eHealth interventions to support self-management in people with musculoskeletal disorders: ‘eHealth: it’s TIME’

Background and Aims Musculoskeletal disorders (MSDs) are a leading cause of disability worldwide, significantly impacting individuals’ quality of life and contributing to substantial healthcare costs. Despite the high demand for rehabilitation services, access to appropriate care remains limited, leading to what is termed the musculoskeletal (MSK) care gap. To address this gap, self-management support has been identified as a key element of modern healthcare reform. The increasing use of eHealth presents a promising opportunity to facilitate self-management interventions for people with MSDs. However, these interventions are often poorly understood, partly due to fragmentation and inadequate reporting in the existing literature. Moreover, the rapid adoption of eHealth interventions during the COVID-19 pandemic highlights the need to reassess the barriers and facilitators to eHealth-mediated self-management support. Furthermore, many interventions lack a user-centred design and are not grounded in strong theoretical frameworks. Therefore, the overall aim of this thesis is to enhance eHealth-mediated self-management support by mapping the available evidence and describing intervention characteristics, exploring the perspectives of people with MSDs and physiotherapists, and co-designing a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for people with MSDs. Methods First, a comprehensive systematic scoping review was conducted to map the available evidence base and describe the characteristics of existing eHealth interventions. Second, a qualitative interview study was undertaken to explore the perspectives of people with MSDs and MSK physiotherapists on eHealth-mediated self-management support. Building on these findings, a mixed-methods, three-step co-design and development study was conducted. In Step 1, intervention features and content were created, with two focus groups reviewing prioritised eHealth intervention elements. Step 2 involved heuristic testing using Nielsen’s 10 heuristic principles. Finally, Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale as part of usability testing. Results The scoping review highlighted considerable variation in eHealth-mediated self-management support interventions, identifying gaps in specific eHealth modalities, MSK diagnoses, and healthcare utilisation data. Using the Practical Reviews in Self-Management Support (PRISMS) taxonomy, eHealth-mediated self-management support interventions were characterised as complex, multicomponent interventions. The qualitative interview study found that eHealth-mediated self-management support interventions were broadly acceptable for people with MSDs and MSK physiotherapists. However, both groups felt they should be reserved for follow-up purposes due to concerns about assessment, diagnosis and establishing a therapeutic relationship. Based on these results, a new eHealth-mediated self-management support follow-up prototype was co-developed with people with MSDs. The four main intervention components, namely an information library, goal tracking, a support forum, and a ‘contact your physiotherapist’ feature, were approved by people with MSDs and aligned with recognised theoretical frameworks. Conclusion This thesis has made a significant contribution to the evidence base on eHealth-mediated self-management support. It has identified gaps in the existing literature and described the characteristics of existing interventions, likely enhancing the understanding of these complex, multi-component interventions and facilitating their successful implementation. This research has also established perceived barriers and facilitators to eHealth-mediated self-management support in MSK physiotherapy services in Ireland. These findings contribute to the development of new knowledge, guiding the design of tailored implementation strategies. Furthermore, these findings were further refined through the co-design and development of an eHealth-mediated follow-up self-management support prototype for people with MSDs, underpinned by recognised theoretical frameworks. Future research will focus on testing the feasibility of this prototype in clinical practice with a diverse population.

Grantor dc:publisher

University College Cork

Year dc:date.issued

2024

Author dc:creator

• Kelly, Marie

Advisors dc:contributor.advisor

• McVeigh, Joseph
• Bradley, Colin

• Digital health
• eHealth
• Musculoskeletal pain
• Self-management
• Intervention development
• User-centred design approach

Statement dc:rights

• © 2024, Marie Kelly.

Licence dc:rights.uri

• https://creativecommons.org/licenses/by-nc-nd/4.0/

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10468/17475

OAI identifier oai:identifier

oai:cora.ucc.ie:10468/17475