Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis

Abstract

Background Self-management is of paramount importance in the non-surgical treatment of knee/hip osteoarthritis (OA). Modern technologies offer the possibility of 24/7 self-management support. We developed an e-self-management application (dr. Bart app) for people with knee/hip OA. The aim of this study was to document the use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee/hip OA. Methods For this study we used backend data for the first 26 weeks of use by the intervention group (N = 214) of an RCT examining the effectiveness of the dr. Bart app. A central element of the dr. Bart app is that it proposes a selection of 72 preformulated goals for health behaviours based on the ‘tiny habits method’ (e.g. after lunch I rise 12 times from my chair to train my leg muscles). The usability of the app was measured using the System Usability Scale questionnaire (SUS), on a scale of 0–100. To assess the association between the intensity of use of the app and health care utilisation (i.e., consultations in primary or secondary health care) and clinical outcomes (i.e., self-management behaviour, physical activity, health-related quality of life, illness perceptions, symptoms, pain, activities of daily living) we calculated Spearman rank correlation coefficients. Results Of the 214 participants, 171 (80%) logged in at least once with 151 (71%) choosing at least one goal and 114 (53%) completing at least one goal during the 26 weeks. Of those who chose at least one goal, 56 participants (37%) continued to log in for up to 26 weeks, 12 (8%) continued to select new goals from the offered goals and 37 (25%) continued to complete goals. Preformulated goals in the themes of physical activity (e.g., performing an exercise from the exercises library in the app) and nutrition (e.g., ‘eat two pieces of fruit today’) were found to be most popular with users. The mean usability scores (standard deviation) at the three and six month follow-ups were 65.9 (16.9) and 64.5 (17.5), respectively. The vast majority of associations between the intensity of use of the dr. Bart app and target outcomes were weak at ρ < (−) 0.25. Conclusions More than one-third of people with knee/hip OA who started using the app, continued to use it up to 26 weeks, though usability could be improved. Patients appear to have preferences for goals related to physical activity and nutrition, rather than for goals related to vitality and education. We found weak/no associations between the intensity of use of the dr. Bart app and health care utilisation and clinical outcomes. Trial registration (21 September 2017): Dutch Trial Register (Trial Number NTR6693/NL6505)

Human Factors in AI-Driven Digital Solutions for Increasing Physical Activity: Scoping Review

“…The 15 included articles were published between 2015 and 2023. Countries of origin of these studies were: United States (n=3) [ 25 , 26 , 36 ], Australia (n=2) [ 32 , 38 ], South Korea (n=2) [ 29 , 35 ], the Netherlands (n=1) [ 31 ], Italy (n=1) [ 27 ], Belgium and Italy (n=1) [ 30 ], Thailand (n=1) [ 37 ], and Taiwan (n=1) [ 33 ]. A total of 3 publications did not specify in which country the study was performed [ 28 , 34 , 39 ].…”

“…Regarding the study design, 8 publications followed a quasi-experimental approach [ 26 - 29 , 32 , 35 , 38 , 39 ], 5 were randomized controlled trials [ 25 , 30 , 33 , 36 , 37 ], and 2 were exploratory studies [ 31 , 34 ].…”

“…Only 4 of the 15 included publications explicitly mentioned their theoretical foundations. The following theoretical approaches were cited in these 4 publications: the Fogg Model for behavior change [ 25 , 31 ], Capability, Opportunity, and Motivation model of Behavior [ 32 ]; learning theory [ 25 ], social cognitive theory [ 25 ], and the Transtheoretical Model [ 39 ].…”

mHealth for the Self-management of Knee Osteoarthritis: Scoping Review

“…Although participants and interventions were not the same, other similar studies on mHealth have reported no significant differences in QoL outcomes between mHealth and control groups [ 12 , 30 ]. A systematic review with a specific PICO model should be used to determine the effectiveness of mHealth on QoL.…”

Assessment of Mobile Health Applications for Management of Knee and/or Hip Osteoarthritis Using the Mobile Application Rating Scale

“…For example, our search did not yield "Dr. Bart," a Dutch app for people with knee and/or hip OA that has been studied in the Netherlands and Germany. 42,43 Future joint international efforts in identifying and appraising apps targeting the management of knee and/or hip OA would enhance global generalizability. In addition, we used a threshold score of ≥3/5 as a minimum acceptable total MARS score for inclusion in the final app summary.…”