designing interventions for chronic pain patients

designing interventions for chronic pain patientsHow to prevent relapse after treatment

Team #5

4 6 8 11 15 19 2325About usintroduction

methods and

data collection

intervention 1

intervention 2

intervention 3

future intervention

ultimate conclusion

About usWho are we

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5Diederik van AalstDiederik (23) is a Communication and Multimedia Design student from Tiel. He is an all-round designer that always strives to find the most practical solution.

His down-to-earth personality will aid us in finding the

best solution to this design challenge. He has little af-fection with the medical theme, but is always striving to learn new things and broaden his knowledge. Due to this motivation, in combination with his practical approach, he will assist the team in creating interven-tions for chronic pain patients.

Jesse van BeekJesse (21) is a Communication and Multimedia De-sign student. His strongpoints are creating a better user experience and express things visually. When he became a graphic designer he wanted to make things look nice, after his specialisation in user expe-rience he wanted to create a better online web, but now a days he is more interested in social projects and wants to help people and create a better world. With his expertise and his motivation he definitely

could be an added value in this project.

Sam van GerwenSam (23) is an Industrial Product Designer student from Utrecht. He is a designer who is educated to do research, visualize ideas and make it practical by producing a product in the end. These assets can be implemented in the team and the project which results in a good addition overall. He wants to help people wherever possible and this project is a per-fect example of being able to help. Assisting people in need where possible with the ideas and products, this hankering ideal of making everyday life easier as a constant striving.

Marieke VeneklaasMarieke (22) is an Orthopaedic Technology student who is specialised in shoes. This subject is very inter-esting for her work in the future since a lot of clients only come to shoe-technologists when they are in pain. Besides that, she thinks its really satisfactory to work with people. Her medical background will greatly help us in understanding the patients and the assignment. Also her logical way of thinking will aid us in finding the right insights and valuable informa-tion throughout this project.

+31 (0) 6 21 65 76 [email protected]

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+31 (0) 6 23 24 71 91mariekeveneklaas

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+31 (0) 6 40 25 93 [email protected]

IntroductionIntroductionSummary and debrief

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7DebriefAdelante, Maastricht UMC, the Fysiotherapist, Pain patients to one voice and the University of Applied Sciences Utrecht cooperated and started the re-search section Solace. In this section they research what strategies can be adopted to prevent relapse by chronic pain patients.

The reason why they involved the University of Ap-plied Sciences Utrecht in the research is because of the budget that they had for the research. The assignment for the Co-Design students is to design several interventions to gather insides for prevening relapse for patients with chronic pain.

Doing desk research was not necessary because all the information was foreseen, but important was to validate the existing research. A lot of research has already been done, divided in four posters, with different themes:

The patient and his or her goals; The healthcare provider and the treatment

program; The patient and his or her personal space; The patient and his or her life after rehabilitation.

SummaryTreating chronic pain patients is a big issue in the Netherlands, almost one in five has chronic pain,

but no real solution is present. This issue has been presented by Solace, which is a collaboration be-tween three healthcare facilities and the University of Applied Sciences Utrecht.

The hidden design rules are used for the project to come up with three iteration-intervention stages to collect as much useful new insights and data as pos-sible. The second and third iteration and intervention used gathered information from the previous stage to proceed with. This information is clustered to give a direction for a fourth intervention, which will be pre-sented to the client as a future intervention they could conduct afterwards in addition to their research.

After every intervention we will show a strategy map. This map shows the main insights that we have gath-ered throughout the process and will show the cho-sen direction of our research. The first strategy map

is created from the insights that were given at the beginning of the project. The white coloured insights will be tested with interventions.

Throughout this report you will see the term CCP, this stands for Chronic Pain Patient.

Our theme/challengeOur group is doing research on the patient and his/her life after rehabilitation. The big challenge is de-signing an intervention to prevent relapse for patients with chronic pain. We do realise finding a solution to

prevent relapse within three weeks of research with interventions will not be possible. The subject is really complex, even for medical experts.

As mentioned before, the assignment is not about creating a solution but validating the existing re-search. So our challenge is to create three clear assumptions from the existing research, and make three low fidelity interventions based on these as-sumptions. This way we can validate the existing research and gain a lot of new insights for the Solace program.

Methods and Data Collection How do we analyse our data

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9tioner is a possibility but there never was a real bond between care provider and patient. For health care centres, the patient is just a number. Aside from the centre there are always the friends, partner and other people surrounding them, but the question remains; do they understand them?. A solution could be to hide their pain, because their surroundings could interpret as annoying to always talk about their pain.

The chronic pain patient needs goals, structure and feedback. These three key parts are really important to create a successful treatment. If they do have set goals but no real structure a certain kind of relapse is inevitable. A day off does not feel as a relapse but this could change their whole structure goes awry. Is relapse inevitably connected with the moment the patient reaches his/her goal?

As mentioned before there already was a lot of researched information available for use to form as-sumptions with. The project needs a thought-through direction and understanding of the project. Jan Belon from The Department of Extraordinary Affairs (Afde-ling Buitengewone Zaken), whom is an expert in the Hidden Design approach, gave different methods to understand the situation and set a correct direction in the project.

System mapA system map is an excellent tool to get acquainted with the situation of chronic patients and to have an overview of their lives. Through this tool you could see what the patient is going through and see which factors, motivations and stakeholders have influence

on their life and on their possible relapse.

Insights and directionThe system map showed that chronic patients had many locations to visit and activities to attend after treatment. Taking part in all these activities can put a certain strain on the patient, which could influence

the treatment, lifestyle and (possible) relapse of the patient. After intense treatment they wont be provide with any support of the practitioner and have to do it on their own from that moment on. Calling their practi-

Strategy mapThe strategy map is a good way to visualise the assignment or issue that is being addressed. The centered circle will address the main question, which is How to prevent relapse after treatment?. In the second circle of the strategy map the first assump-tions are shown, insights based on the first interven-tion.

For every intervention circle a main assumption has been chosen, which will be validated through an intervention. More insights have been gathered with this method. These insights have been processed to form new assumptions and are validated again through a new intervention. In total three interventions have been conducted and the fourth will be a pro-posal at the end. The strategy map and the conduct-ed interventions can be found on the following pages. The strategy map will be filled in with new insights

after every intervention chapter.

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How to prevent relapse after treatment?

Patients are desperate, because they try too

many solutions

Patients are willing to share their feelings with

each otherWe believe that the

employer of the patient can help him/

her by being more involved in the life

after treatment

We believe that most of the patients dont

know their limits, they do to much so they go

into relapse faster

We believe that the patients will go into relapse when they reach their goals

We believe that patients dont want to be felt

sorry for

We believe that contact with fellow chronic pain patients will decrease

the possibility of relapse

We believe that bonding between patient and

docter results in higher motivation to excersice

after the treatment

It is hard for patients to find other patients

with the same problem

strategy map 1

Intervention oneMy goal is

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What is the intervention?The first intervention is an interactive questionnaire

and contains three parts. The first part is the eye

catcher, in the form of a board which has the ques-tion My goal is:. Respondents got a post-it and were asked to write down their ultimate goal and stick them on the board. The second part is an interactive questionnaire in the form of a spectrum. People have to scale their motivation, feasibility, structure, pleas-ance, dedication and the need of company of their personal goal. While the respondents filled in those

spectra we asked them deeper questions fitted to the

persons to gather more insights.

Intervention goal Its very interesting to know if people maintain work-ing on their goal if it is achieved or if they get bored and thus demotivated. The goal is to learn about what people do when they reach their personal goal. Also, its important to know if the respondents think their

personal goal is feasible, if they are motivated and if they rather work together or achieve goals alone.

Validating our interventionFirst it was the intention to test our intervention at the hospital. However to fulfil the intervention it was

necessary to have permission from the hospital and there was too little time to arrange that. Therefor the intervention was tested at the University of Applied Sciences in Utrecht on the 16th of October 2015.

Passers were willing to share their ultimate goals and enlighten them for the benefit of the research. This

resulted into a lot of interesting insights while testing the intervention. The insights are categorised into four themes to make a clearer image of all the information. The themes are Alone or together, Goals, Con-versation with a young CCP and Spectra.

Alone or together You can disappoint people if you dont reach your goal, but if you dont tell them your goal you cant disappoint them

Achieving your goal alone or with company de-pends on the goal;

Some respondents need support in the form of extra people to push themselves further;

Team sports give more motivation, pressure and distraction;

Achieving or losing goals can have effects on other goals.

GoalsAfter reaching the goal, I lost interest and stopped maintaining itI get more excited just by talking about my goal

Achieving a non-personal goal is demotivating;

You can disappoint people if you dont reach your goal, but

if you dont tell them your goal you cant disappoint them

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Too high demands, a complex goal or too little time are demotivating;

Taking little steps helps someone achieving their goal easier.

Conversation with a young CPPIf I dont want to relapse anymore, I need to change my lifestyle and Im not willing to give up my sport and social environment.My roommate doesnt understand me: one moment everything seems fine to me and on the other mo-ment I am the chronic pain patientI dont follow the advice of the G.P. I pass my limits and just go on.It helps if people in my environment correct me when I go beyond my limits

Spectra Nearly all the participants thought their goal is

feasible; Almost everybody is motivated about reaching

his or her goal; Participants prefer working on a structured man-

ner when it comes to achieving a goal; Although most people like achieving a goal to-

gether, most of them try to achieve goals alone.

ConclusionAlthough some respondents say that after reaching their goal, they lose interest, CPPs may not have this feeling because of their situation. Every day can be a struggle. Other people can help reminding this per-son and motivate them to reach their goal.

Almost everybody has currently a goal and believes it is a feasible goal. Although most people want to achieve their goal alone, they would like extra sup-port in the form of an extra person to reach their goal. Everyone is motivated to achieve their goal, and they get extra motivated when they work in teams or even talk about their personal goal.

These insights can be found on the next page of this document. Here you will find the new strategy map

based on the insights that we gathered from this intervention.

Intervention number two will be about the insight Talking to other people about your goals increases the chance to achieve them, due to a higher motiva-tion. This insight was the most common reaction that was given by the respondents.

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Patients are desperate, because they try to

many solutions





after treatment



into relapse faster


Reaching goals that you didnt set up yourself is

demotivating

Talking to other people about your goals

increases the chance to achieve them, due to a

higher motivation

People with chronic pain rather not talk about their problems to people who dont have chronic pain. They dont understand

their problems


sorry for





after the treatment



strategy map 2

Intervention twoWould you share your goal

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What is the intervention?The intervention is a picture frame with a whiteboard attached to it. People can write their goal on the whiteboard, and pose in the frame and share their goal this way. Pictures that have been made, have been placed on our own created Facebook page: DDWGoal.

So there were two ways to share their goal, through the frame and later on with social media. By using so-cial media, it was possible to find out if people were

willing to share their goals with there personal friends, instead of only the frame or for their own. It was also possible to track if people were willing to help one another achieving or supporting their goals, by giving them tips and advice. Which was possible by posting a reaction on the Facebook post.

Intervention goal The goal of this intervention was to research if people want to share their personal goals publicly. The goals have been shared on Facebook and have been mon-itored to find out if friends and random people were

willing to help them to achieve their goals, and if it motivates other people to share their goals as well.

Validating our interventionThe intervention was split into three parts. The first

part has been conducted on the streets from Eind-hoven. The second and last part has taken place at Design House during the Dutch Design Week in Eindhoven, on 21st of October 2015. And last but not least, the Facebook page.

Eindhoven cityThe first part consisted of asking people if they want-ed to share their goal on the whiteboard, which was attached to the frame. We made a picture of each person holding the frame for an offline Facebook

page, which has been used in the Design House.

InsightsFinding and sharing a jointly goal is way easier and more fun than an individual goal.

It is easier for people to find a jointly goal and share this together;

People were willing to share their goals, but on an abstract level. For example to let things go, earn happiness, these goals were not really personal;

People wanted to have control over sharing infor-mation publicly;

Some people considered sharing their goal as an opportunity of finding more inspiration;

When people were in groups, they motivated each other to share their jointly goal. Even when people were in doubt, they still posed in the frame because of the group pressure.

Finding and sharing a jointly goal is way easier and more fun than an individual goal

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Design HouseThe second part was at the exhibition of the Dutch Design Week. As mentioned before, the pictures that have been made on the streets have been printed and exhibited. At the exhibition people were invited to react on the goals set by the photographed people. These reactions have been written down on post-its and placed next to the pictures. It was also interest-ing to see if people felt like sharing their goals when they were aware of the fact that others were going to see their framed photos at the exhibition.

Insights People found it hard to support unknown people

in comparison to friends and/or family; People liked reacting on other goals, and it in-

spired them to draft their own personal game; People got enthusiastic when they heared or saw

a goal of a person they knew. They were more likely to react on this;

People needed more background information about someone to comment on their goal;

It was easy to say something about others when it was anonymously;

If the goal was more personal it was easier to comment on it, in contrast to more the more ab-stract goals.

FacebookAll pictures, which have been taken on the streets from Eindhoven, and in the Design House itself, where placed on the DDWGoal Facebook page. The Facebook page has been created to give the people a platform and an opportunity to respond on each other his/hers goal. This also made it possible to let people give tips and advice on how they could achieve their goals. All the pictures can be seen on facebook.com/ddwgoal.

Insights People only responded on their friends goals and

were willing to give them tips and advice on how they could achieve this goal;

People said they were willing to share their goals on their personal Facebook page, but in the end they didnt.

ConclusionThe interventions could be compared to the treat-ment. When putting in effort to go to people for a pic-ture, they were eager and willing to participate. The moment they had to put in their own effort, of sharing the picture, there was almost no activity.

Our intervention did work on the offline part, but

the online results were disappointing. People did not like to share the picture on their own Facebook. Many reactions have been given on the pictures, through tagging the people. So people were willing to re-spond on a goal of a friend, but they were not willing to share their goals publicly.

People found responding on each others situations easier when it was offline, instead of online. People

preferred finding and sharing a jointly goal, because

it was easier and more fun than an individual goal. The social pressure was also an important factor. Even when one or two people were in a group and were in doubt of sharing their goal together, they still did it.

On the next page you will find the new strategy map

based on the new insights.

People are willing to respond on goals of friend or family

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many solutions





after treatment



into relapse faster



demotivating



higher motivation


their problems

It is more fun to reach your goals together

It is harder to reach a goal on your own

It is easier for people to find a jointly goal and

share them together

It is easier to motivate/comment on goals of

people you know


sorry for





after the treatment



strategy map 3

Intervention threeAchieving your goals together

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What is the intervention?The intervention consists of two games, which will be presented to the audience. The games have to be played in duos and the participants have to cooper-ate to succeed. Participants could chose between drawing in duos and the bibber spiraal in duos.

Drawing in duos was the most visited game of the two, people had to stretch out their drawing arms and place their wrists against each other. The two arms will be connected with velcro to ensure the connec-tion. One person held the pencil, whereas the other person would take control and draws a card to draw the suggested drawing. The person holding the pen-cil will create an image with help of the other person and has to guess what it is. Weve also let them draw

an object toghether to monitor the way how they cooperate.

Observing the participants will point out if they have fun and/or develop any (positive frustrations) towards the game or the other individual. Afterwards they will be asked how they experienced playing the games and if they felt happy, satisfied and got distracted

during the activity. All this information will be written down and insights will be gathered from this.

Intervention goal The goal of this intervention is playing games with CPPs and their adherents. The game will (hopefully) generate so much fun it will relieve pain (and maybe stress) and distract them from their therapy or pain/sad moments.

Validating our interventionThe intervention took place at the Adelante health-care facility where a lot of CPPs and ex-CPPs are. During the intervention four different kinds of duos presented themselves at the games, which resulted in different insights per group.

CPP with CPP Wait-and-see attitude and reserved; Taking control is hard; Less energy is being shared.

CPP with healthcare provider Dependant of healthcare provider; Healthcare provider lets CPP take over control; Healthcare provider is still directing and giving

instructions to the CPP about what to do; Taking control is hard because of the profession-

al relationship that exists.

CPP with family/friends Familiar with each other; Taking and giving away control goes easier; Trustworthy; Are able to correct one another;

Giving away control goes easier with family or friends

Physically and mentally connected because of the interaction and energy of the other individual.

CPP with unknown Wait-and-see attitude and reserved; The unknown person takes control; Physically and mentally connected because of

the interaction and energy of the other individual. Non-CPP was compromising for the CPP.

ConclusionThe results gathered from the intervention were confirming the presumptions set in advance. Most of

the CPPs that visited the drawing game gave posi-tive feedback concerning their state of mind and the positive frustrations to perform better, which they developed during the game.

On the next page you will find the final strategy map

based on the new insights. The black coloured, obelique insight will be the foundation of the future intervention that will be presented in this report.

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many solutions





after treatment



into relapse faster



demotivating



higher motivation


their problems

It is more fun to reach your goals together

CPPs forget their surroundings by doing

activities with other people around them

It is harder to reach a goal on your own

Participants are not only physically but also mentally connected to

each other

It is easier for people to find a jointly goal and

share them together

When family and friends help the CPPs

achieve (parts of) their goal, it becomes easier and more fun It is easier to motivate/

comment on goals of people you know


sorry for





after the treatment



strategy map 4

future interventionAdvice for the ongoing research

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What is the intervention?The practitioner will end the treatment with a meeting in combination with family and/or friends. The gen-eral goal will be discussed and sub-achievements to make it easier to succeed with help of others. The family and friends present will put in their own effort to make sure some of the sub-achievements to get to the eventual goal will be done in collaboration with the CPP. This will make it easier for the CPP, because he/she wont have to cope with (more) stress or put in a lot of effort to make someone help them. Doing the sub-achievements or even succeeding in reach-ing the goal together, will make it more fun and less stressful to then doing it alone.

Intervention goalMaking it easier to approach known acquaintances for CPPs to achieve their goals more easily and make everyday activities more fun. The energy which had to be invested by the CPPs will go down because then other people will put in energy and effort to help out.

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Ultimate conclusion

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who were willing to give tips and advice on how they could achieve the set goal. Likewise, participants are more willing to share their goals in groups and enjoy it more.

So what happens if participants share their goals together and also work on this shared goal together? Participants become more motivated and concen-trated what resulted in a mental and physical con-nection. I feel his energy and it effects me too said one of the participants. This and the focus, draws the attention from internal and external factors like pain, tiredness and being in a rehabilitation center.

In life after treatment a few things are important for the CPP not to fall into relapse. Three main terms are necessary to maintain the same level or make pro-gress are feedback, structure and goals. The interventions were focussed on the goals and showed that nearly all the participants thought their goal was feasible and taking small steps helped achieving it faster. Almost everyone had a structure to reach a goal. Most respondents prefer company although almost everyone tries to achieve their goal on their own.

I get more excited just by talking about my goalEveryone gets more motivated when talking about their goal(s). The pressure rises after the participant tells about their plan to others, because they do not want to disappoint them. So are people willing to share their goals publicly? Yes however people like control about with whom they share it with and do not like to take initiative themselves. When the goals are shared without their conrol, the goals become more abstract like to let things go and earn happiness. The intervention led to two different groups who could support the CPP. The first group were total

strangers, although these respondents found it hard to write down supportive text to unknown people. The second group consisted out of friends and/or family

The results between family members are the ones who stand out most. Family members are more in sync, they communicate better and emphasize the fact it feels more familiar and nicer than drawing with one of the researchers. On the other hand the results from the interaction between healthcare providers and CPPs resulted in a different outcome. The health-care provider had trouble letting the CPP take control. He/she is used to giving instructions and remained directing the CPP. At the same time, the CPP does not want to take initiative. It seemed like there was a clear professional relationship with behaviour, which could not easily be changed.

It is quite contradictory to see how connected, focussed and motivated participants were when they were working towards a common goal, where as most respondents claim in the first intervention

stressed out they wanted to reach the goal on their own. Feedback clearly helps achieving a goal, which has has been proven through collaboration with fami-ly members. To achieve a goal, structure is preferred according to respondents. So three main terms in the lives of non-CPPs and CPPs are necessary to main-tain the same level or make progress are feedback, pattern and goals.

I feel his energy and it effects me too

Team #5

designing interventions for chronic pain patients

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