Improving the at home physical therapy experience.
Patient adherence is widely problematic in the medical field and physical therapy is no exception. Failure to complete exercises as prescribed slows a patient's recovery, wastes money and causes lasting health consequences. With the help of Premera Blue Cross, this project addressed:
How can I motivate adult physical therapy patients with acute, orthopedic injuries to adhere to their home exercise programs?
This project followed a thorough and robust process of research, ideation, prototyping, testing and final production.
To better frame our project, I began with secondary research in the form of a literature review and a competitive analysis. I learned that current tools for physical therapy adherence are not working because they:
Try to replace the role of the physical therapist.
- A physical therapist’s ability to assess pain in context is imperative to creating a successful treatment plan (i.e. augment, don’t replace).
Are not personalized to a patient’s specific needs.
- Physical therapy exercises are highly customized based on the ability of the patient. Many systems do not adapt to these changes.
Do not accurately represent the patient’s exercises.
- Paper reference sheets use stock images or hand drawn figures to convey movement, shown here. Patients quickly forget what they mean.
The primary research was framed by my secondary research and offered rich, first hand accounts of stories and experiences. My team and I employed the following techniques:
At several points along the way, the team discussed our findings and used affinity mapping, interview coding, concept diagrams and discussion to evaluate our results. Below are journey maps and design principles.
Prior to our primary research, I was under the impression that the patient experience looked like the first diagram. The patient would visit a physical therapy clinic, be expected to complete their exercises at home, and return for assessments until they were healthy enough to stop.
However if we pull apart the treatment phase, we see instead of being a consistent loop, little breakdowns along the way start to compromise a patient’s path to recovery. My research showed that patients did not feel confident remembering their exercises, were unaware of their progress, grew bored, and struggled to communicate their concerns during appointments.
After analyzing our qualitative data, these findings were later incorporated into a set of design principles, which drove the ideation phase of the project.
The ideation process followed three phases of individual expansion and group contraction phases.
Sketches and Storyboards
The team and I began with individual sketching with broad ideas created from a set of ideation prompts, drawn from the user research. Through the multiple week process of storyboarding and imagining what each final product might look like, I was able to discard and collapse features and interactions into our final direction.
In our ideation process, I created a list of values that reflected qualities the solution should have. I vetted solutions we had against these values and arrived at our final product, Motive.
To test these ideas, we built prototypes of the Motive system. First though, I used user flow diagrams to select what paths were most pertinent to testing. Next, the team and I created mockups and a research protocol to run participants through.
Mobile Application User Flow
Kinect User Flow
Mobile App Mockups
To improve and validate these ideas, I recruited former physical therapy patients for testing after running a pilot test.
A total of four participants tested the prototypes in either a private room set up in a campus library, or in the living room of their home. Participants ranged in gender, age, self-identified adherence rates, injury type, and current status of treatment. Testing through a scenario based, semi-structured interview allowed us to have participants interact directly with our prototypes in an imagined context (i.e. at the clinic, in their living room). They responded with quantitative scales and qualitative evaluations.
My hypotheses were the following:
1. Narrated video references will increase a patient’s confidence when completing exercises at home.
2. Gamified exercise experiences will keep patients more adherent than unprompted physical therapy.
3. Explicit progress tracking will motivate patients to adhere to their prescribed exercise regimens.
After testing, I gathered responses to the prototypes for validation or challenging of the goals of the prototype. These are the results of the testing.
The final design is a physical therapy assistant that motivates patients to complete their home exercises through reference videos, exercise reminders, engaging gameplay and progress reports.
The Motive system consists of a standalone mobile app, which can be augmented with a home-based motion tracking component. The mobile application facilitates in-clinic communication with physical therapists and allows patients to capture highly personalized exercise reference videos.
The mobile data is then synced to a motion tracking device in the patient’s home. Here, motion based exercise games are generated to break up the monotony of physical therapy. Progress reports likewise reassure patients that they are on the path to recovery.
Ultimately, Motive succeeded in adding value to the physical therapy experience by empowering patients to take ownership of their recovery, providing confidence building reference materials, visualizing progress and breaking up the monotony of physical therapy -- as confirmed by experts and physical therapy patients. Unlike existing products, Motive accomplishes all of these objectives without requiring additional work on the part of physical therapists.