Usability of a wearable device for home-based upper limb telerehabilitation in persons with stroke: A mixed-methods study

Abstract

Background The use of wearable technology offers a promising home-based self-directed option for upper limb training. Although product usability is a crucial aspect of users’ acceptance of a wearable device, usability studies in wearable devices are rare, with most studies focusing primarily on clinical validity. Objective This study aimed to explore the usability of a wristwatch device called “Smart reminder” for home-based upper limb telerehabilitation for persons with stroke. Methods Eleven stroke participants used the proposed wristwatch for at least two weeks and underwent a home-based telerehabilitation program. A mixed-methods design was used to explore the usability of the wristwatch. Quantitative data were collected through the System Usability Scale (SUS) questionnaire, and the participants’ rate of therapy compliance (gathered from the device) was reported descriptively. In addition, qualitative data were collected through semi-structured interviews with the participants and were analyzed using thematic analysis. Results The results demonstrated that the usability of the proposed wristwatch and telerehabilitation system was rated highly by the participants, with a high SUS mean score of 84.3 (12.3) and high therapy compliance rate (mean = 91%). Qualitatively, all participants reported positive experiences with the wristwatch and indicated keenness to use it again. Participants reported physical improvements and felt motivated to exercise after using the wristwatch. They found the device easy and convenient and appreciated the remote monitoring function. Meanwhile, they highlighted critical considerations for the design of the device and program, including technical support, a wearable design of the device, graded exercise content according to ability, and flexibility in exercise schedules. Finally, they suggested that an interim review with the therapist on their progress might help them continue using the wristwatch. Conclusions This study's results supported the proposed wearable device's usability and showed strong acceptance by the participants for using it as a home-based upper limb telerehabilitation intervention.

Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review

“…Most studies took place in North America (41/103, 40%) [ 46 - 49 , 52 , 55 , 56 , 60 , 64 - 67 , 69 , 70 , 72 , 74 , 76 - 78 , 80 , 85 - 88 , 92 , 93 , 97 , 99 , 101 , 108 - 110 , 126 - 129 , 137 , 138 , 141 , 142 , 145 ] and Europe (35/103, 34%) [ 51 , 53 , 54 , 57 , 58 , 62 , 63 , 68 , 71 , 79 , 81 - 84 , 89 , 111 , 113 - 125 , 132 , 136 , 140 , 143 , 146 , 147 ], with the remainder in Asia (16/103, 16%) [ 50 , 59 , 61 , 91 , 94 , 95 , 98 , 100 , 102 - 104 , 107 , 135 , 139 ,…”

“…Interventions were focused on upper limb rehabilitation in almost two-thirds (65/103, 63%) of the studies [ 46 - 49 , 51 , 54 - 59 , 62 - 65 , 68 , 71 , 72 , 74 , 75 , 77 - 81 , 85 - 88 , 92 , 95 , 96 , 99 , 101 - 103 , 105 - 108 , 110 , 112 , 113 , 116 - 118 , 121 , 123 - 125 , 127 , 128 , 132 , 133 , 135 - 137 , 139 - 142 , 144 - 147 ]. Nearly all interventions (96/103, 93%) [ 46 - 80 , 84 - 94 , 96 - 117 , 119 - 121 , 124 - 148 ] were delivered to individual participants, with over half (62/103, 60%) [ 46 - 50 , 53 - 58 , 60 , 61 , 64 - 70 , 72 , 74 - 77 , 79 , ...…”

“…Most studies (93/103, 90%) [ 46 - 49 , 51 - 62 , 64 - 73 , 75 - 89 , 91 - 93 , 96 - 106 , 108 - 115 , 117 - 137 , 139 , 140 , 142 - 148 ] endeavored to link the intervention to behavior change; however, in the majority of these studies (75/93, 81%) [ 46 , 51 - 56 , 58 - 62 , 64 - 69 , 71 - 73 , 75 , 77 - 89 , 91 - 93 , 96 , 97 , 99 - 101 , 103 - 106 , 108 , 110 , 112 , 114 , 115 , 117 - 120 , 123 , 124 , 127 , 128 , 131 - 137 , 139 , 140 , 142 - 144 , 146 - 148 ], this explanation was centered on the reporting of the techniques perceived to change behaviors without direct reference to use of the BCTTv1 or on the reporting of a component of the intervention or the whole of the intervention as motivating. These explanations lack detail on how or why this influences behavior change.…”

Utility and usability of a wearable system and progressive-challenge cued exercise program for encouraging use of the more involved arm at-home after stroke—a feasibility study with case reports

“…The most common application of wearable technologies is the monitoring and assessment of the quantity and quality of movement [ 18 , 26 , 36 – 40 ]. Wearable technologies can also provide helpful cues (i.e., reminders, nudges) to perform activities such as exercises prescribed as therapy [ 19 , 20 , 24 , 25 , 27 , 28 , 41 ]. In one exemplar study, Holden and colleagues describe a wrist-worn system [ 24 ] that provided a vibratory stimulus to the more-involved arm when that arm’s activity level fell below a personalized threshold for a selected time window.…”

“…However, for technologies to be adopted by clinicians and their patients, the systems must not only have practical utility, but they must also provide a positive user experience within the context of their intended use scenarios cf. [ 20 , 27 , 29 ].…”