Background: Exercise therapy is fundamental to rehabilitation for knee osteoarthritis and anterior cruciate ligament (ACL) reconstruction, yet adherence to prescribed exercise typically declines once clinical supervision ends. Digital rehabilitation platforms offer a promising means of supporting sustained exercise adherence, but qualitative evidence on how patients experience these platforms in real-world clinical practice remains limited, particularly in non-Western health care contexts. Objective: This study aimed to explore how patients with different knee conditions experienced the Healthy Knees digital rehabilitation platform in Hong Kong and to identify the factors shaping their platform engagement and exercise adherence. Methods: A qualitative design was adopted using reflexive thematic analysis. Fifteen adults (9 with ACL, 6 with osteoarthritis) who had been prescribed the Healthy Knees web-based platform at Prince of Wales Hospital participated in semistructured, in-person interviews (30‐45 min). Interviews were conducted in Cantonese or Mandarin, transcribed verbatim, translated into English, and analyzed inductively. Ethics approval was obtained from the Chinese University of Hong Kong and the University of New South Wales. Results: Participants were aged 21 to 79 years, with most being male (11/15). Younger participants were predominantly patients with postoperative ACL, while older participants were predominantly patients with preoperative osteoarthritis. Three interrelated themes were identified, collectively describing the fit between the platform and participants’ contexts. Content fit captured the alignment between exercise content and rehabilitation needs; participants across both groups perceived substantial overlap with existing physiotherapy, and content was often mismatched to their recovery stage. Motivational fit captured the alignment between platform support features and motivational needs; pain functioned as both a driver and a deterrent to exercise, and participants ranged from highly self-directed to reliant on external scaffolding, not following a simple age pattern. Access fit captured the alignment between the platform’s delivery mechanism and participants’ technological circumstances; QR code–dependent access, absence of a dedicated mobile app, and display issues created friction that led several participants to migrate to alternative resources, maintaining exercise adherence while abandoning platform engagement. Conclusions: Adherence to digital knee rehabilitation was shaped by the degree of fit between the platform and users’ contexts across content, motivational, and access dimensions. When access fit failed, participants often substituted alternative exercise resources rather than ceasing exercise entirely, highlighting a distinction between platform engagement and exercise adherence. As the sample’s clinical and demographic characteristics were closely linked, these findings should not be interpreted as diagnostic comparisons between ACL and osteoarthritis populations but as patterns shaped by the recovery phase and age. These findings suggest that digital rehabilitation platforms should incorporate adaptive content aligned with the recovery stage, integrated feedback mechanisms, and reduced access friction to sustain platform engagement within an ecosystem of competing alternatives.
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Young Adults’ Perspectives on an Ecological Momentary Intervention for Drinking to Cope: Qualitative Study
<strong>Background:</strong> Young adults have high rates of mental health problems, such as mood or anxiety symptoms, and high rates of problematic drinking. Many young adults who undergo psychiatric hospitalization to address depression and anxiety symptoms also engage in risky drinking and tend to drink to cope with negative emotions. However, in many cases, treatment programs focusing on mood and anxiety symptoms often fail to adequately address problematic alcohol use in young adults. <strong>Objective:</strong> This study aimed to address this treatment gap by investigating patient perspectives on a potential ecological momentary intervention mobile app. Researchers used qualitative methods to gather perspectives of young adults hospitalized for psychiatric care on their use of drinking to cope with negative emotions and their feedback for a prospective app designed to suggest healthy coping strategies when participants report low mood and cravings to drink. <strong>Methods:</strong> We recruited a total of 12 young adults admitted to a partial hospitalization program to participate in a qualitative interview. To be eligible, participants needed to be aged 18-25 years and report drinking at least once weekly, binge drinking at least once monthly, drinking to cope with negative emotions, and depression and/or anxiety symptoms. <strong>Results:</strong> Qualitative analysis of our data resulted in 4 major themes. These included (1) motivations to use substances, (2) healthy coping, (3) general reactions to the proposed app, and (4) suggestions for the app. Participants generally had insight about their use of alcohol to cope and were able to identify several motivations for drinking; the most frequent motivations were to alleviate anxiety and depression, although many participants noted drinking to cope with other emotions, such as guilt or loneliness. Participants overall had positive responses to the prospective intervention and reported that they would appreciate the portability of a digital intervention in helping them “step down” from higher levels of psychiatric care. Participants also made several valuable suggestions about content, features, and usability, such as suggesting ways to “gamify” the app to increase use. <strong>Conclusions:</strong> This feedback will be crucial in designing and testing an ecological momentary intervention designed to reduce drinking to cope in young adults hospitalized for psychiatric care.
An Evaluation of the Usability and Feasibility of the 50K4Life Mobile App for Delivering Walking Challenges to Public School Administrative Employees: Beta Testing Study
Background: Mobile health apps show promise for delivering physical activity interventions, but uptake remains low due to usability barriers. Beta testing is essential to optimize user experience before full implementation. Objective: This study aimed to evaluate the usability, acceptability, and feasibility of the 50K4Life mobile app prototype for delivering a 2-week walking challenge to public school administrative employees. Methods: Following the Integrate, Design, Assess, and Share framework, we conducted a single-group beta test with 12 public school administrative employees in El Paso County, Texas. Participants used the 50K4Life app built on the Pathverse platform for a 2-week walking challenge. Data collection included acceptability surveys, satisfaction questionnaires, app use metrics, and qualitative debriefing sessions. Results: All 12 participants completed the walking challenge. Acceptability was high for app design (n=12, 91.7%), layout (n=9, 75%), and battery impact (n=10, 83.3% reported no issues). However, participants experienced difficulties with navigation (n=7, 58.3%), delays in updating step counts (n=8, 66.7%), and completion of assigned tasks (n=5, 41.7% could not locate all features). App use was high: 100% (n=12) accessed the leaderboard and walking challenge page, and 91.6% (n=11) synced step data and set step goals. Results from participants’ responses in the surveys and feedback from debrief interviews identified needs for improving user engagement features, synchronization, and visual appeal. Conclusions: The application of a participatory approach and Integrate, Design, Assess, and Share framework yielded valuable insights into the acceptability of the 50K4Life app reported by this study cohort and potential for enhanced features in <i>real-world</i> use contexts.
Acoustic stimulation in pain management: neurobiological mechanisms and clinical applications—a narrative review
Pain affects over 30% of the global population, with an underlying pathogenesis involving a complex interplay of biopsychosocial factors. Despite the availability of conventional pharmacological and interventional therapies, their clinical utility is frequently constrained by concerns regarding substance misuse, surgical complications, and other adverse sequelae. Acoustic stimulation (AS) has emerged as a promising alternative in pain management, characterized by its non-invasive nature, favorable safety profile, and high cost-effectiveness. However, current literature lacks a comprehensive evaluation of cutting-edge AS technologies and a profound decryption of its pleiotropic analgesic mechanisms, which has hindered the integration of AS into multimodal analgesic strategies. This review provides the first comprehensive synthesis of the neurobiological mechanisms and clinical applications of AS. We comprehensively evaluate the analgesic efficacy of diverse modalities, ranging from established interventions—such as music therapy (MT), natural sounds (NS)/noise, and auditory beat stimulation (ABS)—to emerging approaches, including vibroacoustic therapy (VAT) and immersive interactive technologies that integrate multisensory acoustic information. Emerging evidence suggests that AS exerts its therapeutic effects via a multidimensional neurobiological framework, notably through the modulation of corticothalamic circuits, the activation of descending pain-inhibitory systems, and the dynamic regulation of neurochemical mediators. Clinical data consistently highlight the adjunctive value of MT, NS/noise, and VAT in the management of both acute and chronic pain. Furthermore, the convergence of AS with immersive interactive technologies is pioneering a novel digital intervention paradigm, facilitating the seamless integration of AS into multimodal analgesic frameworks. Collectively, these findings suggest that AS represents a robust, non-pharmacological strategy that warrants further exploration as a cornerstone of future personalized, multimodal pain management.
Digital Platform to Provide Health Data Feedback for Neurorehabilitation Patients: User-Centered Development and Proof-of-Concept Usability Study
Background: An increasing amount of digital health data are being collected across rehabilitation settings, but their integration into routine clinical practice remains limited, despite its potential to motivate patients or inform clinical decision-making. Specifically, effective visualization and communication of assessment outcomes to both patients and health care practitioners (HCPs) represent a key gap in the neurorehabilitation practice. Objective: This study describes the development and evaluation of RehaLink (author ND, ETH Zürich), a proof-of-concept mobile app that delivers structured, interpretable feedback from conventional and technology-based assessments to neurorehabilitation patients and HCPs. Methods: The app was developed through a 3-step iterative co-design process involving 17 inpatients with multiple sclerosis and 15 HCPs from a single rehabilitation center. The app integrates a full battery of conventional assessments routinely conducted at the clinic, as well as digital health metrics from the Virtual Peg Insertion Test, a validated technology-based assessment of upper limb function, as a proof of concept for integrating technology-based assessment data into clinical workflows. Three structured feedback sessions were conducted, in which participants evaluated feedback types, visualization formats, and app usability using Likert-scale ratings, preference rankings, open-ended questions, and the System Usability Scale. Data were analyzed using descriptive statistics and directed content analysis. Results: Across all 3 sessions, progress bars and color-coded indicators were consistently preferred over text-heavy or abstract formats by both patients and HCPs. A persistent set of competing demands was observed, with participants requesting both visual simplicity and access to absolute values and normative comparisons. HCPs tended to underestimate patients’ preference for informative visualizations. The perceived value of structured feedback increased over the course of the study; patients’ median ratings rose from 4.0 to 5.0 and HCPs’ from 4.0 to 4.5 on a 5-point Likert scale. The resulting mobile app prototype demonstrated high usability, with patients achieving a mean System Usability Scale score of 93.6 (mean 6.4; best imaginable) and HCPs 80.9 (SD 8.1; good), according to established benchmarks. Conclusions: These findings demonstrate the feasibility and value of a co-designed digital feedback tool for neurorehabilitation. By combining conventional and technology-based assessment outcomes in an accessible, user-centered format, the app has the potential to enhance patient engagement, support clinical decision-making, and advance the implementation of value-based, personalized care.
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Correction: Barriers and Facilitators in the Implementation of the Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health Digital Intervention in Rural India: Mixed Methods Process Evaluation Study
Asynchronous Broadcasting of Audiovisual Content as a Telerehabilitation Strategy for Patients in Rural Areas: Development and Usability Study
Background: Geographical and economic barriers limit access to health care services in rural regions of Colombia. In San Vicente del Caguán, the lack of infrastructure and rehabilitation professionals forces patients to travel long distances. Asynchronous telerehabilitation using video broadcasting is a viable strategy to address these challenges. Objective: This study aims to design and validate a telerehabilitation model using asynchronous audiovisual content broadcasting for rural patients, evaluating functionality, usability, and clinical effectiveness. Methods: A 4-stage case study developed and validated the model in San Vicente del Caguán: (1) analysis of telemedicine experiences and video-based therapy; (2) solution design including telecommunications infrastructure (radio links and Wi-Fi), mobile app (HSRehabiAPP), and web platform (HSRehabiWEB); (3) fieldwork with 7 patients receiving physical, occupational, or speech therapy, evaluating functionality (11 criteria), usability (8 criteria), and content quality (5 criteria); and (4) results analysis. The infrastructure connected San Rafael Hospital with remote centers in Los Pozos and Tres Esquinas. Participants (aged 7-68 years) from urban and rural areas had conditions including stroke, shoulder injuries, knee pathologies, hypertension, and attention-deficit hyperactivity disorder. Results: All 7 patients achieved 100% compliance across functional, usability, and audiovisual content criteria. Functional evaluation covered login, navigation, therapy access, session viewing, exercise execution, pain assessment, therapist communication, and satisfaction surveys. Usability assessment evaluated initial access, content location, navigation comfort, instructional guidance, session organization, video playback, instruction clarity, and interface intuitiveness. Content criteria included exercise clarity, step-by-step instructions, visual quality, audio quality, and correct posture demonstration. Patients reported high satisfaction, noting reduced travel costs and time, family convenience, and effective outcomes. Offline functionality proved essential in areas with limited internet connectivity. Conclusions: The asynchronous audiovisual telerehabilitation model is an effective solution for improving access to rehabilitation services in rural areas. It successfully addressed geographical barriers and infrastructure limitations while maintaining clinical effectiveness across therapies. Implementation requires adequate technological infrastructure, user-friendly platforms with offline capabilities, and quality therapeutic content. Future work demands inclusive health policies, professional training, and research with larger sample sizes to assess long-term sustainability in diverse rural contexts.
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Usage of the Tablet-Based “Keep On Keep Up” Digital Program and Resulting Changes in Physical Capacity and Real-World Walking in Community-Dwelling Older Adults: Process Evaluation
Background: “Keep On Keep Up” (KOKU) is a tablet-based digital program based on the well-validated Otago and Fitness and Mobility Exercise programs for older adults to decrease the risk of falling. Objective: This substudy involved a process evaluation in order to analyze the usage patterns of the KOKU digital program, specifically training frequency, volume, and intensity among older adults over a 3-month self-managed training period. Pre-post changes in physical capacity and real-world walking were examined. Methods: This study is a nested cohort study within the three-armed randomized controlled SMART-AGE trial conducted in Germany (German Clinical Trials Register ID: DRKS00034316). Participants aged 67 years or older with basic digital literacy were included. KOKU provided guided but unsupervised progressive strength and balance training for 3 months. The data on training adherence, engagement, and progression were collected. Instrumented assessments included the Timed Up and Go Test, the 30-Second Chair Rise Test, and real-world walking monitoring using wearable sensors. Results: A total of 113 participants (n=63, 56% female; mean age 74.02, SD 5.36 y) were included in the analysis. During the 3-month period, participants used KOKU for 24 (SD 15) days, that is, 2 to 3 times per week. Over the entire study period, no falls or other adverse events were reported due to KOKU usage. The number of exercises performed per participant ranged from 2 to 213, with a median value of 70. The instrumented Timed Up and Go Test results revealed a prolonged total duration (=0.26; =.009). In the instrumented 30-Second Chair Rise Test, improvements were observed in the number of completed repetitions (=0.21; =.04) and frequency of repetitions (=0.23; =.03). This was mainly due to a reduction in inactive time (=−0.60; <.001). Real-world walking parameters remained unchanged, except for a slower walking speed during walking bouts of less than 30 seconds (=0.49; <.001). All changes did not meet the criteria for minimally important differences. Conclusions: KOKU is a novel digital intervention for older adults, promoting balance and strength exercises. Physical capacity improvements were small. However, the use of instrumented assessments provided further insights into participants’ capacity and mobility that would not have been identifiable with conventional assessments. Future improvements to the program should focus on incorporating more challenging exercises for individuals with varying levels of physical capacity. Trial Registration: German Clinical Trials Register DRKS00034316; https://drks.de/search/en/trial/DRKS00034316
Examining the Influence of Social Network Factors on Weight Loss Among Latina and Non-Hispanic White Breast Cancer Survivors: Observational Cohort Study
<strong>Background:</strong> Breast cancer is the most commonly diagnosed cancer among women and is the leading cause of cancer death among Latina individuals. Breast cancer survivors are at increased risk of obesity. Mobile health interventions have been shown to be an effective way of reducing the risk of weight gain. Less studied but also important is the extent to which social networks play a role in supporting or undermining weight loss efforts. <strong>Objective:</strong> We examined the association between 4 kinds of social network interactions and change in BMI among Latina and non-Hispanic White breast cancer survivors engaging in a mobile health app pilot study. <strong>Methods:</strong> Latina and non-Hispanic White breast cancer survivors were randomized to engage in either the <i>Mi Salud</i> or <i>Mi Vida, Mi Salud</i> app. <i>Mi Salud</i> allowed participants to engage in self-monitoring by recording their behaviors and symptoms. <i>Mi Vida, Mi Salud</i> used these same features in addition to a self-discovery feature that would summarize and report back this information to participants. We collected information on BMI and health-related social support; positive and negative health-related social control (which included persuasion and pressure, respectively); and undermining at baseline and after 12 weeks of the intervention. <strong>Results:</strong> While participants (non-Hispanic White n=22 and Latina n=22) in both study arms experienced decreased BMI over the 12-week period, this change in BMI did not differ according to ethnicity. Furthermore, change in social support was not associated with decreased BMI (B=−0.19, <i>P</i>=.12). However, the interaction between change in social support and ethnicity was significant, such that predicted margins were significant for non-Hispanic White individuals (B=−0.57, <i>P</i>=.02) but not for Latina individuals (B=−0.54, <i>P</i>=.72). Change in persuasion was not associated with change in BMI (B=0.072, <i>P</i>=.61); however, increased pressure was associated with increased BMI (B=0.66, <i>P</i>=.02). Finally, change in undermining was not associated with change in BMI (B=0.32, <i>P</i>=.11). <strong>Conclusions:</strong> Latina and non-Hispanic White participants did not differ in weight loss. However, our findings regarding social network involvement and change in BMI show the importance of considering social network processes in weight loss among breast cancer survivors. These findings buttress existing research suggesting the benefits of social support, particularly within specific cultural frameworks, while attempts to increase participants’ healthy behaviors that involve criticism can be detrimental to change efforts. Future research that builds on these findings is needed to elucidate the specific social network processes that may drive health behavior among diverse breast cancer survivors.
Digital Therapeutic Content for Substance Use Disorder Treatment: Development and Evaluation Study
Background: Substance use disorders (SUDs) are a major public health concern, contributing to significant individual and societal costs. Despite this, the uptake of evidence-based pharmacologic and behavioral interventions remains limited. The digital delivery of SUD treatment has emerged as a potentially scalable way to reduce access barriers and increase treatment use. Existing digital therapeutic interventions are often created without clinician involvement, evidence-based materials, interdisciplinary input, or content review. The implementation of a structured and methodologically rigorous development process is needed across digital health interventions to help ensure patient-facing materials are validated, understandable, and actionable for the end user. Objective: This early report seeks to describe and evaluate an iterative, interdisciplinary, platform-agnostic process for adapting and refining existing print materials for digital therapeutic modules in SUD treatment. The a priori goal was to evaluate if a structured, human-centered approach would generate digital modules that were rated as understandable and actionable based on a validated assessment for written materials. Methods: Fourteen therapeutic modules were adapted from existing Mayo Clinic–written, patient-facing education materials originally developed by a board-certified addiction psychiatrist and a doctoral-level education specialist for clinical use. A team of 4 purposively recruited licensed alcohol and drug counselors with lived experience with a SUD, all in recovery, and a doctoral-level therapeutic specialist met weekly for one hour over a 6-month period to iteratively adapt this existing content for smartphone delivery (2‐3 hours per module). The process flow included selecting source material, restructuring content for viewing on a phone screen, simplifying language, improving organization and flow to promote understanding, and including specific actions users could take based on the content. The counselors then independently evaluated the modules using the Patient Education Materials Assessment Tool for printable materials (PEMAT-P). PEMAT-P scores for understandability and actionability were calculated as percentages, and descriptive statistics were used to summarize scores in aggregate and across modules. A target of >70% was set for each PEMAT-P domain, consistent with accepted benchmarking standards. Results: Mean understandability and actionability for all modules were 87.2% (SD 4.8%; range 81.4%‐96.9%) and 75.1% (SD 12.3%; range 57.1%‐95.0%), respectively, exceeding the recommended threshold. While all modules were adequately understandable, 35.7% (5/14) scored below the actionability threshold. Conclusions: This early report highlights the value of a human-centered, iterative process for adapting therapeutic materials for digital delivery in SUD treatment. Although the modules performed well overall on PEMAT-P benchmarks, actionability was less consistent than understandability, and aggregate scores masked weaknesses in several individual modules. This indicates that a standardized process does not guarantee actionable material across all content types. Involving current patients in this process may improve the end product by incorporating a perspective that was previously missed.
