PHYSIO WALL
Julia Renner + Kurt Collins
How Can Physiotherapy Waiting Rooms Promote Health and Wellness?
Rehabilitation is a common process for many people to undertake throughout different points in their lives. Physiotherapies are used as a tool to rehabilitate, strengthen and treat many different muscular-skeletal injuries. However after extensive research, we have found that there are two areas of the physiotherapy world that need improvement: the waiting room spaces and the improvement of injuries (particularly shoulder injuries) in combination with preventative measures to ensure muscle and bone health and strength for the future. The benefits of strengthening the shoulder, as well as the importance of reducing stress and anxiety in a waiting room will be explored in a salutogenic approach. Furthermore, the exploration of preventing future injuries will also be discussed, due to the importance of preserving a patient’s positive wellbeing. By utilizing the vast wall space in physiotherapy waiting rooms, patients (injured or not) can increase the strength and mobility in shoulder muscles and in turn move towards a healthier body and life.
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CRITICAL ANNOTATION
To further explore the world of physiotherapy and salutogenic health measures currently available in the world, we have created a collection of health and design resources that share how and why health offices, spaces, and treatments need to be improved. The precedents gathered here show where in the world salutogenic changes are being made to improve overall health and physicality.
CRITICAL ANNOTATIONS
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WHAT IS WORKING?
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CRITICAL ANNOTATION
Rebecca Onie describes her experience as an apprentice in law working with low-income families who are losing their homes. Onie describes a common trend of families who do not have enough money to pay their rent also suffer from illness or diseases (HIV, asthma, ear infections). While treating the main illness with antibiotics and sending patients home is important, Onie worked to create Health Leads, an organization that puts basic health needs at the forefront of clinical and pediatric care. Patients can be prescribed food, running water, and heating in the colder months before the illness begins instead of waiting for the patient to be in crisis and receiving help at the last minute. One thousand college students signed on to Health Leads and helped nine thousand families find proper resources for a healthier quality of life. Onie then looked at college students studying in medical programs, and asked for them to think beyond the prescription, to search for ways to offer transportation to food stores and gyms, or help to find insurances to cover costs. Rebecca Onie highlights the importance of salutogenesis and healing health concerns with proper diet, home life and exercise. Her speech can help describe a new perspective on rehabilitation in physiotherapy offices.
WENDY WALKER’S ACTIVITY PROMOTION
The author of this article pushes for physiotherapy treatment before issues occur since a lack of constant physical activity is the fourth leading cause of global mortality. Insufficient physical movement can lead to an increase risk of cardiovascular disease, cancer, and diabetes. Patients can improve their cardiovascular health by adding thirty minutes of exercise to five days of the week, such as going on walks, cycling, or playing a sport. Instead of physiotherapists asking questions like, “where is the pain currently?” they can add questions such as, “Does your daily job involve any physical activity?” or “On average, how many hours of exercise do you do per week?” These questions can lead to an open discussion of how exercise can be implemented into the patient’s daily life. The article also discusses changes that can be made to the physiotherapist offices, such as utilizing the vast amount of space on the walls of waiting rooms or patient rooms. Posters about health studies or at-home body weight exercises can give patients ideas of how to improve their physical activity levels before they see the doctor. There is also consideration of patients taking health quizzes while waiting, or writing lists of ways to add activity in each aspect of daily life. Both of these possibilities can be used in our development of space design ideas for physiotherapy
CRITICAL ANNOTATIONS
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ONIE’S TED TALK: A SALUTOGENIC APPROACH
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CRITICAL ANNOTATION
The Modular Healthcare Room Interior was designed by Earl S. Swensson in 2001 and it was designed to create an environment in what would’ve been an empty room. As stated in the abstract to the research paper, “the interior assembly includes a modular sidewall assembly which includes a plurality of pre-fabricated wall panel segments connected together. Each wall panel segment includes a finished interior wall surface. A divider wall separates the room into a bedroom and a bathroom. A pre-fabricated vanity unit is located in the bottom. The vanity unit includes a vanity countertop, a vanity wash basin and a vanity perimeter wall. A prefabricated bathing unit is located in the bathroom. A pre-fabricated nurse’s station is located in the bedroom.” From the description of the invention, quoted from the abstract, an entire new environment has been created which could not of been completed without the panel segments described in the text above. As the text being annotated is a patent, there was not a broad description on what research had been completed but there is a clear understanding that addressing a space for more than one party is imperative in order to successfully influence each user positively.
EFFECTS OF INTERIOR DESIGN ON WELLNESS: THEORY AND RECENT SCIENTIFIC RESEARCH
The article above explores the correlation between mental health and the interior design of a healthcare facility. Ulrich talks about different branches of an interior that can be addressed in order to reduce stress for patients, this includes; “having a sense of control, access to social support and an exposure to positive distractions.” The article briefly touches on the importance having different parties separated as the positive and negative distractions may differ between the parties drastically. For example, the receptionist being separated from the patients in the waiting room should be taken into consideration as the receptionist may want to have the television on or music playing, whereas the patients may be in a fragile state causing them to not want as much if any sensory distractions. The researchers also explore the idea of having an artist in-residence which would be able to have a larger impact on patients by working with them to provide a positive distraction that would be completely unrelated to any wellbeing.
CRITICAL ANNOTATIONS
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MODULAR HEALTHCARE ROOM INTERIOR
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PRECEDENT
The High Line used to be an elevated railway for subway cars, but it was abandoned and re-established as a walking path for NYC locals. There are curved benches for those who need short breaks, but the shape only allows one to two people to sit at once. This promotes constant movement of people along the path. There are flowers, trees, and wrapping plants around the pathway for a “nature” feel. The winding shape of the path encourages locals and tourists to keep moving forward to see what is around the next corner; there are street performers, musicians, and shops all along the High Line. While this space is way too big to employ in a small physio therapy waiting room, the idea of a space faciliating constant movement can be used in our design.
PRECEDENTS
NEW YORK CITY’s HIGHLINE
THERAGUN
Designed by Dr. Jason Wersland, the Theragun is a tool massage tool that is used to decrease pain, increase range of motion, and improve blood flow. The Theragun has a hand held drill aesthetic with a jackhammer-like ball on the end of it. The product was created as a means to easily provide deep muscle relief for patients suffering from muscle aches. Implementing this into waiting rooms as an actual hand held product or inside furniture could provide a positive and salutogenic experience in the waiting room.
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PRECEDENT
Graduate School of Design at Harvard University student Lauren Friedrich created a model of a climbing wall that would separate different workspace offices. Employees would have to navigate, climb through, and step around poles to reach meeting rooms, kitchen spaces, or cubicles. This is a hard design to implement as it does not allow those with mobility issues to move around the office. However, the idea of adding “movement walls” can absolutely be added to physiotherapy waiting rooms. While climbing may be difficult, workout tools like levers and pulleys can be placed on the wall for patients to use while waiting to see the physiotherapists.
PRECEDENTS
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FRIEDRICH”S CLIMBING WALL
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PRECEDENT
PRECEDENTS
TEAMLAB’S TOKYO DIGITAL MUSEUM
Japan’s world famous digital art museum is an interactive space with ever-changing walls, moving floors, and hanging art that can be hit, moved, or changed by visitors. Most of the rooms are kept secret since they are made to be visited in person, but these spaces are an interesting way to manipulate the walls and floors to encourage physical activity.
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HOSPITAL RESEARC
MELBOURNE CBD PHYSIO
BODYCARE WORKPLACE
NEW ENERGY PHYSIOTHERAPY
ERROL STREET PHYSIOTHERAPY
PURE PHYSIOTHERAPY
• Camberwell, Victoria • Focus On: helping back, shoulder and knee pain • Can also help improve chronic injuries and sports-related injuries • Won 4 Health Industry Awards and a Gold Medal Melbourne Design Award
• South Melbourne, Victoria • Focus On: proactive injury prevention and mental health • Offers public training courses on mental and physical health • Holds programs on strength and flexibility solutions for injuries
• North Melbourne, Victoria • Focus On: physio and clinical pilates and sports rehabilitation • Goals to improve current injuries but to also prevent future pains • Offers physiotherapy help and information on their instagram
• CBD, Victoria • Focus On: rehabilitation mostly, pathogenic approach • Wellness Classes: individualized programming to improve current pain • Focuses on mostly ACL injuries and existing knee pains
• Docklands, Victoria • Focus On: prescriptive exercise and healing as quickly as possible • Offers trigger point therapy and post-rehabilitation courses • Holds sessions for ultrasounds and clinical pilates for continuous healing
• Queen St CBD, Victoria • Focus On: existing injuries in the hips, shoulders, and ankles • Waiting Room space is a positive envronment with large windows and helpfull staff • Offers dry needling and therapy
HOSPITAL RESEARCH
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UPWELL HEALTH COLLECTIVE
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CASE STUDY: ERROL STREET PHYSIOTHERAPY
We visited Errol Street Physiotherapy to study the methods of rehabilitation that they offer. The office is very inviting; there are hanging live plants in the corner, bright and colorful paintings on the walls, health and fitness magazines, water cups, and wellness/workout gear for sale. The physiotherapists described their process of care, which included assessment of previous pain (chronic pain or single injury), questions on the client’s future goals, and development of care plans based on the client’s time and ability. Clients are taken as a first come, first serve basis and the approximate wait time is between five and twenty minutes. Outside of the office, clients are encouraged to share their recovery and health journey stories on the Errol Physio Instagram to inspire others to join sports groups and live a healthier life. However, the waiting room space does not reflect this balance as much as it could. Since there are very few chairs and short waiting times, clients tend to only come to the office if physical pain is already occurring. The space behind the waiting room consists of workout and fitness therapy-based machines, but these are out of sight from the main office. There could be a stronger harmony between the new clients and the physiotherapists if the waiting space was organized differently.
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FOCUSED RESEARC
As stated in the article “The Waiting Room ‘Wait:’ From Annoyance to Opportunity,” the patientdoctor connection is incredibly important for longterm health and healing. However, the idea of rehabilitation only occurring in the hospital rooms during one-on-one doctor appointments neglects the possibility of growth occurring outside the hospital. “The most common problem that needs addressing is long-term and short-term shoulder pain,” says physiotherapist Katie. “Many patients are either injured or suffer from chronic pain because of excessive, uneducated use of the back and shoulders.” With eighteen to twenty-five percent of people worldwide suffering from shoulder pain and with the lack of current productive use of space within common waiting rooms, how can we promote health and wellness of shoulder muscles in the time and space allotted in physiotherapy waiting rooms?
FOCUSED RESEARCH
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OUR FOCUS: HOW CAN WE HELP?
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FOCUSED RESEARC
Derived from a paper published by the University of Kentucky, John McMullen and Timothy L. Uhl explore the concept of using the entire body to rehabilitate an isolated area. They focused solely on athletic patients that had suffered shoulder injuries during their particular sport. “The goal of most athletic rehabilitation is to return the athlete to the activity that caused the injury. Successful shoulder rehabilitation depends on an understanding of the cause of injury and a complete and accurate diagnosis of the involved tissues,” says Uhl. Uhl’s research reveals the importance of involving the entire body to rehabilitate one particular area such as the shoulder. “Rather than isolating the shoulder and gradually incorporating the rest of the body, this approach focuses on rehabilitating the entire neuromuscular system by integrating multiple body segments throughout the process” (McMullen, p.330). The ability to implement the entire body in the rehabilitation process of an isolated injury would bring the patient back to their original state prior to injury.
Physiotherapists will use this therapy process during their treatments, and patients will be educated on how to rehabilitate themselves as a supplementary treatment, which then would significantly improve the effectiveness of the rehabilitation process. The most common shoulder injuries include Rotator Cuff Syndrome (where the ball and socket joint in the shoulder are not functioning properly) and Shoulder Bursitis (when the bursa fluid-filled sac that reduces friction in the shoulder is inflamed) (see figure on the next page). The most effective exercises used for improving shoulder movement and relieving pain include doorway stretches (hands placed on the doorway, pulling the shoulder muscles away from the neck and back), and highto-low rows (where the patient pulls resistance bands from above the head to by his or her hip). Shoulder injuries occur commonly in the front section due to incorrect usage in sport or muscle activation whilst lifting heavy objects. Applying resistance to the injured area, using a resistance bands or light dumbbells and performing high repetitions for natural movements may start the rehabilitation process.
Our goal is to combine this fun movement style with the empty space of physiotherapy walls in order to cement the idea that strengthening the body can be a positive activity and not a chore for rehabilitation. In a study where participants try exercises in different settings, it was found that more enjoyable tasks done (watching tv, playing a game) during exercise led to higher moods when the exercise is complete (Privitera). This can be seen in practice in CrossFit workouts. We interviewed the co-founders of NOBULL (a fitness-focused shoe design company) Marcus and Michael, to better understand how individuals can push through intense workouts daily. “CrossFit keeps you moving because when done well, it doesn’t feel like exercise,” says Michael. “It feels like a playground. With the tires and ropes [and] the team running, it feels like recess.” The goal after these interviews was to design a space that took the mind off rehabilitation and instead brought the mind to a place of fun.
FOCUSED RESEARCH
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KEEP MOVING FORWARD
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OUR DIRECTIO
To incorporate the findings discussed above in a physiotherapy waiting room, our group is proposing a feature wall with different activities and sections to enhance the waiting room experience. The feature wall will be a modular system that can be swapped and moved around to suit the needs of those in the waiting room and to create a playful environment. The modular system will comprise of a grid of twelve arranged by three rows and four columns, as interlocking cubes. Three cubes will have weighted puzzles and different activities for the patient to complete whilst being distracted from the pain, the second three will have resistance bands hanging from the centre for light resistance training, the third set of cubes will be comprised of different handles in different positions to target different angle when pushed against, the final set of three will be pigeon holes with different dumbbells, kettlebells and medicine balls that the patient can take out and use in the open area. The application of the modular wall would mean that waiting rooms would need to be organised to allow room for movement of more than one patient depending on the foot traffic of the individual practice. The cubes would be created from a lightweight yet sturdy material such as plastic, which would allow for easy rearranging whilst not falling apart under the force of the user. In conclusion, the modular rehabilitation wall will allow the user to stretch, strengthen and entertain. The Physio Wall will enhance what would otherwise be a dull experience of waiting for a doctor’s appointment.
PHYSIO WALL: A FUN AND EXCITING WAY TO KEEP HAPPY AND HEALTHY
OUR DIRECTION
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OUR PROPOSAL:
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SOPHIE
Persona: Student Physiotherapy Client
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ABOUT
CORE NEEDS
Age: 22 years old Major: Journalism Location: Melbourne
Rehabilitate shoulder Graduate from RMIT Visit family in Spain
BIO
PAIN POINTS
Tennis Player Studies at RMIT Dance Club President Works at Melbourne Baths Extrovert
Very busy schedule Has many time commitments Has a flight coming up Needs to heal from injury
MOTIVATIONS
SKILLS
Making the RMIT Tennis Team Learning to be independent
Time management Strong focus Sympathetic to others
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ANDREW
Persona: Father of two children
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ABOUT
CORE NEEDS
Age: 47 years old Career: Accounting Location: Toorak
On going back pain Graduate from Harvard Visit family in England
BIO
PAIN POINTS
Soccer Player Office Job Father of two children Enjoys playing golf Introvert
Very busy schedule Has many time commitments Has a flight coming up Needs to heal from injury
MOTIVATIONS
SKILLS
Family Soccer team Holiday to Bora Bora
Time management Strong focus Sympathetic to others
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BEATRICE
Persona: Grandmother living with family
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ABOUT
CORE NEEDS
Age: 75 years old Career: Retired Location: Hawthorn
Needs to be able to take care of her grandchildren
BIO
PAIN POINTS
Competitive Bingo Player Lives alone Sees her children every weekend Enjoys crosswords Introvert
Restricted/minimal movements Joint and back pain
MOTIVATIONS
SKILLS
Cheese and Wine Night Bingo Night Playing with her dog
Knitting Lots of free time Caring towards family
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Inspiration Movement Play Strengthen Focused
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Our final proposal will be able to address a wide range of injuries, especially shoulder injuries. As well as addressing common shoulder injuries, the final proposition should be able to cater for a broad range of users with different needs and restrictions, such as height and age. Whilst primarily designed for rehabilitation, the proposition will also bring a different mood to a physiotherapist’s waiting room and fill in large wall areas.
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POST-INTERVIE
POST-INTERVIEW
“That is so interesting, that has never been explored or done before. It think this is great idea for our patients. It would just have to be regulated by physiotherapists for ongoing safety.� -Nick, Errol St. Physio
POST-INTERVIEW: HAVE WE IMPROVED?
After deciding on our final practice-based outcome, we returned to Errol Street Physiotherapy to talk to the physiotherapists again about our project. We discussed our designs for the wall space in the physiotherapy waiting rooms, and they gave feedback on how they believe their patients would take to the new installation.
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The ‘Rehabilitation Wall’ is a wooden frame that holds twelve modular boxes with a total of four different sections. The boxes are made from abs plastic to allow for durability whilst in use and being able to click in place, as well as being light weight to allow for users to easily move each module without dropping it or injuring themselves further. The first three modules are fixed bars that the user can hold on to in order to stretch different muscles. Moving these three modules around to different heights will allow for easier access and different muscle targeting, in addition, all three bars are on different angles to suit the comfort of the user. The following three modules are weighted puzzles that require the user to play and move the pieces around which adds a tactile sense of playfulness and distraction from the original pain source. The third set of modules have resistance bands, these resistance bands can be pulled on and moved in a semi-fixed position which will therefore stretch and activate the muscle being used. The resistance bands not only cater to shoulder movements but also many muscles across the body depending on the position the module is placed in on the wall. Finally, the last set of modules are pigeonholes that act as extra space to hold different objects to be used freely in the waiting room. Objects such as dumbbells, medicine balls, foam rollers, water and even magazines can all be placed in the pigeonholes to allow for additional storage space in the waiting room.
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SOURCE
Barta, Kristen, ‘Five Exercises for Rotator Cuff Pain,’ Healthline. https://www.healthline.com/health/ rotator-cuff-injury-stretches Heather, N, Sherwin, McKeown, Megan, Evans, F, Michael, Bhattacharyya, K, Onil, ‘The Waiting Room “Wait:” From Annoyance to Opportunity,’ Canadian Family Physicians (CFP). https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3653648/ Keast, Karen, ‘Physiotherapist Paves the Way in Mental Health,’ Health Times. https://healthtimes.com.au/ hub/physiotherapy/8/news/kk1/physiotherapist- paves-the-way-in-mental-health/219/ Madigan, Nicole, ‘APA Calls for Funding to Help Chronic Pain Sufferers Access Long-Term Physio,’ Health Times. https://healthtimes.com.au/hub/ physiotherapy/8/news/nm/apa-calls-for-funding- to-help-chronic-pain-sufferers-access-longterm- physio/4368/
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Pazzanese, Christina, ‘Design for Movement,’ The Harvard Gazette. 2016. https://news.harvard.edu/ gazette/story/2016/08/design-for-movement/ Pope DP, Croft PR, Pritchard CM, ‘Prevalence of Shoulder Pain in the Community: The Influence of Case Definition,’ Annals of the Rheumatic Diseases. https://ard.bmj.com/content/56/5/308 Privitera, Gregory, Antonelli, Danielle, Szal, Abigail, ‘An Enjoyable Distraction During Exercise Augments the Positive Effects of Exercise on Mood,’ US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3990878/
SOURCES
Barclay, T, ‘Deltoid Muscle - Anatomy Pictures and Information’ Inner Body, 25 September 2019. https:// www.innerbody.com/image_musfov/musc12-new. html
Onie, Rebecca, ‘What If Our Health Care System Kept Us Healthy?’ TedMed, 2012. https://www.ted.com/ talks/rebecca_onie_what_if_our_healthcare_system_ kept_us_healthy/transcript?language=en
‘Shoulders.’ Shoulders-Arthritis Australia, 2017. https:// arthritisaustralia.com.au/what-is-arthritis/areas-of-the- body/shoulders/ Ulrich, R. (1991) ‘Effects of interior design on wellness: theory and recent scientific research,’ Journal Of Health Care And Design, 3, 97-109.
McMullen, J., & L. Uhl, T, ‘A Kinetic Chain Approach for Shoulder Rehabilitation [Ebook] (pp. 329 - 337),’ Journal of Athletic Training. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC1323395/ ‘The Mental Health of Australian Elite Athletes.’ https:// www.researchgate.net/publication/261989372_The_ mental_health_of_Australian_elite_athletes
Walker, Wendy, ‘Physical Activity Promotion in Your Clinic,’ Physiopedia. https://www.physio-pedia.com/ Physical_Activity_Promotion_in_Your_Clinic
Miller, J, Jack, M, ‘Shoulder Pain,’ Physioworks. https:// physioworks.com.au/Injuries-Conditions/Regions/ shoulder_pain
Yamada, Takeshi, ‘Digital Art by TeamLab,’ Proceedings of the 2018 International Joint Workshop on Multimedia Artworks Analysis and Attractiveness Computing in Multimedia. https://borderless. teamlab.art
Walker-Bonem Dr K, Linaker, Dr CH, ‘Shoulder Disorders and Occupation,’ US National Library of Medicine National Institute of Health. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4836557/
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THANK YOU
Julia Renner + Kurt Collins