A Holistic Approach on Smart Garment for Patients with Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA) is a widespread and chronic condition that affects children and adolescents worldwide. The person suffering from JIA is characterized by chronic joint inflammation leading to pain, swelling, stiffness, and limited body movements. Individuals suffering from JIA require ongoing treatment for their lifetime. Beyond inflammation, JIA patients have expressed concerns about various factors and the lack of responsive services addressing their challenges. The implementation of smart garments offers a promising solution to assist individuals with Juvenile Idiopathic Arthritis in performing their daily activities. These garments are designed to seamlessly integrate technology and clothing, providing not only physical support but also addressing the psychological and emotional aspects of living with a chronic condition. By incorporating sensors, these smart garments can monitor joint movement, detect inflammation, and provide real-time feedback to both patients and healthcare providers. To tackle these comprehensive challenges, the research aims to offer a solution through the design of a smart garment, created with a holistic approach. This smart garment is intended to improve the overall well-being of JIA patients by enhancing their mobility, comfort, and overall quality of life. The integration of technology into clothing can potentially revolutionize the way JIA is managed, allowing patients to better manage their condition and minimize its impact on their daily lives. The synergy between healthcare and technology holds great potential in addressing the multifaceted challenges posed by Juvenile Idiopathic Arthritis patients. Through innovation and empathy, this research aims to pave the way for a brighter future for individuals living with Juvenile Idiopathic Arthritis.


Introduction
In the medical landscape, Juvenile Idiopathic Arthritis (JIA) stands as the prevalent chronic rheumatic disease in children and a significant contributor to both short-term and long-term disability (Ludovico Di et al. 2023) [1].JIA is a chronic rheumatic disease of unknown origin, with a higher occurrence among young female patients (Barut K, Adrovic A, Şahin S, Kasapçopur Ö, 2017) [2].The International League Against Rheumatism (ILAR) identifies seven distinct and mutually exclusive categories of JIA, determined by the disease manifestations observed within the first 6 months of its onset (Martini, A., Lovell, D.J., Albani, S. et al. 2022) [3], the subtypes are depicted in Fig 1 .JIA encompasses all forms of chronic childhood arthritis, affecting not only joints but also extra-articular structures, which can lead to disability and, in severe cases, even associated fatality (Zaripova, L.N., Midgley, A., Christmas, S.E.et al. 2021) [4].As active JIA persists into adulthood, the cumulative effect leads to a higher degree of functional limitation and joint destruction.Nevertheless, some patients may encounter detrimental effects such as joint deformities, destruction, growth The diagnosis is challenging as there are no specific tests to definitively confirm the condition (Capurso [6] et al., 2016).Around 5% of children with JIA exhibit rheumatoid factor (RF)-positive arthritis, which closely resembles adult rheumatoid arthritis (RA) in its phenotype.Notably, the presence of rheumatoid factor persists throughout the patient's lifetime (Anne Hinks, 2018) [7].For patients who travel and live away from home for educational or work purposes, it can be particularly challenging.Activities that impact arthritic patients include running, cycling, dancing, traveling, climbing, dressing, skipping, engaging in physical games, lifting bags, writing, typing, opening jars and door knobs, as well as chopping food.Additionally, Arthritis sufferers may experience a detrimental effect on their sleep quality, and it is equally important to acknowledge that inadequate sleep can worsen pain levels and heighten stress levels (Grabovac I et el. 2018) [8].The impact extends beyond inflammation, disrupting their daily routines and requiring more responsive services (Chaplin et al. 2018) [9].In light of this, the importance of smart garments to their needs cannot be overstated.A smart garment can be described as an intelligent system with the capability to sense and interact with the wearer's surroundings, conditions, and stimuli (Tao, X.,2001 [10], Gilsoo et al. 2009 [11]).Smart garments possesses the ability to remotely predict, prevent, and monitor chronic illnesses, thereby decreasing the necessity for hospital stays and empowering patients to maintain their independence (Brown, D. 2020 [12]).Smart garments are specifically crafted to cater to health and containing various garments such as T-shirts (Sankaran [13], Stojanović [14], Perego [15] , bras (Moreno 2019 [16], Elsheakh 2023 [17], Raji 2020 [18], Navalta 2020 [19], Lee 2021 [20] ), sleeves (Feng 2023 [21] Qiao 2022 [22], DelPreto 2023 [23] , jackets (Vuohijoki 2022 [24], Azam Khan 2023 [25], Uzun [26]), leggings (Hwang [27], Bravo [28], Barhoumi [29]), and more (Rudolf [30], with a focus on healthcare applications.Considering this, the importance of smart garments for their needs cannot be emphasized enough.These essential resources play a crucial role in empowering patients with JIA to navigate their condition more effectively and maintain their independence, ensuring a better quality of life.This article focuses on exploring the requirements of patients having Juvenile Idiopathic Arthritis (JIA), specifically in the context of designing smart garment which a patient can use as a sleepwear also.The research aims to delve into the unique needs of these individuals and understand how to design smart garment to accommodate their condition.Research aims to raise awareness and promote further research and development in this crucial area of care, to ensure that patients with JIA have access to the resources they need to lead fulfilling lives and overcome the obstacles posed by their condition.

Objective
The objective of this study is to identify and understand the specific needs of Juvenile idiopathic arthritic patients regarding smart garment.The focus is on exploring their requirements, preferences, and challenges related to different garments.By gathering insights directly from this demographic group, the study aims to inform the development of tailored solutions that address their unique needs and empower them to engage in daily activities with greater ease and confidence.

Literature Review
Research done in order to develop design requirements for functional sports bras for young women with juvenile idiopathic arthritis, to help retailers and academia better understand their needs (Mccoy L. 2021) [31].Adaptive clothing empowers woman with rheumatoid arthritis, they can dress up independently and comfortably and still feel good about herself, which increases self-confidence.In this study, the researcher devised the patterns of kurta using pattern making techniques.(Shalini Singh 2019) [32].The restricted joint functions of rheumatoid arthritis (RA) patients pose challenges in dressing, particularly with certain garments like sarees.In this study, alternative options are proposed for easier-todrape sarees tailored to arthritis patients' needs (Chandra [33], et al. 2016).
Adaptive clothing research found special features to be highly practical, Three sets of adaptive garments were designed for females with rheumatoid impairements, independence and self-confidence were assessed by wear trail test (Naheed Azher, et al. 2012) [34].The study's main goal is to empower elderly longterm care patients with dressing independence by devising alternative fastener options for dresses.(L.Sperling, M. Karlsson 1989) [35].This research addresses Rheumatoid arthritis, the proposed workflow concentrates on design requirements such as breathability, support in affected areas, lightweight design, and customization to alleviate individual pain points through a wearable glove solution (Jierui Fang 2020) [36].A review assessed therapy gloves' effectiveness in hand function for RA patients, in this review grip strength, pintch strength, ROM and dexterity were selected as the outcome measures to check the effectiveness of therapy gloves (Nasir SH, Troynikov O, Massy-Westropp N, 2014) [37].The study introduces a Bluetooth-enabled glove that quantitatively assesses hand performance for rheumatoid arthritis patients, providing an alternative to subjective descriptions.Additionally, the glove is designed with rubber adjustable rings for a comfortable fit (Socher R. 2018) [38].The study explores wrist orthotics typically crafted from Neoprene material, known for its resistance to abrasion, waterproof properties, and stretchability.These orthotics include five separate hook and close straps for secure fastening and a palmar side pocket to hold a metal bar, providing crucial wrist support (Underwood, S. 2009) [39].

Problem Statement
The problem addressed in this study revolves around the lack of smart garment for juvenile idiopathic arthritic patients.Despite the existence of general adaptive clothing options, there is a lack of holistic solutions that cater to the unique needs of this demographic group.

Observation and Interviews
After conducting interviews and observing juvenile idiopathic arthritis (JIA) patients, it became evident that their limited range of motion affects their elbow, wrist, shoulder, knee and hip areas.Consequently, dressing and other essential activities like travelling, using stairs, bicycle riding, become challenging, causing additional suffering due to joint inflammation and stiffness.However, upon introducing the concept of smart adaptive garments to the arthritic patients and their parents, it was observed that they expressed a keen interest in adopting these new ideas to improve their health and functionality.Data collected by using semi structured interview and …………………………………………..

Feasiblity Analysis
To create a comprehensive framework for this research, the Darden Design Thinking process was utilized in the research, incorporating a user-centred design approach within a sequential mixed methods methodology.The mixed-methods sequential explanatory design consists of two distinct phases: quantitative followed by qualitative (Creswell et al. 2003) [40].The study consisted of three stages, involving focus group surveys, interviews, and market research on arthritic patients garments.Data collection methods included quantitative and qualitative surveys among patients with JIA.Factor and Effect Analysis was used to identify user requirements, while a postures examination provided insights into participants' physical mobility.Based on the findings, specific design elements and strategies for arthritis-targeted garments were proposed using Clo3D.The research takes a holistic approach with the aim of developing smart garment specifically designed for individuals with Juvenile Idiopathic Arthritis (JIA).This approach involves considering the various aspects and needs of individuals with JIA, beyond just the physical challenges they face.The approach considers the diverse needs of individuals with JIA, addressing physical limitations while prioritizing overall well-being, comfort, and fashion preferences.By acknowledging challenges beyond physical symptoms, including self-esteem, independence, health and social inclusion, the smart adaptive streetwear aims to empower individuals with JIA.The garments feature easy dressing, gentle fabrics, adjustable closures, curative qualities and aesthetically appealing designs to enhance daily life and promote a sense of normalcy and inclusivity (Fig. 2).The holistic approach seeks to improve their quality of life, allowing confident participation in daily activities and social interactions.

Conclusions
The research on requirement for smart garments for arthritic patients has shed light on the significant challenges faced by affected individuals.JIA's impact on joint inflammation, stiffness and limited range of motion affects multiple joints, leading to difficulties in dressing and other essential activities causing additional suffering.However, this research contributes to a better understanding of the specific needs of JIA patients and paves the way for improved interventions and services catering to their requirements.As we move forward, the adoption and implementation of smart garments offer a brighter outlook for the lives of these individuals, fostering a future of improved health, functionality, and enhanced well-being.
Limitations: While the research has provided valuable insights into the challenges faced by individuals with JIA, there are certain limitations to be acknowledged.The study's sample size, geographical diversity, and duration may influence the generalizability of the findings.
Future Scope: As medical and technological advancements continue, there is potential for further research and innovation in the development of adaptive clothing and wearable solutions for individuals with JIA.The integration of advanced materials, sensors, and data analytics can lead to more sophisticated garments that provide real-time monitoring and personalized support, optimizing the management of JIA symptoms and enhancing daily activities for the patients.

Fig 1
Fig 1 Types of Juvenile idiopathic arthritis

Fig. 2
Fig. 2 Proposed Smart street-wearable design of the upper garment for arthritic young women Institutional Review Board Statement: APPROVED Informed Consent Statement: YES

Table 1 .
Studies related to arthritis garments and accessories