POAKme
POAKme enables individuals with Osteoarthritis of the Knee access care and rehabilitation from their homes
As populations age, risk of musculoskeletal injuries and degenerative diseases increase. One of these injuries is Osteoarthritis of the Knee, a condition in which the cartilage in the knee joint wears away due to excessive wear and tear. Younger people and those who do not rely on physical strength for their daily labour often do not notice the onset OA Knee until it is too late. The physiotherapy required to manage the injury is a lifelong commitment, with slow gains and low motivation.
Role
Design Researcher, Designer & Developer
Tools
Unity
Arduino
Sketch
Protopie
Adobe AfterEffects
Methods
Contextual Enquiry
Fly on the wall
Expert interviews
SUS based descriptive qualitative analysis
Overview
Improving access to healthcare is fundamental to improving the quality of life of every individual
Problem
Physiotherapy required to manage Osteoarthritis of the Knee is a lifelong commitment that people with desk jobs have very low motivation for, and have very little information to take care of themselves. Doctors at clinics too are heavily burdened and struggle to give personalised care required by the patients.
Solution
A mobile app with a companion device that is attached to the foot to track exercises, with data collected used to inform and motivate patients of their progress.
Outcome
Final application design & solution
Over four months, I collaborated with physiotherapists to understand the types of patients who require physiotherapy, the intricacies of the care they receive, and the challenges that limit their access to care. I then designed, developed and evaluated a prototype for efficacy in improving health outcomes. Through this, I was able to improve motivation and increase adherence to a fixed recovery regimen.
01
Effortless to wear
The device uses a strap harness to stay fixed to the foot, with a toe guide to help position it accurately. The patient only has to log in to the physiotherapist created profile, pair the device to the phone, select the foot they need to exercise, and the exercises are made available.
02
Intuitive Onboarding
The patient logs in to their profile, pairs the device to the phone, selects the injured foot, and the exercises are visible.
03
Scaffolding Information
The patient is kept informed about all the exercises they need to do, how to perform them with textual and visual representation, the number of repetitions and sets for each exercise, and their current progress.
04
Enabling Correct Performance
Real-time feedback during exercise performance allows the patient to know they are doing it correctly. The follow along process also provides motivation similar to the encouragement a physiotherapist would provide. Lateral movements are discouraged with the bright red line showing up.
05
Reflective feedback
Post completion of the exercise, the patient can view how they performed and which reps had lateral movement of the foot. Each incorrect repetition can be reviewed with a replay of the movement that occurred.
06
Visualise improvement
By showing that metrics such as pain reported post exercise decrease over time, potential dips in motivation during improvement plateaus can be countered.
So why did I design POAKme?
Secondary Research
01
Solutions are primarily clinic facing
Existing solutions for osteoarthritis of the knee are expensive, clinic facing, and require large substantial infrastructure. These factors are not suited for resource constrained contexts.
02
Limited motivation
There is a dearth of solutions tailored for motivating patients with chronic disorders through visualisations, both real time and post exercise. The delivery of such information in a manner that will make sense to this audience has the potential to improve adherence.
User research
Patients have two primary goals - improve mobility and increase strength
Improve mobility & range
This is achieved through repeated extension and contraction (reps) the muscles connected to the knee
Improve strength & reduce pain
This is achieved through performing multiple sets of each exercise to improve muscle resilience when performing daily activities
I was able to interact and observe a limited set of patients at BYL Nair Hospital’s physiotherapy ward. This helped me understand the needs and wants of the patients. I used a variety of methods from contextual inquiries, fly on the wall observations and expert interviews to gain this understanding.
The two types of patients observed have differing motivations in accessing physiotherapy
On-site construction workers
These were individuals who were willing to go to the clinic for treatment since their job performance depends on physical mobility. Taking time off from work was also not an option given the daily wage nature of their occupation.
Professionals with desk jobs
These were individuals who did not have a need to exert themselves physically. As a result, they were also unwilling to schedule physiotherapy until the injury began to affect their day to day activities and mobility.
I chose to design for professionals with desk jobs
On-site construction workers were more likely to be diligent in showing up for the scheduled sessions. Whereas, professionals with desk jobs viewed physiotherapy more as a beneficial activity, not a necessity. This revealed problems such as adherence & motivation.
Given that the patients were, more often than not, going to pereform the exercises from home, they are handed a sheet with a list of exercises and a small paragraph about how it should be executed. This is called the Home Program. But there are bunch of reasons this doesn't work as well as one would assume.
Challenges
01
Domestic constraints
Ability to perform exercises at home requires the patient to be affluent enough to dedicate some time away from domestic chores towards their health improvement.
02
Recognising improvement
As the patient hits an improvement plateau, motivation can be hard to come by.
03
Feedback from Home Program
Receiving feedback as a motivational tool and for posture correction, especially with regards to rotating the foot while exercising, is crucial to recovery and is unavailable with the Home Program.
04
Discontinuing performing the exercises
Lack of continuous improvement disheartens patients and they don’t follow-up regularly with their physiotherapists.
"Not doing the exercise is better than doing it incorrectly."
Telephysiotherapy can help address these problems
Tele-physiotherapy has the potential to solve for many of the pain points. Additionally, given the growing user base of smartphone users in India, this was an emerging space to execute potential solutions.
Benefits of telephysiotherapy
01
Flexibility of performing from anywhere
By allowing users to perform exercises from the comfort of their homes, the need to coordinate schedules and logistics is significantly reduced. This not only eliminates the hassle of travel and transportation but also provides users with greater flexibility and convenience in their workout routines.
02
Provide real-time feedback
Recording exercises provides a visual record of an individual's performance, offering valuable reflective feedback and enabling the identification of long-term trends that might have been otherwise missed, ultimately leading to improved exercise outcomes.
03
Educate with reflective feedback
Recording exercise data provides reflective feedback which can help improve technique and help track progress over time.
04
Physiotherapist remains informed
Physiotherapists can remain well-informed about their clients' progress, techniques, and form, while also keeping them accountable.
Problem statement
How can I create an affordable, home-based solution for knee osteoarthritis patients to perform physiotherapy exercises correctly and stay motivated through visualizations?
Real-Time Exercise Correction
Develop an affordable device that provides real-time feedback for on-the-spot corrections during exercises.
Post-Exercise Improvement Analysis
Create visualizations for post-exercise analysis to measure improvement.
Ideation
There were two main questions the brainstorm needed to answer.
01
How can we track movement accurately?
The challenge involves selecting sensors that can precisely monitor movements essential for effective tele-physiotherapy. The selection is crucial as it impacts the accuracy of the real-time feedback and the overall effectiveness of the rehabilitation process.
02
How can we provide intuitive feedback?
For feedback to be intuitive, it must be immediate and understandable, allowing users to correct their movements in real-time. This approach helps in minimizing incorrect practices and reinforces correct motion paths during exercises.
This was tackled in three parts - I explored a variety of sensors to track motion, the kind of wearables that could house these trackers without losing on accuracy, and a variety of feedback modalities.
Tracking movement through space
The MPU6050 accelerometer (left) and HC-SR04 ultrasound sensor (right) were prototyped. While HC-SR04 allowed the leg to be free when exercising, MPU6050 accelerometer was chosen for clarity of signal.
Ensuring it stays on the foot
Various methods to keep the MPU6050 positioned accurately throughout the duration of the exercise ideated. The toe with strap guidance was chosen for the being able to record rotational movement with high precision, while being easy enough to put on and take off.
Exploring different feedback modalities
Visual, auditory, & haptic were explored. Visual and auditory feedback were chosen for universal availability and effectiveness
Prototype and Pilot study
With the parts chosen, it was time to put them together and build a working prototype.
The prototype used an Arduino interfacing with a Unity mobile application via MQTT protocol
Device
The device prototype was made with a NodeMCU soldered to an MPU6050. A strap was attached to this setup with the toe-guide.
Unity mobile application
The application was developed on Unity, with the device communicating with the app through the MQTT protocol.
The user was asked to follow the pace setting quad, with the coloured quad replicating the movement of their foot. If there was too much rotational movement, it would turn red.
Companion web application
This is achieved through performing multiple sets of each exercise to improve muscle resilience when performing daily activities
This is the schema used to get the application working.
The pilot study was conducted with patients from B.Y.L Nair Hospital, Mumbai. Appropriate IRB protocols were implemented and consent of the participants was received to anonymously use the data for study purposes.
The experimental participant noted a significant improvement in strength and pain reduction over the 7 days of the study
Both control and experimental participants were given the same exercises. The control participant was given a Home Program sheet, whereas, the experimental participant was given the prototype device and application.
Strength and pain measurements were taken pre and post the study. The experimental participant noted an improvement in strength of 6kgf compared to the 2kgf noted by the control participant. There was a notable reduction in pain as well.
Given the short duration of the experiment, nothing conclusive can be drawn from this. It could also be chalked down to improved adherence due to awareness of being monitored.
Learnings from pilot study
Learnings that translated to the app design
Highlight the error
While the quad going red was helpful, it wasn't super clear. Users felt a more exaggerated expression would be beneficial in reducing the errors made.
Provide instructions about what to look for
While instructions about what to do were made clear, users found the actual exercise screen confusing in terms of understanding how to read the information presented.
Consolidate exercise and feedback
The exercises were available on the mobile prototype, whereas the reflection and feedback about rotational movement was present on the web application. Users felt a consolidated approach would ease the effort required.
These learnings were noted and accordingly incorporated into the solution described earlier.
Evaluation
Qualitative evaluations were conducted with 7 users & 4 physiotherapists
System Usability Scale based qualitative descriptive analysis through semi-structured interviews were conducted to evaluate the prototype and application with patients and doctors. The concept application was evaluated for the momentary and episodic perceptions, along with the usability of the two visualisations.
01
Easy to use
All participants found the device and application useful, intuitive and easy to use at first glance.
02
Helps in adherence
6 of the patients felt the application would help them stick to a routine better because information is going to their therapist.
03
Error correction useful
All the interviewees found the error correction to be useful and felt that would sway them towards adopting this.
04
Complimentary
Physiotherapists said they found the app and device to be a good complimentary task to the clinical sessions
Conclusion
Telerehabilitation has the potential to massively disrupt rehabilitative medical care.
This project aimed at minimising clinical contact while maximising remotely supervised home care. This is extremely important in areas that have poor access to quality care. In light of the Covid pandemic, interventions that can provide care remotely, similar to those received at the clinic, have become important even to those in urban centres. With the mobile and Internet infrastructure only improving from here on, the potential and need for such solutions in the market will grow.
