Analysis and Improvement of the Web Accessibility of a Tele-rehabilitation Platform for Hip Arthroplasty Patients

  • Tania Calle-JimenezEmail author
  • Sandra Sanchez-Gordon
  • Yves Rybarczyk
  • Janio Jadán
  • Santiago Villarreal
  • Wilmer Esparza
  • Patricia Acosta-Vargas
  • César Guevara
  • Isabel L. Nunes
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 781)


This paper explains some of the challenges that exist to make accessible the web interfaces of a Tele-rehabilitation platform for hip arthroplasty patients and propose an iterative method to improve the level of accessibility using automatic evaluation tools. Web accessibility is not concerned with the specific conditions of people who use the Web, but with the impact that their conditions have on their ability to use it. If the web interfaces of the Tele-rehabilitation platform for hip arthroplasty patients are not accessible enough, the patients will not be able to understand, perceive or operate adequately the platform to benefit completely of the physical therapy. The Web Content Accessibility Guidelines (WCAG 2.0) provides a set of rules and recommendations to help solve the problems of Web accessibility. Additionally, there are evaluation tools that allow identifying main web accessibility problems. These tools are best exploited when used by accessibility experts. The purpose of this research is threefold. First, to present the results of a web accessibility evaluation of the web interfaces of the Tele-rehabilitation Platform for Hip Arthroplasty Patients using three the evaluation tools: WAVE, AChecker and TAW. Second, to analyze the results presented by the tools according to the WCAG 2.0 guidelines to define a list of accessibility improvements. Third, to implement the improvements through the re-factorization of the existing code and re-testing the improved web interfaces to verify that they meet acceptable accessibility levels.


Telemedicine Tele-rehabilitation Hip arthroplasty Physical therapy Web accessibility Web accessibility evaluation tools WAVE TAW ACHECKER 



The authors thank Consorcio Ecuatoriano para el Desarrollo de Internet Avanzado (CEDIA) for partially funding this study through the project “CEPRA XI-2017-15 Tele-rehabilitación”.


  1. 1.
    World Confederation for Physical Therapy: Description of Physical Therapy (2017).
  2. 2.
    Sashika, H., Matsuba, Y., Watanabe, Y.: Home program of physical therapy. Effect on disabilities of patients with total hip arthroplasty. Arch. Phys. Med. Rehabil. 77(3), 273–277 (1996)CrossRefGoogle Scholar
  3. 3.
    Kassebaum, N.J., Arora, M., Barber, R.M., Bhutta, Z.A., Brown, J., Carter, A., Cornaby, L., et al.: Global burden of disease: global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study. Lancet J. 388(10053), 1545–1602 (2016)CrossRefGoogle Scholar
  4. 4.
    Ferri, F.: Ferri’s Clinical Advisor. Elsevier Health Sciences (2017)Google Scholar
  5. 5.
    U.S. Department of Health and Human Services: Hip Replacement Surgery (2012).
  6. 6.
    Schmeler, M.R., Schein, R.M., Michael, M.: Telerehabilitation clinical and vocational applications for assistive technology. Research, opportunities, and challenges. Int. J. Telerehabilit. 1(1), 59–72 (2009)CrossRefGoogle Scholar
  7. 7.
    International Organization for Standardization: ISO 9241-171 Ergonomics of human-system interaction – Guidance on software accessibility (2012).
  8. 8.
    W3C: Weaving the Web Berners Lee (1999).
  9. 9.
    Sanchez-Gordon, S., Luján-Mora, S.: Accessible blended learning for non-native speakers using MOOCs. In: Proceedings of International Conference on Interactive Collaborative and Blended Learning (ICBL), pp. 19–24. IEEE (2015)Google Scholar
  10. 10.
    Rogers, M.: Government accessibility standards and WCAG 2 (2017).
  11. 11.
    WebAIM: Web Accessibility in Mind. World Laws (2018).
  12. 12.
    Urgilés, C., Célleri-Pacheco, J., Maza-Córdova, J.: Web accessibility: a challenge for the developers of Latin America. In: Conference Proceedings UTMACH, vol. 1, no. 1 (2017)Google Scholar
  13. 13.
    W3C: Web Content Accessibility Guidelines WCAG 2.0 (2008).
  14. 14.
    Alzubaidi, L., Elhassan, A., Alghazo, J.: Enhancing computer accessibility for disabled users: a kinect-based approach for users with motor skills disorder. In: Proceedings of the International Conference on Advances in Information Technology for the Holy Quran and Its Sciences, pp. 113–117. IEEE (2013)Google Scholar
  15. 15.
    Dukes, L.C., Meehan, N., Hodges, L.F.: Usability evaluation of a pediatric virtual patient creation tool. In: Proceedings of the International Conference on Healthcare Informatics (ICHI), pp. 118–128. IEEE (2016)Google Scholar
  16. 16.
    Zhao, L., Lu, X., Tao, X., Chen, X.: A Kinect-based virtual rehabilitation system through gesture recognition. In: Proceedings of International Conference on Virtual Reality and Visualization (VRVC), pp. 380–384. IEEE (2016)Google Scholar
  17. 17.
    Chang, Ch., Langel, B., Zhang, M., Koenig, S., Requejo, P., Somboon, N., Sawchuk, A., Rizzo, A.: Towards pervasive physical rehabilitation using microsoft kinect. In: Proceedings of Sixth International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth), pp. 159–162 (2012)Google Scholar
  18. 18.
    W3C: Web Accessibility Initiative: Ageing Education and Harmonization (WAI-AGE) (2012).
  19. 19.
    Wave: Web Accessibility Evaluation Tool (2018).
  20. 20.
    AChecker: Web Accessibility Checker (2011).
  21. 21.
    TAW: Web Accessibility Test (2018).
  22. 22.
    W3C: Developing Websites for Older People: How Web Content Accessibility Guidelines 2.0 Applies (2010).
  23. 23.
    W3C: Web Accessibility Initiative Guidelines and Older Web Users: Findings from a Literature Review (2009).

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Tania Calle-Jimenez
    • 1
    Email author
  • Sandra Sanchez-Gordon
    • 1
  • Yves Rybarczyk
    • 2
    • 3
  • Janio Jadán
    • 4
  • Santiago Villarreal
    • 2
  • Wilmer Esparza
    • 2
  • Patricia Acosta-Vargas
    • 2
  • César Guevara
    • 4
  • Isabel L. Nunes
    • 5
    • 6
  1. 1.Escuela Politécnica NacionalQuitoEcuador
  2. 2.Intelligent & Interactive Systems LabUniversidad de Las AméricasQuitoEcuador
  3. 3.CTS/UNINOVA, DEENova University of LisbonMonte de CaparicaPortugal
  4. 4.Universidad Tecnológica IndoaméricaAmbatoEcuador
  5. 5.Faculty of Science and TechnologyUniversidade NOVA de LisboaCaparicaPortugal
  6. 6.UNIDEMICaparicaPortugal

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