Staying active despite pain: Investigating feedback mechanisms to support physical activity in people with chronic musculoskeletal pain
Chronic (persistent) pain (CP) affects 1 in 10 adults; clinical resources are insufficient, and anxiety about activity restricts lives. Physical activity is important for improving function and quality of life in people with chronic pain, but psychological factors such as fear of increased pain and damage due to activity, lack of confidence or support, make it difficult to build and maintain physical activity towards long-term goals. There is insufficient research to guide the design of interactive technology to support people with CP in self-managing physical activity. This thesis aims to bridge this gap through five contributions: first, a detailed analysis from a plethora of qualitative studies with people with CP and physiotherapists was done to identify factors to be incorporated into technology to promote physical activity despite pain. Second, we rethink the role of technology in improving uptake of physical activity in people with CP by proposing a novel sonification framework (Go-with-the-flow) that addresses psychological and physical needs raised by our studies; through an iterative approach, we designed a wearable device to implement and evaluate the framework. In control studies conducted to evaluate the sonification strategies, people with CP reported increased performance, motivation, awareness of movement, and relaxation with sound feedback. A focus group, and a survey of CP patients conducted at the end of a hospital pain management session provided an in-depth understanding of how different aspects of the framework and device facilitate self-directed rehabilitation. Third, we understand the role of sensing technology and real-time feedback in supporting functional activity, using the Go-with-the-flow framework and wearable device; we conducted evaluations including contextual interviews, diary studies and a 7-14 days study of self-directed home-based use of the device by people with CP. Fourth, building on the understanding from all our studies and literature from other conditions where physical rehabilitation is critical, we propose a framework for designing technology for physical rehabilitation (RaFT). Fifth, we reflect on our studies with people with CP and physiotherapists and provide practical insights for HCI research in sensitive settings.