designing interventions for chronic pain patients How to prevent relapse after treatment
Team #5
About us
introduction
methods and data collection
intervention 1
intervention 2
intervention 3
future intervention
ultimate conclusion
4 6 8 11 15 19 2325
About us Who are we
4
Diederik van Aalst
Sam van Gerwen
Diederik (23) is a Communication and Multimedia
Sam (23) is an Industrial Product Designer student
Design student from Tiel. He is an all-round designer
from Utrecht. He is a designer who is educated to
that always strives to find the most practical solution.
do research, visualize ideas and make it practical by
His down-to-earth personality will aid us in finding the
producing a product in the end. These assets can
best solution to this design challenge. He has little affection with the medical theme, but is always striving to learn new things and broaden his knowledge. Due to this motivation, in combination with his practical
+31 (0) 6 21 65 76 89
+31 (0) 6 41 38 34 43
diederikvanaalst
sam.vgerwen
@hotmail.com
@gmail.com
be implemented in the team and the project which results in a good addition overall. He wants to help people wherever possible and this project is a perfect example of being able to help. Assisting people
approach, he will assist the team in creating interven-
in need where possible with the ideas and products,
tions for chronic pain patients.
this hankering ideal of making everyday life easier as a constant striving.
Jesse van Beek
Marieke Veneklaas
Jesse (21) is a Communication and Multimedia De-
Marieke (22) is an Orthopaedic Technology student
sign student. His strongpoints are creating a better
who is specialised in shoes. This subject is very inter-
user experience and express things visually. When
esting for her work in the future since a lot of clients
he became a graphic designer he wanted to make
only come to shoe-technologists when they are in
things look nice, after his specialisation in user experience he wanted to create a better online web, but now a days he is more interested in social projects and wants to help people and create a better world.
+31 (0) 6 40 25 93 69
+31 (0) 6 23 24 71 91
vanbeek.jesse
mariekeveneklaas
@gmail.com
@outlook.com
With his expertise and his motivation he definitely could be an added value in this project.
pain. Besides that, she thinks it’s really satisfactory to work with people. Her medical background will greatly help us in understanding the patients and the assignment. Also her logical way of thinking will aid us in finding the right insights and valuable informa-
5
tion throughout this project.
Introduction Introduction
Summary and debrief
6
Summary
Debrief
Treating chronic pain patients is a big issue in the
Adelante, Maastricht UMC, ‘the Fysiotherapist’, ‘Pain
Our theme/challenge
Netherlands, almost one in five has chronic pain,
patients to one voice’ and the University of Applied
Our group is doing research on the patient and his/
but no real solution is present. This issue has been
Sciences Utrecht cooperated and started the re-
her life after rehabilitation. The big challenge is de-
presented by Solace, which is a collaboration be-
search section ‘Solace’. In this section they research
signing an intervention to prevent relapse for patients
tween three healthcare facilities and the University of
what strategies can be adopted to prevent relapse by
with chronic pain. We do realise finding a solution to
Applied Sciences Utrecht.
chronic pain patients.
prevent relapse within three weeks of research with interventions will not be possible. The subject is really
The hidden design rules are used for the project to
The reason why they involved the University of Ap-
come up with three iteration-intervention stages to
plied Sciences Utrecht in the research is because
collect as much useful new insights and data as pos-
of the budget that they had for the research. The
As mentioned before, the assignment is not about
sible. The second and third iteration and intervention
assignment for the Co-Design students is to design
creating a solution but validating the existing re-
used gathered information from the previous stage to
several interventions to gather insides for prevening
search. So our challenge is to create three clear
proceed with. This information is clustered to give a
relapse for patients with chronic pain.
assumptions from the existing research, and make
direction for a fourth intervention, which will be pre-
complex, even for medical experts.
three low fidelity interventions based on these as-
sented to the client as a future intervention they could
Doing desk research was not necessary because
sumptions. This way we can validate the existing
conduct afterwards in addition to their research.
all the information was foreseen, but important was
research and gain a lot of new insights for the Solace
to validate the existing research. A lot of research
program.
After every intervention we will show a strategy map.
has already been done, divided in four posters, with
This map shows the main insights that we have gath-
different themes:
ered throughout the process and will show the chosen direction of our research. The first strategy map is created from the insights that were given at the beginning of the project. The white coloured insights will be tested with interventions.
• The patient and his or her goals; • The healthcare provider and the treatment program;
• The patient and his or her personal space; • The patient and his or her life after rehabilitation.
Throughout this report you will see the term “CCP“, this stands for Chronic Pain Patient. 7
Methods and Data Collection How do we analyse our data
8
Strategy map As mentioned before there already was a lot of
tioner is a possibility but there never was a real bond
The strategy map is a good way to visualise the
researched information available for use to form as-
between care provider and patient. For health care
assignment or issue that is being addressed. The
sumptions with. The project needs a thought-through
centres, the patient is just a number. Aside from the
centered circle will address the main question, which
direction and understanding of the project. Jan Belon
centre there are always the friends, partner and other
is “How to prevent relapse after treatment?”. In the
from ‘The Department of Extraordinary Affairs’ (Afde-
people surrounding them, but the question remains;
second circle of the strategy map the first assump-
ling Buitengewone Zaken), whom is an expert in the
‘do they understand them?’. A solution could be to
tions are shown, insights based on the first interven-
Hidden Design approach, gave different methods to
hide their pain, because their surroundings could
tion.
understand the situation and set a correct direction in
interpret as annoying to always talk about their pain.
the project.
For every intervention circle a main assumption has The chronic pain patient needs goals, structure and
been chosen, which will be validated through an
feedback. These three key parts are really important
intervention. More insights have been gathered with
A system map is an excellent tool to get acquainted
to create a successful treatment. If they do have set
this method. These insights have been processed
with the situation of chronic patients and to have an
goals but no real structure a certain kind of relapse
to form new assumptions and are validated again
overview of their lives. Through this tool you could
is inevitable. A day off does not feel as a relapse but
through a new intervention. In total three interventions
see what the patient is going through and see which
this could change their whole structure goes awry.
have been conducted and the fourth will be a pro-
factors, motivations and stakeholders have influence
Is relapse inevitably connected with the moment the
posal at the end. The strategy map and the conduct-
on their life and on their possible relapse.
patient reaches his/her goal?
ed interventions can be found on the following pages.
System map
The strategy map will be filled in with new insights Insights and direction
after every intervention chapter.
The system map showed that chronic patients had many locations to visit and activities to attend after treatment. Taking part in all these activities can put a certain strain on the patient, which could influence the treatment, lifestyle and (possible) relapse of the patient. After intense treatment they won’t be provide with any support of the practitioner and have to do it on their own from that moment on. Calling their practi9
We believe that bonding between patient and
strategy map 1
docter results in higher Patients are desperate, motivation to excersice because they try too after the treatment
It is hard for patients to find other patients with the same
many solutions
problem
Patients are willing to share their feelings with each other We believe that the
patients will go into
We believe that the employer of the
How to prevent
patient can help him/
relapse after
her by being more
treatment?
involved in the life
relapse when they
after treatment
reach their goals
We believe that patients
We believe that contact with fellow chronic pain patients will decrease the possibility of relapse
We believe that most of the patients don’t know their limits, they do to much so they go into relapse faster
10
don’t want to be felt sorry for
Intervention one My goal is
11
personal goal is feasible, if they are motivated and if
Alone or together
they rather work together or achieve goals alone.
“ You can disappoint people if you don’t reach your
Validating our intervention First it was the intention to test our intervention at the hospital. However to fulfil the intervention it was necessary to have permission from the hospital and there was too little time to arrange that. Therefor the
What is the intervention? The first intervention is an interactive questionnaire and contains three parts. The first part is the eye catcher, in the form of a board which has the ques-
intervention was tested at the University of Applied Sciences in Utrecht on the 16th of October 2015.
can disappoint people if “You you don’t reach your goal, but
goal, but if you don’t tell them your goal you can’t disappoint them ”
»» »» »» »»
Achieving your goal alone or with company depends on the goal; Some respondents need support in the form of extra people to push themselves further; Team sports give more motivation, pressure and distraction; Achieving or losing goals can have effects on other goals.
them on the board. The second part is an interactive
if you don’t tell them your goal you can’t disappoint them ”
questionnaire in the form of a spectrum. People have
Passers were willing to share their ultimate goals and
maintaining it”
to scale their motivation, feasibility, structure, pleas-
enlighten them for the benefit of the research. This
“I get more excited just by talking about my goal”
ance, dedication and the need of company of their
resulted into a lot of interesting insights while testing
personal goal. While the respondents filled in those
the intervention. The insights are categorised into four
spectra we asked them deeper questions fitted to the
themes to make a clearer image of all the information.
persons to gather more insights.
The themes are “Alone or together”, “Goals”, “Con-
tion “My goal is:”. Respondents got a post-it and were asked to write down their ultimate goal and stick
Intervention goal
versation with a young CCP” and “Spectra”.
It’s very interesting to know if people maintain working on their goal if it is achieved or if they get “bored” and thus demotivated. The goal is to learn about what people do when they reach their personal goal. Also, it’s important to know if the respondents think their
12
Goals “After reaching the goal, I lost interest and stopped
»»
Achieving a non-personal goal is demotivating;
»» »»
Conclusion Too high demands, a complex goal or too little
Although some respondents say that after reaching
time are demotivating;
their goal, they lose interest, CPPs may not have this
Taking little steps helps someone achieving their
feeling because of their situation. Every day can be a
goal easier.
struggle. Other people can help reminding this person and motivate them to reach their goal.
Conversation with a young CPP “If I don’t want to relapse anymore, I need to change
Almost everybody has currently a goal and believes
my lifestyle and I’m not willing to give up my sport
it is a feasible goal. Although most people want to
and social environment.”
achieve their goal alone, they would like extra sup-
“My roommate doesn’t understand me: one moment
port in the form of an extra person to reach their goal.
everything seems fine to me and on the other mo-
Everyone is motivated to achieve their goal, and they
ment I am the chronic pain patient”
get extra motivated when they work in teams or even
“I don’t follow the advice of the G.P. I pass my limits
talk about their personal goal.
and just go on.” “It helps if people in my environment correct me when
These insights can be found on the next page of this
I go beyond my limits”
document. Here you will find the new strategy map based on the insights that we gathered from this
Spectra
»» »» »» »»
intervention.
Nearly all the participants thought their goal is feasible;
Intervention number two will be about the insight
Almost everybody is motivated about reaching
“Talking to other people about your goals increases
his or her goal;
the chance to achieve them, due to a higher motiva-
Participants prefer working on a structured man-
tion“. This insight was the most common reaction that
ner when it comes to achieving a goal;
was given by the respondents.
Although most people like achieving a goal together, most of them try to achieve goals alone. 13
We believe that bonding between patient and
strategy map 2
docter results in higher Patients are desperate, motivation to excersice because they try to after the treatment
It is hard for patients to find other patients with the same
many solutions
problem
Patients are willing to share their feelings with
Reaching goals that you
each other
didn’t set up yourself is demotivating
We believe that the
patients will go into People with chronic pain
patient can help him/
relapse after
her by being more
treatment?
involved in the life
don’t have chronic pain. They don’t understand their problems Talking to other people increases the chance to achieve them, due to a
We believe that patients
We believe that contact with fellow chronic pain patients will decrease the possibility of relapse
about your goals
after treatment
reach their goals
problems to people who
14
employer of the
How to prevent
relapse when they
rather not talk about their
higher motivation
We believe that the
We believe that most of the patients don’t know their limits, they do to much so they go into relapse faster
don’t want to be felt sorry for
Intervention two Would you share your goal
15
What is the intervention?
Intervention goal
The intervention is a picture frame with a whiteboard
The goal of this intervention was to research if people
attached to it. People can write their goal on the
want to share their personal goals publicly. The goals
whiteboard, and pose in the frame and share their
have been shared on Facebook and have been mon-
goal this way. Pictures that have been made, have
itored to find out if friends and random people were
been placed on our own created Facebook page:
willing to help them to achieve their goals, and if it
‘DDWGoal’.
motivates other people to share their goals as well.
So there were two ways to share their goal, through the frame and later on with social media. By using social media, it was possible to find out if people were willing to share their goals with there personal friends,
“ Finding and sharing a jointly
goal is way easier and more fun than an individual goal ”
instead of only the frame or for their own. It was also
Validating our intervention
possible to track if people were willing to help one
The intervention was split into three parts. The first
another achieving or supporting their goals, by giving
part has been conducted on the streets from Eind-
them tips and advice. Which was possible by posting
hoven. The second and last part has taken place
a reaction on the Facebook post.
at ‘Design House’ during the Dutch Design Week in
Insights “Finding and sharing a jointly goal is way easier and more fun than an individual goal”.
»» »»
It is easier for people to find a jointly goal and share this together; People were willing to share their goals, but on an
Eindhoven, on 21st of October 2015. And last but not
abstract level. For example ‘to let things go’, ‘earn
least, the Facebook page.
happiness’, these goals were not really personal;
Eindhoven city The first part consisted of asking people if they wanted to share their goal on the whiteboard, which was attached to the frame. We made a picture of each
»» »» »»
People wanted to have control over sharing information publicly; Some people considered sharing their goal as an opportunity of finding more inspiration; When people were in groups, they motivated
person holding the frame for an offline Facebook
each other to share their jointly goal. Even when
page, which has been used in the ‘Design House’.
people were in doubt, they still posed in the frame because of the group pressure.
16
Conclusion Design House
The interventions could be compared to the treat-
The second part was at the exhibition of the Dutch
All pictures, which have been taken on the streets
ment. When putting in effort to go to people for a pic-
Design Week. As mentioned before, the pictures that
from Eindhoven, and in the Design House itself,
ture, they were eager and willing to participate. The
have been made on the streets have been printed
where placed on the DDWGoal Facebook page.
moment they had to put in their own effort, of sharing
and exhibited. At the exhibition people were invited to
The Facebook page has been created to give the
the picture, there was almost no activity.
react on the goals set by the photographed people.
people a platform and an opportunity to respond on
These reactions have been written down on post-its
each other his/hers goal. This also made it possible
and placed next to the pictures. It was also interest-
to let people give tips and advice on how they could
ing to see if people felt like sharing their goals when
achieve their goals. All the pictures can be seen on
“ People are willing to respond on goals of friend or family ”
they were aware of the fact that others were going to
facebook.com/ddwgoal.
Our intervention did work on the offline part, but
see their framed photos at the exhibition.
the online results were disappointing. People did not like to share the picture on their own Facebook. Many
Insights
»» »» »» »» »» »»
People found it hard to support unknown people
Insights
»»
reactions have been given on the pictures, through
People only responded on their friends goals and
tagging the people. So people were willing to re-
in comparison to friends and/or family;
were willing to give them tips and advice on how
spond on a goal of a friend, but they were not willing
People liked reacting on other goals, and it in-
they could achieve this goal;
to share their goals publicly.
spired them to draft their own personal game;
»»
People said they were willing to share their goals
People got enthusiastic when they heared or saw
on their personal Facebook page, but in the end
People found responding on each other’s situations
a goal of a person they knew. They were more
they didn’t.
easier when it was offline, instead of online. People
likely to react on this;
preferred finding and sharing a jointly goal, because
People needed more background information
it was easier and more fun than an individual goal.
about someone to comment on their goal;
The social pressure was also an important factor.
It was easy to say something about others when it
Even when one or two people were in a group and
was anonymously;
were in doubt of sharing their goal together, they still
If the goal was more personal it was easier to
did it.
comment on it, in contrast to more the more abstract goals.
On the next page you will find the new strategy map 17
based on the new insights.
We believe that bonding between patient and
strategy map 3
docter results in higher Patients are desperate, motivation to excersice because they try to after the treatment
It is hard for patients to find other patients with the same
many solutions
problem
Patients are willing to share their feelings with
Reaching goals that you
each other
didn’t set up yourself is demotivating
We believe that the
patients will go into People with chronic pain
don’t have chronic pain. They don’t understand their problems
It is easier for people to find a jointly goal and
Talking to other people about your goals
achieve them, due to a
It is more fun to reach
higher motivation
your goals together
It is easier to motivate/ comment on goals of people you know
18
her by being more
treatment?
involved in the life after treatment We believe that patients
We believe that contact with fellow chronic pain patients will decrease the possibility of relapse
increases the chance to
share them together
patient can help him/
relapse after
reach their goals
problems to people who
goal on your own
employer of the
How to prevent
relapse when they
rather not talk about their
It is harder to reach a
We believe that the
We believe that most of the patients don’t know their limits, they do to much so they go into relapse faster
don’t want to be felt sorry for
Intervention three Achieving your goals together
19
What is the intervention? The intervention consists of two games, which will be
an object toghether to monitor the way how they
presented to the audience. The games have to be
cooperate.
played in duos and the participants have to cooperate to succeed. Participants could chose between
Observing the participants will point out if they have
drawing in duos and the ‘bibber spiraal’ in duos.
fun and/or develop any (positive frustrations) towards the game or the other individual. Afterwards they will
Drawing in duos was the most visited game of the
be asked how they experienced playing the games
two, people had to stretch out their drawing arms and
and if they felt happy, satisfied and got distracted
place their wrists against each other. The two arms
during the activity. All this information will be written
will be connected with velcro to ensure the connec-
down and insights will be gathered from this.
tion. One person held the pencil, whereas the other person would take control and draws a card to draw the suggested drawing. The person holding the pencil will create an image with help of the other person and has to guess what it is. We’ve also let them draw
away control goes “Giving easier with family or friends ” Intervention goal
CPP with CPP
»» »» »»
Wait-and-see attitude and reserved; Taking control is hard; Less energy is being shared.
CPP with healthcare provider
The goal of this intervention is playing games with CPPs and their adherents. The game will (hopefully) generate so much fun it will relieve pain (and maybe stress) and distract them from their therapy or pain/ sad moments.
»» »» »» »»
care facility where a lot of CPPs and ex-CPPs are. During the intervention four different kinds of duos presented themselves at the games, which resulted in different insights per group. 20
Healthcare provider lets CPP take over control; Healthcare provider is still directing and giving instructions to the CPP about what to do; Taking control is hard because of the professional relationship that exists.
Validating our intervention The intervention took place at the Adelante health-
Dependant of healthcare provider;
CPP with family/friends
»» »» »» »»
Familiar with each other; Taking and giving away control goes easier; Trustworthy; Are able to correct one another;
»»
Physically and mentally connected because of the interaction and energy of the other individual.
CPP with unknown
»» »» »» »»
Wait-and-see attitude and reserved; The unknown person takes control; Physically and mentally connected because of the interaction and energy of the other individual. Non-CPP was compromising for the CPP.
Conclusion The results gathered from the intervention were confirming the presumptions set in advance. Most of the CPPs that visited the drawing game gave positive feedback concerning their state of mind and the positive frustrations to perform better, which they developed during the game. On the next page you will find the final strategy map based on the new insights. The black coloured, obelique insight will be the foundation of the future intervention that will be presented in this report.
21
We believe that bonding between patient and
strategy map 4
docter results in higher Patients are desperate, motivation to excersice because they try to after the treatment
It is hard for patients to find other patients with the same
many solutions
problem
Patients are willing to share their feelings with
Reaching goals that you
each other
didn’t set up yourself is demotivating
We believe that the
patients will go into People with chronic pain
don’t have chronic pain.
Participants are not only physically but also
They don’t understand their problems
mentally connected to each other When family and
friends help the CPPs achieve (parts of)
their goal, it becomes easier and more fun
CPPs forget their
It is easier for people to find a jointly goal and
Talking to other people about your goals
achieve them, due to a
It is more fun to reach
higher motivation
your goals together
It is easier to motivate/ comment on goals of people you know
surroundings by doing activities with other people around them
22
her by being more
treatment?
involved in the life after treatment We believe that patients
We believe that contact with fellow chronic pain patients will decrease the possibility of relapse
increases the chance to
share them together
patient can help him/
relapse after
reach their goals
problems to people who
goal on your own
employer of the
How to prevent
relapse when they
rather not talk about their
It is harder to reach a
We believe that the
We believe that most of the patients don’t know their limits, they do to much so they go into relapse faster
don’t want to be felt sorry for
future intervention Advice for the ongoing research
23
What is the intervention? The practitioner will end the treatment with a meeting in combination with family and/or friends. The general goal will be discussed and sub-achievements to make it easier to succeed with help of others. The family and friends present will put in their own effort to make sure some of the sub-achievements to get to the eventual goal will be done in collaboration with the CPP. This will make it easier for the CPP, because he/she won’t have to cope with (more) stress or put in a lot of effort to make someone help them. Doing the sub-achievements or even succeeding in reaching the goal together, will make it more fun and less stressful to then doing it alone.
Intervention goal Making it easier to approach known acquaintances for CPPs to achieve their goals more easily and make everyday activities more fun. The energy which had to be invested by the CPPs will go down because then other people will put in energy and effort to help out.
24
Ultimate conclusion
25
In life after treatment a few things are important for
who were willing to give tips and advice on how they
The results between family members are the ones
the CPP not to fall into relapse. Three main terms are
could achieve the set goal. Likewise, participants are
who stand out most. Family members are more in
necessary to maintain the same level or make pro-
more willing to share their goals in groups and enjoy
sync, they communicate better and emphasize the
gress are feedback, structure and goals.
it more.
fact it feels more familiar and nicer than drawing with
The interventions were focussed on the goals and showed that nearly all the participants thought their goal was feasible and taking small steps helped achieving it faster. Almost everyone had a structure
“I feel his energy and it effects me too ”
one of the researchers. On the other hand the results from the interaction between healthcare providers and CPPs resulted in a different outcome. The healthcare provider had trouble letting the CPP take control.
to reach a goal. Most respondents prefer company
So what happens if participants share their goals
He/she is used to giving instructions and remained
although almost everyone tries to achieve their goal
together and also work on this shared goal together?
directing the CPP. At the same time, the CPP does
on their own.
Participants become more motivated and concen-
not want to take initiative. It seemed like there was a
trated what resulted in a mental and physical con-
clear professional relationship with behaviour, which
“I get more excited just by talking about my goal”
nection. “I feel his energy and it effects me too” said
could not easily be changed.
Everyone gets more motivated when talking about
one of the participants. This and the focus, draws the
their goal(s). The pressure rises after the participant
attention from internal and external factors like pain,
It is quite contradictory to see how connected,
tells about their plan to others, because they do not
tiredness and being in a rehabilitation center.
focussed and motivated participants were when
want to disappoint them. So are people willing to
they were working towards a common goal, where
share their goals publicly? Yes however people like
as most respondents claim in the first intervention
control about with whom they share it with and do not
stressed out they wanted to reach the goal on their
like to take initiative themselves. When the goals are
own. Feedback clearly helps achieving a goal, which
shared without their conrol, the goals become more
has has been proven through collaboration with fami-
abstract like ‘to let things go’ and ‘earn happiness’.
ly members. To achieve a goal, structure is preferred
The intervention led to two different groups who
according to respondents. So three main terms in the
could support the CPP. The first group were total
lives of non-CPPs and CPPs are necessary to main-
strangers, although these respondents found it hard
tain the same level or make progress are feedback,
to write down supportive text to unknown people. The
pattern and goals.
second group consisted out of friends and/or family
26
Team #5