Aarzu: Enabling Tele-rehabilitation

Problem overview.

How can we bridge the gap between physiotherapists and patients in Pakistan?

Due to lack of healthcare facilities in the nation, majority of the physical therapy institutions are situated in urban regions. This forces families from rural areas and those belonging to the lower-income strata to travel long distances before they could obtain treatment and therapy. Travel, financial, and variable weather constraints pose hurdles due to which continued therapy becomes infeasible and worsens the disability.

We conducted field research and contextual inquiry methods at Pakistan Society for Rehabilitation of Differently Abled (PSRD), a public hospital in Pakistan, engaging with physiotherapists and patients. We sought to intervene technology to bridge the gap that existed between the physically disabled community of Pakistan and the therapy they require.

In this work, we present an in-depth description of the challenges that the lower-income community faces with regards to the availability and affordance of physical treatment. We also propose a foundational solution that can help guide the HCI community towards more inclusive solutions to introduce physiotherapy through virtual physiotherapy (tele rehabilitation) in context of Pakistan.

Solution at a Glance.

A simple, ease to use mobile app.

We designed and evaluated the high-fidelity prototypes of a mobile application that connected physiotherapists with patients, allowing them to carry out physiotherapy at home, reducing the need to travel long distance to come to appointments on a daily basis. The app featured two distinct interfaces - one for doctors and another for patients, each designed with tailored workflows based on insights gathered from user research and subsequent development phases.

The design system and complete flow of the app can be found on Figma.

Fig 1. Selected screens from the mobile application.

Conducting Field Research.

Understanding user frustrations.

We conducted a total of 4 sessions at PSRD. Our first visit aimed at getting familiar with the environment, talking to doctors and physiotherapists, and creating a sense of understanding of the procedures. Our second and third visits were aimed at interviewing patients in the waiting lounge and physiotherapists in the wards to understand core issues and pain points. Our fourth and final visit relied upon contextual inquiry methods within the physiotherapy ward where we observed the environment, processes, and the use of exercises and equipment that were available at PSRD.

Fig 3. Observations from the field research
Note: Consent was taken before taking images.

What did we learn from our field research?

Through our user research, we were able understand core issues faced by the doctors and the patients.

Doctors struggled with home exercise adherence, as patients often neglected follow-ups once their pain subsided. Limited communication after hospital visits, especially for out-of-station patients, further delayed recovery. Specialized equipment constraints restricted certain exercises to hospital settings, while lack of progress tracking made it difficult to monitor patient recovery. Though most patients had smartphone access, low-tech alternatives like printed instructions were needed for those without personal devices.

"When patients experience pain or problems in mobility, they come to the hospital for treatment. After pain relief, they often forget to follow the home instructions, and their problems resurface."

Patients at PSRD faced travel difficulties, with many commuting long distances due to a lack of quality physiotherapy services near their homes. Long waiting times, often 1 to 3 hours, added to their frustration, as the absence of an appointment system led to unpredictable delays. While most could perform home exercises without specialized equipment, some struggled with consistency. Limited communication with doctors was another challenge, as patients only had access to the reception desk for inquiries. Despite high smartphone access, low-income patients had fewer digital resources. While opinions on virtual physiotherapy were mixed, interest grew when the option to contact or video call doctors was introduced, highlighting the need for a hybrid approach to care.

“We missed a few appointments in the past days when it rained a lot, so there were huge puddles in front of our home, and we couldn’t travel.”

Defining needs and desires.

Based on the insights, we defined our requirements in terms of needs and desires of the our target user groups.

Fig 4. Needs and Desires of our user groups.

Design Ideation.

Different ways of solving the problem.

Our team began ideating possible solutions that could solve the core issues faced by our users. We conducted an initial brainstorming session using sticky notes, addressing each of the needs and desired found above.

Fig 5. Brainstorming session using sticky notes.

From these ideas, we extracted 5 design alternatives that catered to user issues in different ways. Some were holistic than the others.

Mobile Clinic: A mobile physiotherapy clinic (RV) can visit far-off places based on appointed schedules, and serve patients in the proximity of their locality. It can be partitioned into various compartments dedicated for various exercises.
Digital Kiosk: A kiosk at PSRD coupled with PSRD's database could be setup at the hospital. Patients can set up appointments, make payments, view and print exercise plans, and obtain answers to any queries and FAQs
Printed Brochures: A shelf of brochures can be placed in PSRD with exercise plan. Exercises can be divided according to anatomy.
Automated Helpline: A PSRD helpline can be setup where patients will be able to get audio-based guidance from doctors.
Mobile App: A mobile application can be developed for the patients and doctors at PSRD. It would provide exercise videos to practice at home, option to book appointment, contact doctors, and track their progress.

We sketched these ideas in order to weigh their effectiveness and feasibility.

Fig 6. Design Alternatives.

In order to narrow down our ideas to one solution, we evaluated their effectiveness by mapping them onto the needs and desires. We created a matrix to analyze which needs were fulfilled by each of the proposed ideas.

In addition to this, we took these ideas and presented them to our users at PSRD (5 physiotherapists and 21 patients), in order to obtain their feedback.

Our analysis and internal team discussion concluded that a mobile application with the complete features would be the most holistic solution, covering various needs of our users, and solve their issues to a considerable extent.

Design Features.

What features must the app provide?

For the next coupe of weeks, we mapped out the features and flows within our mobile application in order to provide an intuitive, simplified, and effective experience to our users. We wanted to cover as many needs as possible, while keeping the application easy to use. This involved back and forth discussion within our team, and our stakeholders. Finally, we proposed the following set of features with the application as shown in Fig 7. We followed it up by defining the information architecture and user flows of our app.

Fig 7. Finalized features within the application.

Wireframes and Storyboards.

Validating the user flows.

Once we decided upon the features of our app, we created low-fidelity wireframes and mock-ups. We also conducted initial user testing on these paper-based representations of the app in order to validate user flows and discover difficulties within navigation.

Some of the selected screens are as follows:

Fig 8. Wireframes of some prominent screens.

Defining user scenarios through visual stories.

We also wanted to create visual user flows to capture the essence of user interactions with our proposed solution, capturing their pain points and how our application tends to solve those issues. Therefore, we designed storyboards to capture these interactions.

Fig 9. Storyboarding the ten needs and desires as features of the app.

Design Solution.

What does Aarzu stand for?

We chose the name of the application to be Aarzu (in Urdu). Since our target audience includes the differently abled or people who are not able to perform physical activity regularly and independently, Aarzu refers to their desire to be able to perform their exercises from the comfort of their homes, reduce the hassle of travelling, stay in contact with their doctors and improve their conditions. We want to lend a hand towards maximizing their chances of recovery so their desire or Aarzu of living life to the fullest comes true.

Formulating the Style Guide.

We kept the app minimalistic to ensure that the app does not cause any cognitive loads to our users. Attention was paid to simplicity, clarity, and consistency, keeping in mind accessibility principles and design guidelines.

Fig 10. The style guide including colors, typography, and logos.

We designed the high-fidelity prototypes of Aarzu on Figma. Aarzu connected physiotherapists with patients, allowing them to carry out physiotherapy at home, reducing the need to travel long distance to come to appointments on a daily basis.

The full set of design screens for both the doctor and patient interfaces can be accessed here:

Doctors Flow | Patients Flow

Fig 11. Selected screens from the mobile application.

Prominent App Features.

We translated the needs and desires of our users into several features within the app.

Set and View Appointments: Allowing doctors to set appointments and patients to view them transparently (through a calendar) would help reduce the wait time at the hospital and prevent over-booking.
Create Exercis Plan: Doctors can create exercise plans for individual patients as per their needs and requirements.
Monitor Patient's Progress: Doctors will be able to view the progress of individual patients, allowing them to check if they are exercising regularly at home.
Send Reminders: Doctors will be able to send reminders regarding exercises and appointments to patients.
Contact Patients: A two-way communication channel will create a direct channel of communication between them where patients can clarify confusions, update doctors of their progress and receive active guidance.
Print Exercise Plan: Patients will be able to print their exercise schedules and follow instructions from printed paper instead of using the app repeatedly.
View FAQs: FAQs will serve as an additional source of information for the patients.

End-User Evaluation.

How well did the solution meet user needs?

We conducted usability testing followed by short semi-structured interviews with 10 patients and 6 doctors to obtain the feedback on the app. We tested for learnability, efficiency, consisteny, ease of use, satisfaction and usability.

The application was well received and welcomed by majority of the users. Doctors were able to navigate through the application with relatively greater ease than the patients, which is attributed to their higher literacy levels. Patients hailed it as a solution to most of their challenges.

"My favorite feature was tracking progress while the patient is at home. That they’re following the instructions I gave them.”

“Conveyance issues can be solved as I have to go to the office right now, and they have asked me to come for 15 days. Therefore, I have to manage this very difficultly for 15 days.”

“My favorite feature was the exercise plan feature with the video and gif files.”

“It can be used once we are finished with exercises from PSRD, or as a supplement at home.”

"This app will solve problems to most extent. It will cater to 70% of the patients. Since some come from rural backgrounds, and they have mobile, internet, or time issues so might not be feasible to those.”

“To be able to see the exercise videos and photos. That is most useful for me.”

We also identified challenges faced by patients in our context. These challenges originate due to language barriers and lack of tech-expertise. Some of the terminologies and icons used were not familiar for some of the patients. Similarly, the doctors proposed if diagnosis history of each of the patients can be added as well, which would enable them to shift from traditionally used manual registers to automated databases. Patients also demanded if in-app reminders can be made available that would remind them of exercise schedules.

Way Forward.

Creating a positive impact at scale.

Our work laid foundations for building a user-centered technological solution that impacted thousands of lives either directly or indirectly. We made our design guidelines, prototypes, and findings public to the university and the PSRD hospital in order for the application to be developed.

A group of students from the subsequent cohort of our undergraduate program took ownership of this project, and developed the applications built on our design foundations. The application, along with the updated PSRD website is now live, functional, and used by thousands of deserving users in Pakistan.

View the website: PSRD Charitable Organization

We would like to think everyone who took a part in this project, and helped bring this vision to life.
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Aarzu: Enabling Virtual Physiotherapy in Developing Contexts