A Gesture-Based Game to Motivate Patient Activity | Pilar Córdova González, Vera Johanne Engsberg & Lucía Montesinos García
Image of two patient participants interacting with a bespoke gesture-based game to motivate physical activity in single-bed hospital rooms

Nursing Staff, Physiotherapists, Gastroenterology Patients, Hospital IT Consultants, Herlev Hospital

Literature Review, Interviewing, Ethnographic Observation, Digital Prototyping, Computer Vision Algorithm Development, Interface Development, In-Hospital Evaluation

The Capital Region of Denmark provides physical and mental healthcare for 1.7 million people or approximately 30% of the population of Denmark, and since 2018 has been engaged in an intensive program for the modernisation of three of the largest hospitals under its remit; Herlev, Hvidovre and Rigshospitalet. One key measure undertaken in this regard has been to implement single-occupancy patient rooms in place of the double rooms previously the norm; for the purpose of reducing infection, increasing sustainability, and improving patient privacy and comfort.

This change has brought about many benefits, and yet has also led to an unexpected decline in physical activity among hospitalised patients. Early mobilisation is considered an essential component of the process of recovery; critical to reducing post-surgical complications, readmission and mortality rates while accelerating rehabilitation and improving overall physical function and patient wellbeing. It is therefore widely considered a costly and challenging problem that so many hospitalised patients, regardless of the reason for admission, spend long periods of time sedentary.

Diverse methods to motivate in-hospital patient activity have been implemented worldwide, from patient guides, to multimodal peri-operative care pathways and the standardisation of physiotherapy consultations. Prior research has likewise examined a diverse range of behaviour change interventions to motivate physical activity. And yet, these are each solutions which often require significant resources to implement in the hospital context, which in turn impacts their effectiveness in practice. Little research has to date however, examined the potential of a technological approach to motivating physical activity among patients habiting single-bed hospital rooms.

It was this challenge which Pilar Córdova González, Vera Johanne Engsberg, and Lucía Montesinos García embraced in the work of their MSc thesis. Adopting a user-centred approach, Pilar, Vera and Lucía conducted observations of nursing activities, group and one-to-one interviews with hospitalised patients, physiotherapists and nursing staff at Herlev Gastroenterology department.

Through these efforts, they developed an understanding of the significant time spent sedentary by patients and the psychological impact of hospitalisation, the pressures on staff induced by bottlenecks in workflows and the challenge of prioritising never-ending tasks, as the existence of diverse interpretations of just what it means to be physically active, yielding as a result, inconsistent approaches to assessment. These insights, Pilar, Vera and Lucía leveraged to inform the iterative design and eventual development of Kinetip — a gesture-based, digital game which, through a combination of hand tracking and optical character recognition, provides a natural user interface for an active and dynamic version of the popular puzzle game Wordle.

Devised with the specific needs of patients and staff at the Gastroenterology department at Herlev Hospital in mind, and informed by intrinsic motivation, self determination and gamification theories, this bespoke technology was designed to resolve patients’ fears of falling, motivate accessible and appropriate physical activity, and enable effective assessment of patient progress with minimal staff input. Iteratively developed through think-aloud, Wizard of Oz and usability testing, this final solution was evaluated with a group of 16 hospitalised patients with gastrointestinal complications, revealing the game to provide an enjoyable experience motivating physical activity for patients in single-bed hospital rooms.


González, P. C., Engsberg, V. J., & García, L. M. (2022, July). A User-Centered Technological Intervention To Motivate Physical Activity Among Patients in Single-Bed Hospital Rooms. Joint Design & Innovation, Computer Science & Engineering and Human-Centered Artificial Intelligence MSc Thesis submitted to the Technical University of Denmark.