Patient Age and Mobile Home Exercise Program (HEP) Use in Outpatient Physical Therapy

Abstract

Home Exercise Programs (HEPs) are typically prescribed by physical therapists based on the individual needs of patients, and are a common supplement to outpatient physical therapy1. While adherence to these programs has been associated with improved patient outcomes, nearly 70% of patients do not perform HEPs as prescribed by their physical therapists, and adherence tends to decrease over time2. Given that 77% of adults in the United States own a smartphone, including 42% of adults age 65 and older, smartphone applications (mobile apps) offer an alternative to paper-based programming for delivering and encouraging adherence to HEPs3. MedBridgeGO is a mobile app designed to facilitate individualized home exercise programs as a supplement to physical therapy. The purpose of this research is to examine if older age is associated with lower levels of MedBridgeGO utilization, and what patient factors are associated with utilization. This study involves a sequential mixed-methods analysis of the MedBridgeGO Mobile HEP. Key themes that reflect performance expectancy, effort expectancy, social influence and facilitating conditions of mobile HEP use are identified through an analysis of app store reviews from Google Play and iTunes. Subsequently, the research tests whether older age is associated with lower levels of MedBridgeGO utilization, as well as what patient factors are associated with use through a bivariate and multivariate analysis of MedBridgeGO. Major themes identified in analysis of app store reviews include: t he role of the MedBridgeGO mobile HEP in supporting successful rehabilitation through motivation, compliance with the exercise program, and consistent use of proper exercise form; the role of the MedBridgeGO mobile HEP in supporting patient self-efficacy and ease of adherence to their prescribed home exercise program; and areas for further development of the MedBridgeGO mobile HEP to better meet the needs of the users. When compared with adults aged 18-45, adults older than age 85 had lower odds of mobile HEP utilization in un-adjusted analysis (OR 0.33, 95% CI 0.24, 0.43) and after adjusting for exercise dose, geographic location and median family income (OR 0.33, 95% CI 0.23-0.45). Older age (85+ years) is associated with lower levels of mobile HEP utilization, and MedBridgeGO mobile app utilization did not differ among adults younger than 85. The results of this research provide insight into the use of app-based technology as an alternate to paper-based HEP programming, indicate age-associated societal, health system and individual factors that contribute to use of mobile HEPs, and serve as a resource for the wider healthcare community to design and develop mHealth technologies that meet the needs of a diverse population .