JMIR Publications

ABSTRACT

Background:

Lumbar spinal stenosis (LSS) is a leading cause of disability among older adults, resulting in reduced walking capacity. Supported self-management is the recommended first-line treatment; however, current approaches do not adequately address behavioural barriers to increasing physical activity. Consequently, only 4% of individuals with LSS achieve recommended daily physical activity levels. A comprehensive in-person 6-week Boot Camp program demonstrated improvements in pain and walking capacity, but its effect on physical performance in daily life remains unknown. Digital health interventions, such as smartphone applications, offer a scalable and accessible means of delivering evidence-based care and may overcome barriers related to cost and provider accessibility. Emerging evidence supporting app-guided self-management for chronic pain conditions provides a rationale for developing a smartphone app to promote an increase in physical activity for individuals with LSS.

Objective:

We aimed to systematically develop the Spinemobility app, a self-management mobile health intervention for individuals with LSS, using the Intervention Mapping (IM) framework, and to evaluate its initial usability.

Methods:

We applied the first four IM steps: (1) conducted a needs assessment, (2) developed program objectives, (3) selected theory-based methods and practical strategies, and (4) designed the intervention. The needs assessment included stakeholder consultations with individuals with lived experience of LSS and an informal literature review to identify barriers to conventional self-management. An interdisciplinary IM team, including clinicians, behavioural scientists, app developers, and patients, guided development through consensus. Behaviour change techniques were integrated into app features. Usability testing involved seven participants (three stand-alone users and four using the app alongside the in-person Boot Camp program). Participants completed weekly semi-structured interviews, which we analyzed thematically to identify features they valued and areas requiring refinement.

Results:

The needs assessment identified internal and environmental barriers. In response, we developed an app incorporating educational resources, SMART (Specific, Measurable, Achievable, Relevant and Time-bound) goal setting, structured exercise progression, tailored motivational messaging, real-time activity tracking, community forums, and gamification. Usability testing showed that participants valued real-time feedback, clear instructions, and personalization. Feedback on motivational messaging and gamification was mixed; some participants found these features encouraging, whereas others did not. Participants recommended improving the layout, increasing the detail of progress charts, and enhancing tracking accuracy. Stand-alone users expressed a desire for features that facilitate communication with healthcare professionals.

Conclusions:

Using a structured, participatory approach, we developed the Spinemobility app to promote physical activity among individuals with LSS. Usability testing showed that participants appreciated most features but identified several areas requiring refinement to improve engagement and functionality. Future work will involve further development to optimize its use as a stand-alone intervention or in combination with in-clinic care, feasibility testing to inform a subsequent randomized controlled trial (RCT), and ultimately evaluation of effectiveness in an RCT.