Previously submitted to: JMIR Human Factors (no longer under consideration since Sep 14, 2026)
Date Submitted: Sep 11, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Codesigning toward usability and implementation: a case series for end-user engagement in rehabilitation technology development
ABSTRACT
Background:
Rehabilitation technologies often fail to achieve sustained clinical adoption despite strong technical performance, in part owing to misalignment with real-world workflows and contextual constraints. User-centered design (UCD) and implementation science (IS) both emphasize end-user engagement but are often applied separately. Codesign offers a potential bridge by integrating end-user perspectives early in development to address both usability and implementation considerations.
Objective:
This study aims to illustrate how codesign methods operate during the pre-implementation phase of rehabilitation development, connecting user-centered design with implementation science.
Methods:
We present four case studies of early-stage rehabilitation technology development that applied different codesign methods: end-user panels, think aloud sessions, one-on-one interviews, and advisory boards. These cases varied in terms of their timelines, resources, and technological maturity, allowing comparisons of how codesign methods were structured and applied across contexts.
Results:
In both cases, codesign methods supported the early identification of implementation-relevant determinants, including workflow compatibility, interpretability of outputs, and perceived clinical value. Codesign approaches vary on the basis of project constraints, with longer timelines enabling iterative refinement and shorter timelines relying on rapid, targeted feedback. Additionally, facilitation quality and re-engagement with participants influence the depth and usefulness of feedback.
Conclusions:
Codesign can function as a practical mechanism for integrating UCD and IS during the pre-implementation phase of rehabilitation technology development. By identifying implementation determinants early, codesign supports alignment between technological design and the clinical context and may inform the selection of future implementation strategies. These findings suggest that the value of codesign lies not only in improving usability but also in shaping adoption potential before formal implementation efforts begin.
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