BackgroundThe 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.ObjectiveWe 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.MethodsWe 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.ResultsA 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.ConclusionsmySARAH 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.

BackgroundThe Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model.ObjectiveThe objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project.MethodsFollowing publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version.ResultsThe major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library.ConclusionsThe use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice.

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Background:The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme is a tailored 12-week progressive hand and arm exercise programme for people with hand problems due to rheumatoid arthritis (RA). The programme was shown to be clinically and cost effective in a large clinical trial and is now recommended in the NICE guidelines for RA in adults. The preliminary version of mySARAH was developed based on the feedback from patient volunteers, the SARAH trial team, and information technology experts. mySARAH includes online assessment and exercise sessions, exercise videos, downloadable materials, selfmonitoring tools, technical support and personalised exercise planners, calendars, and email reminders. The purpose of this study was to evaluate the usability of mySARAH in people with RA. Methods:Guided by previous studies that 95% usability issues can be identified with a minimum of nine participants, we aimed to recruit 10 volunteers with RA. Usability of mySARAH was evaluated in two iterative cycles following: 1) Think aloud protocol 2) Subjective reports on the usefulness, ease of use and confidence in using mySARAH and 3) Evaluation of execution of exercises. The Computer System Usability (CSU) questionnaire was used to evaluate the usability of the programme on a 7-point Likert scale (1 = 'Strongly disagree' to 7 = 'Strongly agree'). Five-point Likert scales were used to measure usefulness, ease of use, and confidence. Correct execution of exercises was evaluated using a simple rating scale (1-correctly demonstrated to 3-had difficulty and required assistance). The study was approved by the