Technology Assisted Healthcare: Exploring the use of mobile 3D … · 2018. 6. 23. · Technology-Assisted Healthcare: Exploring the use of mobile 3D visualisation technology to augment

Technology-Assisted Healthcare: Exploring the use

of mobile 3D visualisation technology to augment

home-based fall prevention assessments

Julian J. Hamm, BSc (Hons)

College of Engineering, Design and Physical Sciences

Department of Computer Science

Brunel University, London

A thesis submitted for the degree of

Doctor of Philosophy

March 2018

Abstract

ii

Abstract

Falls 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).

Declaration

iii

Declaration

I hereby declare that except where specific reference is made to the work of others, the contents of

this thesis is original and has not been submitted in whole or in part for consideration for any other

degree or qualification in this, or any other, University. This thesis is the result of my own work and

includes nothing which is the outcome of work done in collaboration, except where specifically

indicated in the text.

Acknowledgements

iv

Acknowledgements I would like to offer my most sincere thanks to my supervisor Dr Arthur Money for his support,

encouragement, and patience throughout the PhD journey. He has always ensured that the resources

to help conduct my research were made available to me. Attention to detail, thorough comments and

suggestions, and making himself available whenever I needed his support, were all gratefully

received. This research would have not been completed without your help and guidance Arthur, and,

for that, I am eternally grateful.

I would also like to thank Dr Anita Atwal for her assistance and support in enabling me to

understand the occupational therapy field and putting me in contact with healthcare professionals

who helped out tremendously with the recruitment of participants for this research and for providing

advice from a clinical standpoint.

Many other academics from Brunel University and other Universities are owed huge thanks for

their invaluable advice, whether it was a casual conversation or at academic conferences and doctoral

consortiums. There are far too many to mention, but I am sure you know who you are and understand

my heartfelt appreciation and gratitude. More specifically, I must give a special thank you to

Professor Robert Macredie and Professor Carsten Maple for their incredible advice and support and

for making themselves available to discuss the research process, which was always a very

enlightening and stimulating experience. Most of all, I would also like to thank them both for

believing in me, which was often of great benefit during the times where self-belief was short lived.

This research work would not have been possible without the Disabled Living Foundation, the

Staffordshire and Stoke on Trent Partnership NHS Trust, and the Homerton Hospital giving access

to their facilities. I am also grateful to the clinical leads (particularly Jill Sluman and Elizabeth

Taylor) at the Homerton Hospital, and other lead therapists who ran exercise classes at Brunel

University and Leisure centres in London, for their considerable help with the recruitment of patient

participants. I would also like to acknowledge all participants in the research, as, without their

involvement and input, this research would not have been conducted or achievable.

I am incredibly grateful to my counsellors Marie Plose and Alan Clarke for always managing to

make me smile and for coaching me to develop coping mechanisms to deal with the feeling of

isolation and other symptoms that one experiences when doing a massive undertaking such as a PhD.

I would also like to acknowledge the Engineering and Physical Sciences Research Council

(EPSRC) for funding my studies, as it would have been difficult to self-fund or obtain funding

elsewhere.

Finally, and most importantly, I would like to express my heartfelt thanks to my friends and family

for their love, support, and encouragement throughout this journey; words are truly not enough. In

the times of despair, when I felt isolated and doubtful of my ability, I was often reminded by my

Acknowledgements

v

family of the journey I have travelled in the lead-up to undertaking this PhD research, and the trials

and tribulations I have endured in my life, which what kept me going. Particularly, my deepest

gratitude goes to my darling wife and my mother for their tremendous and endless love and support

and for keeping me sane, which admittedly was not an easy task most of the time.

Dedication

vi

Dedication

I would like to dedicate this thesis to my mother, Sophie, my wife, Camille, and my new born son,

Luther.

List of Publications

List of Publications The following list of research papers has been published or being submitted for publication as an

output of the research reported in this thesis:

1. Hamm, J., Money, A.G., Atwal, A. and Paraskevopoulos, I., 2016. Fall prevention

intervention technologies: A conceptual framework and survey of the state of the art. Journal

of Biomedical Informatics, 59, pp.319-345. (Published)

2. Hamm, J., Money, A.G., Atwal, A. and Ghinea, G., 2017. Mobile three-dimensional

visualisation technologies for clinician-led fall prevention assessments. Health Informatics

Journal, p.1460458217723170. (Published)

3. Hamm, J., Money, A. and Atwal, A., 2017. Fall Prevention Self-Assessments via Mobile 3D

Visualization Technologies: Community Dwelling Older Adults’ Perceptions of

Opportunities and Challenges. JMIR Human Factors, 4(2). (Published)

4. Hamm, J., Money, A. and Atwal, A., 2018. Enabling older adults to carry out paperless falls-

risk self-assessments using guidetomeasure-3D: A mixed methods study. (Submitted to a

journal)

5. Hamm, J., Money, A. and Atwal, A., 2018. guidetomeasure-OT: A mobile 3D application to

improve the accuracy, consistency, and efficiency of clinician-led home-based falls-risk

assessments. (Submitted to a journal)

6. Hamm, J., Money, A. and Atwal, A., 2018. Guidetomeasure: a mobile 3D assisted tool to

support occupational therapists with home-based fall prevention assessments. (Working on

submission to a journal)

The first Brunel Computer Science Doctoral Consortium: 1st prize winner based on the

research presented at the conference. Link to presentation slides presented at the conference.

https://www.dropbox.com/s/ukifgt6118dalim/CSDC_brunel_2016_presentation_JH.pdf?dl=0

Table of Contents

viii

Table of Contents List of Publications ........................................................................................ vii

Table of Contents ......................................................................................... viii

List of Figures ................................................................................................ xv

List of Tables................................................................................................. xix

List of Acronyms and Abbreviations ......................................................... xxi

Introduction ................................................................................... 1

Introduction ....................................................................................................................... 1

Research problem and context of study ............................................................................. 1

Problem statement ......................................................................................................... 4

Aim and Objectives ........................................................................................................... 6

Research approach adopted ............................................................................................... 7

Research contributions in brief .......................................................................................... 9

Thesis roadmap ................................................................................................................ 10

A Conceptual Framework and Literature Survey of the state of

the art of Fall Prevention Technology Systems .......................................... 13

Introduction ..................................................................................................................... 13

Research Method ............................................................................................................. 17

Literature search strategy ............................................................................................ 17

Developing the conceptual framework ........................................................................ 19

A conceptual framework of falls prevention technology ................................................. 20

Falls prevention technology systems in practice ......................................................... 20

Pre-falls prevention intervention systems (Pre-FPIs) ..................................................... 20

Post-fall prevention intervention systems (Post-FPIs) .................................................... 22

Fall injury prevention intervention systems (FIPIs) ....................................................... 23

Cross fall prevention intervention systems (CFPIs) ....................................................... 23

Technology deployment .............................................................................................. 23

Pre-fall prevention intervention systems ......................................................................... 26

Fall risk factors ............................................................................................................ 26

Intervention types ........................................................................................................ 29

Systems........................................................................................................................ 30

Information sources ..................................................................................................... 32

Interface types ............................................................................................................. 34

Discussion ................................................................................................................... 35

Post-fall prevention intervention systems ........................................................................ 36


Table of Contents

ix


Systems........................................................................................................................ 39


Interface type ............................................................................................................... 41

Discussion ................................................................................................................... 42

Fall injury prevention intervention systems ..................................................................... 43



Systems........................................................................................................................ 46


Interface types ............................................................................................................. 49

Discussion ................................................................................................................... 50

Cross falls prevention intervention systems .................................................................... 51


Combination of intervention types .............................................................................. 52

Systems........................................................................................................................ 52


Interface types ............................................................................................................. 54

Discussion ................................................................................................................... 55

Challenges and recommendations ................................................................................... 55

Challenges to Pre-FPIs ................................................................................................ 57

Challenges to Post-FPIs............................................................................................... 59

Challenges to FIPIs ..................................................................................................... 60

Challenges to CFPIs .................................................................................................... 61

Concluding discussion ..................................................................................................... 62

Chapter summary ............................................................................................................. 64

Technology-assisted Healthcare Research: A Design Science

Research Approach ....................................................................................... 66

Introduction ..................................................................................................................... 66

Research Paradigm .......................................................................................................... 67

DSR approach .................................................................................................................. 70

Overview of DSR ........................................................................................................ 70

Data collection and analysis techniques .......................................................................... 73

Applying DSR to this research ........................................................................................ 75

Stage 1: Awareness of the problem ............................................................................. 75

Stage 2: Suggestion ..................................................................................................... 77

Stage 3 and 4: Development and Evaluation – iteration 1-3 ....................................... 77

Iteration 1 ....................................................................................................................... 77

Table of Contents

x

Iteration 2 ....................................................................................................................... 78

Living labs ................................................................................................................. 80

Iteration 3 ....................................................................................................................... 80

Stage 5: Conclusion ..................................................................................................... 81

The role of theory in qualitative data analysis for artefact design and evaluation ........... 82

General and ethical considerations .................................................................................. 82

Employing a software development methodology to this research ................................. 83

Conclusion ....................................................................................................................... 84

Chapter summary ............................................................................................................. 85

Occupational Therapist perceptions of Mobile 3D visualisation

technologies as a measurement aid for fall prevention assessment

interventions .................................................................................................. 86

Background ...................................................................................................................... 86

Occupational therapy, EFAP ....................................................................................... 86

EFAP, measurement, and falls prevention .................................................................. 87

Existing and future technologies for falls prevention .................................................. 89

3D Visualisation Technologies for Guiding the EFAP ............................................... 90

Clinician perceptions and acceptance of technology ................................................... 94

Initial conceptual design and application walkthrough ................................................... 96

The Guidetomeasure-beta application: System Walkthrough ..................................... 97

System architecture ........................................................................................................ 98

Application walkthrough ................................................................................................ 99

Methods ......................................................................................................................... 101

Participants ................................................................................................................ 101

Protocol and instrumentation ..................................................................................... 102

Data analysis ............................................................................................................. 103

Results ........................................................................................................................... 104

SUS evaluation .......................................................................................................... 104

Semi-structured interview results .............................................................................. 107

Discussion ...................................................................................................................... 110

Limitations ................................................................................................................ 115

Conclusion ..................................................................................................................... 116

Chapter summary ........................................................................................................... 117

Patient perceptions of supporting falls prevention self-

assessments via mobile 3D visualisation technology ................................ 118

Background .................................................................................................................... 118

Extrinsic Fall-risk Assessment Provision and Patient-Led Self-Assessment ............ 118

Methods ......................................................................................................................... 121

Table of Contents

xi

Overview ................................................................................................................... 121

Participants ................................................................................................................ 122

Protocol and Instrumentation .................................................................................... 123

Data Analysis ............................................................................................................ 125

Results ........................................................................................................................... 126

System Usability Scale (SUS) Evaluation Results .................................................... 126

Semi-structured Focus Group Discussion Results .................................................... 130

Discussion ...................................................................................................................... 134

Limitations ................................................................................................................ 138

Conclusion ..................................................................................................................... 139

Chapter summary ........................................................................................................... 140

Guidetomeasure: A mobile 3D measurement guidance tool for

clinician and patient-led assessments and assistive equipment prescription

....................................................................................................................... 141

Introduction ................................................................................................................... 141

Refining the Guidetomeasure-beta prototype ................................................................ 141

User requirement and specification ........................................................................... 142

The revised system architecture ..................................................................................... 144

Measurement guidance module ..................................................................................... 145

Measurement guidance: module walkthrough ........................................................... 148

GET request API call and stored measurements in the local DB ................................. 155

Recommendation module .............................................................................................. 156

Recommendation function: module walkthrough ..................................................... 159

GET request API call and stored recommendation in the local DB ............................. 162

External-Facing Unified API ......................................................................................... 164

Conclusion ..................................................................................................................... 164

Chapter summary ........................................................................................................... 165

Guidetomeasure: A mixed methods evaluation from older adult

patient and clinician perspectives .............................................................. 166

Introduction ................................................................................................................... 166

Aim ............................................................................................................................ 168

Methods ......................................................................................................................... 169

Participants ................................................................................................................ 169

Occupational therapists (Cohort 1) ............................................................................... 169

Older adults (Cohort 2) ................................................................................................. 171

Protocol and instrumentation: Applied to Cohort 1 and 2 ......................................... 171

Data analysis Protocol: Applied to Cohort 1 and 2 ................................................... 172

Table of Contents

xii

Results: Occupational therapist evaluation study (Cohort 1) ........................................ 174

Measurement accuracy .............................................................................................. 174

Measurement accuracy consistency .......................................................................... 175

Task completion time ................................................................................................ 177

Satisfaction and overall usability .............................................................................. 177

Perceived challenges, opportunities, adoption and use ............................................. 180

Discussion ................................................................................................................. 187

Results: Older adult evaluation study (Cohort 2) .......................................................... 193

Measurement accuracy .............................................................................................. 193

Measurement accuracy consistency .......................................................................... 195

Task completion time ................................................................................................ 196


Perceived challenges, opportunities, adoption and use ............................................. 200

Discussion ................................................................................................................. 204

Limitations for study 3 and 4 ......................................................................................... 208

Conclusion ..................................................................................................................... 210

Chapter summary ........................................................................................................... 211

An equipment recommendation module for prescribing

equipment sizes within the EFAP: results from a pilot study................. 212

Introduction ................................................................................................................... 212

Aim ............................................................................................................................ 213

Design of the equipment prescription algorithm ........................................................... 214

Method ........................................................................................................................... 217

Patient profiles: Creation and validation ................................................................... 217

Equipment recommendation task .............................................................................. 220

Participants ................................................................................................................... 220

Protocol and instrumentation ........................................................................................ 220

Data analysis ............................................................................................................. 222

Results ........................................................................................................................... 223

Patient profiles used for evaluation ........................................................................... 223

Recommendation accuracy ........................................................................................ 224

Recommendation accuracy consistency .................................................................... 226


Perceived challenges, opportunities, adoption, and use ............................................ 230

Discussion ...................................................................................................................... 236

Limitations ................................................................................................................ 242

Conclusion ..................................................................................................................... 243

Chapter summary ........................................................................................................... 244

Table of Contents

xiii

Conclusion ................................................................................. 245

Introduction ................................................................................................................... 245

Thesis summary ............................................................................................................. 245

Research findings........................................................................................................... 247

Research contributions................................................................................................... 254

A conceptual framework of the state of the art of fall prevention technology systems 254

A novel mobile 3D visualisation software artefact ................................................... 255

Implications and recommendations for deployment in practice ................................ 258

Research limitations and future research directions ...................................................... 263

Chapter 2: Remaining challenges .............................................................................. 263

Chapters 4 and 5: Limitations ................................................................................... 264

Chapter 7: Limitation ................................................................................................ 265

Chapter 8: Limitations ............................................................................................... 266

Further limitations ..................................................................................................... 267

References .................................................................................................... 270

List of Figures

List of Figures Figure 1-1: Link between the literature survey findings and EFAP topic of this research work. ...... 4

Figure 1-2: Thesis roadmap. ............................................................................................................ 11

Figure 2-1: Overview of falls prevention interventions. .................................................................. 13

Figure 2-2: Literature survey research protocol adapted from Afzal et al. [82]. ............................. 17

Figure 2-3: Literature search strategy, including the search strategy used to search through the falls

prevention technology literature, inclusion criteria set to include relevant studies, and results obtained

from the search. ................................................................................................................................ 19

Figure 2-4: Conceptual model of falls prevention technology. ........................................................ 21

Figure 2-5: Research focus for this thesis. ....................................................................................... 63

Figure 3-1: Mapping the DSR outputs to the Design Science Research Methodology cycle (adapted

from Vijay Vaishnavi and Bill Kuechler 2004 [26] and March and Storey 2008 [216]). ................ 71

Figure 3-2: Research workflow process model. ............................................................................... 76

Figure 3-3: Living lab of where the study 3 and 4 (in Chapter 7) took place. ................................. 81

Figure 3-4: RAD lifecycle followed in this research adapted from Córdova et al. [243]. ............... 84

Figure 4-1: Research focus from the challenges identified in the literature survey (Chapter 2). ..... 87

Figure 4-2: Paper-based measurement guidance currently used in practice [246, 247]. .................. 89

Figure 4-3: Overview of the protocol for the initial concept design phase. ..................................... 96

Figure 4-4: Concept sketches produced during the participatory design sessions with Occupational

therapists and older adults. ............................................................................................................... 97

Figure 4-5: Guidetomeasure-beta system architecture. .................................................................... 98

Figure 4-6: Guidetomeasure-beta application’s main menu. ........................................................... 99

Figure 4-7: Bath measurement guidance interface. ........................................................................ 100

Figure 4-8: Rotation feature before rotation (left) and after rotation (right). ................................. 100

Figure 4-9: Zoom in/out to facilitate better clinical guidance. ....................................................... 101

Figure 4-10: Overview study design. ............................................................................................. 102

Figure 4-11: Thematic mind map of key themes and associated sub-themes. ............................... 108

Figure 5-1: Overview of the session, methods, and process. ......................................................... 122

Figure 5-2: Thematic mind map of core themes and associated sub-themes. ................................ 131

Figure 6-1: Two examples of BDD scenarios of the application teased out through consultations with

clinicians and interaction designers. The following link is to the .feature file which contains the

scenarios in the Guidetomeasure app repository on [341]. ............................................................ 143

Figure 6-2: Use case diagram from the clinician and patient perspectives. ................................... 144

Figure 6-3: Onion layer-style architecture. This diagram illustrates the removal of dependencies, the

onus on using certain technologies, and highlights the importance of translating use cases into

microservices. ................................................................................................................................ 145

Figure 6-4: Guidetomeasure 3D app system architecture. ............................................................. 147

Figure 6-5: Local and Remote DB schema. ................................................................................... 148

Figure 6-6: Launch screen (measurement guidance). .................................................................... 148

List of Figures

xvi

Figure 6-7: Guidetomeasure application main menu. .................................................................... 149

Figure 6-8: Bath guidance on the booklet (A) vs. the bath guidance provided by the application (B).

........................................................................................................................................................ 149

Figure 6-9: Bed guidance on the booklet (A) vs. the bed guidance provided by the application (B).

........................................................................................................................................................ 150

Figure 6-10: Chair guidance on the booklet (A) vs. the chair guidance provided by the application

(B). ................................................................................................................................................. 150

Figure 6-11: Stairs guidance on the booklet (A) vs. the stairs guidance provided by the application

(B). ................................................................................................................................................. 150

Figure 6-12: Toilet guidance on the booklet (A) vs. the toilet guidance provided by the application

(B). ................................................................................................................................................. 151

Figure 6-13: Popliteal height guidance on the booklet (A) vs. the popliteal height guidance provided

by the application (B). .................................................................................................................... 151

Figure 6-14: Example of recording measurements on the application. .......................................... 152

Figure 6-15: Assessment questionnaire on the ‘About You’ screen. ............................................. 153

Figure 6-16: Note-taking facility for clinicians.............................................................................. 153

Figure 6-17: Zoom in/out of areas of dimensions to take of furniture items. ................................ 154

Figure 6-18: Exocentric navigation (using the drag touch gesture) and rotation button. ............... 155

Figure 6-19: GET request of service user assessments using Postman (an API testing application).

........................................................................................................................................................ 156

Figure 6-20: Local and Remote DBs for the measurement guidance module. .............................. 157

Figure 6-21: Unity 3D game engine environment. This tool was used to facilitate design discussions

where changes were being made to the app whilst participants provided suggestions in real-time.

........................................................................................................................................................ 158

Figure 6-22: Demonstration of an API call to the prescription algorithm microservice. ............... 159

Figure 6-23: Launch screen (measurement guidance). .................................................................. 160

Figure 6-24: Guidetomeasure application main menu. .................................................................. 160

Figure 6-25: prescription of bath board – visualisation view of its context and use. ..................... 161

Figure 6-26: Manipulate the view perspective and zoom-in to view the fit of the equipment on the

furniture item. ................................................................................................................................. 161

Figure 6-27: 3D toilet model interface, selecting a raised toilet seat as part of a prescription. ..... 162

Figure 6-28: Raised toilet seat equipment. ..................................................................................... 162

Figure 6-29: GET request for equipment prescription using Postman. .......................................... 163

Figure 6-30: Local DB and Remote DB for the recommendation module. ................................... 163

Figure 7-1: A disabled living foundation (DLF) measurement guidance tool used by clinicians in

practice (e.g. toilet and bath measurement guidance) [352]........................................................... 167

Figure 7-2: Overview of the user trial session, methods and process. ........................................... 169

Figure 7-3: SUS rating scale with overall SUS results for Guidetomeasure app and booklet for OT

cohort. ............................................................................................................................................ 178

Figure 7-4: Thematic mind map of core themes and associated sub-themes for OT cohort. ......... 181

Figure 7-5: SUS rating scale with overall SUS results for Guidetomeasure app and booklet for older

adult cohort. ................................................................................................................................... 198

List of Figures

xvii

Figure 7-6: Thematic mind map of core themes and associated sub-themes for older adult cohort.

........................................................................................................................................................ 200

Figure 8-1: Flowchart of the equipment prescription algorithm. ................................................... 215

Figure 8-2: Overview of the user trial session, methods and process. ........................................... 217

Figure 8-3: Examples of two patient profiles developed by expert clinicians. Link to Guidetomeasure

repository on GitHub [393]. ........................................................................................................... 219

Figure 8-4: SUS rating scale with overall SUS results for Guidetomeasure app. .......................... 228

Figure 8-5: Thematic mind map of inductive and deductive themes and sub-themes. .................. 231

Figure 9-1: Limitations and recommendations for future research directions. .............................. 264

List of Tables

List of Tables Table 2-1: Pre-fall prevention interventions. ................................................................................... 27

Table 2-2: Post-fall prevention interventions. .................................................................................. 38

Table 2-3: Fall injury prevention interventions................................................................................ 44

Table 2-4: Cross falls prevention interventions. .............................................................................. 51

Table 3-1: Research Paradigms in CS (adopted by Vaishnavi and Kuechler [26]). ........................ 69

Table 3-2: Hevner’s seven DSR guidelines (adopted by [197]). ..................................................... 72

Table 3-3: Triangulation approaches used in the research. .............................................................. 74

Table 4-1: Participatory design meeting user requirements. ............................................................ 97

Table 4-2: Summary of participant profiles. .................................................................................. 102

Table 4-3: Written instructions for the interactive task. ................................................................. 103

Table 4-4: Mean SUS score and Mid-point comparison. ............................................................... 105

Table 4-5: Study outcomes, implications and recommendations. .................................................. 112


Table 5-2: Mean system usability scale (SUS) score and midpoint comparison. .......................... 128

Table 5-3: Study outcomes............................................................................................................. 135

Table 6-1: User requirements and specification for the Guidetomeasure 3D app. ........................ 142

Table 7-1: Summary of OT participant profiles. ............................................................................ 170

Table 7-2: Summary of older adult participant profiles. ................................................................ 171

Table 7-3: Measurement accuracy for Guidetomeasure app and booklet guidance for OT cohort.174

Table 7-4: Comparison of accuracy consistency for Guidetomeasure app and booklet for OT cohort.

........................................................................................................................................................ 176

Table 7-5: Statistics of the task completion time using Guidetomeasure app. and booklet for OT

cohort. ............................................................................................................................................ 177

Table 7-6: Guidetomeasure app. and booklet comparison of SUS scores for OT cohort. ............. 179

Table 7-7: Comparison of SUS constructs for OT cohort. ............................................................. 180

Table 7-8: Measurement accuracy for Guidetomeasure app and booklet guidance for older adult

cohort. ............................................................................................................................................ 194

Table 7-9: Comparison of accuracy consistency for Guidetomeasure app and booklet for older adult

cohort. ............................................................................................................................................ 196

Table 7-10: Statistics of the task completion time using Guidetomeasure app. and booklet for older

adult cohort. ................................................................................................................................... 197

Table 7-11: Guidetomeasure app. and booklet comparison of SUS scores for older adult cohort. 198

Table 7-12: Comparison of SUS constructs for older adult cohort. ............................................... 199


Table 8-2: Patient profiles and their respective gold standard recommendations. ......................... 224

Table 8-3: Recommendation accuracy for recommendation module and no app condition. ......... 225

Table 8-4: Comparison of accuracy consistency for the app and no app. ...................................... 227

List of Tables

xx

Table 8-5: Guidetomeasure app. and booklet comparison of SUS scores. .................................... 229

Table 8-6: Comparison of SUS constructs. .................................................................................... 230

List of Acronyms and Abbreviations

List of Acronyms and Abbreviations

2D Two-dimensional

3D Three-dimensional

ADL Activities of daily living

AE Assistive Equipment

Async Asynchronous

AU Application use

Bal Balance impairments

Bs Bespoke sensor

C Context

Co Co-opted

Cog Cognitive impairments

DB Database

DC Desktop Computer

DSR Design Science Research

EFAP Extrinsic fall-risk assessment process

Eh Environmental hazards

Fun Functional ability deficit(s)

G Game

GC Game Console

He Home environment

Hs Hospital

ICT Information and communication technologies

ICTs Information and communication technologies

ML Machine Learning

NHS National Health Service

Nii Non-interactive interface

NUI Natural User Interface

OT Occupational therapist

OT Occupational Therapy/Occupational Therapist

PEOU Perceived ease of use

PU Perceived usefulness

Rp Repurposed sensors

S Static

SA Self-assessment

Sm Smart-phone

SUS System usability scale

Sync Synchronous

TAM Technology acceptance model

Ts Touch screen

U User-worn

UI User interface

UK United Kingdom

VR Virtual Reality

Introduction

Introduction This chapter sets the scene for the research reported in this thesis. It is an exploration of the benefits

of employing mobile three-dimensional (3D) visualisation technology to augment environmental

assessment interventions aimed at overcoming extrinsic fall risk factors in the home environment.

Following a discussion of the research problem and context of study, which introduces the fall

prevention and technology-assisted fall prevention research domain areas, the need for augmenting

environmental assessments for extrinsic risk factors as the problem statement is defined. The overall

aim of the research and its objectives are then established, and the approach employed to achieve

that aim is briefly described. After that, attention shifts to the research contributions: (1)

conceptualisation of and conceptual framework based on a survey of the fall prevention technology

research domain; (2) a novel mobile 3D visualisation artefact; and (3) implications and

recommendations for the use of the artefact in practice, which are outlined in brief. Finally, a

roadmap of the overall thesis is provided at the end of the chapter.

Specifically, the chapter is organised as follows: Section 1.2 provides the research problem, which

is framed by issues that impact upon: (1) the independence of community-dwelling older adult

patients in their home environment; (2) patient involvement; and (3) patient-clinician collaboration

in shared decision-making. To address the research problem, exploitation of the benefits of 3D

visualisation technology is proposed to overcome issues with conventional approaches/tools

currently in use. Section 1.3 presents the overall research aim, and, thereafter, its objectives, based

on the lack of effort expended on targeting environmental assessments to overcome extrinsic fall

risks and the need for patient involvement and clinician-patient collaboration (the research problem).

The design science research approach employed to achieve the aim and objective of this research is

briefly explained in Section 1.4. An overview of the three research contributions made by this thesis

is presented in Section 1.5. The chapter finally concludes with a walkthrough of the thesis structure,

along with a synopsis of each respective chapter, in Section 1.6.

Research problem and context of study Falls are a major health concern and pose a significant challenge to the well-being of an ageing world

population. The number of falls and related injuries has risen in recent years in the United Kingdom

(UK), in part due to a growing population aged 80 years and over [1]. There have been many attempts

in clinical literature to achieve a consensus as to how a ‘fall’ should be defined. According to the

literature, the perception of what a fall is differs between clinicians and older adult patients,

particularly if no injuries are sustained [2]. The different approaches in which they are investigated

often creates considerable disparity between studies in the literature [3]. Consequently, it is important

Chapter 1

Introduction

2

to set out a clear and standardised definition of what a fall actually is, and the different movements

that may constitute such an event. The definition upon which this research work is based defines a

fall as “an unexpected event in which the participant comes to rest on the ground, floor, or lower

level” [4]. In terms of adverse effect, falls often cause debilitating injuries, which precipitate

hospitalisation and long-term care admission and result in an increased burden on health care services

[5]. The cost of falls to the National Health Service (NHS) in the UK is estimated at over £2.3 billion

per year [6]. Recent UK Government initiatives highlight both the importance and need for

innovative technology-based applications which utilise information and communication technologies

(ICTs) within the falls prevention domain.

ICTs are seen as having the potential to reduce health care costs, whilst also lessening the burden

that an ageing population increasingly places on health care services [7, 8]. Furthermore, it is

acknowledged that ICTs have numerous additional benefits, such as the potential to deliver more

effective patient-centred interventions, and improvements in levels of patient engagement and

adherence; which is likely to enhance patient satisfaction and overall quality of life [7, 9]. There are

numerous other benefits that can be realised as a consequence of extrinsic fall-risk assessment,

including enablement of ageing-in-place and independent living, enhanced care facilitation,

increased self-esteem, and overall improvement in quality of life [10]. Healthcare has evolved

immensely by turning increasingly to the use of technology to assist with service delivery beyond

the parameters of the clinical setting and into the home environment, where patients are expected to

take responsibility for their own care. It is of interest to adapt the existing tools - that may have been

developed in-mind for clinicians alone - to develop and/or complement this shift, thereby ensuring

that patients are able to use it to take on such responsibility to self-care independently.

Approximately 50% to 66% of falls occur in or around the patient's home environment [11] from

a complex interplay of multiple factors. Extrinsic fall risk factors focus on risks that are apparent

within the environment in which patients carry out activities on a day-to-day basis, including poor

lighting, slippery floor surfaces, raised door thresholds, stairs and steps, clutter, and trip hazards [12].

Extrinsic fall risk factors also include improper use of assistive equipment (AE), such as stair

handrails, toilet raisers, bath boards, and bathroom grab rails; or its absence, where such equipment

would normally be deemed necessary. Evidence from the literature indicates a lack of support

provided for both occupational therapist (OT) and non-occupational therapist (non-OT) -led

interventions that are conducted for adapting the home environment in accordance with the patient’s

needs [13]. Against this background, ICT-assisted interventions appear to offer a promising

alternative in reducing fall risk factors, thereby allowing patients with complex needs to live

independently at home with a better quality of life [14, 15]. Fall prevention technology systems have

Chapter 1

Introduction

3

been proposed in the literature that address multiple fall risk factors and which are positioned within

the various sub-domains of the overall research domain. To understand this in its entirety, and

identify the gaps that must be bridged, a survey of the literature is required.

Consequently, a comprehensive literature survey has been carried out (in Chapter 2), which

surveys and categorises technology-based fall prevention systems across the fall prevention

technology research landscape. The survey concludes that, although the various fall prevention

systems proposed in the literature are valuable in reducing the multiple fall risk factors, there is a

paucity of systems which target environmental assessment interventions intended to overcome

extrinsic risk factors. There is also a lack of systems that allow patients to self-assess their needs in

the environment in which they usually function. Furthermore, systems in the literature also lack

functionality that allows patients and clinicians to collaborate in assessments and provide additional

contextual detail for the collection and interpretation of data that these systems generate.

Clinicians (mainly being OTs) work with the older adult population with the intention of reducing

falls and alleviating their risk factors through various interventions (discussed in more detail in

Chapter 2). OTs play a major role in assisting older adults who wish to remain in their home and

perform daily living tasks safely. To achieve this, OTs conduct an assessment of the home

environment as part of the discharge and rehabilitation process, irrespective of the point at which the

patient enters the care pathway. Upon assessing the home environment, recommendations are made

in the form of assistive equipment prescriptions and the removal of home hazards. Rehabilitation

training to improve muscle strength and balance is also provided to the patient. However, there are

challenges to these aims, particularly related to ineffective tools used to prescribe the equipment that

assists patients in the home environment, and their lack of involvement in the intervention itself.

In an effort to overcome these challenges, the extrinsic fall-risk assessment process (EFAP) is

used as a case example, as it is a widely-employed procedure for prescribing equipment within the

home to reduce fall risks and involves clinicians and patients working collaboratively to carry out

assessments. Augmenting the EFAP in a way that addresses the aforementioned challenges may

ideally result in equipment prescriptions that are more compatible to patient needs and the home

environment. This research explores the EFAP as a case example and investigates how suitable

existing conventional approaches are to environmental assessment interventions, and the extent to

which they involve and support patients. Furthermore, it will explore ways in which a technology-

based solution could augment the EFAP. Figure 1-1 presents the link from the literature survey

findings to the research topics in this thesis and the case example that will be used in this thesis.

Chapter 1

Introduction

4

Figure 1-1: Link between the literature survey findings and EFAP topic of this research work.

Problem statement It is recognised that in order to reduce the risk of falling, particularly to enable an older adult

population to remain in their homes, targeting extrinsic risk factors is of equal importance to directing

efforts to address intrinsic risk factors [16]. From the fall prevention technology systems reviewed

(in Chapter 2), it is apparent that much of the research effort focuses on the development of

technology-based solutions to augment evidence-based exercises and assessments.

Such solutions are designed to be deployed either in home or clinical settings that only target

intrinsic risk factors or detect falls either obtrusively or unobtrusively via the use of sensor

technologies. The findings of the survey raise important points regarding the considerable extent to

which future fall prevention technology systems would benefit from addressing extrinsic risks. As

Fall

Cost of fallsAgeing

population

ICTs benefits to fall prevention

Shift from delivering healthcare outside the

clinical setting into the patient s home

environment

Extrinsic fall risk factors

Improper use of assistive equipment

(AE), or the absence of assistive

equipment

Literature survey (in Chapter 2)

Fall prevention technology research

Occupational Therapy, EFAP

Technology-assisted interventions

Intrinsic Extrinsic

Environmental

assessment intervention

Pro

ble

m s

tate

men

t

Tackle extrinsic fall risk factors &

equipment use

Barriers to EFAPTechnology-

based solution

Chapter 1

Introduction

5

mentioned previously, limited efforts have hitherto been spent on developing fall prevention

technology for environmental assessments that address extrinsic risks, especially given the likelihood

of fall occurrences caused by extrinsic risks as a result of the increasing push for patients to remain

at home.

The EFAP, as an established intervention in the field of occupational therapy (OT), is typically

conducted by clinicians. It involves working closely with patients to assess intrinsic and extrinsic fall

risk factors, particularly in relation to how equipment can be successfully adopted by the clinicians

conducting home assessments to help patients remain at home. Key tasks conducted as part of the

assessment include collecting information about functional abilities and taking measurements of

patients (i.e. popliteal height), fittings, and home furniture items, all of which is used to prescribe

specific items of assistive equipment. Conventional paper-based guidance forms are used as a visual

measurement aid to assist clinicians with the assessments, with the intention of ensuring that the

correct information is recorded, and necessary associated patient data collected. These include

measurement guidance presented in the form of two-dimensional (2D) illustrations of information

that must be obtained about the patient, fittings, and home furniture. The paper-based (2D)

illustrations are typically annotated with measurement arrows that serve as prompts to indicate the

precise points in 3D space that must be accurately identified and measured to gather the data required

to formulate an assessment and accurately prescribe the necessary assistive equipment [17].

Although the 2D paper-based guidance tool is regarded as valuable for the purpose of visualising

the areas to measure, it is observed that its 2D format presents a challenge. It is limited in permitting

sufficient visualisation of the 3D structures relative to their location and configuration for the

measurements to be taken for equipment prescriptions. This can potentially result in the recording of

inaccurate measurements, skewing the associated assessment data, and, potentially, rendering the

prescribed equipment poorly fitted or incompatible to the patient needs/home. Approximately 50%

of prescribed assistive equipment is abandoned by service users (SU) [18]. One of the principal

reasons for this is ‘poor fit’ between the equipment and the patient using it [18, 19]. Inappropriate

fitting of equipment has significant consequences on the effectiveness of care delivery, negatively

impacts patient health outcomes, accelerates functional decline, increases overall exposure to fall

risks in the home, and, more generally, unnecessarily depletes already scarce and valuable health

care resources [20, 21]. Given the issues of ‘poor fit’ that already arise from trained OTs carrying

out these tasks, it is likely that these will be exacerbated if patients and carers are given the

responsibility for the EFAP [22].

In recognition of this, there is a need to explore whether innovative technology-based solutions

can provide clearer and more effective assessment guidance to support and facilitate more accurate

Chapter 1

Introduction

6

and reliable recording of measurements. The use of 3D visualisation technology has shown promise

as an alternative to existing 2D paper-based tools used in healthcare, where limited visualisation

capabilities impact stakeholders’ ability to perceive aspects of treatment/rehabilitation. A review of

3D visualisation technologies in the medical and healthcare field is given in section 4.1.4.

Furthermore, the employment of 3D visualisation provides an opportunity for interaction with tools

that allow delivery to be perceived as in the natural environment. Introducing such technology in this

sphere could tackle the ‘poor fit’ issue, and also help to address the pressing issue of self-assessment

that lies at the frontier of healthcare delivery for older adults. The purpose of this research is to

explore the use of 3D visualisation technology within the OT EFAP and identify its potential for

augmenting existing 2D paper-based tools to provide a better aid for carrying out key measurement

tasks in the EFAP.

Aim and Objectives In light of the above, this research explores the potential value that mobile 3D visualisation

technology could have in OT, and, specifically, the fall prevention technology domain, by supporting

both clinicians and patients in the provision of assistive equipment in the home. This is achieved

through co-designing a novel 3D visualisation application with clinicians and patients. By novel

application, this refers to the use of 3D visualisation technology introduced in the OT field in the

form of an application that augments the visual quality of existing 2D clinical guidance tools. Using

a more enhanced visualisation of measurement guidance could improve

interpretation/comprehension of crucial illustrations that aid the collection of information required

for equipment prescriptions, which has not previously been explored. The primary aim of this

research, therefore, was:

To develop and evaluate a novel application that utilises mobile 3D visualisation

technology to assist patients and clinicians in carrying out more effective and efficient

extrinsic home-based fall-risk assessments.

The overall research aim is achieved through the following six objectives that are linked to the

research studies reported in this thesis:

O1. Survey the fall prevention technology domain to conceptualise the state of the art systems,

identify gaps, and explore the literature for a suitable approach to guide the research in the

development of an artefact to address the identified gaps in the fall prevention domain;

Chapter 1

Introduction

7

O2. Explore the challenges and opportunities of the EFAP as a case example to address the

limited efforts spent on environmental assessment interventions and the existing methods

used to overcome extrinsic fall risks;

O3. Design and develop an alternative approach with stakeholders to overcome visualisation

limitations of existing EFAP methods currently in use;

O4. Evaluate the research artefact through user-based studies (i.e. clinicians and patients)

concerning its effectiveness in enabling accurate recording of measurements, efficiency, and

perceived satisfaction of its general usability, compared to the conventional 2D method

counterpart;

O5. Explore the artefact’s functionality in assisting stakeholders with prescriptions of accurate

equipment sizes based on a collection of assessments;

Research approach adopted The research approach has been carefully selected for each stage of the data collection, taking into

account the problem statement, the main aim and objectives, and the setup of the experimental

studies. To fulfil the overall aim and objectives, the research employed design science research

(DSR) [23, 24] as the overarching approach, while adopting a mixed method approach for each

experimental study carried out in this research. The rationale for selecting this was premised upon it

being a problem-solving approach, improving existing tools used in practice, and, as a result,

designing technology-based solutions in the form of artefacts to address those problems [25, 26]. The

data was gathered in four distinct research stages, with the outcomes of the preceding stage used to

further develop the artefact for use and evaluation of the proximate stage. A more detailed overview

of the research process is given in Chapter 3.

There is a debate in the literature regarding what an artefact represents. Put simply, March and

Smith [27] classify artefacts as a construct, model, method, and instantiation. Given that the purpose

of this research was to design a novel technology-based solution to address the defined problem, the

artefact produced is classified as an instantiation. In order to implement the instantiation, a software

development methodology was employed that allows for iterative prototypes of the artefact to be

developed rapidly, in parallel to evaluating its performance and general usability at the end of each

cycle. A DSR artefact is, by definition, a technological innovation that is functional and enhances

existing systems, or proposes new ones to address a specified problem, which, in terms of what the

artefact offers, is considered a contribution in its own right [23, 25]. The research artefact is,

therefore, based on this definition in terms of how it contributes to the fall prevention technology

Chapter 1

Introduction

8

domain. Furthermore, it is worth noting that the artefact is not a software development project. Whilst

a software application is designed, the problem which it has been designed to solve is linked to a gap

identified in the literature and is aligned with being able to undertake a task more easily. A more

elaborate discussion of this is given in Chapter 3. All of the experimental studies reported upon in

this thesis employed a mixed method approach. This research is divided into five stages:

Stage 1: this stage involved surveying the fall prevention technology literature to gain an

understanding and conceptualise the sub-domain areas that make up its knowledge base (by

developing a conceptual framework) and identify the various challenges that warrant attention (see

Chapter 2 for more details).

Stage 2: studies 1 and 2 used participatory design workshops, ‘think-aloud’ semi-structured

interviews, focus groups, and a questionnaire to co-design a prototype, together with user cohorts to

investigate the use of 3D visualisation technology in an EFAP context. A high-fidelity prototype was

developed based on outcomes of the participatory design workshops. An evaluation was performed

to gain insights into the perceptions and experiences of the two user cohorts and measure their

subjective satisfaction of the proposed artefact.

Stage 3: studies 3 and 4 conducted user-based studies within a living lab setting to evaluate the

measurement guidance module of the artefact against the 2D measurement guidance booklet

currently in use, based on the established usability metrics [28] i.e. effectiveness, efficiency, and user

satisfaction (semi-structured interview and usability questionnaire).

Stage 4: study 5 conducted a user-based study to evaluate the equipment recommendation

module, based on accuracy and consistent accuracy of recommendations generated by the app

compared with conventional methods used for equipment prescriptions. Furthermore, this research

employed technology acceptance theories to analyse the semi-structured interviews that were carried

out at each stage of the research. A more detailed discussion of the overall research approach and the

experimental studies undertaken is provided in Chapter 3. Carrying out these studies resulted in

findings that impact the research domain and clinical practice within three high-level contributions,

as presented briefly in the next section.

Stage 5: this stage draws conclusions from across the studies and establishes the overall

contributions that this research work makes to the research sphere. Furthermore, the research findings

have also been discussed and presented to other researchers and healthcare practitioners to determine

its wider impact and ecological validity.

Chapter 1

Introduction

9

Research contributions in brief The research presented in this thesis makes the following contributions to the domain areas of fall

prevention technology, occupational therapy, and the wider healthcare provision arena:

A conceptual framework of the state of the art of fall prevention technology systems:

This first contribution provides a comprehensive literature survey of the falls prevention

technology domain. A systematic approach was employed to search and synthesise the fall

prevention technology studies that belong to the various sub-domains within the field,

resulting in a conceptual framework. This was then unpacked and used to survey the research

literature where a set of trends and challenges in the various sub-domains were identified

and discussed. These contribute to a growing body of literature, as the findings provide a

novel lens through which to view the research landscape; which, to the researcher’s

knowledge, did not exist prior to undertaking this work. It also provides other researchers

with challenges which they can address to further advance the field of study. Furthermore,

the systematic approach taken to survey the literature could also serve as a reference point

for other researchers to conduct a literature survey of a similar nature.

A novel mobile 3D visualisation software artefact: This primary contribution is a novel

mobile 3D visualisation software artefact which is more effective, efficient, and usable than

the conventional 2D paper-based guidance tools currently used as measurement guidance for

equipment prescriptions. The Guidetomeasure app is adaptable for use by both clinicians and

patients alike and could be redesigned for a different assessment purpose in healthcare.

Implications and recommendations for deployment in practice: This research

contributes to the enhancement of the healthcare provision through the employment of the

mobile 3D visualisation approach for use by OTs and older adults by providing improved

visualisation and equipment prescription capabilities to alleviate cost and societal

implications as a result of equipment abandonment. The issues that the artefact is expected

to highlight, and resolve could have implications for the use of similar technology in other

neighbouring areas of healthcare.

Overall, this research has demonstrated that improving the visualisation of the measurement guidance

and using a complementary algorithm to help prescribe assistive equipment sizes more accurately

can be effective for ensuring successful fit of equipment. More broadly, it can be extrapolated to

address other related areas in healthcare. A detailed discussion of the contributions presented above

is provided in section 9.4.

Chapter 1

Introduction

10

Thesis roadmap This thesis is divided into nine chapters. Figure 1-2 presents the roadmap of the thesis, in addition to

the contents of each chapter that is subsequently provided.

Chapter 2 presents a comprehensive literature survey of the state of the art of the fall prevention

technology landscape in order to understand this and develop a conceptual framework, using

thematic analysis to examine the range of fall prevention systems proposed in the literature (O1).

Each theme in the framework and findings from the survey are explained in detail. Subsequently, the

various gaps in the literature are identified. The challenge of a lack of research effort expended on

integrating environmental assessment interventions to overcome extrinsic risk factors forms the focus

of this research.

Chapter 3 describes the research approach adopted, and the design, data collection, and analysis

techniques employed at each stage of the research in support of addressing the overall aim and

research objectives, previously outlined (O1). An overview of the design science research paradigm

is provided. Subsequently, the design science approach applied to the research is discussed, with the

research divided into stages and a mixed methods approach employed in the experimental studies.

The role of theory in this research is also discussed. Further, the general and ethical considerations

for this research are explained. Finally, this chapter provides a rationale for adopting the software

development methodology for the intended purpose.

Chapter 4 presents the first user-centred design and exploratory study with OTs of a mobile 3D

visualisation prototype to overcome visual quality limitations with 2D paper-based EFAP tools.

Subsequently, the challenges and benefits of employing mobile 3D visualisation technology to

facilitate EFAP in practice and how the prototype can be further adapted are explored (O2, O3). The

chapter initially provides existing literature and a rationale for the study. A walkthrough of the

prototype is given. The study procedure, data collection, and analysis methods employed for the

study are presented. Then the results of the study are discussed. The key outcomes linked to the

results are reviewed, resulting partly in user requirements to be implemented in a prototype to be

evaluated further in a subsequent study. Finally, the conclusions of this study are drawn.

Chapter 5 provides the second study, similar to the first, but exploring the benefits and drawbacks

of mobile 3D visualisation technology via a developed prototype (presented in Chapter 4, section

4.2) for EFAP with older adult service users (O2, O3). The data collection and analysis methods

employed for the main study are presented. The usability evaluation and semi-structured interview

results are discussed. Then the key outcomes of this study are reviewed, mapped to the results source

with recommendations provided. This is followed by limitations encountered in the study. Finally,

conclusions are drawn.

Chapter 1

Introduction

11

Figure 1-2: Thesis roadmap.

Chapter 6 explains the design and implementation process of the refined research artefact based

upon user requirements collected from studies 1 and 2 (reported in Chapters 4 and 5). The revised

system architecture is presented. The measurement guidance module and its components are

Chapter 1: Introduction

Sets the scene

Chpater 2: Fall prevention

Intervention Technologies: A

Conceptual Framework and

Survey of the State of the Art

Chapter 3: Technology-Assisted

Health Research: A Design

Science Research Approach

Chapter 6: Guidetomeasure: A

mobile 3D measurement

guidance tool for clinician and

patient-led assessments and

assistive equipment prescription

Chapter 9: Conclusion

Brings the thesis to a close

Chapter 4: Occupational

Therapist perceptions of Mobile

3D visualisation technologies as

a measurement aid for fall

prevention assessment

interventions

Study 1

Chapter 5: Patient perceptions of

supporting falls prevention self-

assessments via mobile 3D

visualisation technology

Study 2

Chapter 7: Guidetomeasure: A

mixed methods evaluation from

older adult patient and clinician

perspectives

Study 3 & 4

Chapter 8: An equipment

prescription module for

prescribing equipment sizes

within the AEPP: Results from a

pilot study

Study 5

Ob

jecti

ve 1

Ob

jecti

ve 2

& 3

Ob

jecti

ve 2

, 4

& 5

Stage 2:

Suggestion

Stage 1: Awareness of problem

Stage 3 and 4:

Development and

Evaluation

Stage 5:

Conclusion

Chapter 1

Introduction

12

described and a walkthrough of how to use it is given. The recommendation module and a

walkthrough of how to use it are also described.

Chapter 7 presents the third and fourth studies, evaluating the performance of the

Guidetomeasure app, compared with an existing 2D measurement guidance paper-based tool that is

currently in use, within a living lab setting (O2, O4). First, an overview of the previous studies is

presented and a rationale given for carrying out such evaluation with OTs and older adults. Then the

protocol and methods used for data collection and analysis methods/techniques are described. The

results of the evaluation in relation to the research questions outlined in this chapter are presented.

The key findings associated to the research questions for each of the studies are discussed.

Conclusions are then drawn and findings across studies are presented at the end of the chapter.

Chapter 8 presents the fifth study, evaluating the effectiveness of the recommendation module

prescribing accurate minor equipment compared with existing approaches used by clinicians within

the EFAP in practice (O2, O5). First, the chapter presents the outcome of the previous studies and

how it provides the basis for this study. The design of the prescription algorithm which underlies the

recommendation module is explained and presented. The study procedure, data collection, and

analysis methods employed for this study are presented. Then the results of the study are reviewed.

The findings related to the research questions are discussed. Conclusions to this chapter are then

drawn.

Chapter 9 summaries the thesis and discusses the findings of the research carried out in relation

to the objectives outlined in Chapter 1. The main contributions of this research and the value they

provide are presented. Finally, the limitations encountered during the course of the research are

acknowledged, and future research directions to address those limitations are examined.

A Conceptual Framework and Literature Survey

of the state of the art of Fall Prevention

Technology Systems

Introduction Falls prevention within the home environment has been a topic of research for over 30 years [29] and

is recognised as an important health issue in the UK, Europe, North America, and Australia [16]. The

frequency of falls increases with age, often as a result of physical, functional, and cognitive

impairments, which are likely to emerge as a result of advanced ageing [30]. Consequently, it is

estimated that 30% of older adults aged 65 and over fall at least once a year [1]. One in five falls

result in bone fractures and the need for specialist medical attention [31]. Fall-related fractures may

cause disabilities, and, in some extreme cases, premature death among older adults, which has a

significant impact on demand for health and social care services, resulting in a cost of £1.8 billion

per year to the NHS in the UK [32].

Falls prevention activities are carried out across a range of health disciplines, including

occupational ther

Documents

Technology Assisted Healthcare: Exploring the use of mobile 3D … · 2018. 6. 23. · Technology-Assisted Healthcare: Exploring the use of mobile 3D visualisation technology to augment