Avyay's Portfolio: POAKme

Improving accessibility and affordability of healthcare is key to achieving better health outcomes. For patients with Osteoarthritis of the Knee, ongoing engagement with healthcare providers is critical. Tele-physiotherapy can help address physical and logistical barriers by allowing patients to exercise from the comfort of their own homes, while also facilitating more meaningful conversations with their healthcare providers. Through the POAKme mobile app, patients can access rehabilitation exercises on their smartphones and use the on-body motion sensor POAKY to track, record, and analyze their exercise performance in real-time. This data is presented in a graphical format that helps patients visualize their recovery and long-term trends, providing additional motivation to stay on track. Overall, tele-physiotherapy with POAKme has the potential to greatly improve the management of Osteoarthritis of the Knee and enhance patient outcomes.

View prototype ➡️

Context

What is Osteoarthritis of the Knee?

Degenerative disease in which the cartilage slowly starts to disintegrate
Generally occurs due to excessive wear and tear of the joints
Treatment is lifelong commitment
People tend to ignore it until it’s too late

What does the treatment involve?

Improve mobility and range

Achieved through repeated extension and contraction the muscles connected to the knee

Improve strength and reducing pain

Achieved through performing multiple sets of each exercise to improve resilience of legs when performing daily activities

What exercises are involved in the rehabilitation program?

There are several exercises prescribed as part of the rehabilitation program. Usually, these are tailored to the needs of the patients.But a general overview of the exercises is shown below. The ones with diagrams are called active exercises and the ones without diagrams are are called static exercises, which often involves clenching and relaxing muscles internally.

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While medial movement is key to improvement, lateral/rotational movement is detrimental as the joint compensates for its lack of mobility.

Process of accessing physiotherapy treatment

Patient is diagnosed with the condition Generally by an orthopaedic surgeon. Referred either to surgery or physiotherapy

Initial assessment by physiotherapist Understand the capabilities and schedule of the individual before prescribing exercises and planning follow-up visits

First few sessions at the clinic The initial sessions are conducted at the clinic with the physiotherapist walking the patient through the correct procedures

Patient is handed the Home Program The Home Program allows the patient to perform the exercises at home. It is a sheet that contains a list of exercises and a short description of how to perform them

Follow-up visits Involves the patient informing the physiotherapist about how many times and how they did the exercises, the amount of pain they felt and learning more complex exercise routines

User groups observed

Labourers/ On-site workers

Willing to go to the clinic for treatment since their job performance depends on physical mobility

Professionals with desk jobs/ home-makers

Don’t have a need to exert physically. Unwilling to schedule physiotherapy until the injury affects daily life

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I chose to work with patients with desk jobs and homemakers as they were the appropriate target audience. I also had better access to them for testing a solution.

Pain points of performing physiotherapy from home

While the process of undergoing physiotherapy brings about the necessary improvement in a patient's health, there are several factors that can cause some consternation to all the stakeholders.

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Burden on therapists

They deal with nearly 50 patients a day. Reassessing patients to discern the stage of recovery is a time consuming activity. They also need to constantly remind the patient of the do’s & don’ts which is repetitive & mundane.

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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.

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Logistics of transport & schedule

Commute with an injury, combined with having to take time off from work to provide treatment is unfeasible for many.

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Feedback from Home Program

Receiving feedback as a motivational tool and for posture correction is vital and is unavailable with the Home Program.

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Recognising improvement

As the patient hits an improvement plateau, motivation can be hard to come by.

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Discontinuing performing the exercises

Lack of continuous improvement disheartens patients and they don’t follow-up regularly with their physiotherapists.

Tele-physiotherapy

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.

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.

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.

Educate with reflective feedback Recording exercise data provides reflective feedback which can help improve technique and help track progress over time.

Physiotherapist remains informed Physiotherapists can remain well-informed about their clients' progress, techniques, and form, while also keeping them accountable.

Project Goals

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Inform the patient

Educate the patient about which exercise they are performing and the correct process of performing them.

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Enable correct exercise performance

Provide feedback about the motion they need to follow and any rotational movement that occurs.

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Provide reflective feedback

Allow users to reflect on the things they did right and inform them about any incorrect movements they might have done.

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Visualise improvement

Display trends to keep the patient motivated as they hit a plateau in their recovery journey.

Problem Statement

How can I provide an affordable means of performing physiotherapy exercises for patients with Osteoarthritis of the Knee from the comfort of the their homes, while addressing issues such as ensuring correct practice of exercises and motivation through visualisations?

Scope Limitation

Had to be a low cost device since I was developing a solution rooted in India.
Designing for educated homemakers meant I could take the liberty of making the visualisations more complex

Prototype iteration

The prototype was developed through a systematic approach, involving testing of various sensors and feedback methods. After careful evaluation, the accelerometer was selected, and the final form of the prototype was chosen.

Sensors The MPU6050 accelerometer and HC-SR04 ultrasound sensor were prototyped. While HC-SR04 allowed the leg to be free when exercising, MPU6050 accelerometer was chosen for clarity of signal.

Feedback Visual, auditory, & haptic were explored. Visual and auditory feedback were chosen for universal availability and effectiveness.

Wearables 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.

Pilot Study

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. Study group

1 Control Participant

Age 22 | Male Given website with prescribed exercises and a step by step guide on how to perform the exercise.

1 Experimental Participant

Age 20 | Male Given mobile app + wearable sensor for real-time feedback and website to visualise post exercise trends.

Results

Control Participant

Strength measurement | 0th day: 18kgf | 7th day: 20kgf Pain measurement | 0th day: 3/10 | 7th day: 0/10

Experimental Participant

Strength measurement | 0th day: 16.5kgf | 7th day: 22.5kgf Pain measurement | 0th day: 5/10 | 7th day: 1/10

Prototype The device prototype was made with a NodeMCU soldered to an MPU6050. A strap was attached to this setup with the toe-guide. The application was developed on Unity, with the device communicating with the app through the MQTT protocol. A website was also developed to allow the user to reflect on their performance.

Prototype and Unity application

Realtime feedback when connected to the device

Website for post exercise feedback

System architecture

Final Concept

POAKme is a service that uses a device on the foot to track motion during exercise, and relay the information to the mobile app for real time feedback regarding performance. The data collected is used to generate visualisations that help the user reflect on their exercise performance and forecast the steady progress they are likely to make if they adhere to the program.

View prototype ➡️

Effortless to wear

Designing the device and strap to be independent of each other makes the strap easy to adjust and customise, while also making it quick to place on the foot. The guiding toe loop helps position the sensor accurately with the least amount of effort. The same device can be used by multiple users by pairing it with the mobile application

Onboarding

The user profile is created by the physiotherapist. The patient only has to log in, pair the device to the phone, select the foot they need to exercise, and the exercises are made available. Easy and interactive onboarding experience utilises a plug and play model that reduces user input.

Inform

The user 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. Before the exercise begins, the user is told to what elements to keep track off to perform correctly.

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 to try and keep up with the device, similar to the kind of encouragement a physiotherapist would give. Lateral movements are discouraged with the bright red line showing up.

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.

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. The number of minutes exercised increasing throughout the program also acts as an additional motivator.

Feedback

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Easy to use

All participants found the device and application useful, intuitive and easy to use at first glance.

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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; remote surveillance adherence.

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Error correction useful

All the interviewees found the error correction to be useful and felt that would sway them towards adopting this.

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Complimentary

Physiotherapists said they found the app and device to be a good complimentary task to the clinical sessions

Conclusion

Telerehabilitation is a field with potential for massive disruption in 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.

My takeaways

There’s a lot to physiotherapy that wasn’t incorporated here, such as hold time, or static exercises which can’t be measured. I did not keep accessibility or elderly citizens in mind when designing either. But this leaves scope to explore the solution further for these populations. Personally, there was a lot of growth in this project. This was the first time I had developed an app, handed it over to someone else along with a device and just seen it work.