57 Patient perspectives on a smartphone app to support home-based exercise use of the app as part of treatment appear to be based mainly on the perceived benefit. When a patient did not perceive or no longer saw any benefit from using the app, use declined quickly. The participants unanimously agreed that Physitrack was easily integrated into their daily routine. Although none of the participants had previously used Physitrack or a similar app during physical therapy, the app was accepted by all participants. Unfortunately, the quick and easy acceptance of a new mHealth app is not always reliable and depends on several different factors such as “perceived usefulness,” “social influence,” and “attitude”(20,21). The acceptance of Physitrack in this study was possibly realized by the combination of the physical therapist introducing the app as part of treatment and the ease of use of the app. Even when a participant no longer found the app useful, it was very easy for them to stop using the app. As a result, there was no downside for the participant to try the app, as they could decide on its usefulness and continued use later on. The participants felt that more instructions from their physical therapist were needed for optimal use of the app. The participants viewed the app as part of treatment and therefore relied on the physical therapist to provide guidance and support. Similarly, when participants experienced a problem using the app, they relied on the physical therapist for assistance. This finding underlines the importance of instructions, personal contact, and support from a physical therapist during treatment when using apps such as Physitrack (22). It appears that part of the success of the integration of Physitrack into treatment relies on patient-therapist interaction. This is further supported by previous findings that the diagnosis of the patient does not seem to significantly impact the acceptance of mHealth apps during treatment(20). “Satisfaction” describes the perceived benefit of using the app during treatment and how the app supports treatment and adherence. Having easy access to the exercise recommendations from the physical therapist through their own smartphone made it easy for patients to not only exercise as often as recommended, but also maintain proper form during the exercises. The push messages sent by the app as a reminder to perform the exercises, the option to set the reminder at a preferred time, and the video instructions of the exercises all contributed to patients’ confidence when exercising at home. In a previous study, participants had no experience with digital technologies to support exercise adherence but were asked about their expectations regarding new technologies (12). The patients were not very enthusiastic about the idea of reminder messages on their smartphones and expected them to be too intrusive. It is possible that in practice, it is important for a patient to use a new technology as part of treatment for some time before deciding on its added value. The participants in this study mentioned using this strategy to determine the usefulness of the app for themselves. Therefore, physical therapists 3
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