[ARTICLE] Open rehabilitation initiative: design and formative evaluation – Full Text PDF

ABSTRACT

Development and testing of virtual environments for rehabilitation is a lengthy process which involves conceptualization, design, validation, proof concept testing and ultimately, if appropriate, randomized controlled trials. Ironically, once vetted, many of these VEs are not available to clinicians or their patients. To address the challenge of transferring research grade technology from the lab to the clinic the authors have created the Open Rehabilitation Initiative. It is an international independent online portal that aims to help clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools. In this paper, the conceptualization, development and formative evaluation testing are described. Three groups of developers of VEs (n=3), roboticists who use VEs for robot interactivity (n=10) and physical therapists (n=6) who are the clinicians end-users participated in the study. Interviews, focus groups and administration of the System Usability Scale (SUS) were used to assess acceptability. Data were collected on three aspects: 1) discussion of what a resource might look like; 2) interaction with the site; and 3) reaction to the proposed site and completion of the SUS. Interviews and focus groups were recorded and transcribed. Data from the SUS was analyzed using a One-way ANOVA. There was no significant difference by groups. However, the clinicians’ mean score of 68 on the SUS was just at the acceptable level, while the developers and roboticists scored above 80. While all users agreed that the site was a tool that could promote collaboration and interaction between developers and users, each had different requirements for the design and use. Iterative development and discussion of scaling and sustaining the site is ongoing.

1. INTRODUCTION

Development testing of virtual environments (VEs) for rehabilitation is a lengthy process, which involves conceptualization, design, validation, proof concept testing and ultimately, if appropriate, randomized controlled trials. Often, once the technology has been developed and tested for a specific application, it is discarded. This results in a lack of transfer of the technology to the clinician at the point of care. Several explanations exist for the lack of transfer. One explanation is that the technology was not developed with the end-user in mind and therefore uses hardware that may not be readily available to persons in clinical practice. Another explanation is that the route to commercialization is expensive and lengthy and many scientists are not interested in pursuing this avenue. In this paper we propose the development of an international community as a solution, the Open Rehab Initiative (ORI), whereby developers may share their technology with clinicians. As the virtual rehabilitation field evolves and technology becomes more accessible and available, the authors believe, it is increasingly important to find mechanisms to coordinate and bring together clinicians, scientists and engineers to interact with and share their efforts with virtual rehabilitation tools. Recent reviews support the use of virtual rehabilitation training in people with neurological diagnoses (Pietrzak et al., 2014; Laver et al., 2015). However, a large part of the implementation of VR in rehabilitation is limited to work developed in the context of research projects – which does not reach end users, in particular clinicians and patients. Currently what is available to clinicians are the results of efforts to repurpose commercial games available for game consoles by providing clinicians with tools to adapt the Wii™ (Deutsch et al., 2011) and online resources on how to use the Adventure Games for the Kinect™ (Levac et al., 2015). Resources are also made available by clinicians or researchers themselves through blogs or structured websites where hardware and software lists – mostly commercial Wii™ or Kinect™ games, and sometimes companies developing bespoke rehabilitation systems – are shared together with therapy game suggestions, ratings and tips (Leynse Harpold, 2016; Scott, 2016; TherapWii, 2016). In implementation sciences, researchers have studied transfer knowledge as well as support of clinical reasoning by using online resources (Deutsch et al., 2015). The use of these resources for knowledge translation has been associated with positive behavior change in healthcare workers including nurses, physicians, physical therapists, and occupational therapists (Magrabi et al., 2004; McKenna et al., 2005; Grimshaw et al., 2006; Honeybourne et al., 2006). Unfortunately, less work can be found in the systematic transfer of virtual environments and serious games technology from developers to users. Multiple efforts exist in the creation of indices of games specially designed for specific health purposes (Lieberman et al., 2013; Serious Games Association, 2016). Unfortunately, available indices do not refer to literature specific to the applications and, consequently, the use of such games and applications is mostly not validated. On the other hand, other initiatives such as Games for Health and Games for Health Europe (van Rijswijk et al., 2016) feature a limited number of research projects with detailed descriptions and information regarding their target population and scientific outcome. However, in most cases content is unavailable to the clinician and end user. Consequently, there is still a large body of work on validated and research-driven technology that remains unavailable to clinicians and patient populations. There is therefore the need to facilitate the translation from research into daily clinical practice and to create new communication channels and a common framework to share and improve interventions in this area. The ORI is an international independent initiative that aims to help clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools. The ORI portal is planned as a hub where the community who build and use software tools for virtual rehabilitation can easily communicate, interact with and share these tools. The webpage currently offers software, drivers, and documentation of evidence and application, with support for discussion boards, and blogs. Although ORI originates from academic institutions, it is designed to grow through community driven content, incorporating inputs from all the relevant communities. This sentiment is reflected in the ORI mission statement: ORI’s mission is to become “the go-to community for clinicians, scientists, engineers, game developers and end-users to interact with and share virtual rehabilitation tools”. As such, we aim to attract both developers and virtual rehabilitation users, for research as well as for clinical practice. The scope of the simulations encompasses sensorimotor and cognitive rehabilitation. The objective of this study was twofold: first, to describe the conceptualization and preliminary rendering of the ORI site; and second, to report on the formative evaluations conducted on three groups of users: clinicians in a rehabilitation setting, developers (clinician scientists and engineers) of VEs for rehabilitation and an engineering group that develops robotic devices that have serious game interfaces. As developers and roboticits have a certain degree of technical expertise and would be both contributors and users to the site, we anticipated that their assessment of the site capability as well as the usability ratings would differ from those of the clinicians.

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