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Abstract
Background International recommendations state that all patients with hand osteoarthritis (HOA) should receive education and training in ergonomic principles, use of assistive devices and hand exercises as first-line treatment (1). However, research shows that the quality-of-care service in general is sub-optimal for this patient group, with few patients receiving recommended first-line treatment before being referred to specialist healthcare (2).
Objectives To make recommended treatment available for patients with HOA by developing a user-friendly self-management application (HAPPY Hands).
Methods The development process was conducted four phases: 1) information needs analysis and patient interviews; 2) app illustrations and prototype development; 3) heuristic evaluation; and 4) pilot-testing.
Two patient research partners were involved in developing the content of the app. Researchers, in collaboration with experienced clinicians, the patient research partners and professional film photographers and animators, developed short informational videos and animations. Illustrations and a prototype of the app was developed in five two-week iterations by the University Center for Information Technology at the University of Oslo (Figure 1). Digital meetings were conducted at the end of each two-week iteration, where illustrations and prototype were discussed with developers, researchers, and patient research partners, informing the next iteration. The HAPPY Hands app will be pilot tested in 70 participants with HOA, simultaneously assessing the feasibility and usability of the app.
Illustrations of the Happy Hands smartphone application
Results The prioritized content themes presented by the patient research partners were 1) information about hand OA; 2) goal setting, motivation, and self-efficacy; 3) assistive devices; 4) hand exercises; 5) orthoses; and 6) communication. The app was developed based on a combination of behavioural change techniques informed by Social cognitive theory and the EULAR recommendations on management of HOA. The 12-week intervention consists of 25 short informational videos addressing the prioritized themes. Additionally, the intervention includes a hand exercise program consisting of 8 videos providing instructions on warm up, exercises to improve mobility, strength and coordination, and a stretching exercise. The informational videos and exercise program are delivered in a progressive order over the 12 weeks. When downloading the app, participants are asked to specify when they plan to use the app (three days a week with time points). Thereafter, the patients get a notification on their smartphone with that week’s informational videos and hand exercises at the specified days. After each exercise session the patients are asked to rate their pain and stiffness. Their answers are used to generate graphs that visualise their development over the 12-week intervention period. Each month, patients also answer questions about hand function, which they can use to self-monitor their development. Encouragement and motivational messages are provided each week to enhance continued adherence to the intervention. To date, 60 patients have been included in pilot testing of the app.
Conclusion In this study we successfully implemented a user-centred and iterative approach to develop a e-self-management intervention for treatment of patients with hand OA. The 12-week follow-up in the pilot study will be finished medio May 2022.
References [1]Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2018:10.1136/annrheumdis-2018-213826
[2]Gravås EMH, Tveter AT, Nossum R, Eide REM, Klokkeide Å, Matre KH, et al. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study. BMC Musculoskelet Disord. 2019;20(1):180:10.1186/s12891-019-2567-3
Disclosure of Interests None declared