Roles for Personal Informatics in Chronic Pain

Self-management of chronic pain is a complex and demanding activity. Multidisciplinary pain management programs are designed to provide patients with the skills to improve, maintain functioning and self-manage their pain but gains diminish in the long-term due to lack of support from clinicians. Sensing technology can be a cost-effective way to extend support for self-management outside clinical settings but they are currently under-explored. In this paper, we report studies carried out to investigate how Personal Informatics Systems (PIS) based on wearable body sensing technology could facilitate pain self-management and functioning. Five roles for PIS emerged from a qualitative study with people with chronic pain and physiotherapists: (i) assessment, planning and prevention (ii) a direct supervisory and co-management role, (iii) facilitating deeper understanding, (iv) managing emotional states, and (v) sharing for social acceptability. A web-based survey was conducted to understand the parameters that should be tracked to support self-management and what tracked information should be shared with others. Finally, we suggest an extension to previous PIS models and propose design implications to address immediate, short-term and long-term information needs for personal use of people with chronic pain and for sharing with others. / Note: As originally published there is an error in the document. The following information was omitted by the authors: "The project was funded by the EPSRC grant Emotion & Pain Project EP/H017178/1 rather than the EPSRC grant EP/G043507/1: Pain rehabilitation: E/Motion-based automated coaching.." The article PDF remains unchanged

The affective body argument in technology design

In this paper, I argue that the affective body is underused in the design of interactive technology despite what it has to offer. Whilst the literature shows it to be a powerful affective communication channel, it is often ignored in favor of the more commonly studied facial and vocal expression modalities. This is despite it being as informative and in some situations even more reliable than the other affective channels. In addition, due to the proliferation of increasingly cheaper and ubiquitous movement sensing technologies, the regulatory affective functions of the body could open new possibilities in various application areas. In this paper, after presenting a brief summary of the opportunities that the affective body offers to technology designers, I will use the case of physical rehabilitation to discuss how its use could lead to interesting new solutions and more effective therapies

Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives

The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety

Pain level recognition using kinematics and muscle activity for physical rehabilitation in chronic pain

People with chronic musculoskeletal pain would benefit from technology that provides run-time personalized feedback and help adjust their physical exercise plan. However, increased pain during physical exercise, or anxiety about anticipated pain increase, may lead to setback and intensified sensitivity to pain. Our study investigates the possibility of detecting pain levels from the quality of body movement during two functional physical exercises. By analyzing recordings of kinematics and muscle activity, our feature optimization algorithms and machine learning techniques can automatically discriminate between people with low level pain and high level pain and control participants while exercising. Best results were obtained from feature set optimization algorithms: 94% and 80% for the full trunk flexion and sit-to-stand movements respectively using Support Vector Machines. As depression can affect pain experience, we included participants' depression scores on a standard questionnaire and this improved discrimination between the control participants and the people with pain when Random Forests were used. / Note: As originally published there is an error in the document. The following information was omitted by the authors: "The project was funded by the EPSRC grant Emotion & Pain Project EP/H017178/1 and Olugbade was supported by the 2012 Nigerian PRESSID PhD funding." The article PDF remains unchanged

Feasibility and Acceptability of Mobile Phone–Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults

Background: Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. Objective: MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. Methods: A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. Results: In all, 90% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control (βint=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more (βint=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day (βint=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. Conclusions: In the pilot study, MyBehaviorCBP’s automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP’s efficacy on a larger cohort and over a longer period of time

Supporting Everyday Function in Chronic Pain Using Wearable Technology

While most rehabilitation technologies target situated exercise sessions and associated performance metrics, physiotherapists recommend physical activities that are integrated with everyday functioning. We conducted a 1-2 week home study to explore how people with chronic pain use wearable technology that senses and sonifies movement (i.e., movement mapped to sound in real-time) to do functional activity (e.g., loading the dishwasher). Our results show that real-time movement sonification led to an increased sense of control during challenging everyday tasks. Sonification calibrated to functional activity facilitated application of pain management techniques such as pacing. When calibrated to individual psychological needs, sonification enabled serendipitous discovery of physical capabilities otherwise obscured by a focus on pain or a dysfunctional proprioceptive system. A physiotherapist was invited to comment on the implications of our findings. We conclude by discussing opportunities provided by wearable sensing technology to enable better functioning, the ultimate goal of physical rehabilitation

Leveraging Multi-Modal Sensing for Mobile Health: A Case Review in Chronic Pain

Active and passive mobile sensing has garnered much attention in recent years. In this paper, we focus on chronic pain measurement and management as a case application to exemplify the state of the art. We present a consolidated discussion on the leveraging of various sensing modalities along with modular server-side and on-device architectures required for this task. Modalities included are: activity monitoring from accelerometry and location sensing, audio analysis of speech, image processing for facial expressions as well as modern methods for effective patient self-reporting. We review examples that deliver actionable information to clinicians and patients while addressing privacy, usability, and computational constraints. We also discuss open challenges in the higher level inferencing of patient state and effective feedback with potential directions to address them. The methods and challenges presented here are also generalizable and relevant to a broad range of other applications in mobile sensing

Human Observer and Automatic Assessment of Movement Related Self-Efficacy in Chronic Pain: from Exercise to Functional Activity

Clinicians tailor intervention in chronic pain rehabilitation to movement related self-efficacy (MRSE). This motivates us to investigate automatic MRSE estimation in this context towards the development of technology that is able to provide appropriate support in the absence of a clinician. We first explored clinical observer estimation, which showed that body movement behaviours, rather than facial expressions or engagement behaviours, were more pertinent to MRSE estimation during physical activity instances. Based on our findings, we built a system that estimates MRSE from bodily expressions and bodily muscle activity captured using wearable sensors. Our results (F1 scores of 0.95 and 0.78 in two physical exercise types) provide evidence of the feasibility of automatic MRSE estimation to support chronic pain physical rehabilitation. We further explored automatic estimation of MRSE with a reduced set of low-cost sensors to investigate the possibility of embedding such capabilities in ubiquitous wearable devices to support functional activity. Our evaluation for both exercise and functional activity resulted in F1 score of 0.79. This result suggests the possibility of (and calls for more studies on) MRSE estimation during everyday functioning in ubiquitous settings. We provide a discussion of the implication of our findings for relevant areas