A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

Abstract

PurposeThe study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment.MethodsFocus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery.ResultsBreast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content.ConclusionsbWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness.Implications for cancer survivorsMobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.Electronic supplementary materialThe online version of this article (doi:10.1007/s11764-017-0630-3) contains supplementary material, which is available to authorized users.

MOBILE HEALTH APPLICATION - PREVENTING PATIENTS OF BREAST CANCER POST-TREATMENT FROM UPPER LIMB DYSFUNCTION (ULD) (Chemotherapy, Radiotherapy, and Surgery) : LITERATURE REVIEW

“…The study from Harder et al, (2017) and Testa A (2014) recommends the physical exercise of patients to begin in 1-3 days after surgery (13,23). By doing so, it will avoid decreasing ROM levels from the patient's shoulder that can delay the range of arm motion of the patient.…”

“…There are several types of mobile health applications used in these nine journals, namely bWell (demonstration videos and documentation), Smart After Care, Smart goal (games application), BrightArm duo rehabilitation system (games application), e-CUIDATE system, telephone, Short Message Service, web-based internet, and m-Health BENECA application. The main focus of 9 journals used in examining the contents of Mobile Health application is physical exercise (ROM, arm and shoulder movements, resistance and muscle strength) for breast cancer survivor, although there are other variables also measured by these journals, such as quality of life, level of pain, cognitive function, and level of patient depression (8,(12)(13)(14)(15)(16)(17)(18)(19). The duration of application from journals used averaged 8-12 weeks which then evaluated until six months, except in 1 journal which uses the cross-sectional method…”

“…Symptoms of ULD are a pain, decreased range of motion of the shoulder joint, decreased strength, decreased sensation, lymphoedema, and axillary web syndrome (13). The leading causes of ULD are usually posted mastectomy, axillary lymph node dissection, axillary radiotherapy, and an abnormal increase of BMI (20).…”

Introduction to special section on digital technology and cancer survivorship

“…Roberts et al [5] also conclude that improved understanding of strategies for enhancing patient engagement with digital interventions to help maintain adherence is necessary. This is a salient issue within the exercise intervention feasibility studies provided by Timmerman et al [6] (lung cancer survivors) and Harder et al [7] (breast cancer survivors) where the value of putting patient user input at the centre of the design and assessment of digital interventions is clearly demonstrated. We are pleased to include these studies as they also reveal the extent of developmental work required to design and implement electronically supported interventions.…”

mHealth Supportive Care Intervention for Parents of Children With Acute Lymphoblastic Leukemia: Quasi-Experimental Pre- and Postdesign Study (Preprint)

“…12 Studies have documented the feasibility and effectiveness of mobile apps in supporting adult cancer patients and survivors in healthcare and clinical practice. [13][14][15][16] However, to our knowledge, there has not been much use of apps in supporting parents of pediatric cancer patients.…”