An investigation into the use of an exercise app for patients with subacromial impingement syndrome

Abstract

Introduction
Rehabilitation of musculoskeletal (MSK) conditions requires more than medical input. Conservative treatment includes physiotherapy and pharmacological interventions. Face-to-face appointments aren’t always feasible due to lack of time and resources. Mobile health (mHealth) is effective for providing education and self-management skills. Despite numerous commercially available apps related to pain management, there is no published guidance on how to identify a user-friendly, evidence-based app.

Methods
Mixed methods were utilised including a systematic review and meta-analysis of evidence for exercise in the management of SAIS (subacromial impingement syndrome); scoping review of mHealth use within MSK physiotherapy; evaluating shoulder pain related apps. Focus groups with physiotherapists (N = 14), one-to-one interviews with patients (N = 8) informing design of the app. Designing prototype exercise app based on findings using a software design package.

Results
Findings highlighted strong evidence for exercise improving pain, patient reported function (PRF), strength, and Quality of Life (QoL). Statistically significant findings supported improved PRF, strength, and QoL. Evidence-base for mHealth has been strengthened, with telephone/videoconferencing calls widely used. Poor uptake with patients included lack of high quality information and limited uptake amongst clinicians due to lack of training. App ratings showed high scores regards functionality and engagement, scoring less regarding engagement and information quality. Focus groups themes: Tailored rehab, App content, App design, Benefit to the therapist; Interviews themes: Personalisation, Interactivity, App design, Marketing.

Conclusions
Strong evidence for exercise improving pain, PRF, strength, and QoL across all time points measured. More research regards frequency and type of exercises due to heterogeneity. MHealth helps to increase adherence. Future research should focus on high-quality information within interventions and more clinical training. Apps lacked high-quality information. Focus groups and interviews showed therapists prefer time-saving components and exercise modification. Patients deemed personalisation important. Communication with a therapist via the app would increase confidence with rehabilitation.

Date of Award	Oct 2023
Original language	English
Sponsors	Department for the Economy
Supervisor	Catherine Hanratty (Supervisor), Christopher Nugent (Supervisor) & Daniel Kerr (Supervisor)