47 Patient perspectives on a smartphone app to support home-based exercise INTRODUCTION The effectiveness of exercise therapy in the treatment of musculoskeletal disorders has been studied extensively, and exercise therapy remains an important part of treatment in clinical practice (1). However, treatment is not limited to supervised exercise. Homebased exercise (HBE) programs allow patients to exercise at home between visits to the clinic. Unfortunately, the effectiveness of HBE relies heavily on patient adherence, which has been shown to be low (2–5). Different factors contribute to patient adherence to HBE, including several factors that can be easily influenced by a physical therapist (6,7). For example, a physical therapist can not only provide support and positive feedback, but also follow up on exercise recommendations during future visits to reinforce patient adherence. Additionally, practitioners can increase patient adherence to HBE by recommending a feasible maximum of 2-4 exercises, supporting and improving self-efficacy, and supporting patients to incorporate exercise into their daily life (6). These strategies aim to improve or reinforce patient adherence to the frequency, intensity, and quality of their performance of exercise recommendations. However, increasing adherence to HBE remains challenging even when employing different strategies. Smartphone apps have the potential to provide new solutions to support adherence to exercise recommendations. Exercise apps using personalized exercise programs, video instructions, and reminders to exercise can increase adherence by providing performance guidance and remote support, and improving physical therapist–patient interactions regarding HBE (8,9). Furthermore, apps supporting health behaviors provide health benefits and additional support in the patient’s own home environment (10,11). Research has shown that patients with nonspecific low back pain (LBP) are mainly worried that despite the benefits of new technologies (eg, reminders and remote support), their use leads to less personalized care (12). However, patients also expect these technologies to support HBE by increasing performance and adherence to exercise recommendations (12). To our knowledge, and based on our review of the literature, no qualitative studies are available on patients who used an app to support HBE alongside physical therapy, highlighting an important gap in the literature. With the increasing availability of apps to support physical therapy treatment, a better understanding of patient perspectives on using these apps during physical therapy can assist physical therapists to effectively tailor the use of these apps for their patients and consequently improve treatment efficacy. Therefore, the aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of an app to support HBE following recommendations from a physical therapist. 3
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