Background Patients with musculoskeletal conditions manage their symptoms on a daily basis. The physicality of dress demands movement and dexterity that this population often find difficult to perform due to pain and restricted joint mobility. Mainstream garments do not accommodate such concerns; as a result, patients have limited clothing choice and subsequently devise alternate methods of dress. Emerging technologies such as the 'Internet of Things'¹, wearables and biotechnology create the future potential for clothing to be used as a vehicle in the management of musculoskeletal conditions, by which to deliver topical medication and/or provide real time biofeedback to the patient's healthcare team (so their condition can be continuously monitored).

Objectives 1) To design fashionable everyday garments which cater to the needs of patients with musculoskeletal conditions, and 2) to assess the acceptability of incorporating potential technological enhancements.

Methods Four adult participants who met the inclusion criteria (diagnosis of a musculoskeletal condition and ability to communicate in English) were recruited from the Independent Patient Group, part of a London hospital rheumatology outpatient department, by the group's patient co-chairs (SdS and CS). Two males and two females (aged 37–68 years, 3 rheumatoid arthritis: 1 ankylosing spondylitis, disease duration 6–50 years and of diverse ethnic background) agreed to take part in four co-design workshops over a 4 month period in 2015. Workshops were conducted by a student fashion designer (AC). Garment prototypes were presented to patients and continually modified between workshops based on group feedback.

Results Patients wanted a mode of dress to enable independence and provide comfort; whilst maintaining dignity and a sense of self-expression. It was important that the garments were easy to wear, versatile, made of a lightweight breathable fabric and looked like regular clothing (rather than a garment designed for those with additional physical needs). Patients requested minimum fuss with fastenings. The 5 resultant garments had three basic accommodative dress methods: entry from the bottom-up, side and a flip-over mechanism. Once the basic template designs were established, garments could be personalised to suit individual tastes. Patients were receptive to the potential future use of the clothing to deliver topical pain relief medication and would be happy for biofeedback data to be shared with their healthcare team, provided this data could be transmitted securely.

Conclusions Garments can be instrumental in an individual's continued perception of normalcy, control and confidence over their lives. Technologically-enhanced clothing proposes a more personalised and empowering approach to healthcare delivery by way of connecting the interdisciplinary threads of fashion, medicine, new emerging technologies and user-focused design. Clothing is a big part of everyday life; its enhancement can play a welcome, unobtrusive role in the management of patients with musculoskeletal conditions.

1. Hoy MB. The “Internet of Things”: What It Is and What It Means for Libraries. Med Ref Serv Q. 2015;34:353–8.

Acknowledgement We are grateful to Beatriz Santana Suárez and Prof DL Scott for their support, and to the patient participants.

Disclosure of Interest None declared