Attitudes of patients toward adoption of 3D technology in pain assessment: qualitative perspective

Feasibility and acceptability to use a smartphone-based manikin for daily longitudinal self-reporting of chronic pain

Background

As management of chronic pain continues to be suboptimal, there is a need for tools that support frequent, longitudinal pain self-reporting to improve our understanding of pain. This study aimed to assess the feasibility and acceptability of daily pain self-reporting using a smartphone-based pain manikin.

Methods

For this prospective feasibility study, we recruited adults with lived experience of painful musculoskeletal condition. They were asked to complete daily pain self-reports via an app for 30 days. We assessed feasibility by calculating pain report completion levels, and investigated differences in completion levels between subgroups. We assessed acceptability via an end-of-study questionnaire, which we analysed descriptively.

Results

Of the 104 participants, the majority were female (n = 87; 84%), aged 45-64 (n = 59; 57%), and of white ethnic background (n = 89; 86%). The mean completion levels was 21 (± 7.7) pain self-reports. People who were not working (odds ratio (OR) = 1.84; 95% confidence interval (CI), 1.52-2.23) were more likely, and people living in less deprived areas (OR = 0.77; 95% CI, 0.62-0.97) and of non-white ethnicity (OR = 0.45; 95% CI, 0.36-0.57) were less likely to complete pain self-reports than their employed, more deprived and white counterparts, respectively. Of the 96 participants completing the end-of-study questionnaire, almost all participants agreed that it was easy to complete a pain drawing (n = 89; 93%).

Conclusion

It is feasible and acceptable to self-report pain using a smartphone-based manikin over a month. For its wider adoption for pain self-reporting, the feasibility and acceptability should be further explored among people with diverse socio-economic and ethnic backgrounds.

Guidetomeasure-OT: A mobile 3D application to improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk assessments

BACKGROUND

A key falls prevention intervention delivered within occupational therapy is the home environment falls-risk assessment process. This involves the clinician visiting the patient's home and using a 2D paper-based measurement guidance booklet to ensure that all measurements are taken and recorded accurately. However, 30% of all assistive devices installed within the home are abandoned by patients, in part as a result of the inaccurate measurements being recorded as part of the home environment falls-risk assessment process. In the absence of more appropriate and effective guidance, high levels of device abandonment are likely to persist.

AIM

This study presents guidetomeasure-OT, a mobile 3D measurement guidance application designed to support occupational therapists in carrying out home environment falls-risk assessments. Furthermore, this study aims to empirically evaluate the performance of guidetomeasure-OT compared with an equivalent paper-based measurement guidance booklet.

METHODS

Thirty-five occupational therapists took part in this within-subjects repeated measures study, delivered within a living lab setting. Participants carried out the home environment falls-risk assessment process under two counterbalanced treatment conditions; using 3D guidetomeasure-OT; and using a 2D paper-based guide. Systems Usability Scale questionnaires and semi-structured interviews were completed at the end of both task. A comparative statistical analysis explored performance relating to measurement accuracy, measurement accuracy consistency, task completion time, and overall system usability, learnability, and effectiveness of guidance. Interview transcripts were analysed using inductive and deductive thematic analysis, the latter was informed by the Unified Theory of Acceptance and Use of Technology model.

RESULTS

The guidetomeasure-OT application significantly outperformed the 2D paper-based guidance in terms task efficiency (p <  0.001), learnability (p <  0.001), system usability (p <  0.001), effectiveness of guidance (p =  0.001). Regarding accuracy, in absolute terms, guidetomeasure-OT produced lower mean error differences for 11 out of 12 items and performed significantly better for six out of 12 items (p = < 0.05). In terms of SUS, guidetomeasure-OT scored 83.7 compared with 70.4 achieved by the booklet. Five high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, Social Influence, Clinical Benefits, and Augmentation of Clinical Practice. Participants reported that guidetomeasure-OT delivered clearer measurement guidance that was more realistic, intuitive, precise and usable than the paper-based equivalent. Audio instructions and animated prompts were seen as being helpful in reducing the learning overhead required to comprehend measurement guidance and maintain awareness of task progression.

CONCLUSIONS

This study reveals that guidetomeasure-OT enables occupational therapists to carry out significantly more accurate and efficient home environment falls-risk assessments, whilst also providing a measurement guide tool that is considered more usable compared with the paper-based measurement guide that is currently used by clinicians in practice. These results are significant as they indicate that mobile 3D visualisation technologies can be effectively deployed to improve clinical practice, particularly within the home environment falls-risk assessment context. Furthermore, the empirical findings constitute overcoming the challenges associated with the digitisation of health care and delivery of new innovative and enabling technological solutions that health providers and policy makers so urgently need to ease the ever-increasing burden on existing public resources. Future work will focus on the development and empirical evaluation of a mobile 3D application for patient self-assessment and automated assistive equipment prescription. Furthermore, broader User Experience aspects of the application design and the interaction mechanisms that are made available to the user could be considered so as to minimize the effect of cognitive overloading and optimise user performance.

Enabling older adults to carry out paperless falls-risk self-assessments using guidetomeasure-3D: A mixed methods study

BACKGROUND

The home environment falls-risk assessment process (HEFAP) is a widely used falls prevention intervention strategy which involves a clinician using paper-based measurement guidance to ensure that appropriate information and measurements are taken and recorded accurately. Despite the current use of paper-based guidance, over 30% of all assistive devices installed within the home are abandoned by patients. This is in part due to poor fit between the device, the patient, and the environment in which it is installed. Currently HEFAP is a clinician-led process, however, older adult patients are increasingly being expected to collect HEFAP measurements themselves as part of the personalisation agenda. Without appropriate patient-centred guidance, levels of device abandonment to are likely to rise to unprecedented levels. This study presents guidetomeasure-3D, a mobile 3D measurement guidance application designed to support patients in carrying out HEFAP self-assessments.

AIM

The aim of this study is to present guidetomeasure-3D, a web-enabled 3D mobile application that enables older-adult patients to carry out self-assessment measurement tasks, and to carry out a mixed-methods evaluation of its performance, and associated user perceptions of the application, compared with a 2D paper-based equivalent.

METHODS

Thirty-four older adult participants took part in a mixed-methods within-subjects repeated measures study set within a living lab. A series of HEFAP self-assessment tasks were carried out according to two treatment conditions: (1) using the 3D guidetomeasure-3D application; (2) using a 2D paper-based guide. SUS questionnaires and semi-structured interviews were completed at the end of the task. A comparative statistical analysis explored performance with regards to measurement accuracy, accuracy consistency, task efficiency, and system usability. Interview transcripts were analysed using inductive and deductive thematic analysis (informed by UTAUT).

RESULTS

The guidetomeasure-3D application outperformed the 2D paper-based guidance in terms of accuracy (smaller mean error difference in 11 out of 12 items), accuracy consistency (p < 0.05, for 6 out of 12 items), task efficiency (p = 0.003), system usability (p < 0.00625, for two out of 10 SUS items), and clarity of guidance (p < 0.0125, for three out of four items). Three high-level themes emerged from interviews: Performance Expectancy, Effort Expectancy, and Social Influence. Participants reported that guidetomeasure-3D provided improved visual quality, clarity, and more precise guidance overall. Real-time audio instruction was reported as being particularly useful, as was the use of the object rotation and zoom functions which were associated with improving user confidence particularly when carrying out more challenging tasks.

CONCLUSIONS

This study reveals that older adults using guidetomeasure-3D achieved improved levels of accuracy and efficiency along with improved satisfaction and increased levels of confidence compared with the 2D paper-based equivalent. These results are significant and promising for overcoming HEFAP equipment abandonment issue. Furthermore they constitute an important step towards overcoming challenges associated with older adult patients, the digitisation of healthcare, and realising the enablement of patient self-care and management via the innovative use of mobile technologies. Numerous opportunities for the generalisability and transferability of the findings of this research are also proposed. Future research will explore the extent to which mobile 3D visualisation technologies may be utilised to optimise the clinical utility of HEFAP when deployed by clinicians.

Users' Opinion About a Virtual Reality System as an Adjunct to Psychological Treatment for Stress-Related Disorders: A Quantitative and Qualitative Mixed-Methods Study

This study aims to explore patients' and therapists' attitudes about the psychological treatment they received (patients) or applied (therapists). The treatments were standard CBT protocols for post-traumatic stress disorder (PTSD), complicated grief (CG), or adjustment disorders (ADs), depending on each patient diagnosis. The treatments were delivered following a traditional format or supported by a virtual reality (VR) system "EMMA's WORLD" designed for the treatment of stress-related disorders. "EMMA's WORLD" is a VR application in which patients can explore negative experiences using different virtual elements that can be customized to make them more meaningful to the user. The sample was composed of two groups: the "professionals" (N = 10) were all clinical psychologists who applied the same psychological treatment in both the traditional format ("traditional condition") and using the VR system ("EMMA" condition). The second group consisted of a sample of patients (N = 50) who met the criteria for at least one of three different diagnoses: PTSD (N = 15), CG (N = 15), or AD (N = 20). 25 patients received treatment in the traditional format and 25 supported by the VR system. The patients were asked about their expectations (before treatment) and satisfaction (after treatment) with the treatment they received. All the therapists were asked their opinions about both treatment conditions. A mixed-methods approach using quantitative and qualitative methodologies was used. In both conditions, high scores were observed, and the patient's opinions were even better when they have already received the treatments. A more pronounced pre-test-post-test change in the EMMA therapy group than in the traditional group was observed. EMMA's World was well-accepted by both patients and therapists, and it helped to foster motivation in patients, while helping the therapist to apply the treatment. Thus, VR can be useful as an adjunct tool to enhance the treatment.

Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges

BACKGROUND

In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as "poor fit" of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies.

OBJECTIVE

The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP.

METHODS

Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data.

RESULTS

The quantitative SUS results revealed that the application may be described as having "marginal-high" and "good" levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry.

CONCLUSIONS

Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets.

Pain-QuILT: clinical feasibility of a web-based visual pain assessment tool in adults with chronic pain

Background

Chronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation. Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]).

Objective

The goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI.

Methods

Participants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report.

Results

The sample consisted of 50 adults (54% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use than both the MPQ and BPI (P<.01) and was also associated with the fewest difficulties in completion. On average, the time to complete each tool was less than 5 minutes. A majority of participants (58%, 29/50) preferred Pain-QuILT for reporting their pain over alternate methods (16%, 8/50 for MPQ; 14%, 7/50 for BPI; 12%, 6/50 for “other”). The most commonly chosen pain descriptors on MPQ were matched with Pain-QuILT across 91% of categories. There was a moderate-to-high correlation between Pain-QuILT and BPI scores for pain intensity (r=.70, P<.01).

Conclusions

The results of this clinical feasibility study in adults with chronic pain are consistent with our previously published pediatric findings. Specifically, data indicate that Pain-QuILT is (1) easy to use, (2) quick to complete, (3) preferred by a majority of patients, and (4) correlated as expected with validated pain measures. As a digital, patient-friendly method of assessing and tracking pain, we conclude that Pain-QuILT has potential to add significant value as one standard component of chronic pain management.

Comparison of mobile apps for the leading causes of death among different income zones: a review of the literature and app stores

Background

The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide.

Objective

The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias.

Methods

Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games.

Results

Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps.

Conclusions

Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected.