Wheelchair user and clinician-centered design of a mobile pressure mapping app and dashboard: A pre-implementation development study

Context/Objective: The purpose of this project was to expand the functionality of current seat interface pressure mapping (IPM) toward a novel integrated system that uses a mobile IPM application for wheelchair users partnered with a clinical IPM dashboard. Methods: Guided by user-centered design, this mixed methods study aimed to understand and integrate user needs and preferences across three iterations of development with two stakeholder groups: (1) occupational and physical therapy (OT/PT) experts in spinal cord injury and disorder (SCI/D) care (n = 6) and (2) Veteran wheelchair users (WCUs) with SCI/D (n = 7). At each iterative stage, rapid qualitative analysis was used to summarize feedback and design inputs. Perception of usability was evaluated with the System Usability Scale (SUS) and User-Experience Questionnaire (UEQ). OT/PT feature preferences were assessed through polling during first focus group. Results: Iteration I resulted in wireframes and models of designs for an IPM dashboard, mounting system for mobile IPM system, and smartwatch display options. Iteration II resulted in prototypes of an IPM dashboard, initial redesign of the mobile IPM app to include all-day IPM recording, automatic detection of pressure relief events and smartwatch functionality, and new hardware for IPM interface box. The final integrated IPM system was completed during Iteration III. OT/PTs indicated that aggregated and filtered views of IPM data could enhance patient communication, decision-making, and individualization of pressure management goals. Interface simplicity and automation minimize time and effort engaging with the system. Both stakeholder groups desired maximum control, flexibility, and efficiency in how they collect, access, and use the resulting IPM data. WCUs prefer a range of options for hardware access and use. SUS and UEQ scores were good to excellent across all subscales after three iterative rounds and both groups provided subjective approval of final products. Conclusions: OT/PTs and WCUs with SCI/D perceived positive relative value and usability for using the newly integrated IPM system to objectively measure pressure and patterns of pressure management on the seating surface over time, evaluate seating equipment efficacy, and facilitate individualized care for managing pressure. Following this successful co-design of the integrated IPM system, real-world usability and information needs will be evaluated in the planned pre-implementation inpatient and outpatient pilot studies.