## 4 Discussion
The program was tested for its effectiveness in LBP management with elderly subjects in clinical trials. As the problem in our study was multifaceted and needed a profound understanding of LBP requirements, we explored the distributed disciplinary knowledge of the stakeholders by inquiring and analyzing the expert and subject knowledge. Our design approach contributed as a knowledge integrator to acquire better insights into the problem and in the process, transformed stakeholders' knowledge. The design practice needs to first initiate problem exploration by engaging experts and affected individuals regarding the problems, then lead the collaboration. Second, we extended the co-design process to further analyze and explore the patient-expert interaction for establishing consensus among the stakeholders. Our design approach mediated the knowledge created and negotiated among the stakeholders and connected interdisciplinary knowledge and experiences that emerged during the interaction. We obtained significant contributions from this interaction by analyzing stakeholders' knowledge and experiences to build consensus on patient rehabilitation. The mediating role in gaining this consensus thus facilitated our co-design process. The roles of initiating and leading the exploration of such a complex problem and mediating the knowledge and experiences of the stakeholders to address the problem can increase the pace of healthcare design expansion. Once incorporated into design practice, these diverse roles will, over time, gradually inform healthcare designers with other domain knowledge and expertise. This will, in turn, enable them to become more credible and genuine contributors in addressing complex problems in a distributed disciplinary environment. The results of muscle activation and LBP supports that exercise training can increase muscle strength with changes in muscle activation patterns and alleviate LBP by standing postures on sloped surfaces [11]. Moreover, standing posture training on an inclined surface can flex the lower back and increase lumbar spinal extension. Similarly, [PERSON] et al. [45] found significant improvements in LBP conditions with positive changes in muscle activation during flexion tasks. With regard to standing exercises for posture correction, [PERSON] et al. [46] and [PERSON] et al. [47] showed that postural changes due to standing flexion could improve blood circulation in the lumbar region and change the spinal curvature, making such exercise an effective intervention for patients with chronic LBP. These studies suggest that posture-correcting exercises should be investigated further for their benefits in manipulating trunk muscles to spinal curve balance. The results support that forward bending and partial squatting posture training are effective methods for increasing flexion and extension of the trunk muscles, including those in the thoracic and lumbar regions [48; 49]. The evidence overall is that a strong LES maintains anteroposterior spinal integrity and contributes to spinal stabilization in squat posture training. In support of our results, [PERSON] et al. [50] showed that squat posture training improves the strength of trunk muscles due to a significant increase in muscle contraction. [PERSON] et al. [51] observed a greater increase in lower extremity muscle activation with an increase in board slope from 5\({}^{\circ}\) to 10\({}^{\circ}\). They concluded that an increase in board slope could be an effective method to influence trunk muscles. Moreover, [PERSON] et al. [52] stated that semi-squat postures could be utilized in trunk muscle strengthening exercises. The patterns of increase in muscle activation levels support the findings of [PERSON] et al. [53], who showed an increase in muscle contraction burst duration with exercise intensity due to muscle activation during standing exercises. Our results are further supported by [PERSON] et al. [54] in that trunk muscle training with repetitive postures can induce greater EMG activity to increase trunk muscle activation.