A qualitative study to elicit user requirements for lower limb wearable exoskeletons for gait rehabilitation in spinal cord injury.

OBJECTIVE: We aim to determine a comprehensive set of requirements, perceptions, and expectations that people with spinal cord injury (SCI) and the clinicians in charge of their rehabilitation have regarding the use of wearable robots (WR) for gait rehabilitation. BACKGROUND: There are concerns due to the limited user acceptance of WR for gait rehabilitation. Developers need to emphasize understanding the needs and constraints of all stakeholders involved, including the real-life dynamics of rehabilitation centers. METHODS: 15 people with SCI, 9 without experience with WR and 6 with experience with these technologies, and 10 clinicians from 3 rehabilitation centers in Spain were interviewed. A directed content analysis approach was used. RESULTS: 78 codes grouped into 9 categories (physical results, usability, psychology-related codes, technical characteristics, activities, acquisition issues, context of use, development of the technologies and clinical rehabilitation context) were expressed by at least 20% of the users interviewed, of whom 16 were not found in the literature. The agreement percentage between each group and subgroup included in the study, calculated as the number of codes that more than 20% of both groups expressed, divided over the total amount of codes any of those two groups agreed on (≥ 20%), showed limited agreement between patients and clinicians (50.00%) and between both types of patients (55.77%). The limited accessibility and availability of lower limb exoskeletons for gait rehabilitation arose in most of the interviews. CONCLUSIONS: The limited agreement percentage between patients and clinicians indicates that including both types of users in the design process of these technologies is important, given that their requirements are complementary. Engaging users with prior technology experience is recommended, as they often exhibit strong internal consensus and articulate well-defined requirements. This study adds up the knowledge available in the literature and the new codes found in our data, which enlighten important aspects that ought to be addressed in the field to develop technologies that respond to users' needs, are usable and feasible to implement in their intended contexts. APPLICATION: The set of criteria summarized in our study will be useful to guide the design, development, and evaluation of WR for gait rehabilitation to meet user's needs and allow them to be implemented in their intended context of use.

User Experiences of Well-Being Chatbots.

OBJECTIVE: The current paper conducted two parallel studies to explore user experiences of well-being conversational agents (CAs) and identify important features for engagement. BACKGROUND: Students transitioning into university life take on greater responsibility, yet tend to sacrifice healthy behaviors to strive for academic and financial gain. Additionally, students faced an unprecedented pandemic, leading to remote courses and reduced access to healthcare services. One tool designed to improve healthcare accessibility is well-being CAs. CAs have addressed mental health support in the general population but have yet to address physical well-being support and accessibility to those in disadvantaged socio-economic backgrounds where healthcare access is further limited. METHOD: Study One comprised a thematic analysis of mental health applications featuring CAs from the public forum, Reddit. Study Two explored emerging usability themes of an SMS-based CA designed to improve accessibility to well-being services alongside a commercially available CA, Woebot. RESULTS: Study One identified several themes, including accessibility and availability, communication style, and anthropomorphism as important features. Study Two identified themes such as user response modality, perceived CA role, question specificity, and conversation flow control as critical for user engagement. CONCLUSION: Various themes emerged from individuals' experiences regarding CA features, functionality, and responses. The mixed experiences relevant to the communication and conversational styles between the CA and the user suggest varied motivations for using CAs for mental and physical well-being. APPLICATION: Practical recommendations to encourage continued use include providing dynamic response modalities, anthropomorphizing the chatbot, and calibrating expectations early.

Typing on a Smartwatch While Mobile: A Comparison of Input Methods.

OBJECTIVE: The user experience of typing on a smartwatch was evaluated with three unique input methods (tap, trace, and handwriting) while standing and while walking. BACKGROUND: Despite widespread development within the technology industry, smartwatches have had a relatively slow adoption worldwide compared to smartphones. One limiting factor of smartwatches has been the lack of an efficient means of text entry. The 2017 release of Android Wear addressed this issue by providing support for native text entry (i.e., tap, trace, and handwriting). Determining how user performance and subjective ratings compare across these input methods is essential to understanding their contribution to smartwatch user experience. METHOD: Twenty college-age individuals typed phrases using tap, trace, and handwriting input on a smartwatch in three different mobility scenarios (standing, walking a simple course, walking a complex course). RESULTS: Participants typed faster with trace (30 words per minute; WPM) than with tap (20 WPM) and handwriting (18 WPM), regardless of mobility. Trace also outperformed tap and handwriting across all subjective metrics, regardless of mobility. CONCLUSION: Trace input appears to be especially well suited for typing on a smartwatch as it was found to be objectively and subjectively superior to tap and handwriting regardless of user mobility. Objectively, typing speeds with trace are shown to be nearly two times faster than most alternative input methods described in the literature. APPLICATION: Results suggest smartwatch manufacturers should include QWERTY keyboards with trace input as a standard feature in order to provide the best overall typing experience for their users.

Curved Versus Flat Monitors: Interactive Effects of Display Curvature Radius and Display Size on Visual Search Performance and Visual Fatigue.

OBJECTIVE: The aim of this study is to examine the interactive effects of display curvature radius and display size on visual search accuracy, visual search speed, and visual fatigue. BACKGROUND: Although the advantages of curved displays have been reported, little is known about the interactive effects of display curvature radius and size. METHOD: Twenty-seven individuals performed visual search tasks at a viewing distance of 50 cm using eight configurations involving four display curvature radii (400R, 600R, 1200R, and flat) and two display sizes (33″ and 50″). To simulate curved screens, five flat display panels were horizontally arranged with their centers concentrically repositioned following each display curvature radius. RESULTS: For accuracy, speed, and fatigue, 33″-600R and 50″-600R provided the best or comparable-to-best results, whereas 50″-flat provided the worst results. For accuracy and fatigue, 33″-flat was the second worst. The changes in the horizontal field of view and viewing angle due to display curvature as well as the association between effective display curvature radii and empirical horopter (loci of perceived equidistance) can explain these results. CONCLUSION: The interactive effects of display curvature radius and size were evident for visual search performance and fatigue. Beneficial effects of curved displays were maintained across 33″ and 50″, whereas increasing flat display size from 33″ to 50″ was detrimental. APPLICATION: For visual search tasks at a viewing distance of 50 cm, 33″-600R and 50″ 600R displays are recommended, as opposed to 33″ and 50″ flat displays. Wide flat displays must be carefully considered for visual display terminal tasks.

Assessing the Involvement of Users During Development of Lower Limb Wearable Robotic Exoskeletons: A Survey Study.

OBJECTIVE: To explore user-centered design methods currently implemented during development of lower limb wearable robots and how they are utilized during different stages of product development. BACKGROUND: Currently, there appears to be a lack of standardized frameworks for evaluation methods and design requirements to implement effective user-centered design for safe and effective clinical or ergonomic system application. METHOD: Responses from a total of 191 experts working in the field of lower limb exoskeletons were analyzed in this exploratory survey. Descriptive statistics were used to present responses and measures of frequency, and chi-square tests were used to contrast the answers of respondents who identified as clinicians versus engineers. RESULTS: A vast majority of respondents involve users in their development, in particular at the initial and iterative stages, although some differences were found between disciplines. A variety of methods and metrics are used to capture feedback from users and test devices, and although valuable, some methods used may not be based on validated measures. Guidelines regarding tests on safety of exoskeletons also lack standardization. CONCLUSION: There seems to be a consensus among experts regarding the importance of a user-centered approach in exoskeleton development; however, standardized frameworks with regard to appropriate testing methods and design approaches are lacking. Such frameworks should consider an interdisciplinary focus on the needs and safety of the intended user during each iteration of the process. APPLICATION: This exploratory study provides an overview of current practice among engineers and clinicians regarding the user-centered design of exoskeletons. Limitations and recommendations for future directions are identified.

Supporting Surgical Teams: Identifying Needs and Barriers for Exoskeleton Implementation in the Operating Room.

OBJECTIVE: The objective of this study was to identify potential needs and barriers related to using exoskeletons to decrease musculoskeletal (MS) symptoms for workers in the operating room (OR). BACKGROUND: MS symptoms and injuries adversely impact worker health and performance in surgical environments. Half of the surgical team members (e.g., surgeons, nurses, trainees) report MS symptoms during and after surgery. Although the ergonomic risks in surgery are well recognized, little has been done to develop and sustain effective interventions. METHOD: Surgical team members (n = 14) participated in focus groups, performed a 10-min simulated surgical task with a commercial upper-body exoskeleton, and then completed a usability questionnaire. Content analysis was conducted to determine relevant themes. RESULTS: Four themes were identified: (1) characteristics of individuals, (2) perceived benefits, (3) environmental/societal factors, and (4) intervention characteristics. Participants noted that exoskeletons would benefit workers who stand in prolonged, static postures (e.g., holding instruments for visualization) and indicated that they could foresee a long-term decrease in MS symptoms with the intervention. Specifically, raising awareness of exoskeletons for early-career workers and obtaining buy-in from team members may increase future adoption of this technology. Mean participant responses from the System Usability Scale was 81.3 out of 100 (SD = 8.1), which was in the acceptable range of usability. CONCLUSION: Adoption factors were identified to implement exoskeletons in the OR, such as the indicated need for exoskeletons and usability. Exoskeletons may be beneficial in the OR, but barriers such as maintenance and safety to adoption will need to be addressed. APPLICATION: Findings from this work identify facilitators and barriers for sustained implementation of exoskeletons by surgical teams.

Evaluating Medical Devices Remotely: Current Methods and Potential Innovations.

OBJECTIVE: We present examples of laboratory and remote studies, with a focus on studies appropriate for medical device design and evaluation. From this review and description of extant options for remote testing, we provide methods and tools to achieve research goals remotely. BACKGROUND: The FDA mandates human factors evaluation of medical devices. Studies show similarities and differences in results collected in laboratories compared to data collected remotely in non-laboratory settings. Remote studies show promise, though many of these are behavioral studies related to cognitive or experimental psychology. Remote usability studies are rare but increasing, as technologies allow for synchronous and asynchronous data collection. METHOD: We reviewed methods of remote evaluation of medical devices, from testing labels and instruction to usability testing and simulated use. Each method was coded for the attributes (e.g., supported media) that need consideration in usability studies. RESULTS: We present examples of how published usability studies of medical devices could be moved to remote data collection. We also present novel systems for creating such tests, such as the use of 3D printed or virtual prototypes. Finally, we advise on targeted participant recruitment. CONCLUSION: Remote testing will bring opportunities and challenges to the field of medical device testing. Current methods are adequate for most purposes, excepting the validation of Class III devices. APPLICATION: The tools we provide enable the remote evaluation of medical devices. Evaluations have specific research goals, and our framework of attributes helps to select or combine tools for valid testing of medical devices.

Overall Preference of Running Shoes Can Be Predicted by Suitable Perception Factors Using a Multiple Regression Model.

OBJECTIVE: This study examined (a) the strength of four individual footwear perception factors to influence the overall preference of running shoes and (b) whether these perception factors satisfied the nonmulticollinear assumption in a regression model. BACKGROUND: Running footwear must fulfill multiple functional criteria to satisfy its potential users. Footwear perception factors, such as fit and cushioning, are commonly used to guide shoe design and development, but it is unclear whether running-footwear users are able to differentiate one factor from another. METHODS: One hundred casual runners assessed four running shoes on a 15-cm visual analogue scale for four footwear perception factors (fit, cushioning, arch support, and stability) as well as for overall preference during a treadmill running protocol. RESULTS: Diagnostic tests showed an absence of multicollinearity between factors, where values for tolerance ranged from .36 to .72, corresponding to variance inflation factors of 2.8 to 1.4. The multiple regression model of these four footwear perception variables accounted for 77.7% to 81.6% of variance in overall preference, with each factor explaining a unique part of the total variance. CONCLUSION: Casual runners were able to rate each footwear perception factor separately, thus assigning each factor a true potential to improve overall preference for the users. The results also support the use of a multiple regression model of footwear perception factors to predict overall running shoe preference. APPLICATION: Regression modeling is a useful tool for running-shoe manufacturers to more precisely evaluate how individual factors contribute to the subjective assessment of running footwear.

External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight.

OBJECTIVE: The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). BACKGROUND: Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. METHOD: Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. RESULTS: Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. CONCLUSION: Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. APPLICATION: Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring.

Improving Quality of Care for Patients Receiving Care through Telehealth in the Time of COVID-19 Global Pandemic and Beyond: HCI-based Leading Indicators for Virtual Visits.

The COVID-19 pandemic expedited the growing rate of reliance on telehealth, as it provided a safer option for patients to seek the care they need and avoid potential negative consequences of being exposed to the COVID-19 virus. The aim of this study is to develop a series of Human-Computer Interaction (HCI)-based leading indicators to proactively analyze and evaluate the user interface in telehealth and virtual visits. Building on Nielsen's usability heuristics and mapping them to the six aspects of quality of care introduced by the Institute of Medicine, we identified the design features that had the highest impact on the quality of care and developed a list of leading indicators for each feature. Further, we developed corresponding checklists for each leading indicator to evaluate the features of the user. Beyond the benefits of telehealth for both patients and healthcare providers during atypical circumstances, the changes prompted by the COVID-19 public health emergency have possibly altered the position of telehealth to the point that communicating through video and audio has become the new normal. Therefore, the importance of designing an interface to facilitate user interaction with the system and consequently with one another is of utmost importance.

Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study.

BACKGROUND: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. OBJECTIVE: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. METHODS: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. RESULTS: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). CONCLUSIONS: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

A study on usability and design parameters in face mask: Concept design of UVW face mask for COVID-19 protection.

The aim of this study is to investigate the usability of conventional masks to prevent the transmission of coronavirus 2019 (COVID-19) and subsequently design the proposed concept of the mask to reduce leakage and increase efficiency. Acute respiratory syndrome COVID-19 is spreading around the world and can be transmitted from one person with COVID-19 to another through personal contact and breathing. Improper design of current masks can lead to virus transmission. One hundred fifteen users participated in the study using a simple random sampling method in which N95-FFP2 face mask and surgery face mask usability tests were chosen as the most widely used face masks in Iranian people with an online usability questionnaire. Data were analyzed by SPSS. The results showed that the usability of the N95-FFP2 face mask with a total average of 4.46 and a surgical mask with a total average of 3.35 cannot be considered acceptable. Anthropometric and formal changes in people's faces and improper design of the face masks used make it necessary to review the mask redesign measures to increase the prevention of pathogens. In this study, new parameters for face mask design are proposed. Thirty different types of jaws have been considered with the help of CorelDRAW software, along with ideas for optimal mask design with UVW mask concept to be accessed by manufacturers around the world.

Perceived treadmill function is correlated with enjoyment of use in trained runners: A user-centred approach.

Physical inactivity, a primary cause of most chronic diseases, has been associated with low levels of physical activity enjoyment. Physical activity enjoyment can be impacted by an individual's experience with exercise equipment. The purpose of this study was to adopt a user-centred approach to determine the relationship between physical activity enjoyment and functionality and usability of four treadmills. A running protocol was completed by 57 trained runners (41 male) on four treadmills. Runners reported enjoyment levels as well as their perceptions about treadmill running surface, controls, safety and stability, physical interaction, learnability of data console and aesthetic appeal. Repeated measures ANOVAs showed significant differences between the treadmills for each variable. Multiple regression analysis reported aesthetic appeal significantly predicted enjoyment of use. Results suggest that adopting a user-centred approach to compare exercise equipment usability and features can correlate with enjoyment and further impact on physical activity adherence.

Hand forces exerted by long-term care staff when pushing wheelchairs on compliant and non-compliant flooring.

Purpose-designed compliant flooring and carpeting have been promoted as a means for reducing fall-related injuries in high-risk environments, such as long-term care. However, it is not known whether these surfaces influence the forces that long-term care staff exert when pushing residents in wheelchairs. We studied 14 direct-care staff who pushed a loaded wheelchair instrumented with a triaxial load cell to test the effects on hand force of flooring overlay (vinyl versus carpet) and flooring subfloor (concrete versus compliant rubber [brand: SmartCells]). During straight-line pushing, carpet overlay increased initial and sustained hand forces compared to vinyl overlay by 22-49% over a concrete subfloor and by 8-20% over a compliant subfloor. Compliant subflooring increased initial and sustained hand forces compared to concrete subflooring by 18-31% when under a vinyl overlay. In contrast, compliant flooring caused no change in initial or sustained hand forces compared to concrete subflooring when under a carpet overlay.