An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing

Background The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences.

[1]  Amit Baumel,et al.  Heuristic Evaluation of Ehealth Interventions: Establishing Standards That Relate to the Therapeutic Process Perspective , 2016, JMIR mental health.

[2]  Robert A. Virzi,et al.  Refining the Test Phase of Usability Evaluation: How Many Subjects Is Enough? , 1992 .

[3]  Jo Adams,et al.  A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing , 2017, Journal of medical Internet research.

[4]  J. Battles.  Improving patient safety by instructional systems design , 2006, Quality and Safety in Health Care.

[5]  M. Williams,et al.  Development and delivery of an exercise intervention for rheumatoid arthritis: strengthening and stretching for rheumatoid arthritis of the hand (SARAH) trial. , 2012, Physiotherapy.

[6]  L. Jahangiry,et al.  Web-based physical activity interventions: a systematic review and meta-analysis of randomized controlled trials. , 2017, Public health.

[7]  F. Griffiths,et al.  Why Are Health Care Interventions Delivered Over the Internet? A Systematic Review of the Published Literature , 2006, Journal of medical Internet research.

[8]  James R. Lewis,et al.  IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use , 1995, Int. J. Hum. Comput. Interact..

[9]  Geke D. S. Ludden,et al.  How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint , 2015, Journal of medical Internet research.

[10]  J. Chapman,et al.  Literacy levels required to complete routinely used patient-reported outcome measures in rheumatology. , 2013, Rheumatology.

[11]  Vineet Chopra,et al.  Internet-Delivered Health Interventions That Work: Systematic Review of Meta-Analyses and Evaluation of Website Availability , 2017, Journal of medical Internet research.

[12]  Parisa Rashidi,et al.  The Behavioral Intervention Technology Model: An Integrated Conceptual and Technological Framework for eHealth and mHealth Interventions , 2014, Journal of medical Internet research.

[13]  Rik Crutzen.  The Behavioral Intervention Technology Model and Intervention Mapping: The Best of Both Worlds , 2014, Journal of medical Internet research.

[14]  R. Nolan,et al.  Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure , 2015, JMIR human factors.

[15]  C. McConkey,et al.  Hand exercises for patients with rheumatoid arthritis: an extended follow-up of the SARAH randomised controlled trial , 2017, BMJ Open.

[16]  Jo Adams,et al.  Strengthening and stretching for rheumatoid arthritis of the hand (SARAH): design of a randomised controlled trial of a hand and upper limb exercise intervention - ISRCTN89936343 , 2012, BMC Musculoskeletal Disorders.

[17]  E. Taal,et al.  Acceptance of New Technology: A Usability Test of a Computerized Adaptive Test for Fatigue in Rheumatoid Arthritis , 2014, JMIR human factors.

[18]  Danielle Levac,et al.  Best Practice Recommendations for the Development, Implementation, and Evaluation of Online Knowledge Translation Resources in Rehabilitation , 2014, Physical Therapy.

[19]  Sarah E Lamb,et al.  Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial , 2015, The Lancet.

[20]  Diane Gromala,et al.  Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis , 2013, BMC Medical Informatics and Decision Making.