In today’s physical rehabilitation industry, the experience extends beyond the clinic. Cipher Skin developed a device designed to connect in-clinic therapy with at-home care through remote patient progress monitoring.
Role: As User Experience Designer, I collaborated with members of marketing and development to implement technology and design, while aligning with our business goals.
Tools and Tasks: Adobe XD, Photoshop, user interviews, technology research, prototyping and usability testing.
Challenge: Making the set up process easier to understand with consideration for accessibility.
Outcome: An experience that prioritizes usability for patients with physical limitations, whether at home or in clinical settings.
Duration: 3 months
About the Device
The BioSleeve® is a compression sleeve embedded with sensor technology paired with a mobile app that allowed physical therapists to monitor their patients remotely or utilize in person.
The sleeve collected data such as motion, temperature and heart rate. With these metrics, physical therapist are able to accurately measure the progress of their patients.
The companion app enabled patients to perform and record personalized home exercises and ROM (range of motion) tests that a professional practitioner could monitor remotely or in person with detailed reports.
Hunting For Heuristic Problems
For our patients to successfully use this product, the experience had to be easy to understand. I started the process by evaluating the product, looking for issues that might hinder them from learning how to use our product.
| Heuristic Issue | Evaluation |
|---|---|
| Visibility of System Status | There were no indicators that communicated if the devices were properly paired. Nor was there any signifiers of where to go to do so. |
| Recognition, Consistency, Findability | Navigating was difficult because of unclear labeling and lack of consistent visual affordances. It was easy to become disoriented in the menu system and difficult to backtrack. |
| Error Prevention and Flexibility | Mistakes were not apparent when they occured, nor was it easy to understand how to correct the mistake. |
Accessibility was an important topic to consider when it came to helping those who suffer from injury. These people are seeking physical therapy to restore an ability they’ve lost.
Their dexterity and mobility are often compromised and they’re working with new limitations as they recover.
Getting In Touch With Our Users
I worked closely with and interviewed physical therapists and other subject matter experts, read medical journals and watched instructional videos to gain better understanding of the industry and this is what I learned:
- Language and vocabulary they used when speaking with their patients
- Type of information that was being used to assess performance
- Methods of communication with patients, whether through phone, in-person, or other
Meet the Expert
I chose to focus on professional healthcare providers that worked directly with patients in a clinic setting. They were what I considered to be power users, ones that would have to know the product on an expert level in order to serve their clientele.
Christy the Physical Therapist
“The most challenging part of my work is helping patients improve their quality of life who has tried, yet failed prior services. However, this is also the most gratifying part of my work because helping someone overcome long-term pain is extremely fulfilling.”
Christy spends most of her time managing her staff at a local clinic that employs 6 other physical therapists that specialize in injury rehabilitation. Many patients who are living on social security.
She wants to make sure her patients leave her office confidently knowing how to continue their path to recovery. Her goal is to make physical therapy easy to understand.
Her biggest challenge is trying to communicate to her patients so that they understand their prescribed exercises in order to continue their progress outside of the clinic.
And the People She Serves
I interviewed patients who had extensive experience with physical therapy to get a better understanding of their attitudes and opinions about the subject. Aside from discovering their needs, I also learned that there was a level of fear and hesitation while performing exercises.
Common Injuries and Ailments That Call for Physical Therapy
- Joint injuries: Injuries to joints such as the knee, shoulder, or ankle. Less commonly breaks and fractures to bones.
- Sprains and strains: Injuries to ligaments (sprains) or muscles and tendons (strains) occur the most often.
- Long-term conditions: Injuries such as muscle strains, ligament tears, tendonitis, or stress fractures that may be a permanant matter and have become a condition that needs frequent maintenance.
Jerry the New Patient
“I struggle between wanting to heal and being scared of making things worse. I’ve become really cautious. Every time my therapist tries to push me a little harder, I’m afraid that I’ll end up making the injury worse.”
Jerry just competed in his first Brazilian Jiu Jitsu tournament. Though he was able to place 2nd in his weight-class, he also sustained a shoulder injury.
By escaping an arm bar submission, he injured his rotator cuff leaving him with critical pain and compromised range of motion in his right arm.
He’s seeking help to recover from his injury so that he can get back to training for his next competition.
Patient Limitations
Some patients were already suffering from limited mobility that made it difficult to complete instructed exercises. Most patients had the common goal of returning to their regular activities, such as sports and traveling, safely and preventing reinjury.
Common Limitations During Recovery
- Physical pain: Individuals often experience discomfort or pain directly related to their injury. This may interfere with daily activities, including sleep.
- Loss of function: Temporary or permanent loss of function, such as difficulty walking, lifting, or performing routine tasks. This loss of function can be frustrating and may lead to feelings of dependency or helplessness.
- Fear of reinjury: Individuals may develop a fear of reinjury, especially if the injury was severe. This fear can lead to hesitancy or avoidance of certain activities, which may hinder progress.
Language Barriers and Technical Know-How
Communication was brought up several times in my research. Patients mentioned they would have difficulty understanding what the therapists were asking them to do without demonstration. This pain point was most prominent at stages when expected to follow instructions.
While observing users through contextual inquiry, users felt the most optimistic while learning about the product and creating their accounts, but the experience soon dips from there when tasked to set up their devices.
The biggest limitation was not having enough knowledge or the vocabulary to understand the instructions. Information architecture was a problem as well when users were searching for the connecting functions.
Communication required additional methods to help make instructions clearer. Verbal instructions were just the baseline.
The Problem
Patients need clearer instructions when connecting to their sleeves because they want to monitor their progress and continue on their path to recovery with minimal delays.
With assistance, setting up the devices took more than 15 minutes. In an industry where the patients are being billed for every minute, this was causing serious concern for people like Christy and her clientele.
So, how might we…
make the task of setting up their devices easier so that users who are less familiar with technical terms and vocabulary can successfully follow without assistance?
Hypothesis: if the interface was simplified and more legible, users would be able to read and understand the instructions in order to complete the tasks of connecting and calibrating quicker without supervision.
Goal: get first-time users through these tasks under 10 minutes, cutting down about 50% of the time required previously and make this learnable so that patients are able to do this without a practitioner present in their future visits.
Opportunity: practitioners can tend to other tasks and patients while the patients set up the sleeves themselves. Additionally, patients would be able to acquire these sleeves and take them home to do home exercise programs (HEP) without the aid of the practitioners.
Making It Feel Familiar
I compared connecting sleeves to connecting Apple AirPods, allowing our app to automatically recognize previously paired sleeves to eliminate the need to reconnect every future session.
In my comparative research, I found many of the behaviors of our users shared similarities with users of the Nintendo Wii. This inspired the language we used in our instructions.
Technical Considerations
Because of the limitations of the patients’ mobility, these physical constraints need to be taken into account because it would hinder the experience of performing exercises.
- Space. Is there enough area to exercise in? Where would users be usually?
- Distance between users and the tablet. What is optimal distance for a person to interact with the tablet?
- Orientation of the tablet. Where will the interface be situated in relation to our users? Is at or below eye level? Do we need to communicate ideal positions of the tablet for a good experience?
Making Decisions Easier
To expedite the pairing process, I limited the choices users would have on each screen to one or two call to actions.
Iconography and stronger affordances were used to making interactions easier to understand.
During calibration, simpler vocabulary and enlarged typeface was used to enhance legibility so that users could read the instructions during their exercises.
To make this process more accessible, I chose to enlarge the scale of the text when we anticipate the user putting the tablet down and perform the calibration sequence. When they’ve successfully calibrated their sleeves, the interface returns to its default scale.
How effective would this be?
Through mixed methods of testing, I discovered how we could improve the usability of our companion app. We observed user behaviors during moderated usability testing and were able to gather more information through additional interviews and A/B testing.
Test Planning
To prepare for this test, I recruited an associate to help me moderate the usability tests at our Denver office. We found 5 participants varying in age and education to participate in testing the new concepts.
Goals of Usability Test
- Observe potential heuristic issues while completing tasks through observed user behavior.
- Explore the vocabulary of typical users that aren’t in the profession to inform our writing, information architecture, and user interface.
- Measure overall understandability and learnability of the concept.
To prepare, I walked through each task with my associates and provided a set of notes and script to refer to as we moderated.
The top of our priorities was to observe how our users were handling the tablet and if they could read and follow the instructions from a distance.
We focused on affordances, navigation and content strategy; looking for clues of what else needed to exist to improve understandability. We used time as a measurement but were aware that the metric wouldn’t be accurate to an actual use case since the prototype we tested was still in development.
What We Learned From Testing
Some of the key observations we made during testing were:
- Reassurance and clarifcation was requested often as they were navigating and performing exercises.
- Confusion during calibration, animation did not reflect their own movements, stating that they weren’t sure if there was more action needed to be taken.
- Adequate and readable on-screen instruction made legibility better for the user during ROM tests.
There was also extensive notes taken about the orientation of the tablets while our users completed their exercises. We observed a mix between users setting the tablet flat on horizontal surfaces, requiring them to crane their necks while performing the exercises or users using chairs as make-shift stands to prop up the screens.
This indicated to us that there might be further study on the optimal position to use the companion app. We took these observations and put it toward revising our prototype for further testing.
To comply with my non-disclosure agreement, I have omitted and obfuscated confidential information in this case study. All information in this case study is my own and does not necessarily reflect the views of Cipher Skin.
