Tailoring rehabilitation consults in orthopaedics by design

Abstract

Osteoarthritis is the most common joint disorder for elderly above the age of sixty-five. A Total Hip Arthroplasty (THA) surgery is an effective and common solution for moderate to severe osteoarthritis. After THA surgery patients start a rehabilitation phase in which they have to comply to a rehabilitation regimen. This rehabilitation phase includes execution of physical exercises and compliance to restrictions in their daily life. The patient recovers approximately for 80% after six weeks and 100% after one year. Orthopaedists perceive different rehabilitation outcomes and presume that this is caused by different rehabilitation behaviour of patients. Some patients are acting too passively during their rehabilitation phase, whereas others are acting over-active. Wrong rehabilitation behaviour causes an unnecessary longer rehabilitation time and patient dissatisfaction. Till now, little is known about patient rehabilitation behaviour and techniques to influence this behaviour. Literature research revealed the principles behind rehabilitation. In psychology, rehabilitation is defined as a person making a health behaviour change. In this project, the Health Action Process Approach (HAPA) model was taken as a basis to explain rehabilitation behaviour of patients. This model is a stage model that describes how health behaviour change can take place over time in different phases. Three important initiators for making a health behaviour change are outcome expectancies, risk perception and perceived self efficacy. There are many factors influencing the patient’s health behaviour change, ranging from psychological factors to interpersonal factors. One of these factors is the patient - medical professional relationship. Health care interventions of medical professionals can be improved in many ways. Because of technological developments and use of the Internet patients are becoming more pro-active, which affects the way medical professionals have to approach patients during consultations. Literature gives recommendations about (1) the manner of information provision, (2) the understanding and adaption to the patient’s health beliefs and (2) the involved attitude medical professionals need to have. Comprehensive user studies explored the orthopaedic consultations in practice. The user studies included patient & medical professional interviews, consultation observations and a questionnaire among patients. Patient’s widely differ in how they cope with their rehabilitation. During this project, four different patient types were defined during medical professional interviews with the support of a patient type framework. Combining the literature finding with user study finding resulted in five main insights about the current rehabilitation strategy of hospitals: 1. Orthopaedists have an important advice giving role, but are limited in time 2. Patients do not sufficiently know before surgery what to expect of the impact the rehabilitation period will have on their daily lives 3. The hospital provides limited advice specifically about rehabilitation to the patient and assigns the responsibility about rehabilitation guidance to the local physiotherapist 4. During consultations the rehabilitation advice is mainly provided verbally. Supportive products could improve the rehabilitation advice understanding and remembering of the patient. 5. There is no collaboration between the local physiotherapist and hospital These five main insights formed a basis for the development of three design directions. One of these three design directions has been worked out in this project. The final design brief was: ‘Design an application that supports the communication between the orthopaedist and patient during their first consultation to manage a patient’s personal expectations, taking into account different patient types’ Since from this moment on, the scope was narrowed down to the first consultation of the orthopaedist, a detailed consultation experience journey was developed that represented this consultation. The journey served as a tool to visualise the points of improvement and applicability of the product to the user context. Also, a list of requirements was set out, to give structure to the design process. Because the product would be used in a context that has been described as stressful and time-limited, the product had to be smart and adaptive to the stressful and time-limited situation. The metaphor of looking into a shoebox diorama was taken as the interaction vision, which gave direction the concept design. This methaphor allowed the orthopaedist as well the patient to quickly understand information. In case of the orthopaedist this was valuable to have a quick understanding in his consultation preparation about the patient’s personal context as well physical state. Through an iterative process, including several co-creation sessions with orthopaedists, a final concept was created: BiConnect. BiConnect is an application that serves as a supportive tool for communication during orthopaedic consultations. The main principles of BiConnect are: The main principles of BiConnect are: - Involvement of the patient in his or her treatment path; - Provides tailored and personal advice - Enhances the quality of the conversation, including understanding and explanations, between the patient and orthopaedist during the consultation The overall goal of BiConnect is to let the medical professional and patient effectively talk about the patient’s personal expectations of the rehabilitation period, so that the patient develops realistic expectations resulting in confident and responsible rehabilitation behaviour. The application is used by patients as well as medical professionals during different touchpoints. The patient will have a digital intake that will contribute to a better preparation of patient and orthopaedist. During the consultation BiConnect serves as a supportive tool for communication and after the orthopaedic consultation patients can review and see more information (including their personal advice given during the consultation). Finally, an interactive prototype was build to test the product during consultations. The product was reviewed during two evaluation studies with orthopaedists and patients. The first reaction of patients and orthopaedists on BiConnect during were very positive. The main bottleneck for implementing the product would be the current hospital software systems. BiConnect can work parallel to these systems, but it would be ideal if they can correspond or integrated with each other. BiConnect has the potential to serve for a broader market than only orthopaedic consultations. However, it is recommended that Biomet will bring the product step-by-step onto the market.