Impact of personalized coaching on the use of digital health interventions for movement therapy in rheumatology: a randomized controlled trial

Spondyloarthropathies (SpA) are characterized by low back pain and limited mobility. Therefore, physical activity (PA) is an essential part of the treatment, yielding positive effects on clinical symptoms. Digital health applications (DHAs) present new opportunities to promote clinical outcomes, however, their long-term effectiveness is often limited by low adherence and high dropout rates.This study investigates whether integrating personalized or AI-driven coaching enhances the therapeutic benefits of DHA in patients with SpA. SpAs patients were randomized into one of 3 groups. They were instructed to exercise at least 2-3 times per week for 6 months with the DHA according to their group (intervention groups: ViViRA (with personal coaching) or Kaia Health (with AI-based coaching); control group: ViViRA (without coaching)). Personal coaching consisted of a one-time, 30-min online coaching session prior to using DHA, while the AI coaching consisted of video-based AI integrated into DHA to provide movement guidance during each session. At baseline, after 3 and 6 months sociodemographic, questionnaires and mobility were assessed. Data from 78 participants were analyzed (mean age 51 years; 68% female). All three digital interventions showed a significant improvement in mobility (Bath Ankylosing Spondylitis Metrology Index (BASM), range: 0-10, lower scores = better mobility; BL-3 month: mean BASMI change - 0.6 to - 0.7; all p < 0.001). Pain intensity decreased substantially in all arms (PainDETECT, neuropathic pain, range: 0-38, higher scores = more severe pain; BL-6 month: mean reduction - 4.6 to - 6.6 points; all p ≤ 0.006). PAHCO (Physical Activity-related Health Competence) control competence increased over time and reached statistical significance only in the ViViRA + coaching group (PAHCO: higher scores = better physical activity-related health competence; BL-6 month: + 1.02, p = 0.013) but did not exceed the other interventions in a direct comparison. Overall, none of the coaching strategies showed significant superiority over the stand-alone digital therapy. Adherence was the same in all groups after 3 months (2-3 weekly use of DHA). Digital movement therapy with the use of DHA improves mobility and pain independently of coaching in SpAs patients. In contrast, personal coaching has been shown to improve health-related skills which could indicate potential benefits for self-management and long-term treatment adherence.Trial registration The study is registered in the German clinical trial registry (DRKS) under the following ID: DRKS00035191, https://www.drks.de/search/de/trial/DRKS00035191/details, Registration date: 01.10.2024.