Utilization, Reliability, and Validity of a Smartphone App for Chronic Pain Management: A Randomized Controlled Trial

Abstract

Background: There has been an explosion of smartphone applications (apps) that have been used to track health data and change the management of chronic diseases. However, there have been very few studies designed to comprehensively examine the usability, acceptability, reliability, utility, and content and face validity of a smartphone pain app.

Objective: The overall aim of this study was to determine the effect of introducing a smartphone pain app, for both Android and iPhone devices, that enables chronic pain patients to assess, monitor, and communicate their status to their providers.

Methods: This study recruited 105 chronic pain patients to use a smartphone pain app. The patients were randomized to either receive 2-way messaging or a standard message on the smartphone app using a stratified randomization table. Those in the experimental group (n=53) received 2-way messaging of weekly supportive text messages and feedback about their progress by the study research assistant (eg, “Hello Dave! It looks like your pain, mood and activity interference this week have improved - way to go!”). Those in the control group (n=52) received a standard reply of “Thank you. Your message has been received” every time the participants sent a message through the app. All subjects completed baseline measures and were asked to record their progress every day for 3 months, with the opportunity to continue for 6 months. All participants were supplied a Fitbit to track daily activity. Summary line graphs were posted to each of the patients’ electronic medical records, and physicians were notified of their patients’ progress.

Results: Ninety patients successfully downloaded the pain app. Average age of the participants was 47.1 (range 18-72), 63.8% were female, and 32.3% reported multiple pain sites. Adequate validity and reliability was found between the daily assessments and standardized questionnaires (r=0.50) and in repeated daily measures (r=0.69 pain; r=0.83 sleep). Patient satisfaction survey results showed that the app was easy to use and easy to navigate, and those subjects with more daily assessments were found to be more satisfied with the app compared with those who used the app less often (P<.05).Those patients assigned to the 2-way messaging condition on average tended to use the app more and submit more daily assessments (95.6 vs 71.6 entries) and found the app more appealing, easier to use and to navigate, and less bothersome than those without the 2-way messaging (P<.05), but differences between groups in adherence to the pain app over time were not significant. Seven pain management physicians and six pain fellows completed an anonymous satisfaction survey at the end of the trial. A total of 85.7% reported being satisfied with the way the app was used in the clinic and liked receiving the pain app summary messages. Also, 85.7% believed that using the app would improve their overall practice, while none of the physicians felt that the pain app was an added burden to the clinic.

Conclusions: This study highlights some of the benefits and challenges in utilizing smartphone apps to manage chronic pain patients, and provides insight into those individuals who might benefit from mHealth technology. Overall, the smartphone pain app was found to be usable, valid, reliable, and easily accepted among patients and providers alike. The 2-way messaging feature was also found to moderately improve compliance with daily assessments. Mobile application technologies possess advantages and possibilities that have not previously existed and future programs are needed that tailor to the needs of the individual to engage and motive the user to make changes that enhance health care management.

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