Abstract
Tailored smart home solutions effectively enhance occupational and task performance and improve psychosocial well-being for people with physical disabilities.
Smart home technology provides autonomy and convenience to a diverse range of users, including individuals with physical disabilities, and serves as a critical intervention tool in occupational therapy (Ding et al., 2023; Mun & Kim, 2024). This technology facilitates environmental adaptation, enhances autonomy, and enables independent task performance, empowering occupational therapists to provide clients with user-centered, individualized interventions. Ostrowska et al. (2023) emphasized that occupational therapists play a crucial role in recommending and implementing tailored home modifications that address users’ daily living environments, ultimately promoting functional independent living and enhancing quality of life. Moreover, smart home technology extends beyond mere assistive device usage by offering adaptive approaches to user environments, enhancing independence and emotional well-being for individuals with physical disabilities (Kang et al., 2024). This technological support meets the specific needs of individual users, enabling more effective and user-centered intervention strategies. Occupational therapists can use smart home technology to create tailored task environments, tackling technical limitations and individual adaptation needs.
Smart home technology offers significant potential to enhance the independence and convenience of daily life for individuals with physical disabilities (Mun & Kim, 2024). For example, it can assist with user-specific tasks such as controlling lighting, managing electronic devices, and unlocking doors, thereby promoting user autonomy (Moon et al., 2022). However, the practical application of this technology encounters several technical challenges and limitations. For instance, unstable Wi-Fi connectivity can diminish the user experience, whereas compatibility issues between devices can limit the user’s reliance on the technology (Hercog et al., 2020). Moreover, the initial adaptation burden on users may hinder the adoption of smart home technology or increase its complexity, highlighting the necessity for close collaboration between service providers and users (Morris et al., 2021).
For the successful implementation of smart home technology, it is essential to ensure network stability, enhance system compatibility, and provide tailored solutions that fit the user’s environment. Chang and Nam (2021) emphasized that failing to resolve technical issues during user interaction with smart home systems can significantly undermine trust and lead to a decrease in reliance on the technology. Therefore, the practical application of smart home technology requires more than technical capabilities; it demands a personalized approach and ongoing user support. Addressing these challenges and providing tailored smart home solutions to enhance user autonomy and independence remain critical in occupational therapy.
Tailored smart home solutions must be configured and adjusted according to users’ needs and characteristics, enabling them to use the technology more effectively. Mun and Kim (2025) emphasized that tailored smart home solutions are essential for meeting the diverse needs and preferences of individuals with physical disabilities, because device preferences, interface preferences, and interface usability often depend on diagnosis and functional ability. Similarly, Facchinetti et al. (2023) reported that smart home technologies for chronic disease management and daily living support significantly improve disease management and quality of life through personalized approaches. Such tailored interventions go beyond simply providing technology; they promote harmony between the user and their environment, allowing individuals with disabilities or specific needs to perform everyday tasks more easily. To maximize the effectiveness of smart home technology, personalized interventions tailored to each user’s needs are vital. This highlights the role of occupational therapists in integrating technological interventions with user-specific needs to deliver optimal solutions.
The purpose of this study was threefold: (1) to evaluate the effectiveness of tailored smart home solutions in improving occupational performance, psychosocial well-being, and quality of life of individuals with physical disabilities; (2) to analyze the role of occupational therapists in customizing, implementing, and supporting smart home interventions; and (3) to examine the feasibility and challenges of real-world application of personalized smart home solutions to inform broader implementation strategies. This approach promotes technology-based interventions in occupational therapy, ultimately enabling users and caregivers to live in more convenient and secure environments.
Method
Study Design
The purpose of this study was to identify and improve the activities limited by physical disabilities in community-dwelling individuals through the implementation of a home modification program with smart home technology. The study used a pre–post design to evaluate the program’s effects, incorporating an occupation-centered approach led by occupational therapists. Ten occupational therapists with at least 2 yr of clinical experience were trained in the Smart Home Modification Program, which was originally developed based on the doctoral dissertation of Mun (2024). They applied it to 40 community-dwelling individuals with physical disabilities in South Korea. The intervention’s effects on occupational performance, task performance, quality of life, and psychosocial well-being were assessed by comparing changes before and after the program.
Participants
The study included 40 community-dwelling individuals with physical disabilities who participated in a smart home modification program designed to address their restricted activities. Participants were selected through a screening process based on predefined inclusion and exclusion criteria.
Inclusion criteria were (1) individuals with a physical disability that restricted activities of daily living, (2) those residing in the community, and (3) those who agreed to participate in the study and follow-up assessments. Exclusion criteria were (1) individuals planning to relocate within 1 yr, (2) those with cognitive impairments that would prevent the use of smart home technology, and (3) individuals whose home environments were unsuitable for device installation or whose support needs exceeded the scope of available smart home technology solutions.
Research Procedure
To verify the effectiveness of the smart home modification program, the study was conducted in the following stages: evaluation, intervention planning, intervention execution, monitoring, and assessment. The program was developed on the basis of expert consultation and Delphi survey results derived from Mun and Kim (2024) and included key components for tailoring interventions (see Figure 1).
Research process.
Occupational Therapist Training
A total of 10 occupational therapists participated in this study. Each had a minimum of 2 yr experience providing occupational therapy services in community settings, including home assessments and modifications. To prepare for the study, they received training on both the theoretical and practical aspects of the smart home modification program. This training was developed based on a smart home intervention manual and curriculum, covering topics such as the concepts and applications of smart home technology, home modifications, smart device installation and operation, and procedures for evaluating and optimizing home environments.
The Smart Home Modification Program training was composed of two theoretical lectures and one hands-on practical session, which were designed to equip occupational therapists with the foundational knowledge and technical skills necessary for program delivery. Upon completion, an operational manual was provided to standardize implementation procedures across settings. Occupational therapists were specifically trained in the three core phases of the Smart Home Modification Program, including evaluation, smart home solution, and outcome, to ensure fidelity and consistency in delivering tailored smart home intervention (Table 1).
Process of Smart Home Modification Program
Tailored Smart Home Solution Planning
Through initial interviews and assessments, 40 individuals with physical disabilities were selected as program participants. Ten occupational therapists interviewed four participants each, using a semistructured questionnaire and a task performance scale across different spaces. Both tools were developed on the basis of categories identified in the Delphi study by Mun and Kim (2024; Table 2).
Initial Assessment Checklist
Note. The prompt was “please list three things you currently cannot do because of a physical disability that you hope smart home technology can help you achieve.” IoT= internet of things; NE = not experienced; ND = not done.
Preevaluations included assessments of quality of life and task performance across different spaces to evaluate participants’ functional status and daily living needs. Occupational therapists assessed task performance in various home environments to design appropriate interventions. They then evaluated the applicability of smart home solutions based on three key functional areas—personal, environmental, and task-related performance with smart home technology—as outlined in Table 2. These areas were defined by using commercially available smart home technologies applicable in South Korea. Ultimately, a customized intervention plan was developed to address the needs of each participant.
Smart Home Solution Execution
In this stage, occupational therapists assisted participants in selecting appropriate smart home devices based on the preassessment and intervention plan. The selected devices were installed and set up to support the participants’ functional goals and promote independence in daily activities. Each participant received up to $500 in funding for smart home modifications, covering device costs and installation. The interventions were implemented in participants’ actual homes, ensuring real-world applicability.
The primary intervention areas included the bedroom and entrance, where tailored solutions for lighting control, curtain/blind operation, home appliance use, door lock control, and doorbell monitoring were provided (Figure 2). The smart home interventions involved the following devices for each area: Entrance: smart door lock, smart doorbells, smart hub, smart remote, door sensor, and motion sensor. Bedroom and living room: smart curtain or blind, smart light switch, smart plug, smart hub, smart remote, smart speaker, smart camera, smart air conditioner, and switch robot.
Smart home solution algorithm.
After device installation, participants received individualized training on the operation, usage, and maintenance of the smart home technology to enable them to perform daily occupations independently. In addition, caregivers were educated on device usage and maintenance to support users and provide assistance when needed. Each education session lasted approximately 60 to 90 min, depending on the participant’s level of comprehension and functional capacity. Additional guidance was provided through follow-up visits and phone consultations as needed. However, caregivers typically did not assist participants in operating the smart home devices, because participants were capable of using the devices independently.
Occupational therapists monitored participants weekly for 10 wk after the intervention to assess their experiences and safety concerns regarding use of the smart home devices. They adjusted interventions to maintain and enhance program effectiveness by addressing the participants’ adaptation process. Upon program completion, postintervention assessments were conducted to analyze changes in task performance, quality of life, and psychosocial factors.
Data Collection Tools
The pre- and postprogram evaluations included assessments of the Canadian Occupational Performance Measure (COPM), the EuroQol–5 Dimension (EQ–5D), and the Korean version of the Psychosocial Impact of Assistive Devices Scale (K–PIADS). The K–PIADS, validated by Chae and Jo (2014), measure the psychosocial impact of assistive technology across three domains: self-esteem, adaptability, and competence. Task performance across different spaces was assessed by using a 3-point Likert scale (1 = inability to perform, 2 = assisted performance, and 3 = independent performance). All assessments and smart home solutions were delivered in person through home visits by occupational therapists trained for this program. For monitoring purposes, the safety assessment section of the Smart Home Living Performance Evaluation Tool, developed by Lee and Choi (2004), was modified for this study to focus on four items related to usage safety and two items concerning spatial safety.
Data Analysis
Data analysis was conducted with IBM SPSS Statistics (Version 24.0). The dataset included the general characteristics of users, their daily indoor living performance, smart home services applied according to each user’s algorithm by occupational therapists, user feedback, and any additional measures taken. The Shapiro–Wilk test was used to assess the normality of scores obtained from pre- and postintervention assessments by using the COPM, K–PIADS, EQ–5D, task performance across different spaces, and safety evaluations. If the data met the assumptions of normality, a paired t test was performed; otherwise, the Wilcoxon signed-rank test was applied. In addition, repeated measures analysis of variance (ANOVA) was conducted to examine changes in safety assessments over time. All statistical significance levels were set at p < .05.
Results
General Characteristics of Participants
Of the 40 participants, 22 (55.0%) were male and 18 (45.0%) were female. The most represented age groups were individuals in their 50s and 60s, with 13 participants (32.5%) in each group. The smallest group was participants younger than 40, with 3 individuals (7.5%). Most participants were diagnosed as having conditions related to physical disabilities, including spinal cord injury (42.5%), cerebrovascular accident (25.0%), and traumatic brain injury (12.5%). In addition, 34 participants (85.0%) received basic livelihood security benefits. In terms of household composition, 18 participants (45.0%) lived with two or more residents, 23 participants (57.5%) lived in apartments, and 32 participants (80.0%) resided in nonowned housing (Table 3).
General Characteristics of Participants (N = 40)
Applied Smart Home Solutions
Entrance
Various smart home solutions were implemented in the entrance area to facilitate independent entry and lock control for users. Most participants (n = 28, 70%) experienced difficulties interacting with external visitors. Switch robots and smart remotes were primarily used to address these challenges, whereas a small number (n = 4, 10%) used smartphone-based remote control systems. Over 70% of participants were able to independently unlock their doors from the bedroom using smart remotes, transitioning from assisted to autonomous operation. A few users adopted more advanced setups, including smart locks and automated swing doors. This enhanced independence in entrance control reduced physical burden and enabled more efficient and secure interactions with visitors.
Bedroom and Living Room
In the bedroom and living room areas, various smart home solutions focused on lighting control, electronic device management, and window and curtain automation. Users were able to operate indoor lighting remotely through smart hubs, switches, and remotes, enabling 60% of them to control lighting independently after the program implementation. For participants without Wi-Fi access, switch robots and smart remotes were provided to help overcome physical limitations. This enhanced lighting control contributed to psychological stability and daily convenience, thereby improving overall autonomy. Electronic devices in both areas became remotely controllable through smart plugs. Items such as fans, computers, and mood lights could be operated without physical proximity, increasing users’ independence and reducing reliance on caregivers. Some participants’ bedrooms and living rooms were equipped with motorized curtains and blinds, which were customized based on their frequency of use and individual needs. Automated blinds allowed participants in high sunlight areas to manage natural lighting more effectively. These automated solutions supported convenient environmental control and facilitated personalized living spaces (Figure 3).
Smart home solutions for environmental control and accessibility in daily living spaces.
Effects of Smart Home Solutions on Occupational and Task Performance, Quality of Life, and Psychosocial Impact
Table 4 summarizes the key findings across all three areas, showing significant improvements in occupational performance, quality of life, psychosocial impact, and specific task performance across various environments. Participants demonstrated marked improvements in occupational performance following the implementation of the program. Notable gains in independence were observed in tasks performed in the bedroom and entrance areas, where users autonomously managed daily activities, such as controlling lighting and unlocking doors.
Comparison of Initial and Reassessment Outcomes in Occupational Performance, Quality of Life, and Environmental Tasks
Note. COPM = Canadian Occupational Performance Measure; EQ–5D = EuroQol–5 Dimension; K–PIADS = Korean Version of the Psychosocial Impact of Assistive Devices Scale.
*p < .01. **p < .001.
Assessments with the EQ–5D and K–PIADS indicated significant improvements in overall health status and life satisfaction (p < .05). Participants reported reduced physical discomfort, enhanced psychological stability and self-esteem, and increased adaptability and self-awareness, reflecting a comprehensive enhancement in psychosocial well-being. Environment-specific improvements were also evident. For instance, in the entrance area, the mean score for unlocking locks increased from 1.8 to 2.8, and the score for checking doorbells improved from 1.6 to 2.7. In the bedroom, functions such as controlling lights, electronic devices, and curtains or blinds showed substantial gains in independent performance.
Improvements in Perceived Safety After Smart Home Solution
Following the implementation of the smart home services, the occupational therapists monitored users’ service usability, focusing on usage safety and spatial safety, through weekly phone calls and home visits over 4 wk. Repeated measures ANOVA revealed a statistically significant effect of time on usage safety, F(3, 90) = 10.91, p < .001, indicating that participants’ safety perception improved progressively over the course of the intervention. There was also a significant main effect of time for spatial safety, F(3, 90) = 19.63, p < .001. These results indicate meaningful improvements in safety perception over time following the introduction of smart home solutions (Table 5).
Repeated Measures Analysis of Variance Results for Usage Safety and Spatial Safety Over Four Time Points
**p < .001.
Discussion
This study evaluated the impact of tailored smart home solutions on the daily occupational performance and quality of life of individuals with physical disabilities from an occupational therapy–centered approach. The findings confirmed that applying tailored smart home solutions enhanced users’ occupational performance independence and improved their quality of life.
The tailored smart home solutions application in this study significantly improved users’ task performance, notably increasing their independence in activities such as entering and exiting the bedroom. Previous studies have also highlighted the potential of smart home technology to enhance independence and autonomy for users, including individuals with disabilities. The smart home solutions used in this study enabled participants to regain functional control over their home environments (Ding et al., 2023; Moon et al., 2021). These technologies minimized physical strain and reliance on caregivers while also boosting users’ confidence and sense of autonomy (Moon et al., 2022). For instance, Ahmed et al. (2016) reported that smart home technology contributes to improved self-esteem and autonomy, thereby enhancing quality of life. Similarly, Turnley et al. (2023) noted that smart home technology effectively boosts the daily task performance and satisfaction of adults with developmental disabilities. These improvements align with the findings of Peek et al. (2016), who emphasized that the effective implementation of smart home technology depends on collaborative design processes and personalization to support independent living and task performance among older adults and individuals with disabilities. This technological approach plays a significant role in promoting autonomy and independence by offering tailored solutions that address users’ specific needs.
The application of tailored smart home solutions also improved the quality of life (measured by EQ–5D) for individuals with physical disabilities in this study, as evidenced by reduced physical discomfort, increased psychological stability, and enhanced self-esteem. These benefits were particularly evident among individuals with physical disabilities, such as those with spinal cord injuries or strokes. Many participants in this study faced challenges with hand function and walking ability, which often hindered them from performing indoor daily activities independently and led them to rely on others. Consequently, participants were able to engage more meaningfully in daily activities and experienced improved emotional stability.
In this study, the choice of smart home solutions was based on a thorough analysis of restricted activities within each participant’s living space. The intervention aimed to address specific challenges that participants faced in various areas of their homes. Although bathroom modifications are typically prioritized in previous home modification studies, none of the participants in this study selected bathroom-related smart solutions, possibly because of the need for structural changes rather than sensor-based automation. Instead, most interventions targeted more practical spaces such as entrances and bedrooms, where smart technologies could be implemented more efficiently and with greater flexibility. For example, Aggar et al. (2023) demonstrated that smart home technologies tailored to users’ needs and environments can lead to significant improvements across various quality of life domains such as life achievement and future security, thereby fostering greater independence and overall well-being. Jamwal et al. (2022) highlighted that smart home and communication technologies can promote independence and social participation among individuals with disabilities, ultimately enhancing their quality of life. However, they also stressed the necessity for personalized support and ongoing adaptation during technology use. The findings of the present study, consistent with prior research, suggest that smart home technology positively affects user independence and psychological stability, emphasizing the significance of tailored technological applications. In the future, smart home technology can improve quality of life through more flexible personalization and continuous monitoring.
In this study, tailored smart home solutions were effectively used to meet user needs, but certain limitations were also identified. Specifically, challenges such as unstable Wi-Fi connections, device compatibility issues, and the need for an initial user adaptation period emerged as potential barriers to the sustainability and efficiency of the intervention. These challenges have also been noted in previous studies. Chang and Nam (2021) asserted that the successful implementation of smart home technology relies heavily on network stability and compatibility with existing devices, underscoring the importance of user adaptation during the integration process. Moreover, participants initially experienced difficulties adjusting to the modified environments, and some expressed discomfort or unfamiliarity with the new systems. However, with weekly, personalized training and monitoring sessions facilitated by occupational therapists, participants gradually became accustomed to the smart home devices. This finding parallels that from Ghorayeb et al. (2021), who noted that older adults with practical experience using smart home technologies expressed higher acceptance and fewer concerns over time compared with those without such experience. This personalized and context-specific approach proved to be a robust strategy for ensuring successful adaptation and optimizing the long-term impact of smart home interventions. These findings provide valuable insight into the essential role of sustained support and tailored training in assistive technology implementation (Morris et al., 2021).
In addition, Jamwal et al. (2022) noted that personalization and continuous support are crucial factors for the successful application of smart home technology, emphasizing the need for tailored solutions that align with users’ environmental contexts. In this study’s tailored smart home solutions, participants’ hand function, speech abilities, and preferences for control interfaces were assessed to determine the most suitable options. Control interfaces such as remotes, smartphones, and smart speakers were chosen on the basis of these factors, enabling participants to control their environments effectively (Mun & Kim, 2025). Furthermore, home automation settings were customized to users’ daily routines, widget shortcuts were created on smartphones, and voice commands were adjusted to preferred phrases. These strategies align with prior research indicating that personalized assistive technology configurations enhance usability and long-term adoption (Kang et al., 2024; Moon et al., 2022). However, they still present challenges for implementation across diverse user environments.
This study confirmed the positive impact of tailored smart home solutions, delivered through an occupational therapy–centered approach, on the task performance and quality of life of individuals with physical disabilities. A key strength of the study was the provision of personalized interventions that addressed participants’ individual needs, promoting independence and self-reliance through the use of smart home technology. However, several limitations should be acknowledged. First, the exclusive focus on individuals with physical disabilities limits the diversity of the study population. Zhang et al. (2023) suggested that smart home technology may yield different outcomes for individuals with various types of disabilities, potentially limiting the generalizability of the results. Second, the absence of a control group restricts internal validity. It remains unclear whether observed improvements were attributable to the smart home intervention itself or to extraneous factors such as researcher involvement or natural adjustment over time. Third, although the study followed ethical guidelines and received institutional review board approval, it did not investigate participants’ perceptions of privacy or concerns related to smart home technology use. Given the increasing attention to surveillance and data sensitivity in smart environments, future studies should include direct assessment of users’ privacy attitudes and acceptance. Finally, a more comprehensive evaluation of the long-term effects and applicability of smart home solutions is needed. Mun and Kim (2025) emphasized the need for systematic studies that assess the long-term health outcomes associated with smart home technologies. Despite these limitations, this study highlights the potential of occupational therapists to deliver tailored interventions using smart home technology, resulting in significant improvements in user independence and quality of life.
Implications for Occupational Therapy Practice
This study has the following implications for occupational therapy practice: Tailored smart home solutions are a valuable tool in occupational therapy interventions, significantly enhancing the independence and task performance of individuals with physical disabilities. Occupational therapists can use smart home technology to provide individualized interventions that respond to users’ specific needs and environmental demands, enabling greater autonomy in daily occupations. Training for users and caregivers enhances the effectiveness of these technologies and promotes their long-term use through continued technical support. This integrated strategy demonstrates how occupational therapy can leverage technological innovation to enhance intervention methods.
Conclusion
This study confirmed the positive impact of tailored smart home solutions on the daily task performance and quality of life of individuals with physical disabilities. Personalized interventions led to significant improvements in user independence and autonomy in tasks such as lighting control, door unlocking, and electronic device usage while also contributing to enhanced quality-of-life outcomes. These findings support the integration of smart home technology into occupational therapy practice, promoting user-centered, independence-enhancing interventions. However, the study was limited to individuals with physical disabilities and had a relatively short intervention duration. Future research should investigate long-term outcomes and assess the applicability of smart home solutions across a more diverse range of populations. Further advancements in technology and sustained user monitoring will be essential to optimize the clinical utility of smart home systems in occupational therapy.
Footnotes
Acknowledgments
This work was supported by the National Research Foundation of Korea grant (NRF-2022-NR071369) from the Korean Ministry of Education. I express my sincere gratitude to the occupational therapists at the public health centers in Seoul and Gangwon-do for their invaluable collaboration and participation.