JMIR Publications

ABSTRACT

Background:

Digital platforms and smartphone apps have the potential to help patients with musculoskeletal conditions receive targeted interventions and physiotherapy support within their own home. Currently, other than relying on patients completing questionnaires, there is no direct way to observe their engagement with exercises or track any changes in their physical function, such as balance. We have developed a method that uses the inertial sensors available in all smartphones to track and measure sit-to-stand and single leg balance, used by physiotherapists to assess physical function in patients with musculoskeletal conditions. As musculoskeletal conditions are much more prevalent in older age, it is important to investigate whether these technologies can be used by this demographic, who generally have lower digital literacy than younger adults.

Objective:

In this study, we trialled the technology in a sample of older adults, aged 65 years or over. The objective of the study was to use a mixed-methods approach to investigate the feasibility and perceived usability of completing functional exercises whilst recording the activity using smartphone inertial sensors within this age group.

Methods:

Participants (n=21) were recruited from a diverse range of community settings, including supported living accommodation, religious centres and community centres. Following an in-person onboarding session, participants completed a four-week trial, recording unsupervised sit-to-stand and single leg balance activities at least once a week, using their smartphone. At the end of the trial, we gathered feedback on usability using telephone interviews and the System Usability Score (SUS). We analysed data quality according to the proportion of uploaded datasets that were successfully analysed using the developed algorithms. Finally, we measured adherence by analysing the number of exercises completed each week.

Results:

Inductive content analysis was used to identify and analyse five top-level categories: App, Device, Exercise, Time and Personal Perceptions. Within the top-level categories, the recorded notes and quotations were further classified into sub-concepts. Mean SUS score was 81.217.5. The proportion of valid data uploads was 63.8% for single leg balance and 93.5% for sit-to-stand measures. Adherence was high with no significant deviations in terms of mean number of sessions completed, or duration between sessions

Conclusions:

Overall, smartphone-based monitoring of functional activities can facilitate unsupervised, remote assessments, thus reducing burden on physiotherapy services and increase ability to monitor progress objectively. However, activities should be limited to simple, stable activities such as sit-to-stand, whilst feedback is essential to motivate and inform users of their progress and adherence to the activities.