Measuring the Usability of eHealth Solutions for Patients With Parkinson Disease: Observational Study

Abstract

Background Parkinson disease (PD) is a neurodegenerative disorder with a variety of motor and nonmotor symptoms. Many of these symptoms can be monitored by eHealth solutions, including smartphone apps, wearable sensors, and camera systems. The usability of such systems is a key factor in long-term use, but not much is known about the predictors of successful use and preferable methods to assess usability in patients with PD. Objective This study tested methods to assess usability and determined prerequisites for successful use in patients with PD. Methods We performed comprehensive usability assessments with 18 patients with PD using a mixed methods usability battery containing the System Usability Scale, a rater-based evaluation of device-specific tasks, and qualitative interviews. Each patient performed the usability battery with 2 of 3 randomly assigned devices: a tablet app, wearable sensors, and a camera system. The usability battery was administered at the beginning and at the end of a 4-day testing period. Between usability batteries, the systems were used by the patients during 3 sessions of motor assessments (wearable sensors and camera system) and at the movement disorder ward (tablet app). Results In this study, the rater-based evaluation of tasks discriminated the best between the 3 eHealth solutions, whereas subjective modalities such as the System Usability Scale were not able to distinguish between the systems. Successful use was associated with different clinical characteristics for each system: eHealth literacy and cognitive function predicted successful use of the tablet app, and better motor function and lower age correlated with the independent use of the camera system. The successful use of the wearable sensors was independent of clinical characteristics. Unfortunately, patients who were not able to use the devices well provided few improvement suggestions in qualitative interviews. Conclusions eHealth solutions should be developed with a specific set of patients in mind and subsequently tested in this cohort. For a complete picture, usability assessments should include a rater-based evaluation of task performance, and there is a need to develop strategies to circumvent the underrepresentation of poorly performing patients in qualitative usability research.

The Importance of Digital Health Literacy in an Evolving Parkinson’s Disease Care System

“…In a separate qualitative study, individuals with PD identified wearable device design (e.g., need for battery replacement) as a potential barrier to use [68]. In another study, usability of a camera system was influenced by age and motor impairment while the usability of a tablet-based application was influenced by cognitive status and digital health literacy [69]. These results need to be interpreted with caution as individuals who participate in such studies are a self-selected group likely to have more familiarity with digital health technologies than the general PD population.…”

Investigating and Measuring Usability in Wearable Systems: A Structured Methodology and Related Protocol

“…Bendig et al [17] performed comprehensive usability assessments with 18 patients with Parkinson's disease using a mixed-methods usability battery containing the system usability scale, a rater-based evaluation of device-specific tasks, and qualitative interviews.…”