Darcy Ummels

126 | Chapter 6 when other topics had more priority (e.g., mental health). These exclusion criteria were added to the manual. “I have a client with heavy physiological problems and a client with traumas which I am assessing. There is no room for an activity tracker right now.” ‐ Therapist 2 (reflection session). From the second iteration, therapists also started using the tracker as an intervention tool to support an increase or decrease in physical activity or to divide physical activity equally throughout the day. The goal to increase or decrease physical activity was chosen if the step count or active minutes per day was too high or too low in relation to the physical and mental complaints of the patient. The goal to divide physical activity equally throughout the day was chosen when the data of step count or active minutes showed several outliers in relation to the physical and mental complaints of the patient. Only three patients did not start an intervention period ( n =1: due to absence of a goal related to physical activity; n =1: due to the end of the study iteration cycle; n =1: due to non ‐ attendance). The physical activity goal was mostly decided by the therapist. The most frequently used physical activity goal was to divide physical activity equally throughout the day and was focused on walking a number of steps per day (function level). During the last reflection session, therapists expressed that they wanted to connect the physical activity goal of the activity tracker more explicitly to the overall participation goal of the patient. For example, to be able to walk with friends (participation goal), you have to be able to walk 6000 steps per day (physical activity goal). In the last reflection session, therapists decided that the intervention period should be at least three weeks. Moreover, therapists expressed they could also use the activity tracker during the intervention period to support treatment options such as graded activity. Therefore, both utilizations were added to the manual (intervention tool and support of an intervention). “For a patient with a catastrophizing coping mechanism you could use graded activity or graded exposure and an activity tracker would certainly be of added value .” ‐ PS Therapist 3 (reflection session). During the first iteration, the data of the tracker were seldom discussed by the therapist and patient. From the second iteration on, the data were discussed after the assessment period and once or twice per week during the intervention period. Therapists and patients talked about the number of steps and active minutes and whether the patient experienced the measurement period as a normal week. The app (data graphs over the past week) was used as a starting point for the conversation. In the minority of the patients, therapists and patients discussed how they experienced their symptoms (e.g., pain, fatigue) in relation to their physical activity. In only two cases, advice was given to the patient on how they could reach their physical activity goal.