Quality of a Supporting Mobile App for Rheumatic Patients: Assessment Using the User Version of the Mobile Application Scale (uMARS) and Associated Patient Characteristics (Preprint)
Authors: Lambrecht Antonia , Vuillerme Nicolas , Raab Christina , Simon David , Messner Eva-Maria , Hagen Melanie , Bayat Sara , Kleyer Arnd , Aubourg Timothée , Schett Georg , Hueber Axel , Knitza Johannes 
Published: May 2021

BACKGROUND

Mobile applications promise to improve current health care. A growing number app quality studies exist to help patients and physicians choose appropriate, helpful and useful applications. However, current mobile app quality ratings are mostly physician-based. They exclude patients although as end-users, patients are able to provide the most relevant feedback. In a recent physician-based review of rheumatic apps, Rheuma Auszeit received the best overall rating (4.2/5), however this app has never been systematically evaluated by the intended end-users, rheumatic patients.

OBJECTIVE

The aim of this study was (1) to assess the quality of Rheuma Auszeit by rheumatic patients and (2) to evaluate the association between uMARS (User Version of the Mobile App Rating Scale) scores and patients’ characteristics.

METHODS

Consecutive patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis were seen at the rheumatology clinic at university hospital Erlangen, Germany. They were asked to evaluate the app Rheuma Auszeit using the uMARS and to complete a paper-based survey evaluating the individual preferences, attitudes and ehealth literacy. uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. The association between uMARS scores and patients’ characteristics was further explored.

RESULTS

Between December 2018 and January 2019, a total of 126 patients evaluated Rheuma Auszeit using uMARS and filled out the paper-based survey. The median uMARS score was 3.9, IQR 0.7. Functionality was the domain with the highest rating (median 4.8, IQR 0.8), followed by aesthetics (median 4.0, IQR 0.7), information (median 3.5, IQR 0.8), and engagement (median 3.2, IQR 1.0). Subjective quality was average (median 3.0, IQR 1.0). The lowest scoring individual item was customization with a median of 2.5/5. Lower functionality scores were reported among older female rheumatic patients (P<.004). Older male rheumatic patients reported a higher subjective quality score (P<.024). Perceived disease activity and disease duration did not significantly correlate with any uMARS subdomain scores. eHealth literacy significantly correlated with functionality uMARS subdomain ratings (Rho=0.18; P<.042). Preferred time of app usage significantly correlated with engagement (Rho=0.20; P<.024), functionality (Rho=0.19; P<.029), total uMARS score (Rho=0.21; P<.017) and subjective quality score (Rho=0.21; P<.017). The vast majority of rheumatic patients would consider recommending Rheuma Auszeit to other patients (117/126; 92.9%).

CONCLUSIONS

Rheuma Auszeit was well accepted by patients suffering from rheumatoid arthritis, psoriatic arthritis and ankylosing spondyloarthritis. Lacking customization could lead to low app compliance and should be improved. The study highlights the potential and feasibility of therapeutic complementary digital solutions in rheumatology.