A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing

Abstract

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.

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

“…At least 10 website users were necessary to obtain enough data for evaluation. This number was determined a priori and based on available evidence and previous studies that explored usability of Web-based resources for management of other conditions [38,45,46].…”

“…This methodology assesses elements such as reach, effectiveness, and influencing factors to optimize the design and evaluation of the intervention [36,37]. Interventions developed following similar processes have been successful in delivering acceptable, easy-to-use, and effective Web-based tools for conditions such as rheumatoid arthritis [38], obesity [39], and cancer [40].…”

An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing

“…We used the professionally produced videos on joint protection advice and SARAH exercises that were produced to train hand therapists to deliver the SARAH program using an online training program [ 15 ]. We also produced preliminary videos with a member of the team on goal setting, action planning, and simple ways to adhere to SARAH exercises.…”

Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: An effectiveness–implementation study

“…Stage 1. iSARAH has four modules covering the SARAH trial, SARAH programme, behavioural support strategies and how to deliver the programme to patients. 8 The main components of the SARAH programme are described below. We used written text, pictures, videos demonstrating the exercises and delivery of the programme including baseline setting, exercise progressions/regressions and behavioural support strategies, a self-assessment quiz to check and reinforce knowledge and a library of downloadable patient and therapist resources.…”