"How would you handle this?" The impact of embedding early patient and public involvement in a biomechanical...

Engineering is often described as a technology-driven field. However, whilst frameworks exist to engage with stakeholders, patient and public involvement (PPI) is not often undertaken in projects that have a quantitative methodology, such as engineering. This can have an impact on research quality, relevance, accessibility and experience. This is especially significant in a biomechanical engineering context where the end-user is often a person with an experience or living with a condition that the researcher does not have.

This paper aims to provide a commentary on the first steps taken to embed PPI into a biomechanical engineering doctoral research project, and the outcomes and learnings that have come from this experience.

Three members of the public living with hand osteoarthritis (OA) were involved in the early-stage PPI consultations. These sessions aimed to openly discuss the hand OA lived-experience, current treatments and considerations for the project.

Early-stage PPI allowed a deeper understanding of the hand OA lived experience and prompted further PPI activity within the biomechanical engineering research project. Subsequently, a long-term partnership with public contributors was established, shifting the project's focus from purely developing a computational model to addressing three PPI-identified priorities: (1) patient variability, (2) joint instability, and (3) raising hand OA awareness, using both computational modelling and public engagement methods. Though the number of contributors was small, it allowed for meaningful and long-lasting partnerships to be developed. Based on the learnings from this approach, eight recommendations were developed for researchers seeking guidance on integrating PPI in similar research. These include leveraging the power of storytelling, introducing PPI into the research as early as possible, investing in training and planning, establishing a meaningful partnership with members of the public, understanding the commitment, maintaining flexibility, providing consistent feedback and diversifying research efforts.

This project has demonstrated PPI can inspire ideas and guide critical thinking and technical workflow, uncovering solutions that might not emerge without collaboration. Although the evidence-base is limited, we advocate that PPI has a place in quantitative-heavy research fields such as engineering, especially biomechanical engineering where people are often the end-users of research outcomes.