Developing A Game-based EMG-biofeedback Rehabilitation Program For Knee Osteoarthritis Through A User-centered Design Approach

PURPOSE: Integration of video games controlled by EMG biofeedback is a novel approach to engaging patients during physical therapy in clinical and home environments. The KneeBRIGHT system employs muscle-sensing wearable technology to create an interactive game for conducting rehabilitation exercises that are critical to managing knee osteoarthritis (OA) symptoms. Successful adaptation of KneeBRIGHT relies on ease-of-use and acceptance with OA care providers and patients. The purpose of this study was to implement user-centered design through formative interviews with physical therapists (PTs) and hands-on evaluations with PT and patient end-users to identify pathways and barriers to acceptance of a novel rehabilitation technology. METHODS: Formative design discussions were conducted early in the design process via 2 focus group interview sessions, each attended by 8 licensed PTs. Participating PTs ranked desirability of device and game features. Following prototype development, 6 iterative hands-on sessions were conducted with PT-patient pairs. Each session simulated the PT-patient interaction during a session of exercises using KneeBRIGHT. Sessions were staggered by several months to integrate feedback between sessions. Qualitative analyses were used to identify themes from all sessions. RESULTS: Themes that emerged from the PT design discussions included: (1) the appeal of the system’s interactivity (88% of respondents); (2) ease-of-use of the EMG sensor hardware (75% of respondents); and (3) desire for simplicity in software design (62% of respondents). In the hands-on sessions, all PTs successfully learned and implemented the EMG hardware with their patients, and all patients successfully completed exercises with the game, meeting the usability goals required ahead of deployment in a clinical trial. Key feedback from the hands-on sessions included the need for additional cuing of in-game tasks and practice time; this feedback was used to design an interactive tutorial to instruct patients on the game usage. CONCLUSIONS: This study successfully leveraged user-centered design to gain end-user feedback during the design phase and hands-on evaluations, providing a final system design that meets the needs of both PTs and patients and is ready for efficacy testing through a clinical trial. Supported by: NIH 2R44AG062069-04A1