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A hand exercise mobile app for people with rheumatoid arthritis in Turkey: design, development and usability study


To design and develop a smartphone application for a structured hand exercise programme for patients with rheumatoid arthritis (RA) in Turkey and to test its usability. We followed a two-stage process: (1) Design and Development and (2) Usability testing. In stage 1, we used a qualitative user-centered design approach. We conducted a focus group (8 therapists and people with RA) to discuss the content, features and design to produce a prototype of the application. In a second focus group session, the participants tested the prototype, provided feedback and further revisions were made. In stage 2, 17 participants with RA used the app for 4 to 6 weeks. The System Usability Scale and the adapted Usability, Satisfaction and Ease to Use Questionnaires were used to measure usability, ease of use. Semi-structured interviews were conducted to explore user experiences with the application with 17 participants. In stage 1, the following themes were identified from the focus groups (a) login techniques (b) self-monitoring (c) exercises, (d) exercise diary, (e) information, (f) behavioral change and encouragement (g) exercise adherence. In stage 2, 3 themes were determined from interviews: (a) learning and accuracy, (b) ease of use, (c) motivation and adherence. USE and SUS scores indicated that users reported a high level of usability, satisfaction and ease of use. A mobile app for hand exercise for people with RA was developed using a mixed-method and iterative design. Participants perceived the mobile app as easy to use with high levels of satisfaction.

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We would like to thank the health professionals and study participants who contributed to this work.


This research was funded by The Scientific and Technological Research Council of Turkey, the SE2020 Translational Fund for Social Impact at the University of Oxford and the National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust and supported by the NIHR Biomedical Research Unit, Oxford. Marmara University, Scientific Research Projects Committee supported the study. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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Authors and Affiliations



ET, SL and EW conceived funding for the study. ET led the study team. SL was the senior author. ET, EW, CS, and SL contributed to the study design, and drafted and revised the manuscript. FS was involved in study recruitment and ethics approval process. TB and FS assisted in data collection, analysis, and technical works. All authors reviewed and approved the manuscript.

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Correspondence to Eda Tonga.

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There are no conflicts of interest to declare.

Ethical approval

The study protocol was approved by the Clinical Research Ethics Committee of Marmara University Medical Faculty, Turkey (Number: 06.2019.577).

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Informed consent was obtained from all participants.

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Tonga, E., Williamson, E., Srikesavan, C. et al. A hand exercise mobile app for people with rheumatoid arthritis in Turkey: design, development and usability study. Rheumatol Int 41, 1151–1160 (2021).

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