OT gals do research

Welcome to our research blog! We plan to use this to inform the public about the realm of 3-D printing and it's use in assistive technology.  

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In Conclusion...

Future studies in 3D printing assistive devices may benefit by being carried out by an interdisciplinary team involving engineers. Additionally, further research studies would be stronger if conducted as randomized control trials, where some participants receive either a commercial pillbox recommended by an OT researcher or a customized 3D printed pillbox. Furthermore, a future RCT will be double-blinded to ensure that the same researcher does not administer the baseline and follow-up from the protocol with the same participant. This will help measure the adherence to medications and see if there are any differences with user satisfaction while eliminating potential biases that could occur from establishing rapport with participants.

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Limitations to our study

Within the study, there were characteristics that have the potential to impact research findings.

Due to previously built rapport with some participants, the potential for biases in participant satisfaction could occur.

Data related to medication adherence (ARMS) was obtained through participant self-report, leading to potential inaccuracies.

Sample size does not generalize to entire population as participants in this study all received at least 1 year of college education.

Participants reported the time frame for using the pillbox was too short to accurately measure significant changes in QUEST measures such as durability and effectiveness.

This study required a high learning curve for the researchers to achieve competency in using software, designing structurally sound pillboxes, and trouble-shooting 3D printer errors.

Study was not double-blinded, creating potential for participant biases.

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Our Research Results!

After conducting our pilot study, the results indicate that clients overall satisfaction increased when using a customized 3D printed pillbox. Data established that:

The results of the QUEST revealed a statistically significant difference in satisfaction concerning the aesthetics of the customized 3D printed pillbox.

The results from the COPM showed that the 3D printed devices made a positive impact in their daily occupations, however, it did not reveal a significant improvement in anyone's performance or satisfaction.

Although the ARMS showed a slight increase in medication adherence, changes in data did not reflect a significant change.

Although the results indicate that participants were satisfied, participants gave the 3D printed pillbox a low rating in respect to its dimensions being either too big or too small. Additionally, a recurrent theme seen across participants was the mention of the 3D printed pillbox compartments not being able to fit all of their pills.

Participants rated durability of the 3D printed pillbox higher, however, spoke about how using the pillbox for a longer period of time may result in breaks and cracks in the plastic.

During this study some participants took prescribed vitamins, but did not identify as being sick or having a disability, while other participants had involved conditions such as a stroke and took a variety of medications to manage.

The results show that participants of various health conditions, ages, and ethnicity could benefit from this intervention, however, further research is needed.

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Here are some more cool pillboxes that were made for our participants!

T. (n.d.). MakerBot Thingiverse. Retrieved, from https://www.thingiverse.com/  

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A comparison of patient adherence and preference of packaging method for oral anticancer agents using conventional pill bottles versus daily pill boxes.

The purpose of this study was to test whether the use of a simple, low-tech assistance device, such as daily pill boxes, vs. conventional pill bottles, will increase the rate of patients’ adherence to oral chemotherapy pills. They also evaluated patients’ satisfaction and preference of the more user-friendly packaging methods.

The study measured compliance by pill count and utilized a crossover design, with patients serving as their own control. The primary outcome variable was defined as the difference in adherence when using the daily pill boxes compared with adherence when using the conventional pill bottles. A secondary outcome was to evaluate the patient’s preferred packaging method, defined as an ordinal

outcome (preferred daily pill boxes, no preference, preferred conventional pill bottles).

The study results showed the following adherence rates: Using the daily pill boxes (81%), Using the conventional pill bottles (86%). Some of the Trends observed in this study were that being female was the only statistically significant predictor of packaging method preference (they preferred the daily pill boxes). Patients with higher educational levels preferred the daily pill boxes.

This study demonstrates that a low-tech aid such as daily pill boxes can prevent or correct non-compliance behavior that is due to patient misunderstanding of their prescriptions.

MacIntosh, P. W., Pond, G. R., Pond, B. J., Leung, V., & Siu, L. L. (2007). A comparison of patient adherence and preference of packaging method for oral anticancer agents using conventional pill bottles versus daily pill boxes: Original article. European Journal of Cancer Care, 16(4), 380–386. https://doi.org/10.1111/j.1365-2354.2006.00758.x

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The following shortcuts were provided through trial and error throughout our research project. We wanted to share these tips so that they can be helpful for the next time you use a 3D printer. 

-When modifying objects, you will be working on a 2D workplane to resize and rotate. This workplane uses X and Y coordinates to change the angle you look at the object and move the object on. There is no origin and no end to the workplane giving the user and infinite amount of space to work on (Kelly, 2014).

-Select object(s), press Alt, and drag object= copy/pastes selected object(s) quickly without pressing Ctrl C+ Ctrl V.

-Changing the snapgrid to a smaller number will make moving objects more accurate (Move them a smaller distance).

-When rotating objects, there is one ring that appears around objects to tell you degrees. rotating within the circle will rotate the object quickly in increments of 22.5mm, while rotating on the outside of the object will rotate at increments of 1mm (or whatever the snapgrid is set to) for more accurate/ precise movements.

-using the cone located above objects will move the entire object between planes (NOT resize). To resize the height: use the white box located just below the black cone.

-When sizing objects, if you know the exact measurement you want, click on the dots that show the dimensions and scroll your mouse over the number it gives you. Click on that number and type in the exact dimension you want it to be. No more fiddling with the sizing!

-Also, using the ruler will tell you the dimensions of the objects when you line it up with the corner of the object on the workplane. Just highlight the objects you want measured.

Most of this information was found from trial and error on our own. However, the resource attached to this post is very helpful and provides a more in depth explanation. It describes the commands and shortcuts for both Mac and Windows users to do what you want it to do in the program in a written out format.

References:

Kelly, J. F. (2014). 3D Modeling and Printing with Tinkercad: Create and Print Your Own 3D Models. Indianapolis, IN: Pearson.

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Research on Reviews and Monofilament Types

While our Institutional Review Board (IRB) submission was still under revision, our research team scanned the internet for the newest trends in pillbox design. With items on the market for fashion pillboxes and multi use medisets, we learned there is a need for finding how these products can be improved. The best way to find out what devices on the market are effective and ineffective is researching product reviews and obtaining data based on qualitative interviews. Before obtaining this data, we researched product reviews on sites like amazon.com. Based on a preliminary review of pillboxes available online at an affordable price, here were some of our findings.

Many affordable pillboxes are not airtight, creating a safety risk for medications. Certain medications may oxidize when exposed to air, changing the texture, making the medication leak, or caking on other medications in the box. Several reviews expressed concern regarding the size of pillboxes and the inability to make them more portable. When we found pillboxes that had removable compartments, some reviews said that the individual boxes were hard to remove because of snap features. Other pillboxes had 7 individual pillboxes for each day of the week that could be removed from a large compartment if you wanted to take a small pillbox with you for the day. However, based on reviews, it is difficult to get one of these small pillboxes out of the larger compartment without spilling the rest. Lastly, many materials used to make pillboxes that can be opened with one hand are flimsy and are prone to spilling medications.

After reading several reviews, one of the largest challenges ahead of us is finding out if there is a possibility to make our materials seal tightly. We have been looking into various materials that can be added to our 3D printed designs to ensure a tighter seal, but the 3D printer materials alone have little capability to meet this need. More pliable materials can be used to make easy-to-open pillboxes, but we do not have several options to change this through the lulzbot mini 3D printed technology alone. The 3D printer uses a plastic monofilament that creates a hard finished product. According to Janson, two monofilament types have been used regularly in the occupational therapy field for 3-D printing assistive technology: Acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA) (2015, p. 2). ABS is particularly useful in creating assistive devices that are strong and resistant to high temperatures whereas assistive devices created using the PLA monofilament are more brittle and soften under exposure to high temperatures (Janson, 2015, p. 2). Although these two monofilament types have been used in recent occupational therapy based literature, we have printed our pillboxes with high impact polystyrene (HIPS) due to its pricing, ease in attaching with adhesives, and ability to withstand forces. We will have to make adjustments to external materials such as velcro, vinyl, or sewed materials to create any variety in the final texture of pillboxes we make for our future research participants. We will be sure to update you on any other findings on reviews from clients!

References

Janson, J. (2015). 3-D Printing: Shaping the Future of Occupational Therapy Practice. Technology Special Interest Section Quarterly 24:4 (1-4). http://ezproxy.fiu.edu/login?url=http://search.proquest.com.ezproxy.fiu.edu/docview/1758634446?accountid=10901

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For the past month we have been working on printing customized 3D printed boxes for our participants wants and needs. Here are some pictures of what we have created!

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Troubleshooting Lulzbot Tips:

Pausing the progress of the pillbox on the laptop is possible, but if power is disconnected from the Lulzbot or the laptop is disconnected from the Lulzbot, DO NOT attempt to resume printing. The Lulzbot will attempt to reorient itself when you try to resume and it will end disastrously–forcing you to scrap your print and start over.

We discovered that for extended print times, a fan was necessary to prevent the filament from melting before reaching the nozzle to extrude it. Also not printing in a window with direct sunlight would prevent this from occurring.

Components that fit into others or are supposed to lie flush with another surface may need to be sanded down after printing. Be careful with sanding! Precision is key to making the end product look nice and fit well.

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Common patterns and routines with medication adherence

The purpose of this research study was to describe the medication adherence strategies used by a sample of community-dwelling older adults. In this research study, most participants commonly planned taking their medications around mealtimes & wake-up or bedtime. Some relied on environmental cues in order to remind them of the specific hour for medications such as an alarm or TV show. Many participants expressed how important it was for them to take medications with activities they commonly performed throughout the day. Weekly pillboxes were the most common equipment used to take medications and included features such as: larger font, compartments for 2 weeks, & varied colors to denote days. Some participants used higher-tech pillboxes with timer, audio, or watch with timed vibration.Participants also showed patterns of taking their medications around breakfast, dinner, morning hygiene, and evening hygiene. In summary, environmental cues seem to be an effective reminder for older individuals to adhere to their medications.

Sanders, M. J., & Van Oss, T. (2013). Using daily routines to promote medication adherence in older adults. The American Journal of Occupational Therapy, 67(1), 91-9. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.proquest.com.ezproxy.fiu.edu/docview/1270316701?accountid=10901

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Check out our flyer for our research project! 

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Using Tinkercad

Good Afternoon bloggers,

Today we want to share some information regarding the awesome program we are using to design and create the unique pillboxes for our study participants!

If you are unfamiliar with Tinkercad, it is a free website online used to create 3D objects. It is an easy browser-based tool that anyone with internet access can use. There are several tutorials available for users to learn how to use the program and all of its features at their own pace. These tutorials are available at any time on the website and the steps are graded up based on difficulty, allowing the user to learn different aspects and tools such as, how to change color, play with shapes, sizing, and much more. 

Once the user feels feel comfortable using the program, projects can be created from scratch or already created projects can be imported from other users and altered to the create the desired outcome. The finished project is then exported into a system called Cura (or other software of your choice  that connects to the 3D printer being used) to print the creation. It is important to make sure that before you export it from Tinkercad that the items you have created are grouped together; otherwise the design will be “floating” objects.  For the purpose of our research, Tinkercad is the program we are using to edit our pillboxes designs for our participants.

At the bottom of this post we will provide a website that can be used as an additional tool to help you navigate Tinkercad. It provides pictures and step by step instructions on basic terminology and skills you will need when modeling an item on Tinkercad. Enjoy! 

In another post we will be sharing some of our cool designs we have made/printed so far using this software!

Kelly, J. F. (n.d.). 3D Modeling and Printing with TINKERCAD Create and Print Your Own 3D Models. Retrieved January 19, 2017, from http://ptgmedia.pearsoncmg.com/images/9780789754905/samplepages/0789754908.pdf

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About the Lulzbot Mini 3D Printer

The LulzBot Mini 3D Printer ($1,350) is intended for a wide audience, including home users, schools, and libraries, as well as businesses and institutions looking for a 3D printer for prototyping and production. It's made by Aleph Objects, a Colorado-based company that has made other 3D printers, including the LulzBot TAZ 4 and the LulzBot Kittaz 3D printer kit. The company is committed to Libre Innovation, which means the hardware and software it creates is free to be copied, modified, and converted by all users.

PROS: Easy to setup and use. Capable of high resolutions. Self-leveling print bed. Prints with a variety of filament types. Accepts third-party filament spools. Works with Windows, OS X, and Linux. Supports open-source hardware and software. Easy to remove finished objects from print bed.

CONS: Inconsistent print quality. Only includes a small sample length of filament. Open frame increases risk of burns from a hot extruder. Long duration of time to print (could be several hours) depending on the size of the item.

BOTTOM LINE: The LulzBot Mini 3D Printer is amazingly easy to setup and use and can print with a wide variety of filament types!

Retrieved 1/20/17 from  www.pcmag.com

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The Research Team!

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3D Printed Designs using the Lulzbot mini

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About our research!

For the implementation of our graduate research, we will be using the LulzBot Mini 3D printer to create pillboxes for the participants in our study. Our hypothesis is that the customization of pillboxes for individual clients will improve medication adherence. Furthermore, we hope that the satisfaction of using an individually customized pillbox will help clients maintain medication schedules. Research states that 3D printing is being utilized greatly in the medical field for prosthetic creation, custom implants, surgical models (Tack et al, 2016). Although small, the Lulzbot Mini is a 3D printer that can be used for a variety of purposes. Stay tuned to learn more about our journey using the 3D printer and the types of software necessary to create, edit, and print 3D files! We will make sure to keep this blog FUN and entertaining, as us OTs put the FUN in FUNCTIONAL!!!

Tack, P., Victor, J., Gemmel, P., & Annemans, L. (2016). 3D-printing techniques in a medical setting: a systematic literature review. Biomedical Engineering Online, 151-21. dos:10.1186/s12938-016-0236-4