Prostheses and orthoses are trending towards digital methods and automation. Adopting these methods is especially a challenge at Frank Jol, a clinic where patients' wide variety in residual limb characteristics and high activity demands pose a challenge for digital workflows which utilise 3D scanning to arrive at a final prosthesis. This is because certified prosthetists and orthotists (CPOs) who design and produce prostheses, apply a series of tactile adjustments to the residual limb using plaster that result in a more optimal fitting and distribution of weight in the socket, which cannot easily be captured and digitised. In collaboration with Gyromotics, a high-tech prosthetic foot start-up, and Frank Jol, this graduation project is an exploration into the potential for a pressure-sensing textile tool to capture the tacit knowledge of CPOs in the fitting of below-knee prostheses.

The project begins with a detailed analysis. First, the clinical situation of the residual limb and the biomechanics of transtibial prosthesis is studied to understand what factors influence prosthesis fit, and how CPOs manipulate the residual limb to that effect. Then the process towards producing a prosthesis is analysed as it is executed at Frank Jol, in order to then compare to alternative processes that incorporate digital methods to understand the barriers and opportunities for intervention. Finally, CPOs and patients are interviewed to uncover their needs and values in the process. This analysis reveals the need for an intervention that captures and standardises the stump modification process in a digital way, while retaining CPO control and tactiliy, and keeping the patient in the communication loop.

The design result is PressFit: a pressure-sensing textile tool to be worn by the patient, which registers CPO applied pressures and provides visual feedback during stump measuring and plastering. PressFit is introduced as it fits into an envisioned future prosthesis prescription workflow. PressFit is developed through iterative technical development of the physical prototype, alongside development of the interaction for both measuring and plastering use cases. A co-design method with a CPO is followed throughout this development.

An evaluation is conducted with 5 CPOs at Frank Jol to assess the prototype's performance against design drivers. Results show that PressFit standardises the measurement process. All participants agreed PressFit is a helpful tool with potential to improve patient-CPO communication and bring traceability to the plastering process. Additionally, the tool shows promise for us as a training tool for new CPOs. As this thesis serves as a proof-of-concept for the application of pressure-sensing textile in the prosthesis prescription process, it concludes with recommendations for further development in physical prototyping (textiles), software, and user interaction.

This thesis is initiated by the Reinier Haga Orthopaedic Centre (RHOC) and shows the creation of a patient-centred healthcare network for orthopaedic hand and wrist care. A healthcare network can be defined as a group of interconnected stakeholders that directly or indirectly influence the patient’s care. In this project, the involved stakeholders are people undergoing treatment for their hand and wrist and healthcare providers from seven disciplines; orthopaedic surgeons, hand therapists, general practitioners, plaster technicians, orthopaedic instrument makers, rheumatologists and rehabilitation physicians. A literature review and a user research study sketch the context and underlying problem. The context is shaped by ongoing developments that cause an increase in the care demand, an increase in healthcare costs, empowered patients and digitalisation. This asks for care that is efficient and gives patients more control. Currently, both are lacking in orthopaedic hand and wrist care. The user research, which consists of interviews with the stakeholders, shows that patients are not feeling involved, and inefficient guidelines and lack of cooperation prevent an efficient treatment process. The hand and wrist is a speciality within the medical field of orthopaedics. It entails a wide range of care disciplines that could benefit a well-connected network, which is currently missing. This prevents effective cooperation, which research showed would lead to more efficient and improved care, fewer treatment sessions and a reduction in costs (Ypinga, 2018). The developed design aims to create more involvement of the stakeholders in the orthopaedic hand and wrist care and active participation of the patient. This design is developed through ideation using the “How-Tos” method, which resulted in three ideas that three healthcare providers reviewed. This approach gave insight into the aspects that were perceived as most relevant by them. These were: an overview of the whole treatment, which helps in contacting other healthcare providers, holistic treatment and patient involvement. In addition, allowing patients to set a goal for their treatment allows for more control and better treatment. With this input, the concept of WegWijs is developed and evaluated with patients. WegWijs means to be wise, informed and in control in healthcare. It provides all the stakeholders with the knowledge needed to create a holistic and patient-centred care process by providing an overview of the treatment process and the involved parties. The patient actively shapes their treatment by formulating a treatment goal and cocreating their treatment plan with the doctor. The care providers remain actively involved throughout the process and in close contact with each other, creating a well-connected healthcare network. Two patients and two healthcare providers validated these aspects. The established implementation strategy outlines the required steps that include the co-creation of new protocols and the execution of a pilot. However, further research is needed to develop this concept and implement it in the RHOC, and eventually in the wider healthcare system.

The coming years, demand for healthcare will increase exponentially, resulting in increased pressure on the decreasing number of healthcare providers. A digital transition of healthcare is needed in order to be able to keep offering widely accessible, quality care.

Unfortunately, the healthcare sector has difficulties keeping up with the trend of digitalization in comparison with other sectors. This project aims to bring to light why the healthcare sector is struggling with the process of digitalization. Through this exploration it endeavors to design a solution with the intention of facilitating the digital transformation of the Reinier de Graaf Gashuis (RdGG). To keep the project scope limited it was decided to focus on digitalization of colorectal cancer care.

The following methods were used during the research phase of the project:

1) Conducting a literature review that explored the current state of affairs regarding digitalization in the context of colorectal cancer care and methods for digitalization of care processes.

2) Observing interactions between healthcare professionals and colorectal cancer patients and observing during meetings with different stakeholders in the RdGG.

3) Conducting interviews with colorectal cancer patients, healthcare professionals and organizational employees.

This led to the creation of a colorectal cancer patient journey map. The map displays the care process and reveals its ‘non-digital state’. The result showed that mapping a complete care process in a clear way is challenging. Most care processes are not linear or fixed; there are different treatment options and exceptional circumstances. It was discovered that there isn’t a journey mapping format available that is simultaneously comprehensive and user friendly.

The research outcomes revealed numerous factors hindering the digital transformation within the RdGG, some of which include:

1) The complexity of hospitals makes it difficult to keep overview over the process of digitalization.

2) Not all digital resources are perceived in a positive light, one reason being that they sometimes clash with existing workflows or care processes.

3) Patient journey maps and care pathways can help to prevent this from happening, but there are problems with the making of, managing and use of journey maps.

4) There are issues in the communication between healthcare professionals and organizational employees.

The following design goal was created:

Design an interactive journey mapping tool for care professionals and organizational employees at the RdGG, that helps to better comprehend care and digitalization processes, by offering overview, knowledge and easy communication.

This led to GoMedFlow. A design created to help hospitals transition into smart hospitals. It utilizes journey mapping as a facilitator for the digital transformation of healthcare. GoMedFlow offers:

1) Overview in the current state of affairs of digitalization of care processes

2) The opportunity to easily and cooperatively form, maintain and analyze care pathways and patient journeys.

3) Aid to effectively implement digital resources in care processes, assuring digital resources fit well within the care processes.

4) Easy communication between different stakeholders in the RdGG; healthcare professionals and organizational employees

Using GoMedFlow results in an efficient deployment of employees and resources in the future.

Spinal cord injuries (SCI) occur when damage to any part of the spinal cord is sustained. Depending on what vertebrae segment the injury occurs, the patient will develop paraplegia or tetraplegia and have a complete or incomplete spinal cord injury. After sustaining a spinal cord injury, the patient must undergo rehabilitation.

For incomplete SCI patients, part of their rehabilitation is improving their mobility skills through gait training. To assess gait, the methods of the clinical eye and laboratory gait assessment are used. The starting goal of the project was to combine the quickness and easiness of conducting a gait assessment with the clinical eye with the objective data from a laboratory gait assessment into one system. This system consists of Xsens Awinda wireless motion trackers to collect the kinematic data and a user interface to view it.

User research was conducted in the form of questionnaires and focus groups. The research aimed to learn more about how physiotherapists and physicians within Rijndam Revalidatie currently assess gait, what features and parameters they would like in the user interface, and how they would prefer the selected parameters to be visualized (in numbers, graphs, or animations). Three physiotherapists and physicians were also interviewed to better understand the process incomplete SCI patients go through in gait rehabilitation and who is involved in each step.

From the results, a design direction and vision was created: “To develop an easy to use user interface that aids physicians and physiotherapists in selecting interventions for patients with incomplete spinal cord injuries in an objective and time efficient manner through intuitive data visualizations.”

Using design methods and tools, ideas for the data visualizations and the interface layout were formed, selected, and then made into concepts. The layout and visualizations concepts were evaluated through concept test sessions with physiotherapists and physicians. In the sessions, the interface layout was assessed in terms of usability and functionality. The data visualizations were evaluated based on if the participants, who had minimal pre-existing knowledge on gait analysis, could understand them. From the evaluation results, the final design of Gait Vision was created.

Gait Vision is an easy-to-use interface that allows physiotherapists and physicians to assess gait objectively and time-efficiently. It provides more accurate and objective information than can be obtained with the clinical eye, in a way that is more intuitive and comprehensible for clinicians with minimal gait assessment experience than laboratory gait assessment.

An interactive prototype of the final design was developed using Adobe XD. The interface prototype and the visualization concepts were evaluated through conducting individual user tests with seven physicians and physiotherapists. The interface and visualizations were tested with regard to usability, functionality, intuitiveness, and aesthetics. Overall positive feedback was received regarding the interface and visualizations. Testing was also conducted to compare gait assessment with the clinical eye versus with the interface. The interface was found to more objective than the clinical eye.

An implementation plan was developed to ensure Gait Vision survives in the long term. Future recommendations were also made to aid in the continuation of the development of Gait Vision.

The human body, although seemingly symmetrical, can in fact be highly asymmetrical. Our bodies are predetermined by our DNA and co-shaped by our environment. This leads to most of the world's population having a discrepancy in leg length either from birth or developed during their life time. It is completely natural and goes unnoticed, as changes are incremental and people get used to it. On the contrary, when undergoing total hip replacement surgery and waking up with one leg longer than the other, the change is almost instantaneous and immediately noticeable. Current surgical solutions do not address this issue in a practical manner within the operating theatre, leading to surgical teams developing their own methods and procedures to evaluate the change in patient's leg length.
 
Introducing new workflows to medical professionals often entails neglecting the protocols they spent years practicing. This thesis identified this bottleneck and instead of introducing new methods and procedures, it was decided to build on existing ones. This was done by exploring common surgical workflows in respect to total hip replacement and determining an approach to enhance surgical team's capabilities in evaluating leg length discrepancy.. Important in achieving this goal it to make any given design solution effortless, reliable and undisruptive to various workflows

In order to do so, user research was performed by joining multiple surgical teams within the OR, thereby observing and evaluating their methods. One method in particular stood out, which is best described as the 'loaded assessment'. During this assessment the surgeon or circulating nurse will centre the patient's feet, apply pressure to the heels and try to evaluate the discrepancy. Although this method being seemingly simple, its execution is difficult to perform by a single person and varying pressure differences may confuse the assessment.

Following the initial research phase, co-creation sessions with technical experts were organised, after which various concepts were developed and tested on the basis of feasibility, desirability and viability. Finally, a functional prototype based on the loaded assessment principle was developed and tested for its functionality and conceptual expectation.

This graduation project is on behalf of TU Delft and Zimmer Biomet in collaboration with Orthopedic surgeons from Bergman Clinics, Orthopedic Clinic, in Naarden. The aim of this master thesis was to design a product which could reduce the pollution of harmful noise during hip replacement surgery. Noisy workplaces and especially within this procedure carry a large risk of noise-induced hearing loss, as sound levels of more than 120 decibels are generated by the usage of (powered) instruments. In the analysis phase observations in the operating theatre and interviews with experts are conducted to get insights and background information about the total hip arthroplasty procedures. It was found that noise levels experienced during surgery generated levels above the human pain threshold, ranging between 120-130 decibels and caused temporary and long-term noise induced hearing loss. Via a design vision and a list of requirements multiple concepts where generated. In the embodiment and evaluation phase, cadaver and saw bone testing showed that the new instrument design functioned and implant parts and/or tools could be implanted successfully. The outcome of this project is a new surgical instrument, which can press-fit (impact) and extract various implant components used during surgery. The instrument has multiple unique selling points compared to the currently used mallet as it reduces the noise level with more than 15 decibels and scores better on aspects of safety when looking into the risks at musculoskeletal disorders by improving surgical ergonomics. The instrument could be improved further when looking at the design and the current surgical workflow. Further research and clinical testing is necessary to see if this product is suitable for hip replacement surgery.

This thesis describes the design process of a service/tool for the management and prevention of periprosthetic joint infection (PJI) cases. PJI is a complication that follows total joint replacement and is devastating for the patient. It causes physical and mental strain and the patient's health never returns to close to what it was prior to the complication. It furthermore lays a financial burden on hospitals and society. The assignment for this thesis is initiated by Zimmer Biomet, the leading manufacturer for orthopaedic medical devices and joint prostheses. It is expected that providing services and tools that aid in the management and prevention of PJI cases will become a future strategy of Zimmer Biomet. The research in this thesis defines that the biggest problem concerning the management and prevention of PJI cases is the presence of a knowledge gap between guidelines defined by experts and appliable knowledge by staff. The multidisciplinary team (MDT) dashboard is a solution to this problem. This dashboard aids in the diagnosis and decision for treatment method of PJI cases. It is used both prior to and during the MDT meeting, which is a meeting during which a team of physicians from varying disciplines discuss PJI cases to arrive to a just diagnosis and optimal decisions for treatment methods. The dashboard provides visual aids, to help all members communicate their substantiation and to ensure that every aspect is discussed. It furthermore gives a non-binding advice, based on the patient data and guidelines developped by PJI experts. A digital prototype of the dashboard and a strategy are also presented. After validation of both these elements, further elaboration is given on the technical and organisational implementation of the dashboard, into hospitals. It is concluded that the dashboard is feasible, desirable and viable and that it will aid in the management and prevention of PJI cases. Next to aiding surgeons and MDT members, it will improve patient outcome and will serve an economic and societal goal. It is therefore recommended that Zimmer Biomet continues the development and pursues the implementation of the dashboard.

This graduation project has been carried out in the context of the research project ‘Tailored Healthcare through Customer Profiling’ at the TU Delft, in collaboration with hospital Reinier de Graaf Group in Delft, and medical device company Zimmer Biomet. Together we focus in this project on the rehabilitation journey after total hip replacement (Total Hip Arthroplasty, THA).

The central aim of this project has been to find out how different patient profiles benefit from different interaction features in the rehabilitation device ‘BioCoach’, to effectively support them in their rehabilitation process.
This project investigates how a tailored version of the BioCoach could meet the needs and wishes of three different patient profiles: the ‘optimistic’ patient; the ‘managing’ patient; and the ‘modest’ patient.