Study: Ahmed 2013		Title: Effectiveness of Home Modification on Quality of Life on Wheelchair User Paraplegic Population
Authors: Junaid Ahmed, Syed Shakil-ur-Rehman, Fozia Sibtain
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
RCT	District Kohat & Hangu in Pakistan January–December 2012	Paraplegic adult wheelchair users	N/A	Insufficient information provided.	Insufficient information provided.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 40 n = 20 home modification (mean age: 33.66 years) n = 20 control (mean age: 31.57 years)	The intervention group received home modifications: wheelchair accessible doors, ramps, rails, tub seat in bathrooms, & non-slip surface.		Modified LiSAT questionnaire (6 point scale): life as a whole, vocational situation, financial situation, leisure situation, contact with friends and relatives, ability to manage self-care, family life. Before and 2 months after the intervention.	SPSS v 20 and paired t-test used at significance level 5%. Quality of life significantly enhanced in the experimental group, compared to the control group: LiSAT score 33.32 (p = 0.001) vs. 22.85 (p = 0.154). No SD or CI specified.	MMAT ** (Insufficient information provided on randomisation, sequence generation or allocation concealment.) Small sample size unlikely represents the target population.
Study: Brunnström 2004		Title: Quality of light and quality of life—The Effect of Lighting Adaptation among People with Low Vision
Authors: Gunilla Brunnström, Stefan Sorensen, Karin Alsterstad, John Sjostrand
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
RCT	Goteborg, Sweden	Adults with low vision	Visual acuity ≤0.3 (6/18)	Insufficient information provided.	Participants were consecutively recruited from those receiving lighting adaptation by the Low Vision Clinic at Sahlgren University Hospital.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 56 recruited: Nine dropped out before randomisation and one before the first stage. N = 46 (mean age 76 years, range 20–90 years) n = 24 intervention n = 22 comparison Macular degeneration dry form (n = 12), macular degeneration wet form (n = 16), retinitis pigmentosa (n = 2), glaucoma: (n = 5), and other diagnoses (n = 11)	The intervention group received lighting adjustment in the kitchen, bathroom and hall according to a pre-determined measurement protocol. They received an additional lighting adjustment in the living room. Controls received lighting adjustment in the kitchen, bathroom and hall. They did not receive the additional lighting adjustment.		Perceived certainty in performing activities (7 points): pouring a drink, slicing bread, regulating the cooker, findings things finding cupboards, on the table, and plate Perceived certainty in performing activities (yes/no): preparing food, washing up, laying the table, looking in the mirror (bathroom), seeing if clothes are dirty, matching items of clothing Reading the newspaper Psychological and general well-being (PGWB) scale: seven points Participants were interviewed before and 6 months after the intervention.	Seven point scale daily activities tested using Wilcoxon signed ranks test, and OR and 95% CI used for yes/no activities. Overall, no significant change in perceived activity performance in the kitchen and bathroom in both groups. Only the activities on the working surface in the kitchen improved significantly: “pour drink” Median difference Md 1.5 to 3.5, p = 0.03, “slice bread” Md 3.0 to 6.0, p = 0.04. Quality of life tested using Wilcoxon signed ranks test at significance level 5%. Comparison group had no change in quality of life and well-being, whereas the intervention group showed a significant improvement for all items (range p = 0.01–0.04). No CI specified.	MMAT *** Small sample size unlikely represent the target population. Differences between groups for demographic characteristics not specified. Samples were heterogeneous in terms of diagnosis. Approximately half of the participants reported that their perceived eyesight had worsened during the actual study period. It might have affected their activity function. Validity and reliability issues of psychometrics used (ADL and quality of life).
Study: Campbell 2005		Title: Randomised Controlled Trial of Prevention of Falls in People Aged ≥75 with Severe Visual Impairment: The VIP Trial
Authors: A John Campbell, M Clare Robertson, Steven J La Grow, Ngaire M Kerse, Gordon F Sanderson, Robert J Jacobs, Dianne M Sharp, Leigh A Hale
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
RCT 2 × 2 factorial design	Dunedin & Auckland, New Zealand Recruitment period: over 12 months from October 2012	Older adults ≥ 75 with severe visual impairment	Visual acuity ≤6/24	Those who could not walk around their own residence Those who were receiving physiotherapy Those who could not understand the trial requirement	Participants were recruited through records from the blind register, low vision clinics and hospitals.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 391 n = 100 home safety programme only (mean age 83.1 years) n = 97 exercise programme (mean age 83.4 years) n = 98 both home modification & exercise (mean age 83.8 years) n = 96 social visits (mean age 84.0 years)	Home safety programme: Occupational Therapist visited home, carried out home safety assessment, made recommendations to implement and facilitated payment for home modification. 90% of participants (152/169) reported complying partially or completely with one or more of the recommendations: removing or changing loose floor mats, painting the edge of steps, reducing glare, installing grab bars and stair rails, removing clutter, and improving lighting. Exercise programme included modified Ontago exercise for a year with vitamin D supplementation.Social visits included two 60 min lasting home visits.		Number of self-reported falls, and injuries resulting from falls Economic evaluation One year follow-up	Negative binomial regression models used. 41% fewer falls in the home safety programme only group compare with those who did not receive this programme (incident rate ratio 0.59, 95% CI 0.42 to 0.83); exercise programme (incident rate ratio 1.15, CI 0.82 to 1.61). No significant difference in the reduction of falls at home compared to outside home environment. Neither intervention was effective in decreasing fall related injuries. The home safety programme costed $NZ 650 (£234, 344 euro, $US 432 at 2004 prices) per fall prevented.	MMAT **** The duration of visual impairment varied significantly. Participants’ abilities were not taken into account for participating in an exercise programme.
Study: Fänge 2005		Title: Changes in ADL Dependence and Aspects of Usability Following Housing Adaptation—A Longitudinal Perspective
Authors: Agneta Fange, Susanne Iwarsson
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Longitudinal, before and after	Medium sized municipality in southern Sweden with urban and rural areas.	Adults >18 with functional limitations	Those who were being considered for housing adaptation grants.	Terminally ill clients Clients who spent most of the in a bed or chair Clients with communication problem	Clients were consecutively enrolled over 18 months, who applied for housing adaptation grants.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 131 (88 female, mean age 71 years) 2–3 months follow-up: N = 104 8–9 months follow-up: N = 98	Housing adaptation grants administered. The majority of the adaptations targeting hygiene facilities (installation of grab bars at the bathtub or shower, replacing the bathtub with a shower), entrances including balcony and patio, and stairways and doors. A few adaptations targeting floor surfaces in bathrooms.		ADL staircase, Revised version that comprises 5 personal ADL and 4 IADL, 3 graded scale (independent, partly dependent, dependent) Usability in My Home Instrument: environmental impact on performance of ADL/IADL, 23 items in total with 16 of 7-point scale and 7 of open-ended questions Before (T1), 2–3 months after (T2), 8–9 months after the intervention (T3).	ADL ranks and changes in overall as well as in each ADL item were analysed by means of the Sign test at significance level 5%. No significant change in overall ADL dependence at any time point relative to baseline, whereas dependence in bathing decreased between T2 and T3 (p = 0.0020). Usability: No significant change in activity aspects between T1 and T3, although great improvement between T1and T2 (p = 0.045). Significant improvement in personal and social aspects between T2 and T3 (p = 0.008), although no changes earlier.	MMAT ** Small sample size may explain the lack of significant changes over time. No comparison group. Other interventions may have been implemented on the participants: mobility devices were prescribed from other interventions during the home modification process.
Study: Gitlin 2006a		Title: A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults
Authors: Laura N. Gitlin, Laraine Winter, Marie P. Dennis, Mary Corcoran, Sandy Schinfeld, Walter W. Hauck
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
RCT	Urban, United States Participants were recruited 2000–2003	Older adults ≥70 who reported difficulty with one or more activities of daily living and were ambulatory	Self-reported difficulties or need for help: one or more in ADLs, and two or more in IADLs	MMSE ≤23 Non-English speaking people Those who were receiving home care	Participants were recruited from an area agency on aging and advertisements through media and posters.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 319 (mean age 79) n = 160 intervention (mean age 79.5) n = 159 control (mean age 78.5) Follow-up 1(6 months): N = 300 (94%) Follow-up 2 (12 months): N = 285 (89%)	The intervention group received home occupational (four 90 min visits and one 20 min telephone contact) and Physical Therapy sessions (one 90 min) during the first 6 months. OT/PT sessions included home modifications (e.g., grab bars, rails, raised toilet seats) and training; instruction in problem solving strategies, energy conservation, safe performance, fall recovery technique, and balance and muscle strength training. Control: no treatment Home modifications were paid for through grant funds.		ADL, mobility/transferring, and IADL: 5 point scale, perceived difficulty Tinetti et al.’s Falls Efficacy Scale, and three items from Powell et al.’s Activities-specific Balance Confidence Scale: 10-point scale, perceived fear of falling Self-efficacy: confidence in managing ADL, IADL and mobility, 5 point scale Secondary: observed home hazards, use of adaptive strategies Before and at 6 months and 12 months.	At 6 months, the intervention group reported less difficulty than controls with ADL (p = 0.03, 95% CI = −0.24 to −0.01) and IADL (p = 0.04, 95% CI = −0.28–0.00). The biggest benefits were in bathing (p = 0.02, 95% CI = −0.52 to −0.06) and toileting (p = 0.049, 95% CI = −0.35–0.00). No significant change in mobility/transfer difficulty. The intervention group had greater self efficacy (p = 0.03, 95% CI = 0.02–0.27), less fear of falling (p = 0.001, 95% CI = 0.26–0.96), and greater use of adaptive strategies (p = 0.009, 95% CI = 0.03–0.22). 12-months effects similar to those at 6 months.	MMAT **** The study participants were voluntary: they might have been more motivated. As it was the multicomponent intervention, it is unclear if one intervention was more effective than others. Use of a no-treatment control group: attention from health professionals may account for beneficial effects.
Study: Gitlin 2006b		Title: Effect of an in-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary Findings
Authors: Laura N. Gitlin, Walter W. Hauck Laraine Winter, Marie P. Dennis, Richard Schulz
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
14 months follow-up of RCT (Gitlin 2006a)	Urban, Philadelphia, United States Participants were recruited 2000–2003	Older adults ≥70 with functional difficulties and were cognitively intact	Functional vulnerability: needing help with two IADLs, having difficulty performing one ADL, or experiencing one or more falls within 1 year before study entry	MMSE ≤23 Non-English speaking Who were receiving home care	Participants were recruited from local social service agencies, an area agency on aging, and media announcements.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 319 (mean age ± standard deviation 79 ± 5.9) Female 62%, living alone 62% n = 160 intervention (mean age 79.5) n = 159 control (mean age 78.5)	The intervention group received home occupational (four 90 min visits and one 20 min telephone contact) and physical therapy sessions (one 90 min) during the first 6 months. OT/PT sessions included home modifications (e.g., grab bars, rails, raised toilet seats) and training; instruction in problem solving strategies, energy conservation, safe performance, fall recovery technique, and balance and muscle strength training. Control: no treatment Home modifications were paid for through grant funds.		Health and physical function: health conditions, days hospitalised 6 months before study entry, self-rated health, formal services, medications, emergency visits, days in rehabilitation, difficulty in ADL, IADL and mobility/transfer Mortality over 14 months Control-oriented strategy use	The intervention group had a significantly lower mortality rate than controls: 1% vs. 10% (p = 0.003, 95% CI 2.4–15.04). No one from the intervention group with previous days hospitalised (n = 31) died, whereas 21% of control group counterparts did (n = 35; p = 0.001). Mortality risk was lower for intervention participants with low strategy use at baseline (p = 0.007).	MMAT **** Cause of death generally not known. Health professionals might have detected medical problems and recommended treatment for intervention subjects. Exploratory analysis, this was not planned. Subjective self-reports of functional difficulties were used. The number of deaths that occurred in the study period was modest (n = 14).
Study: Gitlin 2014		Title: Correlates of Quality of Life for Individuals with Dementia Living at Home: The Role of Home Environment, Caregiver, and Patient-Related Characteristics
Authors: Laura N. Gitlin, Nancy Hodgson, Catherine Verrier Piersol, Edward Hess, Walter W. Hauck
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Cross-sectional	Urban, East Coast region, United States Participants were enrolled June 2009–October 2010.	Adults with dementia Caregivers ≥21 years; lived with/in close proximity to patients; English speaking; Provided care for 5 months or more	Insufficient information provided	For patients MMSE <10 Those who were bed-bound or unresponsive Those who could not speak English	Participants were recruited through media advertisements and mailings by aging and faith-based organisations, targeting caregivers.
Samples	Data collection		Outcome measures	Results	Quality (MMAT) & Limitations
N = 88 dyads (97%) completed two home assessments and are included in the analysis n = 88 patients (mean age 82 years, range 56–97) n = 88 caregivers (mean age 65.8, range 38–89)	All participants received a 45-min telephone interview, 90-min first home visit with MMSE administration, and a second visit within 2 weeks of completion of interviews.		Quality of Life in Alzheimer Disease: 4 point scale Home Environmental Assessment Protocol: home hazards (access to dangerous objects), adaptations (grab bars, visual cues), measured via observation or interviews, two indices represent the total number of hazards and adaptation Unmet home environmental needs by asking two yes/no questions to caregivers Patient-related factors: health conditions, behavioural frequency, fall risk, pain & sleep quality Caregiver-based factors: mood, positive caregiving, & communication	Linear regression model used, two sided, at significance level 5%. Home environmental factors were not associated with perceived quality of life: adaptation (Regression Coefficient B = −0.284, 95% CI −0.647 to 0.079, t = −1.558, p = 0.123), hazards (B = 0.002, 95% CI −0.292 to 0.296, t = 0.016, p = 0.987). Environmental factors were not associated with caregiver-perceived quality of life of patients. Having more unmet assistive device/navigation needs (B = −2.314, 95% CI −4.370 to -0.258, t = −2.240, p = 0.028) and health conditions (B = −0.707, 95% CI −1.161 to −0.253, t = −3.101, p = 0.003) were associated with patient-perceived lower quality of life in separate regressions.	MMAT ** Small sample size and cross-sectional design. Not all modifiable and relevant factors were included in this study.
Study: Heywood 2004		Title: The Health Outcomes of Housing Adaptations
Authors: Frances Heywood
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Mixed method: interviews and questionnaires	England and Wales in the UK Field work 1999–2000	Recipients of housing adaptation	No definition or description of disability types provided, although the term of “disabled people” are used in this article.	Insufficient information provided.	Participants were recruited through social services or housing authorities records.
Samples	Data collection		Analysis	Results	Quality (MMAT) & Limitations
N = 104 interviews (84 face-to-face and 20 telephone) N = 162 questionnaires (mean age 71 years, women 115) NB: There is a primary report (Heywood 2001) of this research study with more information on samples and interventions. This article focuses on health related findings.	Combination of structured and semi-structured interviews, also asked to give a score out of 10 for the effect of adaptation. The pairs of interviewers agreed a score themselves. 104 interviews with recipients of major home adaptations and 162 postal questionnaires by recipients of minor adaptations in six out of seven areas. Minor adaptations: quickly and easily fitted fixed alteration costing less then £500, e.g., hand-rails, grab-rails. Major adaptations: stair-lifts, bathroom conversions (usually providing a level-access shower, extensions to provide ground-floor bedroom, bathroom or both, stair- and through-floor lifts, the installation of a downstairs toilet, door widening, ramps, kitchen alterations. Home modifications included heating.		SPSS database used for establishment of core frequencies and links. Then, an adapted version of the NCSR framework methodology was used, involving repeat reading of interview transcripts to identify themes. Searches from the themes on words or groups of words were carried out to check frequency.	Key themes: Health impacts on disabled people before housing adaptation or after inadequate adaptation: pain, accident, exacerbated illness, feeling of depression Health impacts on caregivers & other family members: injuries, falls Health gains from good quality adaptations for disabled people: relief of pain, preventing accidents & reducing fear of accidents, ending depression Health benefits to other household members Inter-active effects	MMAT overall **: Qualitative **, Quantitative **, Mixed Method ** Low response rate for questionnaires: 60%. Questions were sent to participants in advance for interviews.
Study: Petersson 2008		Title: Impact of Home Modification Services on Ability in Everyday Life for People Ageing with Disabilities
Authors: Ingela Petersson, Margareta Lilja, Joy Hammel, Anders Kottorp
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Quasi-experimental pre-post test Part of a larger ongoing longitudinal research project	A large city in Sweden Data were collected 2002–2005	Adults ≥40 with disabilities	Problems in everyday life and requesting home modifications related to at least one of the followings 3 areas: Getting in & out of the home Mobility indoors Self-care in the bathroom	MMSE <19 CES-D depression ≥24 Those who could not communicate in Swedish	The Home Modification (AHM) identified potential participants.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
Baseline: N = 114, n = 73 intervention, n = 41 comparison group Follow-up: N = 105 (mean age 75.3) n = 73 intervention, (mean age 75.7 years) n = 41 comparison (mean age 74.6 years)	Those who have been scheduled for home modifications within 4 weeks were allocated in the intervention group, and received home modifications as scheduled. Common home modifications included shower, ramps and automatic door openers. Those who were waiting for their application to be investigated by the AHM were allocated in the comparison group. They did not receive home modifications during the time of the study. All cost were covered for modifications by the local authorities.		Client–Clinician Assessment Protocol (C-CAP) Part I: self-rated independence (4-point scale), difficulty (5-point scale) and safety (3-point scale) in ADL, IADL, mobility & leisure Before and 2 months after the intervention	Paired sample t-tests used with a level of significance level at p < 0.05. Intervention group had a significant increase of safety (t = −3.820 p = 0.001 effect size d = 0.40) and decrease of difficulty (t = −3.353 p = 0.001 d = 0.32) in ADL. No significant change in self-rated functional independence in the intervention group (t = −0.630 p = 0.531). Specifically, decreased difficulties and increased safety in bathroom use, and getting in and out of house. Self-rated safety in taking medication was significantly decreased in the intervention group. No significant change in abilities in the comparison group.	MMAT *** Small sample size and urban living samples that applied for home modifications might not be generally representative. Psychometric limitations in the C-CAP Part I: validity issue. Unclear whether self-rated improvements in everyday life were directly from home modifications, or were related to other factors, e.g., technical devices.
Study: Petersson 2009		Title: Longitudinal Changes in Everyday Life after Home Modifications for pEople Aging with Disabilities
Authors: Ingela Petersson, Anders Kottorp, Jakob Bergstrom, Margareta Lilja
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Quasi-experimental pre-post test	A large city in Sweden Data were collected 2002–2005	Adults ≥40 with disabilities	Problems in everyday life and requesting home modifications related to at least one of the followings 3 areas: Getting in & out of the home Mobility indoors Self-care in the bathroom	MMSE <19 CES-D depression ≥24 Those who could not communicate in Swedish	The local Agency for Home Modification (AHM) identified potential participants. Those who have been scheduled for home modifications within 4 weeks: intervention group Those who were waiting for their application to be investigated by the AHM: comparison
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
Baseline: N = 103 (mean age 75.1 years), n = 74 intervention (mean age 75.19 years), n = 29 comparison (mean age 74.5 years) Follow-up 1: N = 94, n = 69 intervention, n = 25 comparisonFollow-up 2: N = 84, n = 64 intervention, n = 20 comparison	Intervention group received home modifications as scheduled. Common home modifications included shower, ramps and automatic door openers. Comparison group did not receive home modifications during the time of the study. In Sweden, the local authorities are obliged to provide home modifications in the form of a grant to people with disabilities. All cost are covered for modifications		Self-rated Difficulty scale of the Client–Clinician Assessment Protocol (C-CAP) Part I: only difficulty part used, 5-point scale Before, 2 months after and 6 months after home modifications	Random coefficient models used. Intervention group had less difficulty up to 6 months than the comparison group: intervention vs. comparison mean difference Logits = 0.450 SE = 0.156 p = 0.023 95% CI 0.082 to 0.819 Small to moderate effect size for home modifications for the intervention group at both follow-up: follow-up 1 (Mean = 0.35 SE = 0.15 d = 0.34) & follow-up 2 (Mean = 0.37, SE = 0.16, d = 0.0.32) No effect in the comparison group. One confounding factor, waiting time for home modifications had an additional impact on experienced difficulties in ADL	MMAT *** Small sample size, large dropout in the comparison group, and urban living samples might not be generally representative. Psychometric limitations in the C-CAP Part I. Difficulty of measuring whether self-rated improvements in everyday life were directly as a result from home modifications, or were related to other factors, e.g., technical devices.
Study: Stark 2004		Title: Removing Environmental Barriers in the Homes of Older Adults with Disabilities Improves Occupational Performance
Authors: Susan Stark
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Non-randomised pre-post	Urban area in United States 1999–2000	Low income older adults with functional impairments and indicated a need for environmental modifications	Problems in one or more areas of the Functional Independence Measure (FIM) motor scale	Cognitive subscale of the FIM ≤ 25	Participants were identified by a not-for-profit agency that provides free or low cost architectural (accessibility) modifications in partnership with occupational therapists.
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 29 (age range 57–82 years, mean age 70.69 years) 16 participants were retained in the study: n = 12 African Americans n = 12 women	Participants received occupational therapy home modification programme, an average of 2.5 home modifications per person, ranging from 1–7. Most common modifications were the installation of handrails, grab bars and ramps. Less common modifications included bedrails, widening doors, relocating laundry facilities from the basement to the living floor, and additional lights. Interventions were limited to compensatory strategies only. No other remedial intervention. If participants were able to pay for home modifications, they did so. If not, the agency provided it at no cost.		Canadian Occupational Performance Measure (COPM) via semi-structured interviews and structured scoring method (10-point scale). Participants were asked about importance, performance and satisfaction in self-care (personal care, functional mobility and community management), productivity in work, household and play/school, and leisure (quiet recreation, active recreation and socialisation) Baseline data collection: Severity of disability by the FIM, COPM, Environmental Functional Independence Measure (Enviro-FIM) assessed by interviews and observations. Before, 3 months after and 6 months after home modifications.	Paired t tests used to examine the differences between pre and post intervention. Participants’ self-perceived occupational performance (t = −8.23 p = 0.0001) and satisfaction with performance (t = −9.54 p = 0.0001) increased significantly at 6 months.	MMAT ** Small sample size and limited follow-up, longitudinal studies may be required regarding health status changes over time. No control group. Participants were mainly African American: not representative of the general population of older adults with disabilities. Lengthy time lapse from enrolments to completion of modifications may have allowed changes in physical status.
Study: Stineman 2007		Title: Population-Based Study of Home Accessibility Features and the Activities of Daily Living: Clinical and Policy Implications
Authors: Margaret G. Stineman, Richard N. Ross, Greg Maislin, David Gray
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Cross-sectional (survey)	United States Phase I: August 1994–1997 Phase II: 206–722 days later, limited to persons with disabilities	Adults>18 with disabilities, non-institutionalised, answered all survey questions themselves, and described at least one physical limitation (Phase II of the National Health Interview Survey (NHIS) supplements on Disability (NHIS-D))	Limitations in kind and amount of activities or work, receipt of any form of insurance or financial support because of disability, limitations in sensation or communication, or use of mobility devices, artificial limb, etc.	Those who were institutionalised and ≤18	Data from phase I and II of NHIS-D: Phase I was representative of the US non-institutionalised civilian population > 18 years. Phase II was limited to persons with disabilities. Phase II data was used to address person-environmental interactions.
Samples	Data collection		Outcome measures	Results	Quality (MMAT) & Limitations
N = 25,805 in Phase II	80% (n = 20,644) randomly assigned to a model building sample, and 20% (n = 5161) to a validation data. 7922 (85%) in the model building data met all the criteria, and had all variables necessary for primary analysis. This made up the samples on which the effects of environmental barriers were modelled: 1952 respondents in the validation data set who met the same criteria.		Outcome measure Self-reported difficulty or inability in ADLs Primary predictors: Self-perceived environmental barriers: wide doorways, ramps into the home, railings inside the home, automatic doors, elevators, bathroom, kitchen or other modification Physical limitations: lower boy use, hand use and reaching Assistive technology: limited to mobility aids Socioeconomic variable	There were 12,743 people with physical impairments, 10.3% of whom perceived an unmet need for at least o 1 home accessibility feature. After adjusting for severity of physical limitation and socioeconomic differences, the odds of an ADL difficulty were 3.7 times larger (95% CI 2.9–4.6) among participants who perceived an unmet need for accessibility features.	MMAT *** It was restricted to physical limitations only and the perceived effects of architectural barriers. Subgroup analyses of the NHIS-D may be vulnerable to errors resulting from non-response bias that occurred during the original survey. Cross-sectional designs limit inferences about causality. Time specific: longitudinal studies are required.
Study: Tchalla 2012		Title: Efficacy of Simple Home-Based Technologies Combined with A Monitoring Assistive Centre in Decreasing Falls in a Frail Elderly Population (Results of the Esoppe Study)
Authors: Achille Edem Tchalla, Florent Lachal, Noelle Cardinaud, Isabelle Saulnier, Devender Bhalla, Alain Roquejoffre, Vincent Rialle, Pierre-Marie Preux, Thierry Dantoine
Study type	Setting	Inclusion criteria	Definition of specific functional limitation	Exclusion criteria	Recruitment procedures
Longitudinal Perspective cohort (pilot study)	Correze district in Limousin area, Southwest France July 2009–June 2010	Frail older adults ≥65, registered on a list of frail elderly people and living at home	Fried frailty criteria ≥3 Functional autonomy Measure System Profile (ISO-SMAF) classification	People with a severe dementia: MMSE ≥25 People in a falls prevention rehabilitation programme	Participants were recruited through a population survey in Correze district (pre-selected by the council).
Samples	Interventions		Outcome measures	Results	Quality (MMAT) & Limitations
N = 194 (mean age 83.4 years, women 77.4%) n = 96 intervention group (mean age 84.9 years, women 76.6%) n = 98 control group (mean age 82.0 year, women 78.1%)	The intervention group received light path installed near the bed, which is a 1.5 m long and turns on automatically on when the person sets foot on the ground. The light path proved visibility by showing the right path and improving conscious awareness of environment. They also received tele-assistance service 24/7: a remote intercom, an electronic bracelet. The control group did not receive any intervention.		Incidence rate of fallsBaseline clinical assessment: medical history of previous falls, comorbidities and medications, ISO-SMAF classification, Tried Frailty criteria, MMSE, Mini Nutrition Assessment, Geriatric Depression Scale 12 months following inclusion in the study	After taking into account significant variables in the multivariate model, the use of light path coupled with tele-assistance was significantly associated with reduction in falls at home: OR = 0.33 95% CI = 0.17 to 0.65 p = 0.0012. There was a great reduction in post—fall hospitalisation rate in the intervention group: OR = 0.30 95% CI = 0.12 to 0.74 p = 0.0091.	MMAT ** Potential recall bias, especially in older adults population: this reporting bias can underestimate the rate of falls. Identification of the falls is influenced by knowledge of exposure group: over or under-estimation of falls.

RCT: randomised controlled trial; N/A: not applicable; MMAT: mixed method appraisal tool; MMAT *: * the lowest and **** the highest score; SD: standard deviation; CI: confidence interval; OR: odds ratio; ADL: activities of daily living; IADL: instrumental activities of daily living; CES-D: center for epidemiologic studies depression scale; NHIS-D: national health interview survey on disability; ISO-SMAF: functional autonomy measurement system.