Our research questions were: 

R1. How do care home staff and residents think digital technologies contribute to community resilience?  

R2. How can we ensure that robotic telepresence used to aid with the delivery of exercise programmes contributes towards creating and maintaining resilient communities in care homes? 

Objectives:  

1. To explore service users (older people) and staff (nurses, managers, health care assistants) perceptions about telepresence robots  

2. To test the feasibility and evaluation of remote 1-2-1 assessment and 4 weeks of group exercise classes delivered using telepresence robot for older frail people living in care homes. 

 
METHODS 

Two care homes were selected (Scotland and Bristol).  

Work package (WP) 1: We conducted two workshops with staff and residents at two care homes and explored stakeholders’ perceptions, understanding, awareness and use of telepresence robots. 2) Telepresence robot was installed in each care home and one online workshop was conducted with residents and staff to familiarise themselves with the robot.  

WP2: A physiotherapist conducted remote 1-2-1 assessments to establish baseline parameters using the robot that was maneuvered from his home through his laptop. The residents at care home then participated in a 4-week group exercise sessions (one session per week) delivered via telepresence robot and had their 1-2-1 post assessments at the end of exercise programme.  

WP3: A focus group workshop was conducted using Microsoft Teams to evaluate the Telepresence robot intervention.  

 
RESULTS AND DISCUSSION 

For the initial workshop Eight residents (older frail, neurological conditions), four support staff, two nurses and one manager participated. Key themes regarding Telepresence robot were 1) it can act like a friend, a companion 2) Could be used by health care professionals for remote consultation 3) should not replace health care professionals contact time with patients. For the exercise class, all residents completed pre and post 1-2-1 assessments and attended the 4 weeks group class. Participants were positive about robots, found it interactive and that session felt personal when compared to online exercise programmes. Safety concerns were raised when doing balance tasks, technical (screen size, volume), group exercises may not fit all.  

From researchers’ perspective, the experience of remotely asking sociological questions, and observing the study was very challenging and much work needs to be done. An important methodological observation is this: we found that consumer or prosumer grade communications technology such as Microsoft Teams was not sufficient by itself to provide the robust research infrastructure needed to observe real world trials remotely.  

 Significance:  

This project suggests that telepresence robot has the potential in care home settings. However, technology should be used as a tool to enhance, rather than substitute, therapeutic engagement. Also, future funders will need to provide adequate finance for digital research infrastructure suitable for remote trials and pilots if these are to proceed. 

Workshop feedback 

Participants shared mixed feeling about exercising in front of a telepresence robot. Some felt that it acted as a substitute for a human presence, while others viewed it as an additional layer between them and the instructor. However, in general, they were positive about the interactive nature of telepresence robot compared to traditional video-based exercise programs. One participant noted, "the participants seem to be more engaged with the robot than they would with video on the TV”. 

Preferences for exercise formats varied. One participant with a severe disability found certain generic exercises difficult and preferred one-on-one sessions or small groups of no more than two people. This preference was based on the limited activities that the participant was able to perform due to their physical condition, reinforcing the need for individualised sessions with specific exercises tailored to their capabilities. Conversely, other participants from both centres preferred group sessions, highlighting the social factor and group motivations. 

When asked about the usefulness of the sessions, all participants strongly agreed, giving a "strong thumbs up" at Beaufort Grange. At Aberdeen, one participant commented, “We enjoyed it, obviously”. This enthusiasm could be attributed to the limited physical activity opportunities in the care homes, making any form of exercise highly anticipated and appreciated. This observation was consistent across both care centres. In such circumstances, telepresence robot could be a suitable alternative, allowing health professionals to remotely deliver exercise sessions in multiple settings reaching those in need. 

Despite positive feedback, remote sessions raised concerns about fall risks, safety policies, and the training of support staff. Participants emphasised that properly trained staff could mitigate these risks. A major concern was safety during specific exercises involving standing or sit-to-stand movements, which require additional supervision to prevent falls. While one-on-one support was provided when needed, it is important that the trained support staff be available to ensure safety, particularly for individuals with balance issues or more severe conditions. These concerns underscored the need for continuous monitoring during sessions, especially for participants requiring tailored assistance. 

The role of support staff was important, as they assisted the session, relayed instructions, encouraged residents, and ensured continuity. Staff feedback highlighted some technical challenges encountered during the sessions, such as issues with the robot’s screen size and volume at Beaufort Grange. Participants suggested improvements, like better screen visibility and textual references, with one participant commenting, “It would be helpful to see the whole body through the robot’s screen.” Another suggested adding subtitles or visual instructions with pictures. Volume issues were noted, particularly when the robot moved to a0reas with poor network connectivity. In these cases, staff often had to relay instructions when participants struggled to hear. At Aberdeen, occasional glitches occurred, but participants didn’t feel much impacted acknowledging, “its technology after all- we expected it”. Overall, participants expressed a favourable impression of the robot’s ability to visually demonstrate exercises, stating that they could clearly observe and follow the therapist’s instructions. 

When first introduced to the robot, one participant joked, “I hope I won’t drive over anyone!”. Participants expressed caution about positioning themselves correctly, noting, “you have to position yourself so you're not obstructing others, and others are not obstructing you.” When asked who in-charge of the session was, one participant at Beaufort Grange initially responded, “nobody”. The participant elaborated that until the support staff were well-trained, and competent in handling high-risk situations, the instructions for certain tasks-especially those deemed safety-sensitive- might be ineffective. Nonetheless, despite these concerns, all participants- including those at Aberdeen- agreed that “the person on the screen” (the physiotherapist operating the robot) was in-charge of the session. 

While most participants were comfortable with technology, one engineer remarked, “Technology is necessary and essential, but I’m not in favour of technology for technology’s sake.” Nevertheless, the general sentiment was that the telepresence robot provided a more engaging experience and was viewed as a promising innovation. One participant described it as, “a way forward for progress.” Another participant at the other centre echoed this sentiment, saying, “This is the way forward. You just have to go forward.”  

Participants from both centres particularly enjoyed dance-based exercises, finding them engaging and personal, especially when support staff actively participated and motivated them. The social aspect was particularly significant- although the physiotherapist was present on the screen, group exercises felt more engaging when support staff participated. One support staff member noted, “Exercise feels more personal when it comes from someone who knows the residents”. 

From researchers’ perspective, the experience of remotely asking sociological questions, and observing the study was very challenging and much work needs to be done. An important methodological observation is this: we found that consumer or prosumer grade communications technology such as Microsoft Teams was not sufficient by itself to provide the robust research infrastructure needed to observe real world trials remotely.  

Overall, the telepresence robot demonstrated strong potential as a tool for remote physiotherapy, with participants recognising its potential in enhancing exercise programs in care settings. They expressed a strong desire for more sessions and unanimously agreed that they would recommend the sessions to others, indicating the program's overall success.  

Principal investigator: Dr Praveen Kumar – Associate Professor in Stroke Rehabilitation, University of the West of England

Dr Maria Jose Galvez Trigo, Cardiff University, Lecturer. 

Dr Cian O’Donovan, University College London, Senior Research Fellow. 

William Wright, Blackwood Homes and Care

Mrs Raji Sunil, Manager at the Beaufort Grange Care Home, Bristol 

EMERGENCE Mentors: Dr Mauro Dragone and Prof. Praminda Caleb-Solly