JMIR Publications

ABSTRACT

Background:

Treatment non-adherence to home exercises leads to decreased clinical efficiency and is an important problem in physiotherapy. It is the result of various factors, including limited motivation and social support.

Objective:

To improve adherence, we propose, implement, and assess the novel coaching concept hybrid ubiquitous coaching (HUC). In HUC, physiotherapists are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality (AR) environment.

Methods:

Four design-and-evaluate loops were conducted by an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists, and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients’ perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a four-week N-of-1 trial was conducted to assess the long-term adherence and feasibility of HUC in the everyday life of one patient.

Results:

Patients perceived HUC to be useful, easy to use, and enjoyable, and preferred it to state-of-the-art approaches and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an AR-based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% and a substantial increase in exercise accuracy during the four weeks.

Conclusions:

The overall positive assessments from both patients and physiotherapists suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises, and test HUC with patients suffering from different disorders.