Three-dimensional visualisation of activities of daily living for home modification planning (VisADLs) after spinal cord injury: stakeholder perspectives from a qualitative proof-of-concept study.

PURPOSE: Home modification planning after spinal cord injury (SCI) is often complicated by limited opportunities for people with SCI to attend their homes and participate in decision making. This proof-of-concept study explored whether three-dimensional visualisation of activities of daily living (ADLs), created from motion capture of people with SCI, could support understanding and collaboration during planning. METHODS: Twelve stakeholders (four people with SCI and home modification experience, eight occupational therapists) participated in semi-structured focus groups and interviews. Participants viewed a prototype tool depicting ADL movements captured from people with SCI in home environments, then discussed its perceived usefulness, design requirements, and feasibility for clinical practice. Data were analysed using reflexive thematic analysis. RESULTS: Five themes captured perceived benefits and the conditions required for use. Participants described the visualisations as reducing spatial uncertainty, supporting more informed participation in decision making, and improving communication among people with SCI, clinicians, builders, and funding assessors. Authentic motion capture and respectful person-like representation were seen as essential ethical requirements. Participants emphasised the need for functional precision where body, equipment, carers, and environment interact, and for flexibility to accommodate individual variation in movement and equipment. Sustainable adoption was seen to depend on integration with existing tools and workflows. CONCLUSIONS: Three-dimensional visualisation of ADLs based on real movements shows promise for improving communication, confidence in design decisions, and stakeholder alignment in home modification planning after SCI. Realising this potential will require respectful representation, functional precision, and workflow integration.