59 Patient perspectives on a smartphone app to support home-based exercise from the app. Patients who might have found the app unusable or who would not be able to use the app effectively might not have been offered the app as part of treatment. A second limitation of the study was that the participants were relatively young, with just one exception. Older patients might not be able to use an app as effectively as younger participants. Similar to the first limitation, the physical therapists might not have offered the app to patients they expected would have no or little benefit from it. In addition to age, a patient might not have been suitable for treatment using an app for other reasons. Using an instrument, such as the “Dutch Blended Physiotherapy Checklist,” can assist physical therapists with deciding when to and when not to use an app such as Physitrack (25). The last limitation is that the generalizability of the results in this study might be limited because of the specific app used and the inclusion of only patients with LBP in the study. However, the advantages of Physitrack mentioned by the patients relate mainly to features of the app and the patient-therapist interaction. Patients did not mention the cause of their complaints as having an impact on their acceptance of the app or how they used the app. Combined with the previously mentioned findings that barriers and facilitators related to the acceptance of mHealth apps do not seem to be impacted by a specific diagnosis, the results of this study can most likely be safely generalized to patients with other musculoskeletal disorders (20,23,24). To increase the trustworthiness of data collection, prior to interviewing participants, the interviewer practiced the interviews and use of the interview guide with volunteers not participating in the study. The feedback from the volunteers helped to improve the thoroughness and consistency of the interviews. During data collection, a member check was performed by providing participants with a written summary of the interview and the opportunity to request changes or additions to their interviews to ensure its completeness. Furthermore, the use of the “Framework Method” methodology provided a transparent and rigorous method for data analysis (18). Implications Physitrack appears to be a useful tool to complement physical therapists’ face-toface treatment of patients with LBP. Although other mHealth solutions have displayed beneficial effects for patients with LBP and other musculoskeletal complaints, further research is required to investigate whether adherence to HBE interventions improves when using these apps during treatment (26–28). Knowledge of the added value from Physitrack and similar apps to support HBE and the results of this study can support the implementation of these apps in clinical practice. The apparent importance of the physical therapist–patient interaction found in this study should be investigated further. Additional information on physical therapists’ perspectives regarding working with mHealth apps to 3
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