2012 Pilot Study 1

Daily Interaction with the Environment Method (DIEM)

Investigator: Rosemary Bakker, MS – Research Associate, Division of Geriatrics and Gerontology, Department of Medicine, Weill Cornell Medical College; David Feathers, PhD – Assistant Professor, Department of Design & Environmental Analysis, Cornell University

Daily Interaction with the Environment Method (DIEM); Environmental Effects on Pain and Self Care Functions for Targeted Design Interventions. A significant cohort of adults with osteoarthritis of the hip and knee are surgically averse (i.e. forgo joint replacement) and live with chronic pain. When a patient experiences pain during self-care (e.g., bathing), the patient’s dysfunction (e.g., osteoarthritis), is often targeted in an intervention to the exclusion of investigating the interaction between the user’s capabilities and the designed environment (e.g., a high bathtub wall). Environmental studies on retrofitting the home environment for enhanced patient functioning have been conducted with varying successful outcomes (e.g., increased functional independence, reduced pain levels, reduced health care costs) in older patients with a wide range of activity limitations, but the authors know of no studies to date that have targeted patients with chronic pain, including patients with persistent osteoarthritis-related hip and knee pain who are surgery averse. A broader understanding of the functional movement within activities of daily living is needed to ascertain to what extent environmental solutions can mitigate pain and enhance function for this targeted patient cohort. The short term goal of this pilot study is to develop a needs assessment tool, DIEM, targeting surgically adverse patients with persistent hip and knee pain. DIEM will be a micro analysis tool that combines critical body movements, compensatory behaviors, and assessment of pain levels during self-care activities to analyze the person-environment fit. This would allow for more targeted interventions that minimize physical effort or change the muscle force, torque, or joint angle during activity-causing pain. The long term goal of this study is to moderate pain levels and increase self-care and mobility of persons with persistent hip and knee pain through a multi-faceted intervention that includes 1) targeted interventions of the home environment, 2) home monitoring systems to collect objective data to assess the effectiveness of environmental interventions on activity levels, and 3) mobile health technologies to assess pain levels and provide a positive feedback loop. DIEM would be used to investigate these suggested hypotheses.