Web-based and smartphone based exercise prescription program

Purpose

  • Evaluate the quality and adherence of patients with MSK conditions to agreed exercise programmes when using a digital platform compared to a printed version.
  • Evaluate the patient´s experience when engaging with an exercise programme and their interaction with clinicians and any differences related to patient characteristics (age, gender).
  • Evaluate the impact on generic patient reported outcome measures (PROMS) (eg PSFS, EQ5D, MSKHQ)

Approach

Two levels of data were collected. Patient level data (PROMS, demographic data and condition specific data) was collected and prospectively analysed to inform exercise adherence and effectiveness. Service level data was collected and compared to the same data for the same period one year prior (using as the baseline reference group when Physitrack was not in place). Data was collected and synthesised from mixed sources: the physitrack system; the hospital electronic health record systems Cerner and EPR; and paper.

Within appointment process for new patient appointments:

  1. During the initial appointment with the patient, the physiotherapist will log in to the Physitrack application either on a desktop PC or an iPad and build a tailored exercise programme in agreement with the patient.
  2. The patient will be able to choose how they want to interact with their exercise programme out of three possible options.
    1. Via the Physitrack website on a desktop computer
    2. Via the Physitrack app on their smartphone.
    3. A PDF print out

Between appointment process: 1. The patient logs in to the website or smartphone application and follows the on screen instructions to perform their exercises and record completion. Within appointment process for follow up appointments (face to face and telephone):

  1. The physiotherapist will log in to Physitrack to review and discuss compliance and performance of the exercise programme.
  2. All exercises will be reviewed in clinic (if face to face)

Exercises should then the progressed as needed.

Outcomes

Despite Physitrack being made available to all clinicians, only 65% of patients were given an exercise programme using the system. Recording of adherence to exercise was marginally better for patients using a web based (35%) and smartphone (38%) system, compared to a paper version (28%). There was no difference in actual adherence across groups. There was no significant difference in PROMS between groups, but patient experience was positive for using the web and smartphone based platforms, when compared to a paper version.

Implications

Patient experience and engagement with clinicians and the service was improved by using a digital platform to deliver exercise. There was minimal difference to adherence with exercise or with clinical outcome. Clinicians engagement with the system may also be a factor when considering the effectiveness of digital exercise prescription programs.

Digital solutions delivering exercise programmes have huge potential to improve adherence to exercise and patient experience when accessing physiotherapy. More work needs to be done to realise this potential.

Top three learning points

  1. Clinician adherence is key therefore training staff is essential
  2. Delivering new technology doesn’t automatically improve adherence to exercise as exercise adherence is a complex science.
  3. Good IT infrastructure and support is key

Fund acknowledgements

We were provided with 44 free licences and 10 iPads to deliver this project

Additional notes

This work was presented at Physiotherapy UK 2017

For further information about this work contact Ben Wanless