1. Introduction

Rheumatoid arthritis (RA) is defined as inflammation of the tissues or muscles around the joint that is caused by metamorphosis or metabolic disorders. RA is the general name given to the whole-body chronic inflammatory symptoms of unknown joint chronic arthritis that indicates multiple pain and motor disorders in the joints or muscles ^[1]. Other diseases, such as rheumatoid fever, early-aged cataracts, and many other diseases, including systemic erythrocyte cysts and multiple myocarditis, are common diseases that cause similar joint pain ^[1-4]. RA is chronic and difficult to cure once symptoms have occurred. Moreover, it is very difficult to attribute them to their previous physical functions. Therefore, continuous rehabilitation may be required and can be applied with a mixture of medication and aids. Nevertheless, many scholars disagree with its efficiency ^[5].

RA patients, like non-disabled people, have a large share of work involving computers, but there are no evaluation tools that can assess their usability, as is rare for a special computing mouse and other input devices developed for this purpose ^[2,6]. This makes it difficult to establish a basis for occupational therapists and other medical professionals and clinical reasoning.

Indeed, patients with RA and almost everyone recovering from various cerebral diseases, degenerative diseases, musculoskeletal abnormalities, vision problems, limited hand motion, and post-incident symptoms tend to use computers. Therefore, quantitative comparisons of the computing skills before and after onset are clinically important ^[7,8].

Among other things, keyboards have been designed with many specialized and other input devices for the disabled, but the task of pointing the cursor where it wants to be on the screen is still valid and challenging for many patients and people with disabilities ^[6,9].

Several mouse or pointing devices or programs have been attempted, but they were developed primarily for hardware to minimize the physical barriers and optimize the related computing tasks. Sometimes, specially developed hardware devices come with programs that work with them. The recent development of wearable and IoT markets have minimized the physical barriers ^[8,10]. On the other hand, there is little need to score computer mouse pointing skills for the public. Hence, there has been little development of evaluation tools in this area. In the case of patients, these circumstances should be interpreted differently. In almost all the rehabilitation fieldworks, numerical quantification of a client’s functions would be an important part. Therefore, evaluation programs, tools, or computerized practical programs are necessary.

This research redesigned and developed assessment tasks that could evaluate the use of computer input devices, by evaluating the mouse operational capability so that the effectiveness of existing assistive devices could also be examined. These tasks can be used to assess the functional fundamentals of how much a patient with RA can ``actually'' operate a mouse before or after symptoms, as well as to help determine if it works when using assistive engineering equipment because it is tough for the rheumatoid arthritis patients to use a conventional computer mouse. The key contributions in this study are summarized as follows.

· The participants of this study would like to identify a prototype as a case-series clinical research method before verifying its reliability and validity to a large number of actual subjects.

· A program was produced to identify the pointing test among computer input devices for Parallax Scrolling Design or Single Page Design-based internet sites.

· To verify that the computerization test was valid, and an actual RA patient can be scored. Wearable devices suitable for patients with limited operating ranges of muscles and joints were applied to obtain reasonable data.

The remainder of this paper is organized as follows. The next section describes the related works. Section-3 discusses the redesign and development of the program. Section 4 reports the results of clinical trials and discusses the effects of the proposed scheme. The usability check with and scoring handled is reported in section 5. The final section concludes this paper.

2. Related Works

People with limited physical movements generally find it difficult to engage in daily activities normally carried out by non-disabled people. Most people who have experienced severe trauma, cerebrovascular disease, and spinal cord injury have a strong desire to carry out basic and manual daily activities, such as walking, driving, and eating when they recover ^[11,12].

With the development of the Internet in modern times, personal computers have become a powerful factor among these patients. Many devices have been developed to overcome limited situations, such as touch screens, special mice, and wearable devices [8, 10, 13]. Because computers are used in most industries, regardless of the job category, the key to rehabilitation is whether computing skills are maintained when the patients return to work ^[14].

Many clinical evaluation tools are being used in hospitals to determine if they can continue what they were doing in most communities back home ^[15-18]. Similarly, assessment tools that have been validated against computing skills or proficiency would be computerized. Hence, tools with this purpose exist. Each of these is estimated to be a good program for physical damage, and that the work attempted to standardize ISO exists ^[19,20]. On the other hand, there is an urgent need for tools that can provide an optimized minimal and quick grasp of Korea’s Internet culture, web page form, and culture regardless of ages [16, 18, 21].

3. Development and Redesign

3.1 Procedures and Details

This study developed two programs, including pointing and scrolling tasks in the Windows 10 version, considering almost all situations that could occur when operating computer mouse input tasks through visual C++ from MFC (Microsoft$^{\mathrm{\circledR }}$ Foundation Class Library) programming. The basic concept of this program was derived from the author’s permission by modifying the method based on previous research ^[15].

A pointing task can calculate the time and success rate of the path taken when the button appears sporadically on the screen. A scrolling task was designed to assess the situation, in which the scroll wheel of the computer mouse was operated, and participants could be used to view the animated bar moving from the bottom to top (visual feed-backs). The assessor measured the range of operation and durations. Fig. 1 shows the task demonstration shots. To evaluate and score each task in depth, two different tests were conducted so that they could not be performed simultaneously.

The task was developed with limited themes to point and scroll, a common method shared by existing Korean websites, including Google, Naver, and other shopping sites, and document-making products, such as Microsoft and Hancom Office.

Web pages in Korea tend to be aesthetically enhanced or have more user-friendly interface features that have become popular in Korea since 2010. It could be divided into Parallax Scrolling Design and/or Single Page Design in the view of macroscopic perspective. Single Page Design generally involves continuous mouse scrolling to search for information, and Parallax Scroll method is a technique that allows users to move over time between objects when scrolling. These are done to enhance their understanding of information and interest ^[23]. Visual elements on the screen move at a time retarded, depending on the user’s simple operation, such as scrolling or dragging the mouse with clicking. The existing flat web interface forms a sense of space and adds to the use of auditory elements to provide audiovisual stimuli to users. This technique has appeared relatively recently ^[24] in overseas service landing web pages. The technique is used widely in production and in personal portfolio websites to provide a special atmosphere. In Korea, it is also dealed for service-landing web pages and web pages to promote products, most shopping websites, research or academic websites, and the websites of public institutions ^[25].

To evaluate the usability of prototypes, actual rheumatoid patients were recruited and cross-engineered with two general and wearable mice, with male and female bases aligned as much as possible. If higher performance levels are recorded in point devices, such as wearables, the design will be considered reasonable and pave the way for further development.

At the beginning of a trial, the arrow-shaped pointer appeared. An assessor can score by clicking randomly on the points that pop up on the screen and calculate the success and failure rate within one minute, and record and save the area only to the extent that there is a position that has not been reached on the azimuth axis. The success rate of the scroll test could also be calculated in one minute, recording whether the limit line of the randomly rising area is presented in the vertical rectangular-shaped boxes and the boxes can be glided into that area. The areas on the screen that were not usually reached on the Y-axis are recorded. There are no restrictions as to which hand is used among the protocols of the experiment. Moreover, the use of the hand to use the computer was prescribed without dominance and correlated factors.

Fig. 1. Tasks demonstrations.

Fig. 2. (a) Commercial wireless mouse and with similar functions, (b) Wearable assistive air mouse.

4. Clinical Trials

This study examined two patients (one male and one female) with upper extremity and hand rheumatoid arthritis who visited community health center officials. All the experiments had voluntary consent from the patient. Both subjects provided informed consent before participating in the study according to the Declaration of Helsinki and public health. According to the criteria of ``the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis'' ^[22], a male and female inflammatory RA patient were tested for less than 6 points, less than 8 points. Both participants had more than seven years of experience working on a computer web design for more than five hours a day before the diagnosis. All experiments allowed each mouse equipment a run-in period of three hours a day for one week.

They performed each test set to one minute per test by determining how much click and scrolling could be made in time with a general computing wireless mouse (Logitec$^{\mathrm{\circledR }}$ MX Master 2S), which has side buttons and scroll wheels (on the side too) and is a wireless Bluetooth-mouse with specifications and characteristics that are as similar to a wearable mouse as possible. The same task was carried out using the finger-wearing type mouse (Neo Reflection$^{\mathrm{\circledR }}$ NM930308002), which is used with a slightly more suitable finger for RA patients who have difficulty moving their hands freely. All experiments allowed each mouse equipment a run-in period of three hours a day for one week. (Fig. 3). According to the experimental design, in Fig. 3(a), a common wireless mouse with similar functions was used. In Fig. 3(b), the wearable air mouse was used to verify the sensitivity and clinical validity of the evaluation tool.

The subjects decided whether to perform the task with the existing mouse or use wearable aids by putting selecting an invisible envelope. The equipment was used three times per day for 10 minutes per episode, with 10 minutes resting time between each episode during one week and three days of wash-out period. The final values were then calculated by averaging each result. The reliability of the assessment was verified by conducting the tasks randomly three times with each computer mouse equipment, and the average results were calculated.

Fig. 3. Sessions of Trials (a) Commercial wireless mouse and with similar functions, (b) Wearable assistive air mouse.

5. Results

The wearable mouse on their fingers is more suitable because RA patients have a limited articulation range, and higher success rates were noted in most tasks except for the pointing tags of the female patient (Table 1). A higher level of performance was recorded in the active device mouse, such as wearables, so the design was considered reasonable. Moreover, it is expected to pave the way for more advanced development. After the performance skills of the experiment, all the participants were asked to respond to a verbal questionnaire asking them to report their experience in using each device. The emotional aspects of whether the device was uncomfortable or good to use were not recorded. Although the success rate of the task appeared to be gender-specific, this study found that the difference was not the main focus and that thorough control of the baseline in the patient’s personal computer or electronic equipment was meaningless or almost impossible. Therefore, the results should be considered when looking at the sensitivity of each test.

6. Conclusion

This paper proposed a computerized version of the standardized evaluation program, which was presented to identify computing aspects and mouse pointing ability or proficiency in computing-related skills.

A limited theme range with pointing and scroll, a common method shared by existing Korean websites and office product lines, was developed. To evaluate the usability of prototypes, actual RA patients were recruited and cross-engineered with two general and wearable mice. The male and female bases were aligned as much as possible.

The development of assessment tools for disabled people has limitations in areas not expected by the non-disabled, which will be used as a basis for determining if the assistive device is truly useful. Further advanced and improved graphical user interfaces (GUIs) will be needed. Pointing and scrolling, as well as activities, must be measured. These devices can also be applied to patients in hospitals if a large number of ordinary people in various age groups are surveyed, and their validity and reliability as evaluation tools are supported.