Keywords

1 Introduction

Spinal disorders in particular back and neck pain are a very common situation, regardless of age, gender or social status. According to recent studies, spinal disorders affect our work capacity and consume more health care resources than any other health problems [1]. An efficient and user-friendly method to assess disability in people with spine pain is the use of Patient-Reported Outcome (PRO) questionnaires [2]. Although this method is demonstrated to facilitate patient self-management strategies [3], this might not be enough to properly monitor the effectiveness of a physical treatment. The possibility of obtaining objective data, which describe the movement of the spine while the patient is doing exercises, can help the clinician improve the rehabilitation process.

The development of Information and Communication Technologies (ICT) have enabled health and healthcare systems to improve the quality of life and bring innovative products on the health market. e-Health represents the use of ICT in health products, services and processes in order to improve the health of citizens. e-Health or health information technologies (HITs) include the interaction between patients and health-service providers, institution-to-institution transmission of data, or the peer-to-peer communication between patients and health professionals. The wellbeing and e-Health domains present a high growth potential by unlocking effective health data exchange [4].

Human Computer Interaction (HCI) involvement in eHealth will help to design more informative health records for clinicians [5], but the main opportunity is to bridge individually developed health strategies with health information provided by professionals [6].

The main factors that need to be evaluated in the process of designing and developing an online health application are users’ needs, data security and privacy, products risks and benefits, its feasibility and user acceptance to the new technologies [7].

2 Materials and Methods

The architecture of the wearable scoliosis monitoring system is presented in the following figure (Fig. 1).

Fig. 1.
figure 1

The architecture of the wearable scoliosis monitoring

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Regarding the communication of the system with the users and physicians, two wireless connections were implemented, Wi-Fi and Bluetooth. While Wi-Fi has the advantage of directly transmitting the information to the remote data storage, it comes with the cost of great energy consumption and is not recommended for real time monitoring. Bluetooth is preferred because it increases the autonomy of the system and the user can easily verify his recommended posture with the help of a mobile application installed on a smartphone or tablet. In order to further increase the autonomy, the information gathered from the sensors is stored locally on a microSD card and regularly transmitted to the remote data storage.

The number of sensors that can be used is limited by their size and also by the limitations of the I2C communication protocol. While a higher number of sensors enables a better detection of the movements of the spine, the number of IMUs was limited to five, which presented good results.

A key point is the adaptability and ergonomics of the system. The frame has rubber bands that can be easily adjusted to fit patients of different sizes.

A major challenge is represented by data security and privacy. As stated by the European Commission [8]: “In all countries, trust in e-Health systems by both citizens and professionals has been identified as one if not the key challenge. Privacy is recognized as the most sensitive aspect of e-Health records systems.” The information gathered by the system can be accessed by the patient and his physician from any computer, by using a username and password. Access control ensures that users can only access healthcare data that they are allowed to access based on their authentication and access levels.

The mobile application for patients has two main roles: inform the patient about the recommended posture and give alerts in case of prolonged bad posture, and also transmit the information received from the acquisition board to the cloud.

The user interface of the e-Health application is designed to be easy to use by both patients and physicians and does not require a special training in order to use it. A further study is necessary to find more ways to increase motivation and improve acceptance in order to make the technology more user friendly for older people [9].

3 Challenges

The progress of health care systems has been rapidly growing thanks to the Information and Communication Technology advances. A recent trend is to use advanced equipment to monitor a patient’s progress from the comfort of their own home.

The main challenges identified by Kreps [10] for designing HITs include the following: high interactivity, interoperability, dynamic and engaging design, and providing interpersonal connections that can have the reach of mass media. Interactivity factors that have the biggest influence on the quality of a web site are connectedness, playfulness and reciprocal communication [11]. Interpersonal connections can be developed by the help of artificial intelligence that can act as a guide for the rehabilitation session, although this feature will not be implemented in the present application. A direct link between the patient and physicians is facilitated by a mobile application and a web based user interface, which can only be accessed with a username and password. Interoperability represents the ability that allows distinct systems to exchange information and perform compatible transactions [12].

Other challenges that need to be addressed in order to ensure an effective communication of eHealth applications are the following: strategic design, accurate monitoring and responsive adaptation [10]. Studies have shown that communication between patients and clinicians that is based on computer applications, has the potential to enhance the confidence and knowledge of the patient [13].

Petersen et al. [14] highlighted a major challenge that appears in eHealth development, and that is how to create a connection between individuals with different backgrounds. IT professionals need to consider the point of view of the user and focus on making the applications easy to work with, in a clinical context.

In order to prioritize the technical and functional characteristics of the scoliosis monitoring system, we used competitive engineering methods. The Analytical Hierarchy Process (AHP) is used to assist researchers in finding the appropriate solution that fits their needs, but it does not guarantee that it will be the correct one. AHP offers a comprehensive and rational environment that helps in the process of decision making, by representing and quantifying the elements of the problem, correlating them to the main objectives of the system and to evaluate other possible solutions.

The software Qualica QFD [15] was used to perform the criteria-based AHP. The first step is to identify the criteria, which are entered in the ‘Functional Requirements’ tab. In Fig. 2 we see the matrix generated by the software, after entering the criteria. The second step requires a direct comparison between the criteria by ranking them with the help of numbers from 0 to 9 (9 – most important, 0 – less important) (Fig. 3).

Fig. 2.
figure 2

Matrix criteria of Qualica QFD

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Fig. 3.
figure 3

Criteria assessment

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The results from the prioritization process of the criteria are presented in Fig. 4. Two criteria stand out from the graphic and reveal the most important conditions that the scoliosis monitoring system must fulfill: the device should not affect the position of the spine and it must provide accurate and meaningful data regarding the movement. The criteria that are included in the 5.5–10 % interval are also crucial and refer to aspects such as ergonomics, safety, stability, adaptability and communication. The remaining six criteria should also be taken into consideration, but their impact on the overall system is less significant.

Fig. 4.
figure 4

Results of multi-criterial analysis

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4 Conclusions

Health technologies are becoming more ubiquitous and are starting to become a part of our lives. By developing wearable devices that patients can use at home, with minimal intrusion in their normal lives, rehabilitation sessions may become more efficient and pleasurable. There are several mobile applications that monitor health related parameters, but they are not accurate enough to be taken in consideration by clinicians. A solution for allowing better home measurements is to use special equipment/sensors that can transfer the data straight to the Internet, where medical professionals have access. The main problem is guaranteeing the security of the data and blocking unauthorized access.

The scoliosis monitoring system uses specific sensors to measure motion and transmits the data to a paired mobile device. Patients have access to their own data and can receive a feedback regarding their posture. Patient related data is backed up regularly on a server and can only be viewed by their corresponding physician.