Mobile Health (mHealth) for Chronic Low Back Pain Assessment: Design, Development, and Usability Evaluation

Chronic low back pain (cLBP) requires precise phenotyping for tailored treatments. This study introduces a mobile health (mHealth) system for cLBP assessment, aiming to collect extensive biomechanical and behavioral data from in-clinic and seven-day at-home assessments from 1000 individuals with cLBP to accommodate accurate phenotyping.

Using a user-centered design approach, an integrated mHealth system was developed, comprising two mobile applications: a clinician-facing in-clinic app and a participant-facing at-home app. The in-clinic app aids physical therapists in conducting in-clinic assessments, while the at-home app allows cLBP patients to manage and submit responses to ecological momentary assessments (EMA). Usability evaluations were conducted using the mHealth App Usability Questionnaire (MAUQ) and qualitative open-ended questions asking about ease of use, learnability, overall impression and satisfaction, and reflective questions. Scores from MAUQ were summarized using median and interquartile range (IQR). The usability results were used to iteratively refine the system's design and functionality.

Three physical therapists and 337 out of 522 cLBP patients participated in the usability evaluations. The evaluations demonstrated positive feedback for both apps. For the in-clinic app, the first iteration median MAUQ score was 6 (IQR 1) and the second iteration median MAUQ score was also 6 (IQR 2). For the at-home app, the median MAUQ scores were consistently high across five iterations (median score of 7 (IQR 1) for all iterations). These scores indicated good usability, meaning they were easy to use, efficient, and satisfying. Iterative modifications based on the feedback focused on enhancing navigation consistency, responsiveness, and user interface, resulting in overall improved usability.

The in-clinic app was successfully used by physical therapists for the assessments of 1000 cLBP patients, receiving positive feedback. Similarly, 989 cLBP patients used the at-home app to complete and submit their EMA, finding it easier to comply with the assessment.