JMIR Publications

ABSTRACT

Background:

In previous work, 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:

To evaluate the overall usability, quality, and effectiveness of an mHealth App prototype for aiding knee OA self-management from the perspectives of OA patients and health care providers (HCPs).

Methods:

Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth App prototype co-developed 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 HCPs 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. The patient baseline assessments included a semi-structured interview and survey to gather demographics, and to assess quality of life (EQ5D-5L) and patient activation (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. Semi-structured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate usability and quality of the App prototype.

Results:

Interviews with patients and HCPs revealed overall positive impressions of the App prototype features and functionalities relating to likeability and usefulness. Between the baseline and follow-up patient assessments, mean EQ5D-5L scores improved from 0.77 to 0.67 (p=0.04) and PAM scores increased from 80.4 to 87.9 (p=0.01). Following the 6-week evaluation, patients reported a mean system usability scale (SUS) score of 57.8 indicating marginal acceptability according to SUS cut-offs. The mean number of goals set over the usability period 2.47 (SD 3.08) and mean number of activities completed for knee OA self-management over the study period were 22.2 (SD 17.8). Spearman’s rank correlation (rs) calculations revealed follow-up PAM scores were weakly correlated (rs = -0.32) with the number of goals achieved and the number (rs=0.19) of activities performed over 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 shared decision-making around OA management. However, the future iterations of the App prototype are required to address shortcomings in usability and quality.