Brunel University, Department of Computer Science, Wilfred Brown Building, Uxbridge, UB8 3PH, United Kingdom.
Brunel University, Department of Computer Science, Wilfred Brown Building, Uxbridge, UB8 3PH, United Kingdom.
Int J Med Inform. 2019 Sep;129:349-365. doi: 10.1016/j.ijmedinf.2019.07.004. Epub 2019 Jul 8.
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.
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.
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.
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.
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.
职业治疗中一项关键的防跌倒干预措施是家庭环境跌倒风险评估过程。这涉及临床医生访问患者的家庭，并使用二维纸质测量指南手册，以确保所有测量都准确地进行和记录。然而，家庭中安装的所有辅助设备有 30%被患者放弃，部分原因是作为家庭环境跌倒风险评估过程的一部分，记录的测量结果不准确。在缺乏更合适和有效的指导的情况下，设备放弃率很可能会持续居高不下。
本研究提出了 guidetomeasure-OT，这是一款用于支持职业治疗师进行家庭环境跌倒风险评估的移动 3D 测量指南应用程序。此外，本研究旨在通过实证评估 guidetomeasure-OT 与等效的纸质测量指南之间的性能。
35 名职业治疗师参与了这项在居住环境中进行的基于参与者的重复测量研究。参与者在两种平衡的治疗条件下进行家庭环境跌倒风险评估过程；使用 3D guidetomeasure-OT；和使用 2D 纸质指南。在完成两个任务后，参与者填写了系统使用情况调查问卷和半结构化访谈。使用比较统计分析方法，探讨了与测量准确性、测量准确性一致性、任务完成时间以及整体系统可用性、易学性和指导有效性相关的性能。对访谈记录进行了归纳和演绎主题分析，后者受到统一接受和使用技术模型的启发。
在任务效率（p < 0.001）、易学性（p < 0.001）、系统可用性（p < 0.001）和指导有效性（p = 0.001）方面，guidetomeasure-OT 应用程序的表现明显优于 2D 纸质指南。在绝对方面，guidetomeasure-OT 产生了 12 项中 11 项的更低的平均误差差异，并且在 12 项中有 6 项表现明显更好（p < 0.05）。就 SUS 而言，guidetomeasure-OT 的得分为 83.7，而小册子的得分为 70.4。从访谈中出现了五个高级主题：绩效期望、努力期望、社会影响、临床效益和临床实践的增强。参与者报告称，guidetomeasure-OT 提供了更清晰、更现实、更直观、更精确和更易用的测量指南，优于纸质等效指南。音频说明和动画提示被认为有助于减少理解测量指南和保持任务进展意识所需的学习开销。
本研究表明，guidetomeasure-OT 使职业治疗师能够更准确和高效地进行家庭环境跌倒风险评估，同时提供了一种被认为比临床医生在实践中使用的纸质测量指南更易用的测量指南工具。这些结果非常重要，因为它们表明移动 3D 可视化技术可以有效地用于改善临床实践，特别是在家庭环境跌倒风险评估方面。此外，实证研究结果构成了克服与医疗保健数字化相关的挑战，并提供新的创新和支持性技术解决方案的重要一步，医疗服务提供者和政策制定者急需这些方案来缓解现有公共资源的日益增加的负担。未来的工作将专注于开发和实证评估用于患者自我评估和自动化辅助设备处方的移动 3D 应用程序。此外，可以考虑应用设计和向用户提供的交互机制的更广泛的用户体验方面，以最大程度地减少认知过载的影响并优化用户性能。
