Exploring the clinical context of adopting an instrumented insole: a qualitative study of clinicians' preferences in England

Abstract

Objectives: This study explores clinicians' views of the clinical uptake of a smart pressure-sensing insole, named Flexifoot, to enhance the care and management of patients with osteoarthritis (OA). Clinicians are key users of wearable technologies, and can provide appropriate feedback for a specific device for successful clinical implementation.

Design: Qualitative study with in-depth, semi-structured interviews, analysed using inductive analysis to generate key themes.

Setting: Conducted in a University setting.

Participants: 30 clinicians were interviewed (11 physiotherapists, 11 orthopaedic surgeons, 5 general practitioners, 3 podiatrists).

Results: All clinicians regarded Flexifoot to be useful for the care and management of patients in adjunction to current methods. Responses revealed four main themes: use, data presentation, barriers to use and future development. Flexifoot data were recognised as capable of enhancing information exchange between clinicians and patients, and also between clinicians themselves. Participants supported the use of feedback for rehabilitation, screening and evaluation of treatment progress/success purposes. Flexifoot use by patients was encouraged as a self-management tool that may motivate them by setting attainment goals. The data interface should be secure, concise and visually appealing. The measured parameters of Flexifoot, its duration of wear and frequency of data output would all depend on the rationale for its use. The clinicians and patients must collaborate to optimise the use of Flexifoot for long-term monitoring of disease for patient care in clinical practice. Many identified potential other uses for Flexifoot.

Conclusions: Clinicians thought that Flexifoot may complement and improve current methods of long-term patient management for OA or other conditions in clinical settings. Flexifoot was recognised to be useful for objective measures and should be tailored carefully for each person and condition to maximise compliance. Adopting the device, and other similar technologies, requires reducing the main barriers to use (time, cost, patient compliance) before its successful implementation.

Keywords: osteoarthritis; pressure sensors; self-managment; users’ preferences; wearable technologies.

Figure 1

(A) Layout of pressure sensors on the insoles with connectors for the circuit boards. (B) Insoles covered with neoprene with circuit boards for data transmission attached and ready to be inserted into shoes.

Figure 2

Clinician preferences for the specific measurements that they would like Flexifoot to obtain.