Discussion
visuo-cognitive problems, anxiety, TVT, alertness, PD, depression, apathy
DISEASE, LENS
The purpose of this study was not to determine the efficacy of TVT compared to standard care, but rather to explore what aspects of the technological interventions contribute to their appeal and usability in people with PD. Conceptualising the themes generated from the interviews through the lens of NPT has enhanced our understanding and interpretation of factors involved in implementing and embedding technology into home-based interventions from the perspectives of people with PD. Our findings supplement previous studies that have investigated perceptions and attitudes of older adults towards new technologies [The first NPT construct of Our findings suggest that people with PD had few expectations of what value the technology might add to their rehabilitation experience over the standard care intervention prior to entering the study. Current literature suggests that in order to evaluate a novel technology, consideration must be given to the health need that the technology is intended to address [Since the emergence of Covid-19, there is a wealth of literature purporting the more generic benefits of technology-enabled remote healthcare [Participants were better able to differentiate between the technology and standard care treatments on completion of the study, having had the opportunity to experience, and therefore make sense of, both interventions. Adding context to this sense-making work, the second NPT construct of On completion of the training, technology ‘buy in’ was apparent, even for those participants who denied having visuo-cognitive problems, or those who were self-proclaimed “technophobes”. This response is in keeping with past studies, which have shown that the perceived value of a technological intervention appears to have a greater influence on the degree of legitimation (or “buy-in”) than individual characteristics and personal attitudes to technology [People with PD recognised that enrolment of support from family members and health professionals was necessary for the successful implementation of TVT. The added degree of difficulty associated with the technology-based intervention was identified as a potential barrier to implementation for people with more advanced disease. This finding is in keeping with literature exploring perceived barriers to exercise which identify safety concerns (such as fear of falling) as a major barrier to engaging in interventions for people with PD [The third NPT construct, Technical challenges, such as difficulty engaging with the touch screen interface on the device, did lead to frustration and dissatisfaction for some participants. Similar results have been found in previous studies where loss of power and fine motor ability can represent a barrier to users with long-term health conditions [There was a consensus that the technology offered an immediacy of feedback which were seen as an advantage over the standard care intervention. Parker et. al. suggest that elements of feedback such as rewards or knowledge of results are required to facilitate usage [The final NPT construct, Also evident in the appraisal work undertaken by participants was a reflection on the psychological improvements associated with technology usage. Increased mood and alertness were frequently mentioned as outcomes of the TVT with words such as “buzz” and “boost” used to describe its effects. The responsiveness and stimulation of the technology may therefore prove to be of significant motivational value for people with PD to help them overcome inherent obstacles to rehabilitation in the form on/off fluctuations, co-occurring depression, anxiety and apathy [One of the most pertinent findings from the study was the value that people with PD placed in the therapy interaction that accompanied the training sessions. The study took place in 2021 while the UK was still experiencing social restrictions due to the Covid-19 pandemic [