. -Tele-health based rehab could be more customizable. -Improve access to those who may be geographically isolated from rehab services.
Isaković (2016), Slovenia [126]	Persons with diabetes (50+).	DeStress Assistant (DeSA) (diabetes application).	Adapted questionnaire.	-Use of images as buttons confuses people. -Lack of assistance when introducing the AT. -AT developed without involving older adults (high usability barriers common when OA not involved in whole process). -Fear of technology. -OA more hesitant to click around on the app to figure things out, worried they would break/undo something.	-Including a ‘welcome wizard’ to introduce an app. -Large text. -High contrast between text and background (visibility). -Input checking (ensuring no errors). -Caregivers are also trained in using the AT. -Combine symbols and text. -Built-in accessibility support on modern devices can make apps more usable. -Helpful tips and explanations the user can access if they forget how to operate the app.
Jørgensen (2018), Denmark [97]	14 , average age 65.3, 9 with Rheumatoid arthritis, 4 had Psoriatic arthritis, 1 had ankylosing spondylitis.	Sensor enabled medication injector for arthritic diseases.	3 phase design approach: concept mapping, participatory design, stakeholder evaluation. Focus group and individual interview data collection.	-Concerns around privacy and monitoring.	-Aesthetics of the device. -Portability of the device. -Ergonomics of the device, handleability for people with reduced hand mobility. -Reminders for medication delivery. -Easy legibility.
Kringle (2019), The United States [119]	5 community dwelling people between the ages of 57 and 81, who had had a stroke.	Smart phone/tablet mediated mobile rehabilitation service, iADAPTS, designed to aid stroke survivors with goal setting.	Descriptive case series.	-Due to lack of familiarity, some participants required additional training. -Memory impairments made using the application/device difficult.	-Prior use of technology.
Lemke (2019), New Zealand [103]	6 people had recently experienced stroke, between the ages of 60 and 82.	Smartphone ICT devices used in everyday life and rehab.	Semi-structured interviews and observations.	-Fine-motor skill impairment from stroke make use challenging. -Large/bulkiness of the device further limits use due to motor impairment. -Speed impairments.	-Larger font for those with visual impairments.
Maidment (2019), United Kingdom [53]	20 adults, average age 62.25, 13 males, with mild to moderate hearing loss.	Smartphone mediated/connected hearing devices.	Device trial and semi-structured interviews.	-Lack of awareness of the existence of IAT devices. -Perception that technology is for younger generations. -Smartphone mediated device was cumbersome to use. -Cost of the device.	-Previous experience with technology aids the use and uptake of IAT. -Simple and intuitive design enables use. -Adjustability of the IAT device. -Smartphone component of the IAT may remove stigma of hearing loss and hearing aid use.
Mallet (2018), Canada [120]	33 people who had recently had a stroke, average age 69.5.	Tablet based post-stroke communication therapy device.	Open ended survey.		-Training and assistance is helpful to promote patient use.
Martín-Lesende (2017), Spain [78]	Adult housebound patients with heart failure and/or chronic lung disease with a history of at least 2 hospital admission in the previous year.	Telemonitoring using smartphones to a specific Web-platform.	Daily self-monitoring, and questionnaire.		-Decrease in hospital admissions and emergency department attendance. -Reduction of length of the hospital stays. -Early detection and treatment of exacerbating factors. -Healthcare professionals and patients/relatives high level of satisfaction with telemonitoring.
McGrath (2018), Canada [64]	19 participants. 10 older adults with age related vision loss, 6 caregivers, 1 healthcare provider, and 2 industry professionals.	Low-vision assistive devices.	Field notes from a technology workshop including: show and tell, technology interaction, and app assessment	-Poor usability may lead to abandonment -Lack of portability may lead to abandonment -Lack of training may lead to abandonment -Concerns of privacy when using apps -Many low vision aids were prohibitively expensive	-Simplicity and intuitive design. -Large print buttons. -Aesthetics of low vision aids: discrete, fashionable, non-obtrusive.
Ng (2017), Canada & USA [57]	(a) patients adopting the connected hearing aid, and (b) professionals adopting the connected hearing aid.	Smartphone-connected hearing aids.	Semi-structured interviews and grey literature.	-Cost of the device. -Clinicians perception of candidacy heuristics. -Patient frustrations related to smartphone integration and increased effort to manage their devices. -Fear of surveillance and privacy.	-Patient’s comfort and competence with their smartphone. -Improvements in the technology. -Spent more time with patients and got to know them better based on questions asked for prescribing purposes. -Hearing aids when linked to technology reduced stigma and increase use.
Okonji (2019), Nigeria [25]	443 people between 20 and 92 with visual impairments, average age 60.	Assistive computer technologies.	Qualitative interviews and questionnaire.	-Lack of interest. -Self-perception of not needing the IAT. -Lack of training. -IAT devices not available. -High cost of IATs.	-Training programs for IAT use could increase use. -IAT tailored to the environment of the user. -Caregiver training.
Øksnebjerg (2020), Denmark [88]	112 participants dementia, average age 68, and 98 caregivers.	Dementia management app for mobile devices.	Use patterns, qualitative survey, and log data.	-Difficulty using the device led to non-adoption.	-Time from diagnosis impacts adoption of IAT, shorter interval more likely to adopt. -Caregiver participation in the IAT use lead to greater acceptance for participants.
Philips (2018), Belgium [50]	18 people with cochlear implants above the age of 60.	Application for cochlear implants mediated through handheld tablets.	Baseline questionnaire and follow-up.		-Motivation of the participant. -Choice/autonomy in how the app was used. -Accessibility of the app.
Pludwinski (2016), Canada [110]	People with T2D (mean age male = 63.5, mean age female = 55.8).	Smartphone software for management of T2D.	Semi-structured interviews.	-Comorbidities that conflict with management of diabetes.	-Ability to share health data. -Training on how to use the AT. -Reminder messages. -Increased self-awareness. -Quick/immediate feedback from a health coach on diet choices. -Encouragement from a health coach. -Health coach support reduced feelings of isolation. -Increased happiness. -Feedback specific to individuals. -Health coach gave feelings that someone was “always watching”, which increased accountability. -Educational moments with health coach (i.e., exercise suggestions, diet suggestions to maintain blood sugar). -Increased control over condition. -Motivation outside of app activities (joining other programs). -Strong relationship developed with health coach.
Quintana (2020), Spain & Sweden [105]	19 persons with cognitive impairment and their caregivers, average age 77.5.	Tablet mediated app for mild cognitive impairment.	Clinical usability test followed by four-week home app testing.	-Fear of using tablets and mis-clicking. -Tablet was too small.	-Familiarity with similar technologies. -Portability of small tablet. -Thorough introduction to the app crucial to facilitate use.
Raghunath (2019), The United States [98]	Twenty people with varying levels of cognitive ability, above the age of 54.	Tablet mediated memory notebook app incorporating distributed smart sensor.	Logged app data, questionnaires to assess satisfaction and usability and qualitative participant feedback.		-Iterative design reduced the amount of time it took to complete tasks. -User interface being large enough to be intelligible and interact with. -Simple verbiage in instructions. -Simplified to improve ease of use. -App provides motivation to support continued use.
Rawstorn (2018), New Zealand [108]	162 people with coronary heart disease, 82 of which were allocated to receive the intervention.	Sensory enabled IAT for exercise based telerehabilitation of coronary heart disease.	2-arm noninferioiry randomized controlled trial.	-Battery life challenging. -Poor connectivity: Bluetooth and wireless. -some participants would have valued additional supports during the intervention and after transitioning to independent use.	-Ease of use of the sensor. -Comfort of the sensor. -Desire for app function that would facilitate social interaction. -Flexible accessibility. -Individualized approach to prescribing exercise increased motivation to adhere.
Reyes (2018), Canada [116]	Mobile applications focused on balance.	Balance apps.	Mobile Application Rating Scale	-No instructions on app usage or provide background information about balance. -No Android balance apps available limiting accessibility.	-Gamification and score sharing through social media engaged users. -App customization. -Advanced graphics and auditory design. -Detailed written and audible instructions for app usage and balance information.
Seaborn (2016), Canada [70]	Older powered chair users (55+), majority above 60.	Mixed reality games that involve power mobility and modern facilitating technologies, such as tablets and smartphones.	Focus groups, Questionnaires.	-Stigma around using a powered chair. -Machine makes loud noises that can be embarrassing. -Highly sensitive controls causing unintentional movement. -Concern for safety. -Environmental barriers. -Hinders social life. -Older individuals perceive technology as something for younger people. -Privacy concerns. -Lack of support from family (i.e., family not confident in their ability to learn about tech). -Believed new technology would be too expensive. -Perceived difficulty in learning new tech. -Inability to use most smartphones (because of poor grip, poor vision, inability to use touchscreen).	-Ease of use. -Use without assistance. -AT that allows family/friends to see patient’s perspective. -AT that facilitates interaction with friends/family. -Learning activities turned into games (learning how to use powered chair in tricky situations). -Being shown what to do rather than told. -In-person training on powered chair use. -Initial uncertainties can be alleviated by demonstrating the tech to the patient. -Increasing awareness of low-cost versions of devices and providing senior discounts.
Searcy (2019), The United States [114]	Adults with cardiovascular disease.	Smartphone mediated mobile health tools for cardiac disease and rehabilitation.	Literature Review.		-Mobile health technologies can increase participation in cardiac rehabilitation. -Remote monitoring allows physicians to consult with patients virtually.
Smallfield (2017), The United States [42]	10 participants who are 65 or older, self-identify as having a low vision and use at least one optical magnifier.	Low vision devices.	Semi-structured interviews.	-Progressive nature of low vision causes nonuse to occur. -Participants not receiving training on the device.	-Benefit from technology that accommodates for progressive visual decline.
Span (2018), The Netherlands [125]	People with mild to moderate dementia.	The DecideGuide, a responsive web tool for supporting shared decision-making in a dementia context.	Semi-structured interviews and focus groups, field notes, observational records, and a logbook.		-Can provide greater autonomy for the user. -Facilitates communication. -When people with dementia were helping with the design they showed no signs of distress using the device.
van den Houten (2018), The Netherlands [80]	Intermittent claudication patients currently under supervised exercise therapy with a physiotherapist.	Smart phones apps.	Questionnaires.		-Being younger and having higher education facilitates use. -Track physical activity and life style information for patients and PT to review.
Virgili (2018), Italy [67]	Older adults with low vision, average age 71.	Low-vision aids.	Cochrane review with pooled fixed-effect model.	-Portable near vision aids could not be proven more cost-effective than comparators. -Cost when compared to the short shelf life of LVA IATs.	-Decreased difficulty of use with portable devices. -Portability. -Usability. -Ability to tailor the use of the LVA to different viewing situations. -User training.
Zhou (2019), China [91]	118 people with recent stroke, average age 64.	Caregiver mediated smartphone application for stroke rehabilitation.	A multicenter prospective, randomized open, blinded outcome assessed, controlled trial.	-Provision of care with application could not be proven more effective than conventional care.
Mobility Aids
Krishnan (2014), India [47]	Older adults with mobility limitations.	Mobility assistive devices and self-transfer robotic systems.	Review.	-Automated wheelchairs that rely on environmental cues can fail to work due to damage to guidance system. -For the ROAD robot, patient can only travel in a predetermined path. -Safety risks such as patient slipping through robot arms. -Assistive device can only perform a specific task. -Assistive devices that hang from the ceiling require infrastructure modifications. -Cost of the device. -Some are only prototypes and are not yet commercialized. -Battery life. -Fear of older adults to use devices. -Complexity of device.	-Leveraged freedom chair provides enough torque to conquer steep hills and soft grounds. -Voice command or eye control for those who cannot use their hands. -Decrease caregiver burden and injury. -Provide independence in ADLs. -ROAD robot provides better balance and less risk of collision with the subject.
Distributed Systems
Berridge (2019), The United States [131]	Older adults and their adult children. All had multiple chronic conditions.	In-home surveillance technologies. Distributed systems. Trackers.	Structured interviews.	-Older adult concerns over privacy for the use of wearable sensors and web-enabled surveillance cameras.
Braley (2018), The United States [118]	Persons with dementia, average age 74.6. average mild dementia.	Distributed sensor and computer enabled prompting system to aid PWD in completing IADls.	Observation.	-Task completion failed when prompting system was not specific enough to the user (not accounting for level of impairment or type of prompt needed). -Level of impairment impeding prompt recognition from participants.
Chan (2008), France [46]	Older adults and disabled peoples worldwide.	Smart homes.	Review.	-Still in development or trial. -Not used in practice so barriers have not been uncovered. -Provider being unsatisfied with device. -Importance of reliability of measurement systems. -Consistent habits are necessary for the system to work. -IR sensors only effective if the subject lives alone. -Challenge of interoperability among different systems. -Lack of standardization and licensure requirement causing confusing legal issues for telemedicine→no specific legislation in Canada.	-Better quality of life through independence. -Technology that can control multiple elements throughout the house. -Can notice functional decline and call for intervention. -Being discrete, quiet, passive and fully automated. -Easy to use and data easily acquired. -Continuous monitoring. -User has ability to cancel false alarms. -System that includes adjustable reminders. -Collect data on patient that clinicians can access remotely. -Improve medication and health care compliance rate. -Waterproof. -Long battery life. -Humanoid robots could serve as companions and pet robots could be a source of entertainment. -Robots with legs to navigate rough terrain. -More cost-effective than placing people in healthcare institution.
Choukou (2021), Canada [130]	Community dwelling older adults, caregivers, rehabilitation professionals.	Ambient assisted living technologies: pressure sensors, activity sensors, monitoring technologies.	Scoping review.	-There needs to be a common framework to evaluate AALT IATs that take into account the interests and concerns of intended users.
Etingen (2018), The United States [122]	Veterans with a spinal cord injury or disorder.	Environmental control unit.	Questionnaire.	-Device or its features not working. -Unreliability of internet. -Lack of training on device.	-Provides independence. -Easy to use.
Evans (2016), The United States [84]	Older adults 55 years of age and over with and without heart failure.	An integrated, real-time monitoring system, telehealth system.	Questionnaire.	-Attitudinal/cognitive barriers to technology. -Constant wireless connection necessary.	-A clear medical reason for adopting the AT. -Emphasis of importance of AT by physicians. -Medical trends increase adoption and adherence of AT (i.e., used a weight scale often because of the trend of weight and health). -Support and training.
Hattink (2016), Netherlands, Belgium, & Germany [81]	Persons with either mild cognitive impairment (MCI) or dementia and informal caregivers (62-96).	The full Rosetta system consisted of the following three subsystems designed to support people throughout the disease process, and on different need domains: The Elderly Day Navigator (EDN); The Early Detection System (EDS) software; The Unattended Autonomous Surveillance system – Advanced Awareness and Prevention – System (UASAAPS).	Semi-structured questionnaires.	-People like the system but still too many glitches to implement it successfully. -OA found it hard to understand components (system is too complicated). -Concerns of privacy: “what are these people installing in my house?” -Discomfort when red light on camera turns on. -Outdated graphics. -Reception issues with mobile devices. -Components of the system don’t meet expectations (i.e., supposed to detect falls but will not if person continues to move while on the floor).	-Availability of technical support if something malfunctions. -Safety and comfort (i.e., caregivers felt comfort knowing that there was “an extra set of eyes” on their loved one). -Keeping the person at home longer. -Training on the use of the device. -EDS (sensors in home) that are unobtrusive (i.e., not aware that you are being monitored). -EDS allowed caregivers to track sleeping/eating habits Promotes feelings of self-sufficiency.
Maia (2019), Brazil [86]	4 studies including older adults with dementia.	4 types of IAT: nighttime monitoring, voice command technologies, multifunctional distributed system, navigation assistance robot.	Systematic review.		-Caregiver involvement is important during development. -Verbal prompt system, improvements in medication management for those with cognitive impairments. -Verbal prompt system improved ADLs. -Multi-functional system reduced caregiver burden and increased trust and safety.
Stefanov (2004), International [73]	Older persons and persons with physical disabilities.	Smart houses and other AT.	Review.	-Wheelchair-mounted robots are heavy and wide. -Cognitive load of user can become reduced if robot does most tasks. -Rehabilitation robots have highs cost. -Rehab robots have low efficiency. -Sensor system for automatically guided wheelchairs are complex to install. -Many devices only prototypes and tested with nondisabled people. -AT difficulties in recognizing human intention.	-Feels like a normal house not part of a hospital/assistive care facility. -Improve quality of life. -Reduce medical care costs per person. -Can be used preventatively for early recognition of health issues. -Improves communication to facilitate verbal communication between nondisabled people and those with speech and hearing disorders. -Virtual reality systems can provide emotional relief.
Situation Specific Robots
Bedaf (2015), The Netherlands [44]	Independent living elderly people with no cognitive decline.	Robot designed for elderly or smart technology if able to perform physical activity.	Systematic review.	-Limited available on the market. -Questionable whether robots that focus on self-care or fall detection or interpersonal interactions are the best option for these domain as not cost effective.
Bedaf (2018), The Netherlands [101]	Older adults 60+ with no cognitive decline, living at home, receiving, home care. Also informal and professional caregivers.	Care-O-Bot, a supportive robot with embedded sensors capable of supervising environments in real time.	Survey and interviews.		-Supportive robots should mirror human interactions, adapt to differences in the individual (not one size fits all).
Bedaf (2019), The Netherlands, France, & United Kingdom [113]	Older adults aged 60+, living at home and receiving homecare. Informal and professional caregivers.	Care-O-Bot, a supportive robot with embedded sensors capable of supervising environments in real time.	Focus groups.	-Patient environment would require modification if a robot were to be introduced. -Robot was not aesthetically pleasing.	-Robot should be adjustable to the user’s preference. -Desire for physicians to have access to recorded data housed on the robot.
Crea (2017), Italy [82]	Post-stroke patients (avg 71).	NEUROExos Elbow Module exoskeleton (NEEM System).	Clinical assessment and questionnaire.		-Decreased effort for therapists (including supervising multiple patients at once). -Repeatability of treatment. -Optimization of healthcare resources. -Aid in recovery assessment.
D’Onofrio (2018), Italy & Japan [117]	17 older adults with mild or no cognitive impairment, 36 informal and formal caregivers.	Social robots.	Pre-structured interviews.	-Older adult inability to manage the device. -Fear of robots replacing people.	-Robot should be individualized to the participant. Individualized approach to aiding cognitively impaired goal setting.
Eftring (2016), Sweden, Austria, & Greece [74]	Seniors living alone, 70 + years old, who in the near future will need assistance in order to be able to stay in their own homes.	Social assistive robot.	Participatory action research (Questionnaires, interviews)	-User requirements that could not be fulfilled were: -The robot should be able to grasp objects from high shelves, e. g. sheets from high cupboards (due to stability problems or size). -The robot should be able to carry shopping bags from the grocery store (due to project limitation). -The robot should be stable so it can give mobility support (due to stability problems, size and risk of injuries using a prototype alone). -High reliability (due to sensor reliability when sensors were adapted to fit inside the robot head and due to programming complexity). -Size of the robot (should be able to fit through narrow doorways). -Terrain gets in the way (i.e., carpet, outdoor barriers). -Robot prototypes are expensive to develop and lab set-ups are too simplified to detect and solve problems in real life.	-Multimodal interaction to meet the needs of the hearing/visually impaired (e.g., touchscreen, speech and gestures, messages verbally and visually communicated) -Completion of tasks the patient would be unable to do alone. -Reliability. -Appealing and easy to use. -Appearance of the robot (anthropomorphic features including emotional expression, not looking down on the person interacting, soft with no sharp edges, easy to clean, neutral colours). -Ergonomic positioning of the touchscreen. -Ability to search for and pick up objects. -Although they enjoyed social interaction with the robot, the touchscreen was more reliable so was used more. -Ability to clear the floor of objects (fall hazards), show and check physical exercises, transport objects between rooms, remind patient to take medication/drink water, provide a safety checklist about how the senior could improve safety in the home. -Increase feelings of safety by: searching the person 3h after last interaction, making an emergency call to a list of pre-defined phone numbers, calming the user in an emergency, reminders for important meetings (i.e., doctor). -Adaption to individual preference. -Decreased feelings of loneliness.
Fan (2016), The United States [83]	Community-residing older adults, some with MCI or dementia (66-94).	A multi-user engagement-based robotic coach system architecture (ROCARE).	Survey.	-Speech recognition for few phrases, have to speak loudly and doesn’t recognize accents.	-Adaptable to each individual. -Able to measure recovery. -Informal caregivers can operate the AT Involves family/friends in rehabilitation.
Fiorini (2019), Italy & The Netherlands [93]	20 older adults and 34 informal and formal caregivers.	Assistive robots for older adult independence.	Semi-structured interviews.	-Resistance from older adults due to still feeling independent. -Fear of becoming more dependent if using a robot. -Fear that social contact with caregivers will diminish as the robot fills that role. -Robot is obtrusive and may attract unwanted attention to the older adult. -Caregivers fear robots will diminish social contact.	-Robotic aid can help to motivate older adults. -Robotic aids, that can call for help, help foster a sense of security. -Reduce caregiver burden. -Easy to use interfaces, otherwise demotivating if complicated. -Personalized behavior.
Franceschini (2018), Italy [128]	Stroke patients aged 18 and 80.	Upper limb Robot assisted Therapy.	Demographic and clinical records and clinical assessment.	-Greater impairment and disability.	-Provides independence. -Having fine motor skills.
García-Soler (2018), Germany, Italy, & Spain [95]	215 participants. Older adults, family caregivers, professional caregivers, and health professionals.	Semi-autonomous service robot for domestic environments.	Interviews and focus groups.		-Including stakeholders in the design and decision-making portion of robotic assistant development is essential to establishing the functionality of a robot. -Remote access to records. -Customizable on/off system.
Gerling (2016), Austria [112]	older adults with cognitive impairment, therapists in the long-term care home.	robotic pacesetting for an indoor walking group.	Focus groups.	-Older adults preferred human assistance in terms of cooking, personal hygiene and leisure activities. -Inviting residents to engage with technology in a social setting was problematic (e. g. participants felt self-conscious). -Concerns of privacy. -Participants forgot about their plan of action during navigation through the menu due to dementia and thus needed support from the therapists. -There were several instances in which technical problems impacted therapists perception of the robot. -Many participants were anthropomorphizing the robot in terms of abilities to hold a conversation. -People in wheelchairs cannot easily get out of the way of a robot and people using a walking aid are limited in their agility and ability to circumvent a robot.	-Older adults prefer robot assistance for instrumental tasks, such as housekeeping (e.g., garden work and cleaning), for manipulation of objects (e.g., picking up and moving heavy items, finding and fetching items) and reminder functions. -Appreciated the entertainment function of the robot and feedback showed that the robot had a positive influence on the participating older adults, animating them to sing or dance along, clapping their hands or whistle to the rhythm of the music. -Increases motivation and participation.
Huang (2021), Taiwan [129]	36 older adults, average age 72, who live independently.	Assistive robots for ADL support.	Interviews and questionnaires.		-Robotic IAT can aid in loneliness and socialization. -Perception that robot can help with most ADLs.
Hudson (2020), The United States [127]	20 lonely community dwelling older adults, average age 76, who use a robotic pet.	Robotic pet.	Semi-structured interviews.	-Use of the pet may be stigmatizing.	-Can have a robotic pet in locations where a live pet may not be permitted. -Pet was easy to use and interact with.
Lo (2019), Australia [75]	213 stroke patients above the age of 18 who used robotic devices. 4 of 5 included studies had participants predominantly over the age of 60.	Any robotic device: robotic exoskeleton, end-effectors.	Systematic review.	-Conventional therapy favored over robotic in mild and moderate stroke patients.	-Lower cost for robotic therapy when compared to conventional therapy for 4 of 5 studies. -Dominance ranking shows that the majority of the robotic rehab interventions should be favored. -Weighted cost benefit shows that the robotic interventions are moderately dominant over conventional for all but mild/moderate patients. -Weighted health benefit shows robotic interventions are dominant.
Melkas (2020), Finland [115]	Older adults in care homes and geriatric rehabilitation hospital, 40 care workers (n = 35) and clients (n = 5).	Care robot.	Semi-participatory observation sessions and focus group interviews, analyzed using a qualitative Human Impact Assessment approach.	-Excessive time and personnel resource requirements. -Robot too small for older adults with vision impairments. -Robot to quiet for older adults with hearing impairment. -Care provider attitudes towards the use of technology in rehabilitation. -Fear from clients.	-Reduce care provider burden, allows them to outsource some labor onto the robot.
Mordoch (2013), Canada [89]	Dementia patients in long term care.	Social robots.	Literature review.	-Evidence isn’t strong. -Unsure how to fully utilize the robot. -Decrease staff burn out. -Ethical considerations.	-Increase social interactive behavior. -Regulate anxiety, depression and agitation. -Decease in stress. -Improved neuroactivity. -Improved mood. -Provide motivation. -Substitute for real animals that are not allowed in facilities.
Nasr (2016), United Kingdom, Italy, & The Netherlands [85]	Ten stroke survivors and their family carers (60-77).	A to-be-designed robotic technology for home-based rehabilitation of the hand and wrist.	Cultural probes and interviews.		-Feelings of normalcy. -Ability to be independent. -Ability to perform ADLs. -Confirmation from therapists (and family) that they are improving and doing well. -Hopes to regain abilities. -Device ability to facilitate interaction with professionals was motivating and desired. -Willingness to try new technologies. -Involvement of end-users is critical to surmount implementation problems. Those with tech experience before their stroke had better attitudes towards home rehab systems, see it as enabling their independence. -Stroke patients very motivated by the potential to regain capacities. -Tech needs to incorporate goals, give feedback, enable competition with other patients, have constant feedback with health care: human interaction very important for motivation.
Pradhan (2021), India [48]	People undergoing rehabilitation for various ailments: brain injury, chronic pain, stroke, tremor.	Internet of Things technologies and robotics.	Literature review.	-Cost of robotic rehab is still higher compared to alternatives. -People with limited mobility cannot visit hospital frequently to utilize the tech.	-Augmented reality could increase engagement and participation in the rehabilitation process. -Remote access may improve accessibility.
Swinnen (2017), Belgium [90]	(1) stroke patients who have experience with RAGT (avg 65) (2) stroke patients who have no experience with RAGT (avg 67) (3) therapists who have experience with RAGT (avg 38).	robot-assisted gait training (RAGT).	Questionnaire	-Feelings of nervousness/tension/pressure when using AT. -Time consuming to set up (takes time away from therapy).	-Easy for therapists to learn. -Easy for patients to learn. -Interest and enjoyment in product. -Perceived competence in using the AT. -Patient effort in therapy. -Perceived value and usefulness. -Ease of use. -Satisfaction with preliminary results (improvements). -High motivation to use the AT. -Easy to remember how to use the device after initial training.
Tedesco Triccas (2018), United Kingdom [87]	21 people who had experienced a stroke with upper body impairments, mean age 64.2.	Upper-limb robot rehabilitation therapy using transcranial direct current stimulation (tDCS).	Face to face interview using open and closed questions.	-tDCS component of the IAT made participants feel as though they looked odd. -Robot therapy tiring, frustrating, difficult. -Poor graphical design of the computer game potion of the IAT. -tDCS component cumbersome.	-Upper-limb therapy perceived as being the source of most benefits, compared to tDCS. -Therapy may have improved ability to perform some ADLs: dressing.
Tuisku (2018), Finland [66]	39 healthcare personnel who had experience with the IAT, and the general public.	Social/exercise robot.	Empirical case study.	-Cannot replace human contact. -Cost of a robotic tool compared to income. -Safety of care when using a robotic IAT. -Fear of robotic care from the public and care providers. -Time required of care providers to learn how to use IAT.	-Care providers support the use of robotic IAT in their practice.
van Patten (2020), The United States [79]	Older adults with dementia.	Home-based cognitively assistive robots.	Literature review.	-Fear of robotic devices due to media. -Older adults are slower to adopt to new technologies. -Assistive device use may be stigmatizing, signals dependency and fragility. -Robots which are too large and too human-like may cause uneasiness. -Substitution for human contact. -Privacy concerns.	-Home robots can reduce healthcare utilization. -Interactions with people who use robots/robots may reduce reluctance to use. -Younger people may be more accepting of robotic devices as they enter old age. -Ease of use. -Adjustability. -Small size. -Anthropomorphic design. -Behavior/mood matching. -IAT robots provide motivation. -Reminder functionality desirable for those with cognitive impairments.
Wang (2017), Canada [76]	Older adults with mild-to-moderate Alzheimer’s Disorder and their caregivers.	Customed designed Assistive robots to provide tele-operated stepwise prompting.	Semi-structured interviews.	-Concerns about reliability and maintenance. -Caregivers questioned whether it could adapt to the varying degree of users. -Cost-effectiveness. -Preference for assistance from a human. -Person with AD concerned the robot will replace the social interaction she has from family while she is still cognitively aware. -Stigma associated with using assistive device.	-Robot’s embodied physical presence can help to make interactions more socially engaging, effective, and acceptable. -Prevented a move to a care home. -Social presence of the robot could induce feelings of comfort for the older adult. -Beneficial for context specific activities ex. dressing. -Decrease conflict between caregiver and person with AD.
Werner (2020), Germany [121]	25 older adults, average age 77.9, who were dependent in bathing.	Sensor enabled assistive bathing robot.	Quasi-experimental single-group pre/post assessment.	-Cognitive function impacts gestural ability for IAT use. -High gerontechnology anxiety impacted ability.	-Training was highly beneficial to ability to use bathing IAT.
Wu (2016), France [77]	Older adults (63-88 years) with mild cognitive impairment (MCI).	Assistive robot.	Focus groups and interviews.	-Lack of trust in robots. -Did not see added value for robots if functionalities could be fulfilled by existing systems (diary, cell, GPS). -Makes them feel like their life is terminated. -Perceived to be for ‘people who are very handicapped’. -Associate the robot with disability and loneliness (stigma). -Wanted human presence/contact (i.e., robot cannot replace therapist). -Considered a necessary evil as there is a lack of caregivers to care for older adults. -Robot diminishes autonomy (deskilling by doing everything for them). -Shift from independence to service use is a big change. -Fear of social isolation if using robot. -Robot seen is non-human, cannot establish a relationship. l	-Robots as helpers. -Provides cognitive stimulation. -Motivation and encouragement to do cognitive exercises.
Yasuhara (2019), Japan [109]	Older adults who use caring healthcare robots.	Caring healthcare robots.	Review.	-Legal frameworks develop slowly. -Potential leak of personal data.	-Mimic human speech. -Engage in touching. -Appearance that causes familiarity but does not cause aversion. -Conform to safety standards.
Yurkewich (2019), Canada [71]	Five acute and chronic stroke survivors with hand impairments.	Wearable robotic orthosis glove.	Co-design and clinical assessment.		-Co-design. -Motivation to perform daily tasks and independence. -Portability. -Light weight, non-fatiguing. -Affordability.

Table 2. Themes and sub-themes.

Accessibility	Effectiveness	Usability	Staff Considerations	Patient-Centred Considerations
Awareness and access	Cost-Effectiveness	Participatory approaches to designing IAT	Role in prescription	Patient’s environment
Cost	Effectiveness for Health Systems	Design features	Staff training	Motivation
	Effectiveness for Older Individuals	Individualized, adjustable AT	Staff knowledge and awareness	Beliefs and attitudes
		Patient training and support		Stigma

Table 3. Accessibility summary.

Accessibility
	Barriers	Facilitators
Awareness and access	-Low access to products in development. -Geographical disparities in access. -Low client awareness of IAT devices. -Variety may be overwhelming.	-Computer/internet-based services easily accessed. -Low-cost widespread components, such as single-factor sensors. -Institutions could own and provide greater access to expensive devices through leasing to patients.
Cost	-High cost produced barriers to accessing devices. -Unclear insurance coverage exacerbated costs of IAT devices.	-Affordable devices, such as a wearable robotic glove, were considered facilitators to use. -Designing technologies to be low-cost and providing discounts enable use. -Fast transitions from research to practice mitigates high costs for robotic devices.

Table 4. Effectiveness summary.

Effectiveness
	Barriers	Facilitators
Cost-effectiveness	-Cost-effectiveness reports were mixed. -Unclear data could impede implementation in the health system.	-Devices which delay institutionalization could be more cost effective.
Effectiveness for the health system	-Lack of evidence for some intervention types, such as mobile and connected technologies.	-IAT found to reduce: hospitalization, emergency department visits, healthcare utilization, and length of stay. -Able to track clinical outcomes. -Robotic stroke rehabilitation favoured over conventional delivery for patients with severe disability.
Effectiveness for older individuals	-Timing of device provision impacts successful incorporation and use. -Uncertain outcomes for robot assisted rehabilitation devices. -Some studies found IAT rehabilitation devices were not more beneficial than usual therapy.	-Several devices show effectiveness in improving activities of daily living.

Table 5. Usability summary.

Usability
	Barriers	Facilitators
Participatory approaches to designing IAT		-Including end-users in the design process can improve implementation. -Iterative and participatory design process including user and caregivers.
Design features	-Devices being aesthetically unpleasing increases resistance to use. -Short battery life. -Devices which were too anthropomorphic caused uneasiness. -The degree of a patient’s disability may limit their ability to use IAT, such as hand impairments when using touchscreens.	-Universal design to ensure technology is ambient, discreet, and unobtrusive. -Simple and intuitive design. -Portability. -Robotic IATs should be small, slightly anthropomorphised, possess the ability to communicate, and maintain safety standards. -Individualized prompts and patient reminder functionalities. -Interoperability and communication with the broader health system. -Easy to use interfaces.
Individualized, adjustable AT	-Devices designed for a younger population may not adapt well to use by older adults.	-Adjustability of interventions to suit each patient.
Patient training and support	-Information overload during training limits acquisition and acceptance.	-Training can increase familiarity and alleviate uncertainty with IAT devices. -Ease of installation. -Ease of use and reliability. -Technical support and training for patient caregivers. -Ongoing technical support.

Table 6. Staff considerations.

Staff Considerations
	Barriers	Facilitators
Role in prescription	-Lack of experience with smartphone and technology-enabled devices. -Concerns about incorporating robotic rehabilitation, despite eagerness. -ICT based devices can increase physician burden through increased demand and excessive data.	-Clinician recommendations and attitudes can support initial use and reduce abandonment. -Outsourcing some tasks and responsibilities, such as instruction, decreases physician burden.
Staff training	-Researching and familiarising professionals with IAT.
Staff knowledge and awareness	-Limited knowledge of which IAT devices to recommend. -Legal frameworks for AI-based IAT.

Table 7. Patient-centered considerations summary.

Patient-centred Considerations
	Barriers	Facilitators
Patient’s environment	-Home modification to integrate IAT. -Motorised IAT inability to navigate different surfaces. -Poor wireless connections.	-Tailoring IAT devices to user environments.
Motivation	-Lack of motivation from some older adults to use IAT. -There is a need for frameworks to evaluate IAT devices.	-Desire for increased or preserved independence, activities of daily living, and aging in place motivates use. -Desire to reduce caregiver burden. -Support from friends and family in adopting and operating IAT. -IAT use to promote socializing with friends and family, and to promote leisure.
Beliefs and attitudes	-IAT use can be intimidating, stressful, or induce fear and anxiety. -Belief that IAT is too difficult to use. -Perception that IAT is for young people. -Scepticism from low digital literacy. -Scepticism surrounding privacy and surveillance. -Older adults do not want IAT devices to replace care received from their family.	-More experience with technology prior to IAT prescription.
Stigma	-Visibility of IAT deters use. -Public use of IAT produced self-consciousness, negative attention, and pity. -Older adults felt IAT use broadcasted that they were frail. -Self-perception of being too old for IAT.	-Advocacy to reduce stigma. -Interactions with others who use IAT devices.

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