Spinal Perigoniometer

Research

The initial overall objective of this project was to improve the efficacy of back pain treatment in physiotherapy. Back pain is an extremely complex and broad issue that affects an expansive range of people all over the world, and the processes physiotherapists undertake to diagnose and treat back pain is extensive and features many intricacies. Therefore, it was important to conduct a detailed and thorough literature review to uncover the many functions, movements, and ailments of the spine that may have an effect on the direction of this project.

An initial round of survey questions was distributed to physiotherapist clinics across Queensland with a focus on determining what the most common injuries physiotherapists treat on a day-to-day basis, as well as determining which equipment they use that either excel or underperform for their purpose, and using these insights to determine which criteria were most important to physiotherapists. This round of surveys unveiled that the back was far-and-away the most commonly treated area, which backs up information found in the literature review, and identified regular goniometers as being a commonly used piece of equipment that underperforms due to its lack of accuracy and reliability between users, and identified dynamometers as excellent for their purpose because of their ease of use, accuracy, and objectivity.

The frequency of keywords in the short answer responses from the survey were counted to identify areas of importance, and then the responses as a whole were coded and subjected to relational analysis to identify themes and patterns in responses to identify insights and key pain points.

Key descriptors for the effectiveness of the equipment were mentioned in most survey responses, and the frequency of each potentially indicates the importance of each criteria. Using this assessment, the criteria established in order of importance, with the most frequently mentioned criteria being the most important:

1. Ease of Use (11 times)
2. Accuracy (8 times)
3. Reproducibility (5 times each)
4. Ergonomics & Technological Connectivity (4 times each)
5. Objectivity & Reliability (3 times each)

Following the survey, two in-depth interviews were conducted and subjected to thematic analysis, with the objective of gaining a deeper insight into the process of diagnosing and treating the patients, as well as expanding upon the criteria mentioned in the surveys and relating more specifically to treating back pain. The interviews revealed the importance of the availability of equipment, as well as some factors that may affect whether a clinic may not adopt certain equipment. When a clinic does not have a piece of equipment, practitioners will use techniques such as landmarking to make up for the lack of equipment, but when it is available, they are both able and more likely to use the equipment in order to make more accurate assessments.

The second insight that was unveiled was the motivation behind using tools that produce precise, quantitative measurements. The main advantage of testing for these measurements is to provide a precise and accurate record of the patient’s progress. While it may not always be necessary to have an accurate measurement, as some patients may experience substantial and noticeable improvements very quickly, but for patients with chronic afflictions or issues that otherwise improve slowly, being able to communicate and show them their objective progress can reduce the likelihood of them becoming discouraged and abandoning treatment.

The final insight was that of the main range-of-motion tests conducted, forwards, backwards, and lateral flexion can all be accurately measured using landmarking and a tape measure, while rotational range-of-motion is almost always assessed by simply “eyeballing” the amount of rotation. This does not allow the practitioner to demonstrate subtle improvements to the patient and doesn’t provide a precise track of the patient’s improvement. As such, this was identified as the key movement to target with the design solution.

The insights gained from this research were used to guide the initial direction of the design process and were used to develop a series of design criteria.

Functionality

Angle Dials

The Spinal Perigoniometer measures rotational range-of-motion at two key points of the spine: the lumbar spine, and the thoracic spine. The dual axis system is necessitated by the complexity of spinal movement, while also providing the practitioner with deeper insight into the specific trouble regions for the patient, which can in turn be used to provide more effective treatment and exercise prescriptions. Each angle of axial rotation is measured by reading off the increment decals around the dials, similar to regular goniometers already used in physiotherapy. It was important for the design to use an
analogue measurement mechanism rather than a digital mechanism to keep manufacturing costs low, as the sole competitor in this area produces
a prohibitively expensive product and, to be a truly impactful design, the Spinal Perigoniometer needed to be accessible by as many physiotherapists as possible.

form and ergonomics

Form

The general form of the Spinal Perigoniometer was dictated by the natural curve of the back, with the thorax protruding further out than the lumbar spine, but the sweeping body was implemented this way specifically to achieve a technical aesthetic that matches the physiotherapy context and to provide an intuitive place for the placement of the second hand when using the tool. The notches around the dials add grip for the user, but more importantly create an inherent understanding of the interaction points. Finally, the pads that touch the patient’s thorax are curved and smooth to avoid patient discomfort, and can also pivot to accommodate different body shapes.

Ergonomics

With regards to ergonomics, the dimensions of the device were chosen to exclude as few patients as possible. The width of the arms was based off
the 1st-percentile female, as the smaller width can still accommodate larger patients, but a larger width would extend out past the shoulders of the smallest patients. The height between the two pivot points was chosen so the arms would reach part of the thorax on most people, either lower on the thorax for exceedingly tall patients, or higher up on smaller patients. Finally, the handle length permits use by the largest hands, while the diameter allows it to be used by even the 1st percentile user when used in a power grip.

Final model