Implementing Systematically Collected User Feedback to Increase User Retention in a Mobile App for Self-Management of Low Back Pain: Retrospective Cohort Study

Abstract

BackgroundPromising first results for Kaia, a mobile app digitalizing multidisciplinary rehabilitation for low back pain, were recently published. It remains unclear whether the implementation of user feedback in an updated version of this app leads to desired effects in terms of increased app usage and clinical outcomes.ObjectiveThe aim is to elucidate the effect on user retention and clinical outcomes of an updated version of the Kaia app where user feedback was included during development.MethodsUser feedback of the initial app versions (0.x) was collected in a quality management system and systematically analyzed to define requirements of a new version. For this study, the anonymized data of Kaia users was analyzed retrospectively and users were grouped depending on the available version at the time of the sign-up (0.x vs 1.x). The effect on the duration of activity of users in the app, the number of completed exercises of each type, and user-reported pain levels were compared.ResultsOverall, data of 1251 users fulfilled the inclusion criteria, of which 196 users signed up using version 0.x and 1055 users signed up with version 1.x. There were significant differences in the demographic parameters for both groups. A log-rank test showed no significant differences for the duration of activity in the app between groups (P=.31). Users signing up during availability of the 1.x version completed significantly more exercises of each type in the app (physical exercises: 0.x mean 1.99, SD 1.61 units/week vs 1.x mean 3.15, SD1.72 units/week; P<.001; mindfulness exercises: 0.x mean 1.36, SD 1.43 units/week vs 1.x mean 2.42, SD 1.82 units/week; P<.001; educational content: 0.x mean 1.51, SD 1.42 units/week vs 1.x mean 2.71, SD 1.89 units/week; P<.001). This translated into a stronger decrease in user-reported pain levels in versions 1.x (F1,1233=7.084, P=.008).ConclusionsDespite the limitations of retrospective cohort studies, this study indicates that the implementation of systematically collected user feedback during development of updated versions can contribute to improvements in terms of frequency of use and potentially even clinical endpoints such as pain level. The clinical efficiency of the Kaia app needs to be validated in prospective controlled trials to exclude bias.

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

“…42,43,47,437 Innovative delivery systems, including telehealth and other Web-based applications, can offer technology-based education and self-management support to further engage and empower patients in their care plan. [438][439][440]…”

<p>Less Pain, Better Sleep? The Effect of a Multidisciplinary Back Pain App on Sleep Quality in Individuals Suffering from Back Pain – a Secondary Analysis of App User Data</p>

“…Kaia treatment app has been described in detail previously. 23,25,27 In short, the Kaia app (Kaia Health Software GmbH, Munich, Germany) is a multiplatform app for iOS, Android, and native Web solutions. Kaia came to market in September 2016 and is classified as a medical product class I.…”

“…The differences in the two versions of the Kaia app used by the cohorts have been described elsewhere in detail. 27 In short, in the updated Kaia app version (cohort 2) individual user feedback collected in the course of app usage was increasingly used to tailor the individual training program to the individual patient. Furthermore, push up reminders which however could be declined by users were used in the updated Kaia version (cohort 2).…”

“…22 In recent times, mobile health applications have been seen as an innovative tool to provide effective treatment for pain patients at low costs. [23][24][25][26][27][28][29] We investigated the effects of a 12-week program with the Kaia app which provides multidisciplinary elements (physical exercise, mindfulness and educational content, see method section for a description of the Kaia app and reference) for patients with unspecific low back pain (ie, back pain without medical signs of a specific underlying condition like cancer or fracture). In a secondary analysis of data of app users, we showed a substantial pain reduction by usage of a 12-week training program provided by the Kaia app.…”

“…In order to validate findings, two versions of the app (one version contained updates with user feedback 27 ) were analyzed. Our hypothesis derived from previous studies [23][24][25][26][27] was that both pain symptoms and sleep quality improve over time. Furthermore, the relationship between changes in pain intensity and sleep quality was investigated.…”