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Maja Cuprys and Arizona

There are multiple sources that state physiotherapy is very beneficial and drastically improves

the condition of joints and surrounding muscles. Sources state that “Physiotherapy has proven to

be effective in the treatment and management of arthritis, diabetes, stroke and traumatic brain

injury, spinal cord injury and a range of respiratory conditions offering those afflicted with tools

and techniques to acquire and maintain an optimum level of function and pain free living.”1.

However there are multiple problems with patient non compliance and patient satisfaction.

Studies state that “Non-compliance with physiotherapy, as with drug therapies, is common.”2.

Therefore this information calls for improvement in assessment and prevention of patient non

compliance after knee replacements. In a society that runs on technology, it is possible for

physiotherapy to be monitored digitally on an app designed for the purposes of enhancing

physiotherapy, holding patients accountable for non-compliance, and allowing interdisciplinary

doctors to contact each other more efficiently. With constant online monitoring, the personal

loyalty that research shows is key to initial compliance will be ever present as doctors can see

patient progress in real time and contact patients whenever concerns arise.

Limitations include potential ethical concerns regarding privacy, potential lack of willing

participants, and lack of coding knowledge. Thankfully, since the product will not directly be

tested on individuals, no medical information will be exchanged on the app as of now. However,

in order to survey our patients, we need to complete ISE forms. Other limitations include not

measuring other types of variables such as the effects of types of exercises used, since this

depends on the doctors and individuals associated with them and what works for each individual.
1
(n.d.). Physiotherapy & Rehabilitation | pt Health. Retrieved June 17, 2018, from
https://www.pthealth.ca/service/physiotherapy/
2
(n.d.). Understanding non-compliance with physiotherapy in patients with .... Retrieved June 17, 2018,
from http://jech.bmj.com/content/55/2/132
This would be an interesting variable to measure, but the time to run the experiment is limited

and it is a variable that cannot be directly controlled during this experiment with the means

present. Also time constraints and other limitations such as privacy will not allow to run

experiments that focus on gaining crucial information that would prove the effectiveness of the

application compared with traditional physiotherapy with the application. Therefore the primary

method of concluding this project will be developing the app and user protocol.

Items needed to be included in the final product include a contact portal, a section where

exercises are updated by doctors, different types of accounts, a motivation system to curb non-

compliance, and the final user protocol. The contact portal will help doctors communicate

between themselves and patients to keep information up to date. This will also serve as a means

to curb noncompliance as doctors can directly contact patients if they have not been active on the

app. The most important variable is the exercise regimen section. This section is where doctors

can modify the patients exercise regimen as the patient progresses into later stages of

rehabilitation. Lastly a motivation system must be in place to reduce patient non-compliance.

This will include a system of multiple notifications per day and the ability for doctors to add

notifications about important appointments.There should be a progress section so patients can

see how much they have improved since each assessment. As mentioned in the previous

research, if the patients see improvement they are more likely to continue their program 3. For

these sections, time is the most valuable utility listed since the more time there is to fix and

enhance the app code, the higher the quality of the app will be which should improve overall

satisfaction with the product. This allows the patient and doctors to stay on task and organized

during rehabilitation. Also the literature mentioned previously states that having people being

3
(n.d.). Understanding non-compliance with physiotherapy in patients with .... Retrieved June 17, 2018,
from http://jech.bmj.com/content/55/2/132
directly involved creates a sense of loyalty to the program that curbs non-compliance.

Knowledge of how to use Xcode will be key to developed by Apple themselves and is free to use

which is also key because it makes the development process cheaper. Other app development

resources such as Appypie may be put into consideration as they may be easier to use, or

different development tools may be used to develop different sections of the application,

depending on the strengths and weaknesses of each. In order to protect patient privacy, all

doctors involved need to have different, verified accounts which prevents violation of HIPAA

rights. In order to protect against data breaches, the application has to be run through security

testing. There are multiple tools such as Santoku and Drozer that can help identify faults in

security. This is critical since a single data breach on this application can expose tons of personal

information about healthcare and information violating patient privacy and HIPAA law when it

will actually be released. This is why the app will be run through Santoku which offers mobile

device emulators, tools to simulate network services for dynamic analysis, decompilation and

disassembly tools, and grants access to malware databases among other things4.

There are multiple steps that need to be executed to ensure that this project is successfully

launched. First, a pre-development survey must be conducted. This survey will determine what

additional features would knee implant patients desire and to see if the list of variables created is

sufficient. This will either be done with either distribution of Google Docs surveys or a live

meeting in a rented conference hall. After results are collected, the main features that patients

wish to include will be coded and developed hopefully within the months of October and early

November. After major development has been completed, Alpha testing will ensue. This testing

will call for people to simulate potential users to find bugs and problems with the code that could

4
(n.d.). Santoku Linux. Retrieved June 17, 2018, from https://santoku-linux.com/
have gone unnoticed. Then the first development survey will be launched, which will allow the

alpha testing team to elaborate and report bugs which will addressed in the second development

phase. This should all hopefully happen by early or late November. Final development will ensue

along with writing the final paper section by section. The most important section in the final

paper will be the user protocol. The user protocol will contain a basic overview of how the

application is laid out and how its various features should be used.

The main observed independent variable is patient compliance and the main dependent

variable that is assumed to be affected is patient satisfaction with knee replacements. There are

many studies supporting the benefits of continued physiotherapy, therefore it is predicted that if

patient compliance is increased, so will the satisfaction of the results of physiotherapy. The

reason such a prediction is plausible is because multiple sources state that physiotherapy

produces the best results when continued regularly as the literature above states. The main

control variable will be patients who do not use the app and give responses about patient

satisfaction during the second development survey.

Data will be collected through responses gathered via Google Forms after each survey.

Google Forms collects data automatically and can produce pie graphs that make data easy to read

and interpret in terms of percentages of total responses. Hopefully the use of this application will
reduce patient compliance by having doctors directly observing compliance which is proven to

motivate people to comply. If statistics show that patients generally do not comply, comply less

than average, or are unsatisfied the outcome does not support the stated hypothesis, while an

increase in compliance and patient satisfaction means the outcome supports the hypothesis. If

there are supporting results, this means that the systems in place for helping motivate compliance

work. If the results are negative or inconclusive then that means there must be more at play with

technology, the brain, and how these things relate to physiotherapy. There are multiple

directions further research can take. There may be future research done to see how usage of this

application compares to traditional physiotherapy. While the means to conduct this research are

not present at the moment, it would be very beneficial to compare and contrast the benefits and

disadvantages of each program to test how truly effective the software is. New research that

could be done after is comparing different types of knee replacement post-care and types of

physiotherapy. This could improve the quality of the exercises on the application making it more

efficient and helpful to use.