A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study

Background

To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning.

Objective

The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning.

Methods

Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL.

Results

Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (α=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66).

Conclusions

MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning.

Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis

BACKGROUND

Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA.

OBJECTIVE

This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise.

METHODS

A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14).

RESULTS

A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified.

CONCLUSIONS

This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

OBJECTIVES

COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.

METHODS

Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed.

RESULTS

A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.

CONCLUSIONS

We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.

A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19

Hydroxychloroquine, an essential treatment for many patients with rheumatologic conditions, has recently garnered widespread attention as a potential treatment for COVID-19 infection. The authors appraise the study generating this interest and highlight the potential consequences of rapid dissemination of overinterpreted data, particularly for people with conditions for which hydroxychloroquine has demonstrated benefits in preventing organ damage and life-threatening disease flares.

Patient and clinician views on an app for rheumatoid arthritis disease monitoring: Function, implementation and implications

AIM

Best practice management for rheumatoid arthritis (RA) involves regular clinical assessment of RA disease activity. This is not achievable with current rheumatology systems of care. We aimed to use opinions from people with RA and their specialist rheumatology healthcare professionals to inform development of a mobile app for people with RA for recording their disease activity data for potential integration into clinical service, and assess usability of the app.

METHOD

In phase 1 we interviewed nine people with RA and seven healthcare professionals. In phase 2 we developed an app with professional software developers. In phase 3 we evaluated app usability for people with RA using the System Usability Scale (SUS).

RESULTS

Interview data showed four themes regarding functionality and implementation of a patient-held app in RA care: (a) variable app acceptance and readiness; (b) app use to reduce barriers; (c) pros and cons of patient-reported outcomes; and (d) allocation of clinics by need. The app developed has high usability in people with RA using the app on their own device for a month (SUS 79.5, n = 16) or using the app on a study device for 10 minutes (SUS 83, n = 100).

CONCLUSION

People with RA and healthcare professionals have clearly identified features, benefits and risks of an app for self-assessment of RA and incorporation into clinical care. An app developed informed by these opinions has high usability. Next steps are development and validation of a method of patient-performed joint counts, and implementation, with evaluation, in the clinical setting.

P102 Identifying physical activity mobile applications for people with rheumatoid arthritis: a content analysis and quality appraisal

Background

Physical activity and exercise (PA) are recommended for people with rheumatoid arthritis (RA), although adherence to PA tends to be low. Accessible, tailored interventions are needed to help people with RA change their behaviour to achieve public health PA recommendations and improve health outcomes. Use of smartphones and mobile applications (apps) is increasing and apps may assist people to reach PA recommendations. However, the availability, quality and content of evidence-based PA apps for people with RA is unknown. This study assessed the features, content and quality of apps targeting PA for adults with RA by i) systematically identifying apps ii) summarising their features and content iii) comparing their content to physical activity and exercise guidelines and iv) rating app quality.

Methods

A systematic search of the UK Apple AppStore and Google Play store was conducted to identify apps designed to facilitate PA in adults with RA between 19th-20th June 2019. Apps were excluded if they were i) not in English ii) for use by clinicians only or ii) solely focused on advertising a clinic/product. No fee restrictions were applied. Android and iOS apps were downloaded to smartphones, features/functionality described, content coded using Consensus on Exercise Reporting Template (CERT) and behaviour change technique taxonomy V1 (BCTTv1) and apps rated using the Mobile App Rating Scale (MARS range 0-5) by two independent reviewers. App features were compared with public health PA guidelines (150 minutes moderate PA/week or equivalent plus twice weekly resistance exercise) and American College of Sports Medicine recommendations for exercise prescription.

Results

Initially, 14,047 apps were identified. Following de-duplication, 2,737 apps were screened for eligibly and six apps were downloaded (two UK Apple AppStore, four Google Play store), yielding four unique apps. Only one app provided PA recommendations broadly aligned with public health PA guidelines and no apps aligned to ACSM exercise prescription guidelines or offered information on tailoring of PA to disease symptoms or health status. Apps included between 4-13 behaviour change techniques (BCTs) and three BCTs were common to all apps (demonstration of behaviour, instructions on how to perform behaviour, information about health consequences). Overall, MARS scores ranged between 2.25-4.17.

Conclusion

There is a lack of high-quality mobile apps which can be tailored to support PA for people with RA. Whilst all included apps incorporated some BCTs previously identified as effective for PA promotion, only one, high quality app provided PA recommendations which broadly aligned with public health PA guidelines but offered limited options for tailoring PA or exercise. Collaboration between adults with RA, clinicians, and app developers is needed to produce evidence informed apps, with embedded BCTs, which can be tailored to support people with RA achieve PA recommendations.

Disclosures

L. Bearne None. M. Sekhon None. R. Grainger None. A. La None. M. Shamali None. A. Amirova None. E. Godfrey None. C. White None.

PeerWise and Pathology: Discontinuing a teaching innovation that did not achieve its potential

This article was migrated. The article was marked as recommended. IntroductionWriting and answering multiple choice questions (MCQs) is a learning activity that potentially engages deep learning. We conducted three year-long case studies of MCQ writing and answering in PeerWise to engage students in learning Pathology. MethodsOverall, an instrumental case-study design with the structure of sequential multiple case studies was used. Across three years fourth year medical students were required to write and answer MCQs. In 2016 students were provided with advice for writing questions and were encouraged to adhere to Bloom's taxonomy. In 2017, to reduce cognitive load, students were provided with a MCQ template and allocated topics. In 2018, to encourage engagement, students were informed that the top forty MCQs would be in the final exam.ResultsAn evaluation survey was used to measure each student's perception of the MCQ exercise. In 2016 most students had a negative opinion of the MCQ exercise. Students found writing MCQs too time consuming and demanding. In 2017 student's attitudes to the MCQ exercise were more positive. In 2018 there were insufficient responses to the survey but informal student feedback suggested the MCQ exercise was considered an inefficient use of student study time.There were minimal changes in student's activity levels from 2016 to 2017. However, in 2018 when students were informed that the top forty MCQs generated would be included in their final exam they answered a greater number of MCQs than in previous years.Conclusions Providing students with templates and assigning topics for MCQs may improve student attitudes toward MCQ writing and including student generated MCQs in the final exam encourages students to answer more MCQs. However, due to high demands on their time, medical students' prioritised efficiency and MCQ writing may not be an efficient strategy for deep learning.

Media representation of chronic pain in Aotearoa New Zealand-a content analysis of news media

AIM

To analyse how the New Zealand news media has reported on chronic pain and identify whether this publicly available information is reflective of best practice.

METHODS

A content analysis of news media published between January 2015 and June 2019, with a primary focus on chronic pain was undertaken. The Factiva, EBSCO and ProQuest databases, alongside popular New Zealand news websites were searched.

RESULTS

Two hundred and forty news articles were included; the overarching themes identified in content analysis were (1) the lived experience and the impact of chronic pain (n=119/240), (2) pain management strategies with information on pharmacological (ie, opioids and medicinal cannabis) (n=107/240) and non-pharmacological strategies (eg) psychological therapies (36/240), physical activity (34/240), pain education (34/240), (3) the systemic issues influencing chronic pain healthcare pathways (n=79/240).

CONCLUSION

Living with chronic pain is predominantly represented as a struggle, with a lesser focus on the ability to successfully self-manage and live a meaningful life. The limited emphasis on each of the non-pharmacological strategies suggest that the reports failed to communicate that these strategies should be a key component of self-managing chronic pain. New Zealand healthcare providers and researchers can collaboratively work with the media to provide evidence-based information on both non-pharmacological and pharmacological pain management strategies.

Development of a prediction model for inpatient gout flares in people with comorbid gout

OBJECTIVES

Hospitalisation is a risk factor for flares in people with gout. However, the predictors of inpatient gout flare are not well understood. The aim of this study was to develop a prediction model for inpatient gout flare among people with comorbid gout.

METHODS

We used data from a retrospective cohort of hospitalised patients with comorbid gout from Wellington, Aotearoa/New Zealand, in 2017 calendar year. For the development of a prediction model, we took three approaches: (A) a clinical knowledge-driven model, (B) a statistics-driven model and (C) a decision tree model. The final model was chosen based on practicality and performance, then validated using bootstrap procedure.

RESULTS

The cohort consisted of 625 hospitalised patients with comorbid gout, 87 of whom experienced inpatient gout flare. Model A yielded 9 predictors of inpatient gout flare, while model B and C produced 15 and 5, respectively. Model A was chosen for its simplicity and superior C-statistics (0.82) and calibration slope (0.93). The final nine-item set of predictors were pre-admission urate >0.36 mmol/L, tophus, no pre-admission urate-lowering therapy (ULT), no pre-admission gout prophylaxis, acute kidney injury, surgery, initiation or increase of gout prophylaxis, adjustment of ULT and diuretics prior to flare. Bootstrap validation of the final model showed adequate C-statistics and calibration slope (0.80 and 0.78, respectively).

CONCLUSION

We propose a set of nine predictors of inpatient flare for people with comorbid gout. The predictors are simple, practical and are supported by existing clinical knowledge.

Gout, Hyperuricemia, and Crystal-Associated Disease Network Consensus Statement Regarding Labels and Definitions for Disease Elements in Gout

OBJECTIVE

The language currently used to describe gout lacks standardization. The aim of this project was to develop a consensus statement on the labels and definitions used to describe the basic disease elements of gout.

METHODS

Experts in gout (n = 130) were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach consensus on the labeling and definitions for the basic disease elements of gout. Disease elements and labels in current use were derived from a content analysis of the contemporary medical literature, and the results of this analysis were used for item selection in the Delphi exercise and face-to-face consensus meeting.

RESULTS

There were 51 respondents to the Delphi exercise and 30 attendees at the face-to-face meeting. Consensus agreement (≥80%) was achieved for the labels of 8 disease elements through the Delphi exercise; the remaining 3 labels reached consensus agreement through the face-to-face consensus meeting. The agreed labels were monosodium urate crystals, urate, hyperuric(a)emia, tophus, subcutaneous tophus, gout flare, intercritical gout, chronic gouty arthritis, imaging evidence of monosodium urate crystal deposition, gouty bone erosion, and podagra. Participants at the face-to-face meeting achieved consensus agreement for the definitions of all 11 elements and a recommendation that the label "chronic gout" should not be used.

CONCLUSION

Consensus agreement was achieved for the labels and definitions of 11 elements representing the fundamental components of gout etiology, pathophysiology, and clinical presentation. The Gout, Hyperuricemia, and Crystal-Associated Disease Network recommends the use of these labels when describing the basic disease elements of gout.

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout

OBJECTIVE

There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout.

METHODS

A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions.

RESULTS

The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus).

CONCLUSION

Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.

Do pain management websites foster self-management support for people with persistent pain? A scoping review

OBJECTIVES

To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality.

METHODS

Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification.

RESULTS

Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites.

CONCLUSIONS

The review identified 27 contemporary pain management websites that could be used for self-management skills training.

PRACTICE IMPLICATIONS

Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.

Utility Value Theory Underlies Students' Attitudes to Biomedical Sciences Curricula

INTRODUCTION

The recent wave of curriculum renewal has changed biomedical sciences from standalone science courses to integrated, clinically-oriented components of the curriculum. Although integrated curricula are now common in medical schools worldwide, few studies have systematically investigated students' attitudes towards and perceived relevance of the basic sciences in these new curricula.

METHODS

In a cross-sectional study, surveys were distributed to all year two to six medical students at Otago Medical School. Surveys used Likert-scale items and open-ended questions to explore students' perceived importance, relevance, value and acceptance of the current biomedical curriculum. Three focus groups were conducted to further explore students' perceptions. Transcripts of focus group discussions underwent thematic analysis using inductive coding.

RESULTS

Survey responses were received from 708 of 1500 students. Medical students reported acceptance of the biomedical programme, with no difference between the year groups (χ ²(4) = 8.595, p = 0.072). Perceived value, importance and relevance of the biomedical curriculum decreased from years two to six. Two major themes were identified from focus groups; the importance of contextualising biomedical science into clinical practice and detail being delivered with a just-in-time focus. Students judged the biomedical curriculum on its utility value, focusing on its' clinical relevance and usefulness.

DISCUSSION AND CONCLUSION

Although students understood the importance and relevance of biomedical sciences and believed applying biomedical science to clinical practice is a skill which should be reinforced early in the medical curriculum, the information in the current biomedical curriculum may be too detailed to be clinically useful. The linkages between biomedical teaching and clinical application can still be improved.

Current practices of health care providers in recommending online resources for chronic pain self-management

Purpose

Online health resources (websites, apps and social media) may be an adjunct to provide self-management support for people with persistent or chronic pain. Endorsement of online health resources by health care providers is crucial for uptake by end-users. The aim of this study was to investigate the current practices of New Zealand (NZ) health care providers in recommending online resources for persistent pain management, and to identify what factors predict health care providers’ recommendations and to explore the common concerns.

Methods

An online survey of NZ health care providers (ie, chiropractors, general practitioners, nurses, occupational therapists, osteopaths, physiotherapists, psychologists, specialist consultants, and social workers) involved in the management of persistent pain was conducted. The recruitment strategy was tailored to each occupation via occupation-specific professional organizations, and by approaching multidisciplinary professional organizations.

Results

Data from 213 health care providers were used in the final analysis. Most of the health care providers were physiotherapists (n=71), followed by chiropractors (n=39) and general practitioners (n=31). Fifty three percent (111/210) of health care providers reported currently recommending online resources. A multivariate logistic regression model showed that specialist interest in treating pain (OR=3.84; 95% CI: 1.66, 8.87; P=0.002), and level of confidence in recommending online resources (OR=1.05; CI: 1.04, 1.07; P<0.001), positively influenced recommending online resources. The majority of the health care providers (65%, 138/213) were concerned about the safety issues related to the risk of patients misinterpreting online information and to the lack of evidence-based information.

Conclusion

Half of the health care providers surveyed reported recommending online resources, which may suggest limited confidence in recommending, or knowledge of, existing online resources for persistent pain management. Ongoing education for health care providers on evidence-based online resources is required to recommend online resources as a self-management support tool for people with persistent pain.

Artificial Intelligence for Participatory Health: Applications, Impact, and Future Implications

Objective : Artificial intelligence (AI) provides people and professionals working in the field of participatory health informatics an opportunity to derive robust insights from a variety of online sources. The objective of this paper is to identify current state of the art and application areas of AI in the context of participatory health.

Methods : A search was conducted across seven databases (PubMed, Embase, CINAHL, PsychInfo, ACM Digital Library, IEEExplore, and SCOPUS), covering articles published since 2013. Additionally, clinical trials involving AI in participatory health contexts registered at clinicaltrials.gov were collected and analyzed.

Results : Twenty-two articles and 12 trials were selected for review. The most common application of AI in participatory health was the secondary analysis of social media data: self-reported data including patient experiences with healthcare facilities, reports of adverse drug reactions, safety and efficacy concerns about over-the-counter medications, and other perspectives on medications. Other application areas included determining which online forum threads required moderator assistance, identifying users who were likely to drop out from a forum, extracting terms used in an online forum to learn its vocabulary, highlighting contextual information that is missing from online questions and answers, and paraphrasing technical medical terms for consumers.

Conclusions : While AI for supporting participatory health is still in its infancy, there are a number of important research priorities that should be considered for the advancement of the field. Further research evaluating the impact of AI in participatory health informatics on the psychosocial wellbeing of individuals would help in facilitating the wider acceptance of AI into the healthcare ecosystem.

Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review

Background

Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known.

Objective

The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality.

Methods

A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale.

Results

Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain.

Conclusions

Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy.

Arthritis-Related Support in a Social Media Group for Quilting Hobbyists: Qualitative Study

Background

People with arthritis are increasingly seeking support online, particularly for information about social role participation while experiencing symptoms of chronic arthritis. Social media enables peer-to-peer support on how serious leisure (eg, hobbies such as quilting) can be adapted to allow participation. Research is needed to understand what type of peer support is provided online and how this support occurs.

Objective

The aim of our study was to explore what kind of support is offered by fellow hobbyists (with or without arthritis) in response to requests for advice in a social media group.

Methods

Three vignettes were posted on a Facebook quilting group regarding arthritis-related symptoms or impairments that affect how people quilt. A Facebook Insights report was used to examine the groups’ demographics. Responses to the vignettes were thematically analyzed.

Results

The members of the quilting Facebook group were mostly women (18,376/18,478, 99.45%), aged 55 to 64 years, and most were located in the United States. In response to the vignettes, the 22 participants predominantly offered emotional support and shared information. Participants shared their real-life experiences and creative means in adapting medical advice to their crafting. More than half (30/54, 56%) of the advice that was offered aligned with the OrthoInfo medical best practice guidelines relevant to the vignettes.

Conclusions

Serious leisure social media groups can be useful forums for sharing information about arthritis-related issues. People do respond to requests for support and information, although there is a difference between quilting support (eg, “I need a new iron, what should I buy?”) and health support (eg, “I have arthritis, what scissors should I buy?”). People provide emotional support for life events on serious leisure social media platforms (eg, offering condolences when a person states that she is making a memory quilt), and this extends to health issues when group members reveal them.