55 Patient perspectives on a smartphone app to support home-based exercise The first time, I watched all the videos and memorized them. After that, I think I read the instructions for the exercises once or twice, but mostly used the app for the reminders. [Participant #5] I used the app only when new exercises were added because I already knew the others. [Participant #6] Supporting treatment Patients considered the use of the app to record problems, adherence, or pain scores or the use of the chat function to ask a quick question as contributing to the quality of the treatment. The physical therapist had access to information recorded by the patient between therapy sessions and could use it to personalize treatment for the patient. Participants saw the app as something to combine with the expertise of the physical therapist rather than a replacement. The physical therapist used the face-to-face treatments to adjust and personalize the HBE program, and the participants used the app to bring the support from their physical therapist into their own homes. First, we practiced the exercises together, then I received the app, and the next week the therapist asked me how it went. If I had any problems, I could discuss them with him so he could change the exercise program for me. [Participant #7] The app is good progress, but it’s not yet a replacement of the physical therapist. [Participant #8] Quality of exercise performance Patients felt that the app helped to improve their performance of the recommended exercises and perceived the app as a tool to maintain the quality of performance expected from them by the physical therapist. The visual examples of the app’s exercises appeared to increase self-efficacy and might have increased adherence. There was one exercise I had trouble doing right, so if I didn’t have the video, I probably wouldn’t have remembered how to do it and probably wouldn’t have done it at all. [Participant #3] I wouldn’t say it improves how you do it if you already did it well. But it does make sure you don’t do it worse. It helps to keep the quality high. [Participant #9] 3
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