JMIR Publications

ABSTRACT

Background:

Pediatric and adolescent athletes are a large demographic undergoing ACL reconstruction (ACL-R). Post-operative rehabilitation is critical, requiring patients to complete prescribed exercises, usually home exercise programs (HEP). To address obstacles to HEP adherence, our group developed an interactive health technology (IHT), interACTION (iA) to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app, providing feedback and logging performance, allowing remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements.

Objective:

The objective of this study was to use a user centered design (UCD) process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of impacting patient behavior.

Methods:

Athletes age 10-18 with a history of ACL-R were included (n=10). Patients were > 3 weeks post ACL-R. Participants took part in a triphasic interview. Phase 1 focused on elements of gaming that lead to high participation and information regarding their surgery and recovery. In phase 2, subjects were asked to “think aloud” and rank cards representing components of the Wheel of Sukr in order of interest. In phase 3, patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented data and tagged meaningful codes until descriptive redundancy was reached. Once finalized, two coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework.

Results:

Participants had an average age of 12.8 years, and 70% were female. Most participants (90%) were still in physical therapy. A majority (70%) reported going to sessions twice weekly. Self-reported HEP compliance was 75-100% prescribed (40% of participants), 50-75% prescribed (40%), and 25-50% (20%) prescribed. All were prescribed home exercises. Participants had a positive response to an app that could track their home exercises. Desirable features included exercise demonstrations, a motivational component, and convenience. Participants listed sports specificity, competition, notifications/reminders, rewards, and social aspects of game play as features from favorite games to incorporate. In the Wheel of Sukr card sort exercise, Motivation was ranked first, Self-Management second, and Growth, Confidence, and Fun tied for third. Gameplay components that participants recommended closely followed the themes from the Wheel of Sukr card sort activity.

Conclusions:

Participants believe iA would be a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting that the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation, self-management, and growth/confidence/fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using progressively more developed prototypes of the gamified iA in a controlled setting.