General details
EDIHs involved
Challenges
Marien Aktiv is the interdisciplinary therapy and rehabilitation center of the Marien Gesellschaft Siegen (healthcare company based in Siegen) offering a comprehensive range of services in prevention, rehabilitation and physiotherapy across multiple locations. The focus is on cardiological and orthopaedic rehabilitation, supported by modern equipment and a qualified team of doctors, physiotherapists, sports therapists, and occupational therapists. Additionally, Marien Aktiv collaborates closely with companies to promote employee health and performance through customised prevention programs.
Orthopaedic rehabilitation is not only a medical necessity but also an economic factor,influencing workforce productivity, healthcare costs and the broader economy. Patient motivation plays a crucial role in the success of rehabilitation. While a significant number of patients in orthopaedic rehabilitation, particularly older individuals who may not return to work, face challenges motivating themselves to follow their recovery plan, others remain highly engaged in their recovery. This is especially true for younger patients, who often retain the physical and mental energy to actively participate in rehabilitation, even after a full day of outpatient therapy.
This difference in energy levels represents an untapped resource that could support individual recovery, reduce overall treatment costs, and enable faster reintegration into private and professional life.
As part of an industry project, we observed that a rehabilitation program is needed, providing all patients with exercises that can be done at home, between therapeutic sessions, or as an additional activity within the rehabilitation facility. These exercises must be suitable for individuals with orthopaedic limitations and should ideally be engaging to enhance long-term motivation.
Solutions
In the project, three development steps were conducted: (1) Understanding experiences, needs and expectations of patients and therapists through nine days of observation and 14 interviews, deriving technical and interactive implications. (2) Iterative design and development of a robotic prototype, which we then implemented and evaluated in (3) a study evaluating how patients and therapists used the system in practice.
Based on the initial findings, a system integrating four main components was developed: a mobile telepresence robot (TEMI), a pose detection module, an exercise training application and adaptive music software. The system operated via a tablet on TEMI’s internal Android system, managing pose detection, external music software communication and user feedback. TEMI, serving as a mobile physical interface, featured an internal camera for tracking user movements and providing real-time feedback. It could be remotely controlled to support users to position itself optimally during exercises. The User Interface provided intuitive, real-time feedback, highlighting incorrect postures for self-correction.
A key insight from the research was the potential of adaptive music to enhance motivation and engagement. The integrated music software adjusted in real-time to user movements, fostering an immersive training experience. The system, grounded in established therapeutic interventions and expert feedback, aimed to support orthopaedic patients by combining training with engaging, music-based interactions.
Patients reported reduced pain perception as they focused on music. The camera did not record but counted repetitions, saving them under an anonymous ID within a ranking. Many patients found this motivating, particularly younger ones who enjoyed the challenge. However, older patients also engaged actively. The system encouraged playful participation, motivating patients to practice further movement.
Results and Benefits
Integrating the TEMI has yielded significant benefits for both patients and the orthopaedic rehabilitation institution that we explored and documented in the evaluation study (3). This innovative approach to patient exercise has improved engagement, motivation, and therapeutic outcomes in several important ways:
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Increased Patient Motivation and Engagement
As already described, by transforming exercise into an interactive and enjoyable experience, the solution motivated patients to engage more actively in their recovery process. The software’s ability to play progressively more complex music based on the speed and correctness of movements adds an element of gamification to the other therapeutic offers. -
Pain Distraction Through Interactive Focus
A key finding of this implementation was the reduction of perceived pain during exercises. The need to focus on synchronizing movements with the rhythm and tempo of the music diverted patients' attention away from discomfort. This distraction effect, facilitated by the music-based interaction, helped patients become less conscious of their pain while exercising. Such an approach can enhance the overall experience of physical therapy, making it more accessible and less intimidating for patients with chronic pain. -
Consistent Exercise Routines at Home and in Institutional Settings
The system's design makes it suitable not only for in-institution sessions but also for at-home practice. By allowing patients to follow familiar exercises independently, the program encourages consistent practice outside the therapy centre. This consistency has the potential to accelerate recovery times and increase the effectiveness of rehabilitation programs, as patients build upon gains made in guided therapy sessions. -
Improved Form and Reduced Risk of Injury
The Temi robot’s camera can recognize human movements, allowing for real-time feedback on exercise form. Patients received corrective audio cues, such as reminders to keep their knees aligned correctly during squats, which helped them avoid common mistakes and reduce the risk of injury. This level of personalised guidance typically requires a therapist's supervision but can now be partly managed by the robot, allowing therapists to allocate time more effectively to other patient needs. -
Competitive Element Increases Patient Adherence and Satisfaction
The system’s tracking feature, which counts and records repetitions under a secure, anonymized ID, adds a competitive layer that resonates with many patients. This element of competition was particularly motivating for younger patients, who often aimed to outperform their previous scores. Interestingly, many older patients also responded positively to this feature. Overall, the competitive aspect contributed to a noticeable increase in patient adherence and satisfaction. -
Efficient Use of Institutional Resources
Automating aspects of exercise supervision and real time feedback allows the institution to support its professional therapists. Therapists can focus on high-need areas, while routinized, repeatable exercises are managed by the system. This efficiency may leads to cost savings and optimises therapist-patient interactions, ultimately improving the quality of care provided. -
Creating a Positive Institutional Image
By implementing this cutting-edge technology, the institution positions itself as an innovative leader in orthopaedic rehabilitation. The use of interactive robotic technology not only enhances the patient experience but also appeals to new patients who may be seeking more engaging and technologically supported care options. This advanced approach strengthens the institution's reputation and helps attract both patients and talented healthcare professionals looking to work in a forward-thinking environment.
Perceived social/economic impact
The integration of the system in orthopaedic rehabilitation delivers substantial social and economic advantages.
Social Benefits
The system fosters greater patient engagement, particularly among individuals who struggle with motivation, such as older adults. By making rehabilitation exercises more enjoyable and interactive, it reduces perceived pain and encourages adherence to recovery programs. This, in turn, improves patients' quality of life and accelerates the healing process.
Economic Benefits
From an institutional perspective, the system enhances efficiency by reducing the need for constant therapist supervision during routine exercises. This allows medical staff to focus on more complex cases, optimizing resource allocation. The increased efficiency can lead to cost savings and potentially lower treatment expenses for patients. Additionally, institutions implementing this advanced, patient-friendly technology can build a strong reputation, attracting more clients and ensuring long-term financial sustainability and growth.
Measurable data
A total of 90 patient interviews were conducted following interventions with the robotic system. The findings revealed a distinct relationship between patients’ attitudes toward the music and their perception of the system. Patients who found the music relaxing tended to have a more critical stance toward the technology, whereas those who felt motivated by the music perceived it as a source of support.
To further assess emotional responses, established psychological measures were used, including the Positive and Negative Affect Schedule (PANAS) scale. This scale evaluates an individual’s emotional state through two subscales: positive affect (e.g., enthusiasm, alertness) and negative affect (e.g., distress, nervousness), with participants rating their feelings on a Likert scale.
An analysis of PANAS results over a four-week evaluation period—from T1 (before the first session with the robot) to T2 (after the last session)—showed the following trends:
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Positive Affect: 12 out of 20 patients reported an increase, 6 experienced a decrease, and 2 remained unchanged.
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Negative Affect: 12 patients exhibited a reduction, 2 showed an increase, and 6 maintained the same level.
These findings suggest that the initial interaction with the system not only fostered positive emotions but also contributed to a reduction in negative emotions, highlighting its potential psychological benefits in rehabilitation.
DMA score and results - Stage 0
Before the implementation of the service, the company faced several challenges in its digital landscape:
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Strategy & Leadership: Digital transformation was not yet a core focus, and leadership engagement was limited.
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Technology & Infrastructure: Existing digital tools were used selectively, and system integration posed challenges.
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Processes & Workflows: Manual and paper-based workflows led to inefficiencies in daily operations.
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Digital Culture & Skills: Employees were open to digital solutions but lacked structured training opportunities.
Customer Strengths & Weaknesses Before Implementation
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Strengths: The company had a motivated workforce and was willing to engage with digital tools. Some digital elements were already in place.
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Weaknesses: Limited leadership involvement and a lack of structured digital workflows hindered efficiency and scalability.
Implementation & Results
Through this collaboration, the company was able to strengthen their digital repertoire and improve internal workflows. Employees became more confident in using digital tools.
Lessons learned
The project demonstrated that interactive, gamified rehabilitation can significantly improve patient motivation and adherence, especially in orthopaedic settings where engagement is often challenging. The integration of music as biofeedback was particularly effective in distracting patients from pain and increasing enjoyment. Moreover, providing real-time feedback on form helped patients perform exercises safely, reducing injury risk. Finally, the positive responses from both younger and older patients showed that technology-driven approaches can appeal to diverse age groups if designed thoughtfully.
Do's
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Do ensure that the system is easy to use and accessible to patients of varying ages and physical limitations. User-friendly design is crucial for broad acceptance.
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Do incorporate feedback mechanisms to help patients perform exercises correctly, as this enhances safety and effectiveness.
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Do keep the exercises engaging by using gamified elements, like music or progress tracking, to sustain motivation over time.
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Do respect patient privacy and ensure data anonymity, particularly with features like ranking systems, to build trust.
Don’ts
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Don’t overload patients with complex technology or instructions. Practice-based Design, needs-oriented Features and interactive Simplicity is key, especially for patients unfamiliar with digital tools.
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Don’t rely solely on robotic feedback. While automation is helpful, in this testing phase, we never let the robot alone with a patient.
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Don’t ignore individual patient needs and preferences. Some may prefer or benefit from traditional methods, so flexibility is necessary.
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Don’t underestimate the importance of maintaining a human element in rehabilitation. Technology should enhance and augment, not replace, the patient-therapist relationship.
These lessons highlight the value of a balanced approach that combines innovative technology with personalized care, making rehabilitation more effective and enjoyable.
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