User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study

Abstract

Background Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods This study was divided into 2 phases: phase 1—development of the AvaliaDor app; and phase 2—assessment of the apps’ usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain.

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“… 40 This exponential growth underscores the significant role these apps now play in multimodal treatment approaches, 26 potentially reinforcing behavioral changes among chronic pain patients. 41 Furthermore, they offer real-time valuable information to health care professionals, 42 , 43 enabling the identification of factors such as catastrophic or kinesiophobic thoughts through in-app questionnaires, 44 as well as tracking daily symptoms such as pain intensity and medication use. 45 Despite these advancements, the reliability of an app designed to assess whether sBCs exhibit symptoms of CS has not yet been investigated.…”

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Toward a digital citizen lab for capturing data about alternative ways of self-managing chronic pain: An attitudinal user study

“…However, an attitudinal research survey that was informed by conversations among our team (researchers, PwPPs and caregivers) helped us begin from a low-resolution but wide angled viewpoint that was informed by our team's own ambivalences: Is it safe and acceptable to create a mobile selftracking app for communicating and documenting alternative self-care? Informed by previous user-centered studies (65)(66)(67)(68)(69)(70)(71)(72), we asked questions about features that are known to be important to pain-tracking app users: ability to track pain accurately, to interact, to provide descriptive information about pain, and finally to distract from pain. This allowed us to ask whether there were concerns about these well-desired features (Figure 7).…”

“…In the co-creative and participatory model, citizens share their real-world problems and scientists are codesigners and facilitators of data tools that emerge from the real-world problems of citizen participants. There is a wealth of existing data on what users expect from pain-tracking apps, designed for therapeutic efficacy (64,(68)(69)(70)(71)(72). Our data suggests that the contributory model of citizen science is acceptable to our respondents.…”