ExoWear
ExoWear
The ExoWear sensor measures joint mobility and tracks frequency of movement. ExoWear wants to improve knee surgery outcomes by enlisting physical therapists to prescribe it to their patients.
We conducted UX research and design for the physician interface.
Role
UX Designer
Tools
Balsamiq, Sketch, Invision
Artifacts and deliverables
Research plan
Competitive analysis
User interviews
Contextual inquiry
Journey map
User stories
App map
Balsamiq prototype
Concept testing
Wireframes
Usability testing
Annotations
Invision prototype
Why Wearables
First order of business: find out what physical therapists need from this interface. We chose five areas to explore with the aim of uncovering how ExoWear could add value for physical therapists.
What is the competitive landscape and industry outlook?
What is the recovery process for knee replacement surgery?
How are home exercise programs assigned and monitored?
What motivates patients to adhere to these programs?
What information do physical therapists track and what do they use it for?
Landscape
Our domain research gave us a picture of a growing industry.
But what's in a knee?
By age 80, a full 10% of Americans will have undergone total knee replacement. Prognosis is good, but recovery is painful and requires outpatient physical therapy for up to 12 weeks.
During that time, home exercise program adherence is the biggest factor affecting patient outcomes. Up to 65% of patients don't adhere to their home exercise program.
To complicate matters, the annual, per person Medicare cap is $1,940. With many knee replacement patients having other physical therapy needs, this makes it even more important for physical therapists to maximize patient recovery in as few visits as possible. Improving those exercise program adherence rates goes a long way to achieving a fuller recovery faster.
We were curious to find out what other wearable and digital product companies are doing to address this issue.
![By Dronainfotech (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons](https://images.squarespace-cdn.com/content/v1/57e2f45b893fc04e3338328f/1478975895137-5XIF065T84883Q94EUWK/By+Dronainfotech+%28Own+work%29+%5BCC+BY-SA+4.0+%28http%3A%2F%2Fcreativecommons.org%2Flicenses%2Fby-sa%2F4.0%29%5D%2C+via+Wikimedia+Commons)
Competition three ways
To understand ExoWear's competition, we looked at all of the ways physical therapists help patients achieve better results through their home exercise programs.
Paper and Journaling
Many clinics still rely on paper exercise handouts
Some therapists ask patients to journal the exercises they do between appointments
Wearable Sensors
Three out of four wearable sensor competitors are geared for inpatient therapy only
They improve exercise accuracy, but don't empower the patient to adhere to a home exercise program
Exercise databases
These provide exercises that therapists can customize
Patients receive instructional support via a printout and/or website login
No supportive technology to provide data to patient and provider about at-home progress
The Physical Therapist’s View
We interviewed five physical therapists and one doctor. We also conducted a contextual inquiry at a physical therapy clinic. What we observed caused us to expand our research to include patients and supportive family members.
We heard two things from therapists that made us broaden our research scope:
“Not sure what info I’d be dying for, I already see the patient twice a week.”
“[Patient] motivation is the biggest factor in adherence to HEP.”
Pivoting to the patient
If therapists feel they do all they can to get patients to adhere to their exercise plans, what more can be done? And by whom? We interviewed patients who've had a knee replacement surgery and the people who supported them during recovery. We were particularly interested in factors affecting motivation.
People we interviewed talked about similar drags on their motivation: a sense of confusion and a sense of pointlessness.
“Sometimes it feels you’re just doing the same thing over and over with no results.”
“[The exercises] were difficult for him because he couldn’t understand...what to do from the paper.”
Teasing out the problem
15 hours of audio transcribed and mapped
The patient care ecosystem
Our research revealed an ecosystem of stakeholders involved in knee surgery recovery:
01. The Patient
The patient’s suffering led them to knee surgery, which is itself a painful intervention. They're highly motivated to recover. They're also worried about the pain and frustrated by limitations that make them more dependent on others.
Their main goal is getting full knee function back so they can go back to their normal, independent lifestyle.
02. The Support Person
Family members encouraged the patient to seek help and are very invested in the patient’s recovery. They may drive them to appointments, help them around the house, or call the patient every few days to see how they’re doing.
They know that the patient is very independent and want to show their support without being overbearing. Their goal is to help the patient recover quickly.
03. The Surgeon
These doctors evaluate patients for possible total knee replacement. They prescribe post-surgery physical therapy to all patients.
Many have certain therapists they trust and refer to often. For those therapists the prescription is often “Eval and Treat.” The surgeon expects the therapist to keep them up-to-date during the treatment period. Usually this involves phone calls and faxes.
04. The Physical Therapist
Therapists love working with patients directly and loathe dealing with electronic records and paperwork. They track every minute of an appointment closely.
All therapists assign patients a home exercise program. They see themselves as partners in patient recovery and put a lot of effort into building rapport.
Patient-centered journey map
Next we mapped out how these archetypes relate along the patient's journey to recovery after knee replacement. We wanted to identify where ExoWear could drive improved patient outcomes.
This journey map revealed opportunities for ExoWear to improve information quality at key points in the therapeutic process.
Opportunities emerge
It became very clear from the journey map that patients bear a lot of responsibility for their recovery. Home exercise programs are key to that recovery, but there's no good way for patients to see their progress. And physical therapists must rely on anecdotal responses to questions like, "How are you doing with your exercises?"
We identified three places where ExoWear can address this low information quality:
Initial assignment of exercises
Patient reporting
At-home resource
Framing the problem
Our original task was to design an interface for physical therapists. So we articulated the problem, as we had come to understand it through our research, from the physical therapist's perspective:
“Physical therapists are open to using technology to improve patient outcomes, but they don’t have time to add anything to their workflow and aren’t convinced they can do anything more about HEP adherence.”
Sign in sheet at the physical therapy clinic where we did our contextual inquiry
Principles to design by
We needed our solution to move the needle from mere openness to enthusiasm. With that in mind we developed these design principles:
Five Seconds or Less
Information is understandable in 5 seconds or less.
The Cheers of Wearables
Minimizes learning curve. Meets users where they are no matter their age, technology expertise, device, or eyesight.
Right Hand Tech
Simplifies the micro-routines involved in patient care. Extends the supportive influence of the therapist beyond the clinic.
Makes it Count
Leverages data available to the application for maximum value.
An overview of how the two devices (and users) will work together
A two device solution
We decided that the therapist should be able to assign and modify the home exercise program via a web app. This way we could improve on their current micro routine without adding additional tasks.
For reporting results back to the physical therapist, we decided the patient should be the one to present the data. This keeps the focus on patient accountability. It also offers an opportunity to build the relationship between patient and therapist, something all physical therapists we interviewed valued.
Testing our mobile app concept
To validate our concept we decided to create Balsamiq mockups and present them to testers via a clickable prototype. We tested two dashboard approaches: one more visual and one more narrative.
Summary of feedback on two dashboard approaches
“Patients will say “I’m doing it every day,” but then you would see that it says 50% and you could say, “Aha!” It starts a conversation.”
Key Takeaways
Our next iteration needs two dashboards: one for patients and one specifically for patients to show physical therapists.
Patient dashboard should be goal-centered, motivational, and show incremental improvements
PT dashboard should be goal-centered, granular, and easy to see at a glance
Testing our web app concept
We also tested the web app for physical therapists to assign and modify home exercise programs. I was responsible for this prototype. Feedback was positive overall:
Layout allowed for single screen access
Easy to find patients via smart text search or quick scroll
Ability to edit exercise instructions to suit the patient
Physical therapists also suggested several improvements:
A more extensive library of exercises
The ability to assign multiple sets
Video tutorials that patients can see on the mobile app
Access to patients at the clinic level
Envisioning the dashboards
It was clear from our concept testing that the heart of the ExoWear value proposition is quality data. Our job was to render the data in a meaningful way for both patients and physical therapists.
We did several rounds of quick sketches followed by more in-depth drawings. I experimented with visualizing the range of motion data points and positioning data relative to goals.
final prototype
Users gave us great feedback on the prototype as well as several insights we used to strengthen the data visualization and exercise sequences. Below are the two mobile dashboards after we made changes from the usability testing feedback.
The screen on the left shows the report that patient will show to physical therapist. The screen on the right is the patient's dashboard.
The exercise sequence is a cornerstone of the mobile app. If patients use it, the app provides great data. If they don't, there's no data to report. The final exercise session sequence tested strongly with patients. We're confident it provides primary value that will motivate patients to interact with it.
The final prototype of the web app tested very well, too. Physical therapists completed initial setup of a home exercise plan within 3 minutes. All testers said this was an improvement over their current method. Particularly because the data becomes immediately available to patients via the mobile app.
“Does this technology really exist?
That would have been really helpful.
I got hurt too soon.”
Learnings
I learned from this project that there are numerous ways to reach a goal. The best way is the one that makes sense to the user. If it reflects the user’s values and recognizes their real-world constraints it has a higher chance of being valuable.
Our final solution saves therapists time and increases their insight into patients' home exercise adherence and progress. We set out to simply craft an interface for physical therapists. Through persistent focus on the user we ended up designing a therapeutic tool that will benefit all parties.