Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study

Abstract

Background Falls have implications for older adults’ health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps’ usability and acceptability with both health professionals and patients. Methods There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of “Motivate Me” and “My Activity Programme.” Key changes from the workshops included being able to add more details about the patients’ exercise program and a wider selection of goals within “Motivate Me.” The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable.

Effect of Age on the Touchscreen Manipulation Ability of Community-Dwelling Adults

“…Insufficient attention has been paid to the clinical assessment of the hand function skills needed to operate technology-based devices such as tablets and smartphones, especially the fine motor skills needed to interact with a touchscreen interface. Such data are of particular importance to determine the extent to which older adults are able to cope with the use of such devices that support an active lifestyle by increasing physical exercise, decreasing social isolation, supporting social communication, and increasing participation in meaningful occupations [ 10 , 11 ]. Usage of these devices may enhance the cognitive and physical performance of community-dwelling older adults and provide monitoring technologies in order to increase their independence, autonomy, quality of life, security [ 12 , 13 , 14 ] and improve their medical management [ 15 , 16 ].…”

One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study

“…Demographics of the older adults and health professionals in the workshops are reported in more depth in a previous study [ 33 ]. We recruited 5 health professionals, including 2 physiotherapists, 1 OT, 1 rehabilitation assistant, and 1 assistant practitioner.…”

“…Only 2 of the patients already had Wi-Fi, and 1 agreed to let us install Wi-Fi to enable them to use teleconferencing. A total of 11 health professionals took part in the focus groups; 8 were women, 9 were physiotherapists, 1 was a nurse, and 1 was an OT (see the study by Hawley-Hague et al [ 33 ] for further demographics).…”

“…We have also linked themes to the theoretical framework ( Table 2 ). Two overarching themes related to smartphone were established and are discussed in a separate paper where patients used a smartphone app (see the study by Hawley-Hague et al [ 33 ]). Some themes only occur for either patients or health professionals.…”

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study

“…Recent studies have strived to integrate technology into physical exercise programs that were revealed as effective for adherence and overcoming barriers to exercise, as well as for improvements in health and independence [19]. Currently, several technological solutions address specific aspects of the fall cycle; however, the majority of these do not address fall detection, fall risk assessment, and fall prevention simultaneously.…”