Go-with-the-flow wearable Smartphone app that senses movement and related physiological processes

‘Go-with-the-flow’ was created to support self-management of physical activity and consequently improved quality of life in people with chronic pain (CP). CP (pain that persists typically for at least 3 months) is a costly illness that accounts for 20% of the UK’s total health expenditure and affects 7.8 million people in the UK. Clinical resources are unable to meet demand and many people do not get the help they need.

Daily physical activity is important for CP self-management: it protects against weakening and stiffness, increases confidence in physical capacity, and inhibits the spread of pain. Unfortunately, constant pain and associated emotional factors such as fear of movement and anticipated pain exacerbation due to activity, undermine adherence. Current physical rehabilitation technology does not address these critical psychological barriers nor or do existing CP apps that mainly track mood and physical activity and possibly plan for it.

To address this gap, a plethora of qualitative/ quantitative studies with physiotherapists and people with CP were conducted to understand needs, barriers and successful strategies. Next, a wearable Smartphone app called ‘Go with the flow’ was designed to implement and extend those strategies and to tailor strategies to individual needs and barriers. The solution was evaluated with 23 individuals in lab and home studies and also in two sessions at the hospital with patients and physiotherapists and people found the feedback rewarding and motivating and they felt it would be very useful for their daily activities. The wearable device senses movement and related physiological processes (e.g., breathing) and transforms these signals into sound Smartphone sensors track movement and Arduino-based respiration chest belts detect breathing patterns related to anxiety. A tabard was designed to site all the components on the body.

Sonification feedback was designed to shift focus away from feared movement and pain onto an external pleasurable representation and provided a sense of control over their own movement. Sound was used to design an exercise space through anchor points, tailored by people to reflect their psychological and physical capabilities and set targets; sonification rules changed within this space giving body position and movement information. Alterations to sonification increased awareness of protective movement (e.g., asymmetric positions meant played only in one ear). Our studies indicated that increased body movement awareness increased self-efficacy and confidence. Tailoring feedback to people’s psychological and physical capability, allowing setting of targets and rewarding even small movements increased motivation and perceived value of movement.

This work is innovative in addressing not only the physical, but also and mainly the unique psychological and emotional aspects of CP during physical rehabilitation and support of self-management, through addressing concerns of both physiotherapists and people with CP. Additionally, the technology supports everyday function and skill acquisition for better quality of life as people have to set their own targets according to the needs of the day. This research has the potential to influence the national health service (NHS), mobile health, and gaming industries. It provides a new perspective at a critical time where the mobile health (projected at £16 billion by 2017; wearables at £48 billion by 2025) and gaming industries are seeing unprecedented growth. Timely and regular support through technology developed through this research can reduce physiotherapist visits, empower people to better self-manage hence return to work sooner, and reduce CP’s economic burden. Continuous engagement with industry through presentations and meetings have ensured that this technology is viable and further has the potential to be used in other conditions where mobility is restricted such as wheelchair users, sports injuries, and the elderly.