Designing a motivating home exercise app for children

Abstract

Paediatric physiotherapy deploys a range of methods to rehabilitate and recover movement for children who have been injured, had surgery, or have a disability that affects their motor function. This includes home exercise programs (HEPs) which are a curated set of exercises to be completed at home as part of physiotherapy treatment. Although considered a pillar of treatment within the field, adherence to HEPs has been reported as low as 50%, with patients and their families reporting barriers such as forgetfulness, lack of time, and lack of enjoyment. The use of technology to deliver physiotherapy treatment greatly increased during the COVID-19 pandemic, resulting in a better understanding of how mobile technologies can be used as a tool to reach patients at home. Recent work has started to use this experience to inform the design of mobile health (mHealth) interventions that target these barriers to adherence to treatments or medications within physiotherapy and adjacent fields. However, previous reviews have reported that there is a lack of evidence-based design with these solutions, and have mapped out safety concerns that result from a lack of consultation with experts and target users.

This thesis investigates the design, development, and evaluation of an app that delivers and tracks progress through a goal-based home exercise program (HEP) for children aged 7-11. Through the application of a participatory design method with a group of 24 children and 2 expert physiotherapists, informing functionality, behaviour change, and safety, this research provides requirements and designs for an app that encourages and motivates adherence. Workshops were used to design fundamental functionality within the app with children, including applying behaviour change theory through a rewards system, goal-setting functionality, and a character that motivates the user to exercise. Feedback from designers and testers showed that genuine participation from child designers during the creation of complex interventions is possible and that a design environment with a `least adult’ approach strengthened the adult-child relationship in these workshops.

The results of a 4-week evaluation with 11 additional healthy child athletes generated initial positive findings for the guided goal-setting functionality created through the observation of gameplay with child designers. The athletes could set and track progress towards goals and the 5 athletes from the user group that were interviewed reported that they were motivated to exercise. The rewards system, built on a foundation of fairness defined by child designers offers a promising design for future work, with positive feedback from athletes. Finally, the characters, designed by children with speech modelled after the child designers were particularly powerful in encouraging athletes to return to the app between sessions and also served as a tool for generating discussion or participation in the HEP with family and friends.

The primary contribution of this work is the design and requirements for an app that can deliver, and encourage adherence to, an HEP for children. Additionally, the child-centred design process in this work clearly showed benefits for both the child designers’ and the child evaluators’ enjoyment of the app. Reflecting on the results of the evaluation with physiotherapists, HomeExerciseBuddy has potential for prescription as part of physiotherapy practice to encourage adherence to HEPs. The initial results gathered from healthy athletes were reassuring for the usability of the application and the potential for a digital solution to this adherence problem with children was exciting to expert physiotherapists.