Patients' Expectations for App-Based Therapy in Knee Osteoarthritis: User-Centered Design Approach

Background: Knee osteoarthritis (KOA) requires long-term treatment that faces significant barriers, including inadequate physiotherapy services, especially in Slovenia and comparable European countries. Mobile health apps offer a promising solution to improve accessibility and adherence to KOA treatment. Objectives: This study aimed to identify expectations of patients with KOA for app-based therapy, determine the functional requirements, and assess the main barriers and benefits of using mobile apps for KOA management. It also examined these factors about demographic data (gender, age, and education level) and motivation to perform knee exercises. Methods: A mixed methods approach was used, integrating quantitative data from a structured questionnaire and qualitative data from in-depth interviews. The purposive sample comprised 82 patients with symptomatic KOA graded 1-3 on the Kellgren-Lawrence scale, excluding those with cognitive impairments, wheelchair dependency, significant comorbidities, or language barriers. Results: The analysis revealed that 53.7% (44/82) of patients preferred smartphones, while 40.2% (33/82) favored PCs for remote KOA management, citing accessibility and convenience. Exercise videos received the highest rating (mu =9.45), followed by goal setting and tracking (mu =8.95) and regular e-messages (mu =8.83). Telephone consultations with physiotherapists were also highly valued (mu =8.41). Significant differences were observed in the perceived importance of key disease information (F9=2.077; P=.04) and exercise videos (F9=2.788; P=.05) based on motivation levels but not by gender, age, or education. Perceptions of the appropriate duration of physical activity varied with motivation levels (F9=2.490; P=.02) but not with demographic factors. Men rated ease of use (4.93 vs 4.71; F1=3.961; P=.05) and the clarity of the exercise flow display higher than women. The most significant barrier was inaccurate disease information (mu =3.96), with notable differences across age groups. Younger participants (younger than 40 years) and those aged 51-60 years expressed concerns about time management and information accuracy. Patients highlighted the ability to rewatch exercises as a key app feature, while time efficiency and improved access to physiotherapists were highly valued for convenience. Enhanced communication and accurate information were essential for building trust and ensuring effective treatment. Conclusions: Mobile health apps for KOA management should be designed with a user-centered approach, prioritizing accessibility, motivation, and effective communication. Key functionalities include high-quality exercise videos, goal setting, symptom tracking, and regular electronic reminders. Mitigating user-reported barriers and integrating age-specific adaptations can enhance adherence and therapeutic outcomes. The findings highlight the potential of mobile health technologies to optimize KOA self-management and improve patient quality of life, particularly in health care systems with limited physiotherapy accessibility, such as those in Slovenia.