Ultrasound-based wearable for older chronic back pain patients: A requirement analysis of a user interface for biofeedback

Abstract Purpose This study explores how older adults with chronic back pain (CBP) evaluate different user interface (UI) designs and gamification elements for an ultrasound-based wearable providing real-time biofeedback during segmental stabilization exercises (SSE). The aim is to identify design preferences and motivational factors to enhance usability, engagement, and adherence in this specific population. Methods We conducted a mixed-methods study with 15 older adults (aged ≥ 65) experiencing CBP. Participants interacted with three UI mockups (simple, anatomical, and playful) via a Wizard-of-Oz simulation and evaluated additional motivational elements (e.g., points, badges, progress charts). Semi-structured interviews and the Technology Usage Inventory (TUI) subscales were used to assess usability, acceptance, and intention to use. Results Participants preferred the simple and anatomical UI designs, citing clarity, professionalism, and ease of interpretation. The playful design was viewed as less appropriate due to perceived infantilization. Game elements such as progress tracking, points, and levels were positively received, while competitive features like leaderboards were viewed critically. Most participants expressed interest in integrating pain education, favoring multimedia formats. Conclusion Digital health tools for older adults must prioritize intuitive, medically reliable interfaces and allow personalization of motivational and educational components. The findings highlight the need for age-appropriate UI design and suggest that well-balanced gamification and educational features can enhance acceptance and long-term use of rehabilitation technologies for chronic pain management.