Darcy Ummels

144 | Chapter 7 The results of phase one showed that the validity and feasibility of commercially available activity trackers were insufficient for (older) adults with a chronic disease. In summary, there seemed to be a need for a feasible activity tracker that can validly measure activities of daily living in (older) adults with a chronic disease. Phase Two: Developing an activity tracker for older adults with or without chronic diseases In phase two, an existing activity tracker, the MOX 6 , was (re)designed in co ‐ creation with older adults with or without chronic diseases. The MOX was selected as a departure point since both the algorithm and user interface were adaptable. The (re)design of the algorithm and user interface resulted in the MISS Activity. 7 The algorithm was optimised with parameter settings for step count and physical behaviour of older adults with or without chronic diseases for a pocket worn activity tracker measuring activities of daily living. In chapter four, it was shown that the optimised algorithm was more valid during a non ‐ standardised, free ‐ living protocol with activities of daily living than generic, widely accepted algorithms (Fitbit Alta HR, activPAL and MOX annegran ) when worn by older adults with or without chronic diseases. Next, chapter five describes the process of co ‐ creation with older adults with or without chronic diseases and four experts in wearables (a professor in the field of smart devices, a physiotherapist, an advisor from the knowledge centre for sports and physical activity and a clinical operator of a human kinetics lab) to (re)design the user interface. This (re)design process resulted in the final design of the activity tracker (look and feel), a feedback system on the activity tracker and an app for additional feedback. Thereafter, the user interface using the optimised algorithm was tested by older adults with or without chronic diseases in their daily lives for two weeks. They experienced the MISS Activity as easy to use, thought that the additional material (e.g. manual) offered sufficient support and felt that they could therefore independently use the MISS Activity. In addition, older adults with or without chronic diseases reported that the app provided objective insight into their physical activity levels. Phase Three: Integrating the developed activity tracker into healthcare In phase three, the MISS Activity was integrated into daily clinical practice, together with psychosomatic therapists and patients of Het Rughuis, a specialised rehabilitation centre for people with chronic somatic symptom disorders specific to spinal pain. An action research design with several iterations was used to experience, reflect on and learn about how and when the MISS Activity could be used in a meaningful way in daily clinical practice. Therapists needed guidance from the research team to use the activity tracker in a meaningful way. This was done by composing a manual together and having several