Technology-assisted healthcare: exploring the use of mobile 3D visualisation technology to augment home-based fall prevention assessments

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonFalls often cause devastating injuries which precipitate hospital and long-term care admission and result in an increased burden on health care services. Fall prevention interventions are used to overcome fall risk factors in an ageing population. There is an increasing need for technology-assisted interventions to reduce health care costs, whilst also lessening the burden that an ageing population increasingly has on health care services. Research efforts have been spent on reducing intrinsic fall risk factors (i.e. functional ability deficits and balance impairments) in the older adult population through the use of technology-assisted interventions, but relatively little effort has been expended on extrinsic risk factors (i.e. unsuitable environmental conditions and lack of assistive equipment use), considering the drive for healthcare outside of the clinical setting into the patients’ home. In the field of occupational therapy, the extrinsic fall-risk assessment process (EFAP) is a prominent preventive intervention used to promote independent living and alleviate fall risk factors via the provision of assistive equipment prescribed for use by patients in their home environment. Currently, paper-based forms with measurement guidance presented in the form of 2D diagrams are used in the EFAP. These indicate the precise points and dimensions on a furniture item that must be measured as part of an assessment for equipment. However, this process involves challenges, such as inappropriate equipment prescribed due to inaccurate measurements being taken and recorded from the misinterpretation of the measurement guidance. This is largely due to the poor visual representation of guidance that is provided by existing paper-based forms, resulting in high levels of equipment abandonment by patients. Consequently, there is a need to overcome the challenges mentioned above by augmenting the limitations of the paper-based approach to visualise measurement guidance for equipment. To this end, this thesis proposes the use of 3D visualisation technology in the form of a novel mobile 3D application (Guidetomeasure) to visualise guidance in a well-perceived manner and support stakeholders with equipment prescriptions. To ensure that the artefact is a viable improvement over its 2D predecessor, it was designed, developed and empirically evaluated with patients and clinicians alike through conducting five user-centred design and experimental studies. A mixed-method analysis was undertaken to establish the design, effectiveness, efficiency and usability of the proposed artefact, compared with conventional approaches used for data collection and equipment prescription. The research findings show that both patients and clinicians suggest that 3D visualisation is a promising development of an alternative tool that contains functionality to overcome existing issues faced in the EFAP. Overall, this research makes a conceptual contribution (secondary) to the research domain and a software artefact (primary) that significantly improves practice, resulting in implications and recommendations for the wider healthcare provision (primary).The Engineering and Physical Sciences Research Council (EPSRC)

Guidetomeasure-OT: A mobile 3D application to improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk assessments

Background 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. Aim 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. Methods 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. Results 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. Conclusions 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

guidetomeasure-OT: A mobile 3D application to improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk assessments

© 2019 The Authors. Background 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. Aim 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. Methods 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. Results 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. Conclusions 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

Mobile depth sensing technology and algorithms with application to occupational therapy healthcare

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe UK government is striving to shift its current healthcare delivery model from clini-cian–oriented services, to that of patient and self–care–oriented intervention strategies. It seeks to do so through Information Communication (ICT) and Computer Mediated Re-ality Technologies (CMRT) as a key strategy to overcome the ever–increasing scarcity of healthcare resources and costs. To this end, in the UK the use of paper–based information systems have exhibited their limitations in providing apposite care. At the national level, The Royal College of Occupational Therapists (RCOT) identify home visits and modifica-tions as key levers in a multifactorial health programme to evaluate interventions for older people with a history of falling or are identified as being prone to falling. Prescribing Assistive Equipment (AE) is one such mechanism that seeks to reduce the risk of falling whilst promoting the continued independence of physical dexterity and mobility in older adults at home. In the UK, the yearly cost of falls is estimated at £2.3 billion. Further evidence places a 30% to 60% abandonment rate on prescribed AE by and large due to a ‘poor fit’ and measurement inaccuracies. To remain aligned with the national strategy, and assist in the eradication of measurement inaccuracies, this thesis employs Mobile Depth Sensing and Motion Track-ing Devices (MDSMTDs) to assist OTs in in the process of digitally measuring the extrin-sic fall–risk factors for the provision of AE. The quintessential component in this assess-ment lies in the measurement of fittings and furniture items in the home. To digitise and aid in this process, the artefact presented in this thesis employs stereo computer–vision and camera calibration algorithms to extract edges in 3D space. It modifies the Sobel–Feldman convolution filter by reducing the magnitude response and employs the camera intrinsic parameters as a mechanism to calculate the distortion matrix for interpolation between the edges and the 3D point cloud. Further Augmented Reality User Experience (AR-UX) facets are provided to digitise current state of the art clinical guidance and over-lay its instructions onto the real world (i.e., 3D space). Empirical mixed methods assessment revealed that in terms of accuracy, the arte-fact exhibited enhanced performance gains over current paper–based guidance. In terms of accuracy consistency, the artefact can rectify measurement consistency inaccuracies, but there are still a wide range of factors that can influence the integrity of the point-cloud in respect of the device’s point-of-view, holding positions and measurement speed. To this end, OTs usability, and adoption preferences materialise in favour of the artefact. In conclusion, this thesis demonstrates that MDSMTDs are a promising alterna-tive to existing paper–based measurement practices as OTs appear to prefer the digital–based system and that they can take measurements more efficiently and accurately

Augmented and virtual reality in surgery—the digital surgical environment:applications, limitations and legal pitfalls

The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena