Factors Influencing Physiotherapist’s Intention to Use a Novel

Physical Exercise Communication System in Neurorehabilitation

Elise Klæbo Vonstad, Marit N. Olsen, Linda Rennie and Arve Opheim

Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway

1 OBJECTIVES

Due to increasing pressure on health care system,

technology will play an important role in

maintaining high quality care for patients. In

rehabilitation after illness or injury, physiotherapist-

guided exercises and subsequent home exercises is

an imperative part of patients’ program for regaining

motor function. The home based exercises

prescribed to the patient are often written down or

printed out on a piece of paper. Consequently, the

patient might feel insecure with regards to knowing

if the exercises are performed correctly. Also, the

therapist does not know if the patient is performing

the exercises with sufficient quality and quantity.

A web-based communication platform for

physical rehabilitation (Mobile Movement Monito-

ring, Sunnaas Rehabilitation Hospital, Norway) has

been developed in a concept, combining mobile

telephone technology and sensor technology. This

platform allows patients to get real-time feedback of

their exercise performance. Furthermore, the

physiotherapist can get an overview of the quality

and quantity of the exercises performed by the

patient. The platform is intended to help address the

upcoming challenges in providing more focused

quality health care as the population ages. The

intention is that this interactive feedback system can

be a valuable tool in motivating patients, and

providing effective physical exercises without the

presence of a physiotherapist, both at the hospital

and at home or in the gym. This gives the

physiotherapist the opportunity to follow up the

patients’ exercise quality and adherence and adjust

the exercises accordingly. There’s a need for

exploring the users’ acceptance of, and attitudes

towards, such a platform as its actual use is

dependent on it being perceived as useful and easy

to implement in the clinical setting by the intended

users (Broens et al 2007, Sharma et al 2010, Vincent

et al 2007). The most common way to explore this is

through the Technology Acceptance Model (TAM,

Davis 1989), a robust questionnaire that inquires the

acceptance of information systems (Chen et al

2011). Various versions of this questionnaire exist,

adjusted to be specific to the technology being

evaluated. For the current subject, the Modified

Technology Acceptance Model (mTAM, Gagnon et

al 2012) was deemed appropriate, as it expands the

original TAM to include key domains related to the

use of such a system in an organizational context,

which have been shown to influence user acceptance

(Gagnon et al 2012). The domains are Perceived

Usefulness (PU), Perceived Ease of Use (PEU),

Attitude (Att), Intention to use (Int), Compatibility

(Comp), Social Norm (SN), Facilitators (Fac) and

Habits (Hab). Intention to Use, or user behavior, is

seen as the main determinant in adoption of

telemonitoring systems (Al-Adwan et al 2013).

Therefore, the aim of this pilot study was to

investigate the level of acceptance of the Mobile

Movement Monitoring platform in specialized

therapists in neurorehabilitation.

2 METHOD

Health professionals from three different specialized

rehabilitation institutions in the county of Akershus,

Norway participated. Prior to answering the

questionnaire, participants were, in a plenary

session, given a standardized oral presentation of

how the system works and its different

functionalities both for the patient and the health

care professional. They were also shown a

demonstration video of a work flow using the

system. To ensure a common base of knowledge the

Questions & Answers-session about the platform

was held after the questionnaires were filled out. The

questionnaire consists of 33 statements: 6 each

regarding Percieved Usefullness and Percieved Ease

of Use, 4 each regarding Attitude, Compatibility and

Social Norm, and 3 each regarding Facilitators,

Habit and Intention. Answers were given on a 1-7

Likert scale, where 1=strongly disagree

and7=strongly agree. The items with reverse scoring

Vonstad, E., Olsen, M., Rennie, L. and Opheim, A.

Factors Inﬂuencing Physiotherapist’s Intention to Use a Novel Physical Exercise Communication System in NeuroRehabilitation.

In Extended Abstracts (NEUROTECHNIX 2016), pages 3-5

Table 1. Relationships between domains.

Variable PEU Att Comp Int

r p r p r p r p

0.55 0.001 0.82 0.000 0.57 0.000 0.66 0.000

PEU

0.59 0.000

Att

0.53 0.001

Fac

0.44 0.007 0.60 0.000

0.46 0.005

Hab

0.49 0.002

7=strongly agree. The items with reverse scoring

were coded so all answers given could be interpreted

in the manner higher score = more positive response

to the statement. Relationships between domains

were analyzed in accordance with the theoretical

model in Gagnon et al (2012), and thus not all

relationships are examined. Descriptive statistics

were extracted, and the relationships between the

different domains were analyzed using the

Spearman’s Rho Correlation Coefficient reported

with p-value (α <0.01) for statistical significance.

3 RESULTS

36 participants completed the mTAM questionnaire.

Mean age=39.9 years (SD 11.4), 27 (75 %) were

women. 29 (81 %) were physiotherapists, 4 (11 %)

were sports educators, 2 (6 %) were human

movement scientists and 1 (3 %) was a general

physician. Mean number of years in current

occupation was 11.9 (SD 8.8), indicating that all

participants were experienced healthcare worker.

The median score (Q1, Q3) was 5.29 (4.7, 6.0) for

Percieved Usefullness, 5.17 (4.5, 5.8) for Percieved

Ease of Use, 5.75 (5.0,6.0) for Attitude, 4.50 (3.8,

4.8) for Compatibility, 4.75 (4.3, 5.6) for Social

Norm, 5.33 (4.3, 6.0) for Facilitators, 3.83 (3.3, 5.7)

for Habit and 5.00 (4.5, 5.3) for Intention.

Results show a generally positive attitude to the

developed platform: Lowest median score was Habit

(3.83), while the highest was Attitude (5.75), and all

other domains had a median score close to or over

5.0, which also was the exact median score of Int.

Domains were significantly correlated (Table 1), and

the highest correlation was between Percieved

Usefullness and Attitude with r=.82 (p=.000).

Attitude was also moderately correlated to Pervieved

Ease of Use, with r=.59 (p=.000). Percieved

Usefullness, Attitude and Facilitators showed the

highest correlations to Intention, with r=.66

(p=.000), r=.53 (p=.001) and r=.60 (p=.000),

respectively.

4 DISCUSSION

The current study explored the level of acceptance

of the Mobile Movement Monitoring system among

physiotherapists in neurorehabilitation. Therapists

were generally positive to the concept. The system

was seen as useful (PU) and easy to use (PEU), and

the attitude (Att) towards the system was good.

Intention has been shown to be most influenced

by Attitude and Facilitators (Gagnon et al 2012).

Results in the current study support these findings.

These two domains represent different contexts of

user acceptance, organizational and personal, and

therefore show that it is imperative to take into

account both these contexts when planning on

implementing a new system such as the current one.

Furthermore, the results from these domains are

moderate to high, which indicates that the therapists

have a positive impression of using the system, and

of the institutions being able to facilitate use of the

system. The lowest median score was Habit, with

3.83, which might show that there are not a lot of

similar systems in use today in these institutions. It

also indicates that healthcare workers in physical

rehabilitation might need systematic training to be

comfortable in using a system like the one proposed.

This is also reflected in the median score of the

domain Compatibility, which show a compatibility

with daily routines that is moderate to low, which

again is correlated to Perceived Usefulness.

5 CONCLUSION

The acceptance of Mobile Movement Monitoring

was moderate to high in the current study. The

system is seen as a useful tool in ensuring the quality

NEUROTECHNIX 2016 - 4th International Congress on Neurotechnology, Electronics and Informatics

of home-based physical rehabilitation exercises in

neurological patients. The study also shows that

facilitators and habits should be taken into

consideration when planning on implementing such

a platform into the clinical setting in

neurorehabilitation.

REFERENCES

Al- Adwan, Amer; Al- Adwan, Ahmad; Smedley, Jo.

Exploring students acceptance of e-learning using

Technology Acceptance Model in Jordanian

universities. International Journal of Education &

Development using Information. 2013;9 2

Broens TH, Huis in’t Veld RM, Vollenbroek-Hutten MM,

et al. Determinants of successful telemedicine

implementations: A literature study. J Telemed

Telecare 2007;13:303–309.

Chen S, Li S & Li C. Recent Related Research in

Technology Acceptance Model: A literature Review.

Austr J Bus Manag Res 2011; 1(9), 124-127.

Davis FD. Perceived usefulness, perceived ease of use,

and user acceptance of information technology. MIS Q

1989;13, 319–340.

Gagnon M P, Orruño E, Asua J A, Abdeljelil A B,

Emparanza J. Using a Modified Technology

Acceptance Model to Evaluate Healthcare

Professionals’ Adoption of a New Telemonitoring

System. Telem eHealth 2012; 18(1), 54-59.

Sharma U, Barnett J, Clarke M. Clinical users’ perspective

on telemonitoring of patients with long term

conditions: Understood through concepts of Giddens’s

structuration theory & consequence of modernity. Stud

Health Technol Inform 2010;160, 545–549.

Vincent C, Reinharz D, Deaudelin I, et al. Understanding

personal determinants in the adoption of

telesurveillance in elder home care by community

health workers. J Commun Pract 2007;15,99–118.

Factors Inﬂuencing Physiotherapist’s Intention to Use a Novel Physical Exercise Communication System in NeuroRehabilitation