A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

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Abstract

Purpose

The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment.

Methods

Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery.

Results

Breast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content.

Conclusions

bWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness.

Implications for cancer survivors

Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.

Electronic supplementary material

The online version of this article (doi:10.1007/s11764-017-0630-3) contains supplementary material, which is available to authorized users.

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Most cited references 53

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Mapping mHealth Research: A Decade of Evolution

Maddalena Fiordelli, Nicola Diviani, Peter J. Schulz (2013)

Background For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments.

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Patient engagement and the design of digital health.

Faith Birnbaum, Megan Ranney, Rochelle Rosen … (2015)

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Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial.

Anthony C Bryan, T. Williams, Andrea B Troxel … (2011)

Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise, preventing them from obtaining established health benefits of weight lifting. To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise (control) among survivors at risk for breast cancer-related lymphedema (BCRL). A randomized controlled equivalence trial (Physical Activity and Lymphedema trial) in the Philadelphia metropolitan area of 154 breast cancer survivors 1 to 5 years postunilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs of BCRL at study entry. Participants were recruited between October 1, 2005, and February 2007, with data collection ending in August 2008. Weight lifting intervention included a gym membership and 13 weeks of supervised instruction, with the remaining 9 months unsupervised, vs no exercise. Incident BCRL determined by increased arm swelling during 12 months (≥5% increase in interlimb difference). Clinician-defined BCRL onset was also evaluated. Equivalence margin was defined as doubling of lymphedema incidence. A total of 134 participants completed follow-up measures at 1 year. The proportion of women who experienced incident BCRL onset was 11% (8 of 72) in the weight lifting intervention group and 17% (13 of 75) in the control group (cumulative incidence difference [CID], -6.0%; 95% confidence interval [CI], -17.2% to 5.2%; P for equivalence = .04). Among women with 5 or more lymph nodes removed, the proportion who experienced incident BCRL onset was 7% (3 of 45) in the weight lifting intervention group and 22% (11 of 49) in the control group (CID, -15.0%; 95% CI, -18.6% to -11.4%; P for equivalence = .003). Clinician-defined BCRL onset occurred in 1 woman in the weight lifting intervention group and 3 women in the control group (1.5% vs 4.4%, P for equivalence = .12). In breast cancer survivors at risk for lymphedema, a program of slowly progressive weight lifting compared with no exercise did not result in increased incidence of lymphedema. clinicaltrials.gov Identifier: NCT00194363.

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Author and article information

Contributors

Helena Harder:

ORCID: http://orcid.org/0000-0002-7296-8227

0044 1273 873019 , h.harder@sussex.ac.uk

Journal

Journal ID (nlm-ta): J Cancer Surviv

Journal ID (iso-abbrev): J Cancer Surviv

Title: Journal of Cancer Survivorship

Publisher: Springer US (New York )

ISSN (Print): 1932-2259

ISSN (Electronic): 1932-2267

Publication date (Electronic): 24 July 2017

Publication date PMC-release: 24 July 2017

Publication date (Print): 2017

Volume: 11

Issue: 6

Pages: 732-742

Affiliations

[1 ]ISNI 0000 0004 1936 7590, GRID grid.12082.39, Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, , University of Sussex, ; Brighton, UK

[2 ]ISNI 0000 0004 1936 7590, GRID grid.12082.39, School of Engineering and Informatics, , University of Sussex, ; Brighton, UK

[3 ]GRID grid.410725.5, Brighton and Sussex University Hospitals NHS Trust, ; Brighton, UK

[4 ]ISNI 0000 0004 1936 7590, GRID grid.12082.39, School of Psychology, , University of Sussex, ; Brighton, UK

Author information

Helena Harder http://orcid.org/0000-0002-7296-8227

Article

Publisher ID: 630

DOI: 10.1007/s11764-017-0630-3

PMC ID: 5671540

PubMed ID: 28741202

SO-VID: 52d0de1f-9a86-4695-8c62-b63d13336a13

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 1 December 2016

Date accepted : 10 July 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100009794, Breast Cancer Now;

Award ID: 2014MaySP312

Award Recipient : Helena Harder

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: breast cancer,shoulder function,lymphoedema,exercise,mhealth,mobile app,rehabilitation

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: breast cancer, shoulder function, lymphoedema, exercise, mhealth, mobile app, rehabilitation

A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

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Abstract

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Implications for cancer survivors

Electronic supplementary material

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Karger: Oncology

Most cited references 53

Mapping mHealth Research: A Decade of Evolution

Patient engagement and the design of digital health.

Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial.

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