A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing
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BACKGROUND: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. OBJECTIVE: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. METHODS: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. RESULTS: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. CONCLUSIONS: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice.
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The mean SUS score of 84 indicates that the average participants were highly satisfied with the usability of this online learning tool on all items of the SUS questionnaire, in terms of learnability, efficiency, memorability, errors, and satisfaction.
“indicating that the average participants were highly satisfied with the usability of this online learning tool on all items of the SUS questionnaire, in terms of learnability, efficiency, memorability, errors, and satisfaction [56].”
From Development and usability testing of a web-based and therapist-assisted coping skills program for managing psychosocial problems in individuals with hand and upper limb injuries: Mixed methods study (2020) · cites this paper as [56]
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Experimental — accuracy not yet measuredAccording to Nielsen, 5 users are adequate to identify most usability problems.
“According to Nielsen [56], 5 users are adequate to identify most usability problems.”
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- Authors
- Srikesavan, C. S., Williamson, E., Eldridge, L., Heine, P., Adams, J., Cranston, T., & Lamb, S. E.
- Affiliations
- University of Oxford (GB)
- University of Southampton (GB)
- Corresponding author
- Srikesavan, Cynthia Swarnalatha
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2017-12-13
- Volume
- 19
- Issue
- 12
- Pages
- e411
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5745347
- OpenAlex
- W2773035130
- Cited by
- 18
- References
- 35
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 1
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NIHR-CTF-2015-04-06, NF-SI-0611-10020)
- Oxford Health NHS Foundation Trust
- NIHR Oxford Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- rheumatoid arthritis, hand function, exercise program, online training, physiotherapists, occupational therapists, therapist training, usability testing, ADDIE model, barriers and facilitators, hand exercises, user engagement, wrist function
- MeSH terms
- Adult, Arthritis, Rheumatoid, Exercise Therapy, Female, Hand, Humans, Male, Middle Aged, Surveys and Questionnaires, Education, Distance, Internet, Young Adult, Physical Therapists
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