eTextile Knee Sleeve Research

Project Description

This study intended to understand the interaction between various primary stakeholders, such as Total Knee Arthroplasty (TKA) patients and their doctors.  Through expert interviews and the observation of the rehabilitation process, an examination of existing techniques utilized by physical therapists during knee rehabilitation were analyzed with the intent to recognize how users interact with their existing rehabilitation products.  Ultimately however, the purpose was to look for product opportunities in the current system.

Secondly, a Participatory Ideation Workshop was conducted with users who have either performed, are currently attending, or intending to go through knee rehabilitation.  The goal of this workshop was to understand the user’s perception of rehabilitation and technology, establish design criteria, and develop potential directions for a final product.

Project Details

Course Industrial Design Masters Thesis
Date 2013
Skills Qualitative Coding, Affinity Diagramming, Interviews, Observation, Participatory Design Workshop
Role Individual Project

Interview and Observation Analysis: AEIOU

A total of 6 expert interviews were conducted to discover the sentiments that surrounded rehabilitation and potential opportunities that existed.

AEIOU is a method of analysis that documents and codes information under a guiding classification systems of Activities, Environments, Interactions, Objects, and Users (AEIOU) (see Figure 22).  The interrelated nature of the documentation forces the researcher to observe situations through different lenses.  The advantage of using AEIOU is that it allows for structured synthesis in the future, such as using the ELITO method.  The AEIOU allowed for documentation of both process and tools, and ensured a more thorough Affinity Map.

The AEIOU documented :

  • The experience that users undertake when going through rehabilitation and the timeline consisted of:
    • Patients are in the hospital for 3 days
    • If patients are healing well, they get to go home for 21 days and have a visiting physical therapist come in to help with rehabilitation. If the patient is not healing properly, they go to an outpatient facility for 10 – 21 days, and then move home.
    • After home rehabilitation, the patient has to go to an outpatient facility for 4 – 6 weeks, or until they achieve 90 degrees of bend.
  • The stakeholders are involved in the process are:
    • Family and friends oversee the entire process
    • Physicians meet with the patient once a month
    • The physical therapists meets with users 2- 3 times a week during rehabilitation.
  • Stretching and flexion / extension exercises performed during rehabilitation consist, but are not limited to:
    • Biking
    • Stair climbing
    • Using towels and sheets to help stretch the joint.
  • The patients are exposed to a colorful environment in order to help build morale.

Interview and Observation Analysis: Affinity Diagramming

Using Affinity Maps, two chief directions emerged from the observational studies.  First, the Affinity Map was organized based upon consistent themes that arose during the observation.  These themes are:

  1. Physical therapy is difficult to properly be performed at home, is typically neglected, and often leads to surgical manipulations or infection in the future.
  2. The role of the Physical Therapist is both an educator and a motivator.
  3. The various tools used in the rehabilitation center.

Key observations concluded that, despite understanding that they were being held fully accountable for their rehabilitation, the patients felt it was “too hard” to perform proper rehabilitation, which was performed 3 times daily for 15 to 30 minutes in the home and often led to regression in their rehabilitation at home.  Despite patient problems, physical therapists often responded in direct correlation to the amount of effort the patient wanted to put in – e.g. the more a patient pushed themselves, the more the physical therapist pushed the patient.  Attitude about rehabilitation was very important.

The process of rehabilitation typically started with a heating pad being used during stretching.  In order to make up for the regression, physical therapists would slowly build up the exercises during their sessions to push the patient to their limit, which often led to the patients closing their eyes throughout and bracing themselves while the physical therapist worked on their knee.  Additionally, simple language, analogies, and metaphors were frequently used to encourage patients.  A patient’s progress was determined using a goniometer to measure the degree of flexion and extension of the knee.  The placement of the goniometer was crucial to determining the angle, as it bisected the leg.

Additionally, rehab is very emotional.  The Affinity Map was re-arranged to show the disconnection between the technology-centric Physical Therapist and the emotion-centric patient.  The darker orange corresponds to the amount of technology available for the patient to use in the home, while the dark blue outlines the technology provided at the rehabilitation clinic.  Additionally, the light orange refers to the emotions that the patients consistently brought up during the rehabilitation session, while the light blue outlines the tools used by the physical therapists to mediate those emotions.  The figure shows the difference in technology between patient and physical therapist and show how under-prepared physical therapists are to handle the patient emotionally and physically.

Participatory Design Workshop

The workshop was segmented into 3 stages. An initial mind mapping task was used to get participants into the mindset of rehabilitation, a KANO analysis was used to understand important/unimportant features, and lastly, the participants were asked to design and build tools to help them track their rehabilitation. Six people familiar with rehabilitation were recruited for the participatory design workshop, three females and three males, from a variety of different backgrounds

Key findings from the workshop focused around invisibility and moving the product away from appearing as a technology product.  Results from the mind map showed that people view rehabilitation as this arduous, uncomfortable, expensive, yet required process.  In contrast, wearable products were supposed to be comfortable, light, and breathable, but they had to be careful as to not be itchy, heavy, or difficult to put on or take off.  Moreover, technology was perceived as confusing, modern, bionic, advanced, complicated, and even expensive.

While the mind map was slightly abstract, the KANO analysis provided a clear set of features for the product.  Users required features such as invisibility and reliability, while comfort and colors were considered desirable.  Interestingly, audible feedback and reminders to perform rehabilitation were considered anti-features (see Table 2). Additionally, one thing in particular stood out in the KANO analysis.  In section two, one participant wrote down habit-forming as a desired feature, yet two others ranked it as an anti-feature.

During the design and build phase of the workshop, participants had a chance to propose new ideas.  Most participants developed products that were hidden in everyday wearable products, such as belt loops, socks, jean seams, and kinesthetic tape.  The participants additionally provided a wide range of technologies to be considered, such as multiple accelerometers, microwaves, sonar, IR, and stretch sensors.

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