Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study

Brittany Shewchuk; Lee A Green; Tanya Barber; Jean Miller; Sylvia Teare; Denise Campbell-Scherer; Kelly J Mrklas; Linda C Li; Nancy Marlett; Tracy Wasylak; Elena Lopatina; Deirdre McCaughey; Deborah A Marshall

doi:10.2196/30495

Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study

JMIR Form Res. 2021 Nov 25;5(11):e30495. doi: 10.2196/30495.

Authors

Brittany Shewchuk¹, Lee A Green^{2

3}, Tanya Barber³, Jean Miller⁴, Sylvia Teare⁴, Denise Campbell-Scherer^{5

6}, Kelly J Mrklas^{1

7}, Linda C Li⁸, Nancy Marlett^{9

10}, Tracy Wasylak^{11

12}, Elena Lopatina¹³, Deirdre McCaughey¹, Deborah A Marshall¹

Affiliations

¹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
² Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
³ Enhancing Alberta Primary Care Research Networks, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
⁴ O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
⁵ Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁶ Office of Lifelong Learning and Physician Learning Program, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
⁷ Strategic Clinical Networks, System Innovation and Programs, Alberta Health Services, Calgary, AB, Canada.
⁸ Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
⁹ Patient and Community Engagement Research Unit, O'Brien Institute for Public Health, Calgary, AB, Canada.
¹⁰ Community Rehabilitation and Disability Studies, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹¹ Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada.
¹² Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
¹³ Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

PMID: 34842526
PMCID: PMC8663438
DOI: 10.2196/30495

Abstract

Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA).

Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs).

Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients' perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype.

Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (r_s) calculations revealed that the follow-up PAM scores were weakly correlated (r_s=-0.32) with the number of goals achieved and the number (r_s=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability.

Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality.

Keywords: app; mHealth; mobile health; osteoarthritis; self-management.

©Brittany Shewchuk, Lee A Green, Tanya Barber, Jean Miller, Sylvia Teare, Denise Campbell-Scherer, Kelly J Mrklas, Linda C Li, Nancy Marlett, Tracy Wasylak, Elena Lopatina, Deirdre McCaughey, Deborah A Marshall. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.11.2021.