Excellent Usability Research Articles

Screening for degenerative cervical myelopathy with the 10-second grip-and-release test using a smartphone and machine learning: A pilot study.

Early detection and intervention are essential for the mitigation of degenerative cervical myelopathy (DCM). However, although several screening methods exist, they are difficult to understand for community-dwelling people, and the equipment required to set up the test environment is expensive. This study investigated the viability of a DCM-screening method based on the 10-second grip-and-release test using a machine learning algorithm and a smartphone equipped with a camera to facilitate a simple screening system. Twenty-two participants comprising a group of DCM patients and 17 comprising a control group participated in this study. A spine surgeon diagnosed the presence of DCM. Patients performing the 10-second grip-and-release test were filmed, and the videos were analyzed. The probability of the presence of DCM was estimated using a support vector machine algorithm, and sensitivity, specificity, and area under the curve (AUC) were calculated. Two assessments of the correlation between estimated scores were conducted. The first used a random forest regression model and the Japanese Orthopaedic Association scores for cervical myelopathy (C-JOA). The second assessment used a different model, random forest regression, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The final classification model had a sensitivity of 90.9%, specificity of 88.2%, and AUC of 0.93. The correlations between each estimated score and the C-JOA and DASH scores were 0.79 and 0.67, respectively. The proposed model could be a helpful screening tool for DCM as it showed excellent performance and high usability for community-dwelling people and non-spine surgeons.

Versão para Web do protocolo de avaliação miofuncional com escores: usabilidade e aprendizado

The Orofacial Myofunctional Evaluation with Scores (OMES) protocol has been validated and used in clinical practice and research. The goals of this study were to develop, analyze and improve a version of OMES for the Web and to investigate the relationship between the usability judgments and the prior experience of the evaluators and whether using the interface promotes learning, as shown by the task completion time (TCT). Study steps: 1) inspection of the prototype by the team; 2) evaluation of usability by three experienced speech-language pathologists (SLPs); and 3) evaluation of its usability by 12 SLPs with varying levels of experience in the use of OMES. Participants answered the Heuristic evaluation (HE), the Computer System Usability Questionnaire (CSUQ), and expressed free comments. The TCT was recorded. The OMES-Web reached excellent usability levels, and the participants were highly satisfied. The correlations between the participants' experience and the HE and CSUQ scores were not significant. The TCT decreased significantly throughout the tasks. OMES-Web meets the usability criteria, and participants feel satisfied with the system regardless of their level of experience. The fact that it is easy to learn favors its adoption by professionals.

A Generic Internet of Things (IoT) Middleware for Smart City Applications

The Internet of Things (IoT) is one of the key components of the ICT infrastructure of smart cities due to its great potential for intelligent management of infrastructures and facilities and the enhanced delivery of services in support of sustainable cities. Smart cities typically rely on IoT, where a wide variety of devices communicate with each other and collaborate across heterogeneous and distributed computing environments to provide information and services to urban entities and urbanites. However, leveraging the IoT within software applications raises tremendous challenges, such as data acquisition, device heterogeneity, service management, security and privacy, interoperability, scalability, flexibility, data processing, and visualization. Middleware for IoT has been recognized as the system that can provide the necessary infrastructure of services and has become increasingly important for IoT over the last few years. This study aims to review and synthesize the relevant literature to identify and discuss the core challenges of existing IoT middleware. Furthermore, it augments the information landscape of IoT middleware with big data applications to achieve the required level of services supporting sustainable cities. In doing so, it proposes a novel IoT middleware for smart city applications, namely Generic Middleware for Smart City Applications (GMSCA), which brings together many studies to further capture and invigorate the application demand for sustainable solutions which IoT and big data can offer. The proposed middleware is implemented, and its feasibility is assessed by developing three applications addressing various scenarios. Finally, the GMSCA is tested by conducting load balance and performance tests. The results prove the excellent functioning and usability of the GMSCA.

Usability Evaluation of the Preoperative ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Desktop Virtual Reality Application: Qualitative Observational Study

Systematic communication, such as the ISBAR (identification, situation, background, assessment, recommendation) approach, comprises a generic, transferable nontechnical skill. It can be used during the handover of patients set to undergo surgery and can be practiced in various ways, including virtual reality (VR). VR increasingly has been implemented and valued in nursing education as a positive contribution to teach students about pre- and postoperative nursing. A new nonimmersive 3D learning activity called the Preoperative ISBAR Desktop VR Application has been developed for undergraduate nursing students to learn preoperative handover using the ISBAR approach. However, the usability of this learning activity has not been studied. This study aimed to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application. This was a qualitative study with observation and interviews. The inclusion criteria were undergraduate second-year nursing students of varying ages, gender, and anticipated technological competence. The System Usability Scale (SUS) questionnaire was used to get a score on overall usability. A total of 9 second-year nursing students aged 22-29 years participated in the study. The average score on the SUS was 83 (range 0-100), which equals a "B" on the graded scale and is excellent for an adjective-grade rating. The students expressed increased motivation to learn while working in self-instructed desktop VR. Still, a few technical difficulties occurred, and some students reported that they experienced some problems comprehending the instructions provided in the application. Long written instructions and a lack of self-pacing built into the application were considered limitations. The nursing students found the application to be usable overall, giving it an excellent usability score and noting that the application provided opportunities for active participation, which was motivational and facilitated their perceived learning outcomes. The next version of the application, to be used in a randomized controlled trial, will be upgraded to address technological and comprehension issues.

An Enhanced Multi-Level Authentication Electronic Voting System

Originally, manual voting systems are surrounded with issues like results manipulation, errors and long result computation time, ineligible voters, void votes among others. Electronic voting system helped in overcoming the challenges with manual voting system, to engendered other problems of phishing, men in the middle attack alongside voter’s impersonation. By these challenges, the integrity of an election results in a distributed system has become another top concern for e-voting system based on reliability. To achieve an improved voters’ authentication and result validation with excellent user experience, here, a Facial Recognition Electronic Voting System that is power-driven by Blockchain Technology was developed. The entire election engineering activities are decentralised with improved security features to enhance transparency, verifiability, and accountability for each vote count. The self-service voting system was built by smart contract and implemented on the Ethereum network. The obtained reports and evaluations reflected a non-editable and self-sufficiently certifiable system for voting. It also has a competitive edge over fingerprint enabled e-voting system. Aside it’s excellent usability and general acceptance, the developed method discarded to a larger extend, intended fraudulent actions from election activities by eliminating the involvement of a middleman while facilitating privacy, convenience, eligibility and satisfactory voters’ right.

E-Commerce Website Usability Analysis Using the Association Rule Mining and Machine Learning Algorithm

The overall effectiveness of a website as an e-commerce platform is influenced by how usable it is. This study aimed to find out if advanced web metrics, derived from Google Analytics software, could be used to evaluate the overall usability of e-commerce sites and identify potential usability issues. It is simple to gather web indicators, but processing and interpretation take time. This data is produced through several digital channels, including mobile. Big data has proven to be very helpful in a variety of online platforms, including social networking and e-commerce websites, etc. The sheer amount of data that needs to be processed and assessed to be useful is one of the main issues with e-commerce today as a result of the digital revolution. Additionally, on social media a crucial growth strategy for e-commerce is the usage of BDA capabilities as a guideline to boost sales and draw clients for suppliers. In this paper, we have used the KMP algorithm-based multivariate pruning method for web-based web index searching and different web analytics algorithm with machine learning classifiers to achieve patterns from transactional data gathered from e-commerce websites. Moreover, through the use of log-based transactional data, the research presented in this paper suggests a new machine learning-based evaluation method for evaluating the usability of e-commerce websites. To identify the underlying relationship between the overall usability of the eLearning system and its predictor factors, three machine learning techniques and multiple linear regressions are used to create prediction models. This strategy will lead the e-commerce industry to an economically profitable stage. This capability can assist a vendor in keeping track of customers and items they have viewed, as well as categorizing how customers use their e-commerce emporium so the vendor can cater to their specific needs. It has been proposed that machine learning models, by offering trustworthy prognoses, can aid in excellent usability. Such models might be incorporated into an online prognostic calculator or tool to help with treatment selection and possibly increase visibility. However, none of these models have been recommended for use in reusability because of concerns about the deployment of machine learning in e-commerce and technical issues. One problem with machine learning science that needs to be solved is explainability. For instance, let us say B is 10 and all the people in our population are even. The hash function’s behavior is not random since only buckets 0, 2, 4, 6, and 8 can be the value of h(x). However, if B = 11, we would find that 1/11th of the even integers is transmitted to each of the 11 buckets. The hash function would work well in this situation.

1297. Design and Testing of an Interactive Module for Improving Understanding and Application of Institutional Antibiograms

Abstract Background Many infectious diseases treatment guidelines recommend incorporating local antibiograms (ABs) into treatment decisionmaking. However, studies suggest many healthcare provider trainees are uncomfortable using ABs and rarely incorporate them into their decisionmaking. Our purpose was to develop a brief online module to develop skills in locating and utilizing an institutional AB and to gather feedback on its utility. Interactive Module for Understanding and Interpreting Antibiograms Screen captures displaying initial framing case with learner response (upper left), stepwise navigation of an antibiogram (upper right), embedded task practice (lower left) , and question from final competency assessment (lower right). Methods We developed and tested the module at the University of California San Francisco, with initial testing among 340 pharmacy students during microbiology instruction. We used the Four-Component Instructional Design framework to inform our design approach. Using the Articulate Storyline platform, we developed an interactive online learning module (Figure 1). The module began with a patient case to introduce the whole task and activate prior knowledge, with learners required to enter a freetext answer to the case prompt. Using visuals and narration with captions, the module then reviewed the basics of an AB and how to use an AB for therapy with known pathogens and for empiric therapy, and use of location-specific and combination ABs. Task practice was provided by case-based questions requiring learner response and providing immediate feedback. The module ended with competency assessment questions including revisiting the original case and the learner's initial answer. Learners completing the module were directed to complete a survey to provide feedback on the module; we report quantitative and qualitative feedback from the survey. Results We received 131 survey responses (38.5%). 111/131 (85%) rated the educational value of the module as “Extremely valuable”, and 103/131 (79%) rated the module as having “Excellent usability”. Primary themes among positive feedback included the interactive elements, stepwise approach, and questions with feedback; constructive feedback included desire for speed control of the narration and sound quality. Conclusion An interactive online module for learning about ABs was highly rated by learners and may be valuable to help clinicians apply ABs in practice. Future studies should include other health professions learners, delayed assessment to measure retention, and customization for different institutional ABs. Disclosures Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.

Usability and Teachability of Continuous Glucose Monitoring Devices in Older Adults and Diabetes Educators: Task Analysis and Ease-of-Use Survey.

Continuous glucose monitoring (CGM) devices continuously sense and relay glucose concentration data from the interstitial fluid to a mobile phone or receiver. Older adults benefit from this continuous monitoring of glucose levels. Proper deployment of the sensing wire is facilitated by a specialized applicator. Our aim was to assess a new seventh-generation (G7) CGM device (Dexcom, Inc) for use by adults 65 years of age or older and certified diabetes care and education specialists (CDCESs). Ease of use related to intradermal insertion and mobile app setup will be assessed and compared to the fifth- and sixth-generation systems. Formal task analysis was conducted to enumerate the number and complexity of tasks associated with CGM deployment. We recruited 10 older adults with no prior CGM experience and 10 CDCESs to assess ease of use through hands-on insertion and initiation of a G7 system followed by a survey and, for older adults, a system usability scale survey. About half as many tasks are needed to deploy G7 compared to G6. Older adults and CDCESs reported overall high usability of the G7 CGM device. CDCESs noted G7's easier setup compared to previous generations. The system usability scale score for the CGM system was 92.8, which reflects excellent usability. For CDCESs and for older adults using the G7 CGM system, cognitive burden is relatively low and reduced compared to previous CGM systems. Easing of this burden and simplification of the glucose monitoring aspect of proper diabetes management will likely contribute to improved outcomes in this population.

Verifying the equation for centripetal force: an augmented reality approach

Classroom experiments related to investigating the centripetal force are often underrepresented in the physics teaching practice. This is largely due to the fact that schools lack the proper equipment and teachers lack the time to perform the rather tedious data collection procedures which are characteristic for some of the traditional experimental setups. A possible solution to this problem is to develop and utilize alternative experimental setups within the digital environment. In fact, earlier research has shown that new generations of students are highly motivated to learn physics in digital environments and that these environments often provide at least as efficient learning of concepts as traditional environments. In this article, we present an augmented reality Android application named CEntripetalForceAR (CEFAR) that allows students to experimentally investigate how centripetal force depends on the period of orbital motion and the orbital radius. A possible pedagogical approach to using CEFAR is also described, including suggestions on how CEFAR can be used to overcome some of the most common misconceptions related to circular motion. A user experience survey which included 163 first-year university students showed that CEFAR can be awarded an excellent usability rating. Most students stated that the application helped them to improve their understanding about centripetal force either by visualization or by the possibility to explore cause and effect relationships.

R2Play development: Fostering user-driven technology that supports return-to-play decision-making following pediatric concussion.

To design a multi-domain return-to-play assessment system (R2Play) for youth athletes with concussion. The R2Play system was developed using an overarching user-centered approach, the Design Thinking Framework, and research activities included: 1) structured brainstorming within our research team, 2) interviews with clinician and youth sports coaches, 3) building a testable prototype, and 4) interface testing through cognitive walkthroughs with clinician partners. Clinician and coach participants provided feedback on the R2Play concept, which was integrated into the design process and provided future directions for research. Examples of feedback-driven design choices included reducing assessment time, increasing ecological validity by adding in background noise, and developing youth-friendly graphical results screens. Following refinement based on stakeholder feedback, the R2Play system was outlined in detail and a testable prototype was developed. It is made up of two parts: a clinician tablet, and a series of tablet "buttons" that display numbers and letters. Youth athletes run between the buttons to connect a "trail" in ascending alphanumeric order, 1-A-2-B, etc. Their performance across a series of levels of increasing difficulty is logged on the clinician tablet. Initial testing with five clinicians showed the system's interface to have excellent usability with a score of 81% (SD = 8.02) on the System Usability Scale. Through this research, a prototype of the R2Play system was innovated and evaluated by clinician and coach stakeholders. Initial usability was excellent and directions for future iterations were highlighted. Outcomes suggest the potential benefits of using technologies to assist in complex clinical assessment, as well as utilizing a user-centered approach to design.

A social VR-based collaborative exergame for rehabilitation: codesign, development and user study.

Immersive virtual reality (VR)-based exercise video games (exergames) are increasingly being employed as a supportive intervention in rehabilitation programs to promote engagement in physical activity, especially for elderly users. A multifaceted and iterative codesign process is essential to develop sustainable exergaming solutions. The social aspect is considered one of the key motivating factors in exergames; however, research on the social aspect of VR exergames has been limited. Previous studies have relied on competitiveness in exergames, but research has shown that competition can lead to adverse effects on users. With the aim of motivating elderly individuals to participate in physical exercise and improving social connectedness during rehabilitation, this work presents a social VR-based collaborative exergame codesigned with elderly participants and therapists. This exergame stimulates full-body exercise and supports social collaboration among users through a collaborative game task. Furthermore, this article presents a user study based on a mixed-methods approach to gather user feedback on exergame design and the effect of social collaboration versus playing alone in a VR exergame in terms of physical exertion and motivation. This study spanned five weeks (99 exergaming sessions) with 14 elderly participants divided into two groups, one playing collaboratively and the other playing individually. Between-group comparisons were performed at baseline (first week) and in the fourth week, and within-group comparisons were performed in the fifth week, when the participants played the exergame in counterbalanced order. In contrast to the first week, the participants exergaming collaboratively in the fourth week reported significantly higher intrinsic motivation on all subscales (enjoyment: p < 0.02, effort: p < 0.002, usefulness: p < 0.01) and physical exertion (p < 0.001) than those playing alone. Thereafter, exergaming in counterbalanced order during the fifth week resulted in significant differences (medium to large effect size) within groups. The participants found the social VR gameplay enjoyable and agreed that collaboration played a vital role in their motivation. They reported various health benefits, a minimal increase in symptoms of simulator sickness, and excellent usability scores (83.75±13.3). In this work, we also identify various key design principles to support healthcare professionals, researchers and industrial experts in developing ergonomic and sustainable VR-based exergames for senior citizens.

USABILITY SCORES OF A RELIEVER DIGITAL SYSTEM IN PATIENTS WITH UNCONTROLLED ASTHMA

<h3>Introduction</h3> The CONNECT1 study (NCT03890666) evaluated the Reliever Digihaler System (RDS) in participants with asthma aged ≥13 years with suboptimal asthma control (Asthma Control Test score <19). The RDS comprises an albuterol Digihaler capable of transmitting data wirelessly to a mobile application (App), which transfers data to a web-based provider-facing Dashboard. This exploratory analysis evaluated usability of the RDS, using data from CONNECT1. <h3>Methods</h3> In this 12-week study, 333 eligible participants were randomized to RDS (N=167) or standard of care (SoC) (N=166). Adult participants using the RDS assessed its usability by completing a 10-question System Usability Scale (SUS) questionnaire to rate the App; investigational site staff used the SUS to rate the Dashboard at Week 12. Questionnaire scores were calculated using a 0–100 scale, with higher numbers representing better usability (an SUS score of 71.1–80.7 means good usability and ≥80.8 indicates excellent usability). SUS scores of participants using the RDS were further categorized by age and ethnicity groups. <h3>Results</h3> Usability of the App was rated ‘Good' by the 140 adult participants who used the RDS (mean SUS score [standard deviation (SD)]: 79.8 [15.7]). Investigational site staff (n=21) rated the Dashboard usability as ‘Good' (mean SUS score [SD]: 74.6 [15.0]). SUS scores were similar across different age and ethnicity groups (Figure). <h3>Conclusion</h3> Participants and investigational site staff rated the RDS as having ‘Good' usability, and it is well-accepted by different age and ethnicity groups, indicating that it can be used in a wide population to help with asthma management.

Clinical Decision Support System for Implementing Care Pathways in a Global Radiation Oncology Network

<h3>Purpose/Objective(s)</h3> Evidence-based approaches to cancer care using established care pathways (CPs) are widely regarded as an effective way of improving quality and value in oncology. Yet, busy practicing oncologists can be overwhelmed with the quantity of literature and broad interpretation of evidence. In our global radiation oncology network, we developed a radiation oncology, clinical decision support (RO-CDS) system with evidence-based CPs to minimize variations in patient radiation treatments. This study assessed the usability and performance of our RO-CDS across Australia and UK radiation oncology centers. <h3>Materials/Methods</h3> We have developed a cloud-native RO-CDS (Horizon) that has been implemented with more than 241 radiation oncologists from diverse geographies (178 Australia and 63 UK) at 34 Australian centers and 15 UK centers. Horizon's CP library has been implemented for all treated disease sites and was developed in collaboration with participating radiation oncologists along with national guideline references (NCCN, EVIQ, NICE). Each CP defines an evidence-based radiation treatment approach for a specific cancer site including technical information for simulation and treatment. Horizon allows the oncologist to select from our CP library using a guided, templated workflow collecting high value distinct diagnosis, staging, medical data while pre-populating prescription, treatment and OAR info and data. The output (simulation and prescription structured data and PDFs) can be recorded in the application or sent to an EMR, which facilitates communication with care teams and payers. Horizon also provides access to view the physician schedule, clinic notes and labs, and patient chart information. During the implementation of Horizon, participants were asked to rate the performance of Horizon application and complete statements on a System Usability Scale (SUS) questionnaire. CP compliance was defined as no manual variations or edits to an approved CP by a prescribing physician. <h3>Results</h3> Since 2018, a total of 107,000 individualized prescriptions have been created in Horizon RO-CDS. Over this four-year period, overall compliance to approved CPs has improved from 86% to 97%. For usability, Horizon's SUS score was on average 84.2 (72.5 – 100), classified as an A score (excellent). Prescribing activities (clinical documentation and communication) involving all clinical care team members decreased by 20 minutes post-Horizon implementation saving valuable clinic time. Horizon prescription times for oncologists' software usage averaged 3 minutes per patient case irrespective of disease site. <h3>Conclusion</h3> Our cloud-native RO-CDS demonstrates that evidence-based CPs can be successfully implemented in a global radiation oncology network with high adherence rates, improved efficiency, and excellent usability. Future Horizon implementation includes our AI engine to automatically extract data from clinical reports reducing manual data entry.

VP.26 Potential of the MyoSuit, a lightweight wearable lower-limb cable-actuated exoskeleton in patients with neuromuscular disorders: preliminary findings

Neuromuscular disorders (NMD) are characterized by progressive muscle weakness leading to dramatic impairments in functional capacities and quality of life. A new class of promising lightweight lower-limb wearable powered exoskeletons is currently emerging. However, data regarding the potential of such devices in patients with NMD are scarce. Within this work, we investigated the potential of the MyoSuit (MyoSwiss AG, Zurich, Switzerland), a lightweight wearable robotic device providing assistance for hip and knee extension against gravity using actuated cables. Four patients with NMD (2 with muscular dystrophies, 2 with inclusion body myositis) were studied. Without using the MyoSuit, 2-min walking distance (2MWD) was 128±30 m (66±17% of predicted values), number of repetitions during a 30-s sit-to-stand test (30s-STS) was 8±3, and MRC scores for knee extension and hip flexion were 3±1.1 and 3.9±0.6, respectively. Changes (n patients improved/impaired) in performance while using the MyoSuit during the following tests were as follows: 2MWD (1/3), 30-STS (1/3), TUG (0/4), 4-stairs climbing test (1/3). Regarding perceptions during the 2MWD as assessed using visual analogue scales, changes were: stability (0/4), exertion (2/2), and dyspnea (3/1). One fall occurred in one patient while wearing the device without consequences. Usability of the Myosuit as assessed using the system usability scale (/100) was 77±20, corresponding to good to excellent usability. Discomfort as assessed using the modified Nordic questionnaire (/10) was 1.0±0.5, corresponding to a low level of discomfort. The limited sample size limits the use of insightful statistics so far. Within this small group of patients, the use of the MyoSuit was associated with variable changes in performance and perceptions depending on the functional test. Further research in a larger sample is warranted to further investigate the potential of this device in patients with NMD.

VP.27 Potential of the Keeogo+, a lightweight wearable powered assistive exoskeleton in patients with neuromuscular disorders: preliminary findings

Neuromuscular disorders (NMD) are characterized by progressive muscle weakness leading to dramatic impairments in functional capacities and quality of life. A new class of promising lightweight lower-limb wearable powered exoskeletons is currently emerging. However, data regarding the potential of such devices in patients with NMD are scarce. Within this work, we investigated the potential of the Keeogo+ (B-Temia Inc., Quebec, Canada), a lightweight wearable exoskeleton providing assistance to the knee using compact motors. Five patients with NMD (4 with inclusion body myositis, 1 with Becker muscular dystrophy) were studied. Without using the Keeogo+, 2-min walking distance (2MWD) was 126±31 m (67±17% of predicted values), number of repetitions during a 30-s sit-to-stand test (30s-STS) was 6±3, and MRC score for knee extension and hip flexion was 2.7±0.6 and 3.4±0.9, respectively. Changes (n patients improved/ impaired) in performance while using the Keeogo+ during the following tests were as follows: 2MWD (0/4), 30-STS (2/3), TUG (0/5), 4-stairs climbing test (1/3). Regarding perceptions during the 2MWD as assessed using visual analogue scales, changes were: stability (2/2), exertion (1/3), and dyspnea (4/0). No fall occurred while wearing the device. Usability of the Keeogo+ as assessed using the system usability scale (/100) was 41±23.2, corresponding to good to excellent usability. Discomfort as assessed using the modified Nordic questionnaire (/10) was 1.8±0.9, corresponding to a low level of discomfort. The limited sample size limits the use of insightful statistics. Within this small group of patients, the use of the Keeogo+ was associated with variable changes in performance and perceptions depending on the functional test. Further research in a larger sample is warranted to further investigate the potential of this device in patients with NMD.

The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study

BackgroundIndividuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability.ObjectiveWe aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices.MethodsTwo rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round.ResultsThe first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3).ConclusionsThe mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk.

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study.

BackgroundNeck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck’s state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user’s home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before.Materials & MethodsA total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject’s back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale.ResultsThe mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score.ConclusionThe reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India

BackgroundIn rural regions with few doctors to manage non-communicable diseases (NCDs), people rely on community health workers (CHWs). We developed a tablet-based decision support application (app), called ‘Arogya Sahyog’, to support CHWs in the field. ObjectiveTo assess usability of the app for screening, providing lifestyle advice, and referring patients with NCDs to health centers. MethodsSixteen CHWs in the Tehri Garhwal district of India underwent a five-day training program in November 2019. We assessed: (i) acceptability: through a self-administered questionnaire; (ii) fidelity: by comparing the app data with ‘pre-set’ responses, and (iii) usability: through the validated system usability scale (SUS). The ‘Strengths, Weaknesses, Opportunities and Threats (SWOT)’ framework was used to identify enablers of, and barriers to, use of the app. ResultsUsability on the SUS was 88.3% (95% confidence interval 85.6-92.0%), with ratings between ‘excellent’ and ‘best imaginable’. Most CHWs (87-93%) reported that the app was user-friendly, had a pleasing color scheme, and was entertaining to use. Human error on data entry was < 4%, with most errors being in free-text fields. Four main themes were identified in using the app: ‘strengths’ (clear instructions), ‘weaknesses’ (difficulty in using the inbuilt keyboard), opportunities’ (high motivation), and ‘threats’ (increased workload and interference with their routine work). ConclusionArogya Sahyog was well accepted and achieved an excellent usability rating, supporting its use by CHWs. The next step is to test whether CHWs can use the app to identify and manage people with NCDs in the community.

Developing and testing guidance to support researchers engaging patient partners in health-related research

BackgroundAlthough interest in Patient and Public Involvement in health-related research is growing, there seems to be a lack of guidance supporting researchers in deciding on methods and levels for Patient and Public Involvement in health-related research throughout the research process. Furthermore, the numerous definitions, methods, and frameworks make it challenging for researchers new to this field to decide on the most appropriate approach for their project.MethodsThis study aimed to develop and test guidance for researchers deciding on approaches, levels, and methods for engaging patient partners in health-related research. A group of 11 researchers in Patient and Public Involvement in health-related research participated in six workshops to develop the guidance. The feasibility and acceptability of the guidance were tested in a survey of 14 researchers using the System Usability Scale plus two elaborative questions. The guidance was also tested by five PhD students engaging patient partners in their projects.ResultsThe guidance developed consisted of two resources: Resource I outlined five international approaches to Patient and Public Involvement in health-related research, and Resource II described the different levels and methods for engaging patient partners in research. The System Usability Scale score (at the 50th percentile) was 80, indicating excellent usability. Qualitative data showed that the two resources supported reflections regarding different approaches, levels, and methods.ConclusionThe researchers found the guidance to be supportive of their reflective thinking about engaging patient partners in their research. The testing provided knowledge about when and how to use the guidance but also raised questions about the usefulness of the guidance in communications with patients.

Developing the Patient Falls Risk Report: A Mixed-Methods Study on Sharing Falls-Related Clinical Information from Home Care with Primary Care Providers.

If interRAI home care information were shared with primary care providers, care provision and integration could be enhanced. The objective of this study was to co-develop an interRAI-based clinical information sharing tool (i.e., the Patient Falls Risk Report) with a sample of primary care providers. This mixed-methods study employed semi-structured interviews to inform the development of the Patient Falls Risk Report and online surveys based on the System Usability Scale instrument to test its usability. Most of the interview sample (n = 9) believed that the report could support patient care by sharing relevant and actionable falls-related information. However, criticisms were identified, including insufficient detail, clarity, and support for shared care planning. After incorporating suggestions for improvement, the survey sample (n = 27) determined that the report had excellent usability with an overall usability score of 83.4 (95% CI = 78.7-88.2). By prioritizing the needs of end-users, sustainable interRAI interventions can be developed to support primary care.