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Journal Description

JMIR Rehab is a PubMed-indexed sister journal of the Journal of Medical Internet Research (Impact Factor 2017: 4.671), focusing on development and evaluation of rehabilitation and assistive technologies, including assistive living.

As an open access journal, we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews). Articles are carefully copyedited and XML-tagged, ready for submission in PubMed Central.

 

Recent Articles:

  • Collage of diverse care settings (emergencies, medical care, geriatric care...) and different stakeholders (patients, doctors, care professionals). Source: Kasugai, RWTH Aachen University; Copyright: Kasugai, RWTH Aachen University; URL: http://rehab.jmir.org/2018/2/e10424; License: Licensed by JMIR.

    They Don’t Care About Us! Care Personnel’s Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study

    Abstract:

    Background: Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective: The objective of our study was to investigate professional caregivers’ AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods: A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people’s caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results: The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions: AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional’s needs and concerns (“care about us”). The results contribute to a broader understanding of professional caregivers’ needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts.

  • Discussion by users regarding the use of technology in stroke rehabilitation. Source: Image created by the Authors; Copyright: Andrew Kerr; URL: http://rehab.jmir.org/2018/2/e15/; License: Licensed by JMIR.

    Adoption of Stroke Rehabilitation Technologies by the User Community: Qualitative Study

    Abstract:

    Background: Using technology in stroke rehabilitation is attractive. Devices such as robots or smartphones can help deliver evidence-based levels of practice intensity and automated feedback without additional labor costs. Currently, however, few technologies have been adopted into everyday rehabilitation. Objective: This project aimed to identify stakeholder (therapists, patients, and caregivers) priorities for stroke rehabilitation technologies and to generate user-centered solutions for enhancing everyday adoption. Methods: We invited stakeholders (n=60), comprising stroke survivors (20/60, 33%), therapists (20/60, 33%), caregivers, and technology developers (including researchers; 20/60, 33%), to attend 2 facilitated workshops. Workshop 1 was preceded by a national survey of stroke survivors and therapists (n=177) to generate an initial list of priorities. The subsequent workshop focused on identifying practical solutions to enhance adoption. Results: A total of 25 priorities were generated from the survey; these were reduced to 10 nonranked priorities through discussion, consensus activities, and voting at Workshop 1: access to technologies, ease of use, awareness of available technologies, technologies focused on function, supports self-management, user training, evidence of effectiveness, value for money, knowledgeable staff, and performance feedback. The second workshop provided recommendations for improving the adoption of technologies in stroke rehabilitation: an annual exhibition of commercially available and developing technologies, an online consumer-rating website of available technologies, and a user network to inspire and test new technologies. Conclusions: The key outcomes from this series of stakeholder workshops provides a starting point for an integrated approach to promoting greater adoption of technologies in stroke rehabilitation. Bringing technology developers and users together to shape future and evaluate current technologies is critical to achieving evidence-based stroke rehabilitation.

  • The dashboard overview of a Web-based portal (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://rehab.jmir.org/2018/2/e14/; License: Creative Commons Attribution (CC-BY).

    An mHealth Platform for Supporting Clinical Data Integration into Augmentative and Alternative Communication Service Delivery: User-Centered Design and...

    Abstract:

    Background: The recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence. Objective: The objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery. Methods: A questionnaire and interviews were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals. Results: A Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal. Conclusions: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

  • Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://rehab.jmir.org/2018/2/e13/; License: Creative Commons Attribution (CC-BY).

    Users’ Perspectives, Opportunities, and Barriers of the Strengthen Your Ankle App for Evidence-Based Ankle Sprain Prevention: Mixed-Methods Process...

    Abstract:

    Background: The “Strengthen Your Ankle” neuromuscular training program has been thoroughly studied over the past 8 years. This process evaluation is a part of a randomized controlled trial that examined both the short- and long-term effectiveness of this particular program. Although it was shown previously that the program, available both in a printed booklet and as a mobile app, is able to effectively reduce the number of recurrent ankle sprains, participants’ compliance with the program is an ongoing challenge. Objective: This process evaluation explored participants’ opinions regarding both the methods of delivery, using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework to identify barriers and challenges to program compliance. Although Reach, Effectiveness, and Adaptation were the focus of a previous study, this paper focuses on the implementation and maintenance phases. Methods: Semistructured interviews and online questionnaires were analyzed using qualitative content analysis. Fisher exact, chi-square, and t tests assessed between-group differences in quantitative survey responses. Interviews were assessed by thematic analysis to identify key themes. Results: While there were no significant differences in the perceived simplicity, usefulness, and liking of the exercise during the 8 weeks of the neuromuscular training program, semistructured interviews showed that 14 of 16 participants agreed that an app would be of additional benefits over a booklet. After the 12-month follow-up, when asked how they evaluated the overall use of the app or the booklet, the users of the app gave a mean score of 7.7 (SD 0.99) versus a mean score 7.1 (SD 1.23) for the users of the booklet. This difference in mean score was significant (P=.006). Conclusions: Although both the app and booklet showed a high user satisfaction, the users of the app were significantly more satisfied. Semistructured questionnaires allowed users to address issues they would like to improve in future updates. Including a possibility for feedback and postponement of exercises, an explanation of the use of specific exercises and possibly music were identified as features that might further improve the contentment of the program, probably leading to increased compliance. Trial Registration: Netherlands Trial Register NTR4027; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4027 (Archived by Webcite at http://www.webcitation.org/70MTo9dMV)

  • Control of an Ambulatory Exoskeleton with a Brain-Machine Interface for Spinal Cord Injury. Source: Wikipedia Commons; Copyright: López-Larraz E, Trincado-Alonso F, Rajasekaran V, Pérez-Nombela S, del-Ama A, Aranda J, Minguez J, Gil-Agudo A, Montesano L; URL: https://commons.wikimedia.org/wiki/File:Control-of-an-Ambulatory-Exoskeleton-with-a-Brain%E2%80%93Machine-Interface-for-Spinal-Cord-Injury-Gait-Video1.ogv; License: Creative Commons Attribution (CC-BY).

    Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke

    Abstract:

    Background: Advances in wearable robotic technologies have increased the potential of these devices for rehabilitation and as assistive devices. However, the utilization of these devices is still limited and there are questions regarding how well these devices address users’ (therapists and patients) needs. Objective: The aims of this study were to (1) describe users’ perceptions about existing wearable robotic devices for the upper extremity; (2) identify if there is a need to develop new devices for the upper extremity and the desired features; and (3) explore obstacles that would influence the utilization of these new devices. Methods: Focus groups were held to collect data. Data were analyzed thematically. Results: A total of 16 participants took part in the focus group discussions. Our analysis identified three main themes: (1) “They exist, but...” described participants’ perceptions about existing devices for upper extremity; (2) “Indeed, we need more, can we have it all?” reflected participants’ desire to have new devices for the upper extremity and revealed heterogeneity among different participants; and (3) “Bumps on the road” identified challenges that the participants felt needed to be taken into consideration during the development of these devices. Conclusions: This study resonates with previous research that has highlighted the importance of involving end users in the design process. The study suggests that having a single solution for stroke rehabilitation or assistance could be challenging or even impossible, and thus, engineers should clearly identify the targeted stroke population needs before the design of any device for the upper extremity.

  • Source: Freepik; Copyright: nikitabuida; URL: https://www.freepik.com/free-photo/dance-class-for-women_1285528.htm; License: Licensed by JMIR.

    Scoping Review of Dance for Adults With Fibromyalgia: What Do We Know About It?

    Abstract:

    Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management and overall function rehabilitation. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia. Objective: The aims of this study were to understand how dance is used therapeutically by individuals with fibromyalgia; to examine the extent, range and nature of research activity in the area; and to determine the value of undertaking a systematic review of interventions. Methods: We used and adapted the Arksey and O’Malley scoping framework. The search strategy involved a comprehensive search of main health and electronic social databases, trial registries and grey literature without language limits. Pairs of reviewers independently screened and extracted data and evaluated the methodological quality of randomized control trials. Results: Twenty-one unique records for 13 studies met inclusion criteria; the studies included mostly middle-aged women. Types of dance included were aerobic dance, belly dance, dance movement therapy, biodanza and Zumba. Intervention parameters were different among studies. Frequency varied between one to three times a week; all were done in small group settings. Studies evaluated a variety of outcomes in the symptoms, wellness, psychosocial, physical functioning, balance and fitness categories; no studies evaluated the safety or adverse events systematically which is a major weakness of the literature. Conclusions: There are few studies in the field of dance and fibromyalgia, suggesting research is in its infancy but slowly growing. They are of European and South American origin, focusing on female participants and a limited number of dance modes. Because the body of literature is small, of low quality and highly heterogeneous, we concluded that a systematic review of interventions on dance is not warranted at this time.

  • Nancy Henckle of Delaware, OH undergoes rehabilitation for a stroke by playing a video game developed at The Ohio State University Wexner Medical Center. Developers say this is one of the first games for rehab to use design input from therapists and patients. Early tests showed that patients logged an average of more than 1,500 movements per hour while playing the game, helping them to become more functional and flexible. Source: Ohio State University Wexner Medical Center; Copyright: OSUWMC; URL: http://osuwmc.multimedianewsroom.tv/story.php?id=710&enter=; License: Fair use/fair dealings.

    Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review

    Abstract:

    Background: Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft’s Kinect, a video-based technology that uses infrared to track a user’s body movements. Objective: This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit. Methods: The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS. Results: In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems. Conclusions: This paper calls specifically for further studies of K-SRS—and for studies of technologies that allow patients to generate their own health data in general—to pay more attention to how patients’ own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/index.php?goto=74&idfoto=1965306&term=old%20exercise; License: Licensed by JMIR.

    Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions

    Abstract:

    Background: Prevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders. Objective: This study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website. Methods: We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months. Results: At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group. Conclusions: When comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy.

  • Bespoke Padlet forum with participant and moderator posts (montage). Source: The Authors / Placeit.net; Copyright: JMIR Publications; URL: http://rehab.jmir.org/2018/1/e9/; License: Creative Commons Attribution (CC-BY).

    Patients Using an Online Forum for Reporting Progress When Engaging With a Six-Week Exercise Program for Knee Conditioning: Feasibility Study

    Abstract:

    Background: The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual “sticky notes.” Objective: The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression. Methods: Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically. Results: Nineteen participants were recruited (47%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63%) opted to engage with the forum (range 4-40 entries), with five (42%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95% CI 0.06-6.93). No significant difference manifested between body mass index and engagement P=.46); age and entry frequency did not correlate (R2=.054, 95% CI –0.42 to 0.51, P=.83). Statistically significant conditioning profiles arose in single participants. Themes of pain, mitigation, and response were inducted from the experiences posted. Conclusions: Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee pain populations need further consideration.

  • Source: Image created by the authors; Copyright: The Authors; URL: http://rehab.jmir.org/2018/1/e8/; License: Creative Commons Attribution (CC-BY).

    A Kinematic Sensor and Algorithm to Detect Motor Fluctuations in Parkinson Disease: Validation Study Under Real Conditions of Use

    Abstract:

    Background: A new algorithm has been developed, which combines information on gait bradykinesia and dyskinesia provided by a single kinematic sensor located on the waist of Parkinson disease (PD) patients to detect motor fluctuations (On- and Off-periods). Objective: The goal of this study was to analyze the accuracy of this algorithm under real conditions of use. Methods: This validation study of a motor-fluctuation detection algorithm was conducted on a sample of 23 patients with advanced PD. Patients were asked to wear the kinematic sensor for 1 to 3 days at home, while simultaneously keeping a diary of their On- and Off-periods. During this testing, researchers were not present, and patients continued to carry on their usual daily activities in their natural environment. The algorithm’s outputs were compared with the patients’ records, which were used as the gold standard. Results: The algorithm produced 37% more results than the patients’ records (671 vs 489). The positive predictive value of the algorithm to detect Off-periods, as compared with the patients’ records, was 92% (95% CI 87.33%-97.3%) and the negative predictive value was 94% (95% CI 90.71%-97.1%); the overall classification accuracy was 92.20%. Conclusions: The kinematic sensor and the algorithm for detection of motor-fluctuations validated in this study are an accurate and useful tool for monitoring PD patients with difficult-to-control motor fluctuations in the outpatient setting.

  • Source: Shutterstock; Copyright: Aleksandra Suzi; URL: https://www.shutterstock.com/image-photo/smiling-male-doctor-holding-digital-tablet-588574085?src=oqRZrl2mmBLjFHLjdfqrtw-1-4; License: Licensed by the authors.

    The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review

    Abstract:

    Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access health care services, or are unable to access them easily, for reasons such as mobility restrictions, travel costs, consultation and treatment time constraints, and a lack of locally available MS expert services. Advances in mobile communications have led to the introduction of electronic health (eHealth) technologies, which are helping to improve both access to and the quality of health care services. As the Internet is now readily accessible through smart mobile devices, most people can take advantage of eHealth apps. The development of digital applications and remote communication technologies for patients with MS has increased rapidly in recent years. These apps are intended to complement traditional in-clinic approaches and can bring significant benefits to both patients with MS and health care providers (HCPs). For patients, such eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. These apps also help patients to participate actively in self-management, for example, by tracking adherence to treatment, changes in bladder and bowel habits, and activity and mood. For HCPs, MS eHealth solutions can simplify the multidisciplinary approaches needed to tailor MS management strategies to individual patients; facilitate remote monitoring of patient symptoms, adverse events, and outcomes; enable the efficient use of limited resources and clinic time; and potentially allow more timely intervention than is possible with scheduled face-to-face visits. These benefits are important because MS is a long-term, multifaceted chronic condition that requires ongoing monitoring, assessment, and management. We identified in the literature 28 eHealth solutions for patients with MS that fall within the four categories of screening and assessment, disease monitoring and self-management, treatment and rehabilitation, and advice and education. We review each solution, focusing on any clinical evidence supporting their use from prospective trials (including ASSESS MS, Deprexis, MSdialog, and the Multiple Sclerosis Performance Test) and consider the opportunities, barriers to adoption, and potential pitfalls of eHealth technologies in routine health care.

  • A patient consulting their health care professional because of lower back pain. Source: 59th Medical Wing; Copyright: US Air Force (Jerilyn Quintanilla); URL: http://www.59mdw.af.mil/News/Photos/igphoto/2001632287/; License: Public Domain (CC0).

    Preferences for Web-Based Information Material for Low Back Pain: Qualitative Interview Study on People Consulting a General Practitioner

    Abstract:

    Background: Information on self-management, including addressing people’s fears and concerns, are core aspects of managing patients with low back pain (LBP). Web apps with patient information may be used to extend patient-physician consultations and encourage self-management outside of the consultation room. It is, however, important to identify the end users’ needs and preferences in order to maximize acceptance. Objective: The aim of this study was to identify preferences for the content, design, and functionality of a Web app with evidence-based information and advice for people with LBP in Denmark. Methods: This is a phenomenological qualitative study. Adults who had consulted their general practitioner because of LBP within the past 14 days were included. Each participated in a semistructured interview, which was audiotaped and transcribed for text condensation. Interviews were conducted at the participant’s home by 2 interviewers. Participants also completed a questionnaire that requested information on age, gender, internet usage, interest in searching new knowledge, LBP-related function, and pain. Results: Fifteen 45-min interviews were conducted. Participants had a median age of 40 years (range 22-68 years) and reported a median disability of 7 points (range 0-18) using the 23-item Roland Morris Disability Questionnaire. Participants reported that Web-based information should be easy to find and read, easily overviewed, and not be overloaded with information. Subjects found existing Web-based information confusing, often difficult to comprehend, and not relevant for them, and they questioned the motives driving most hosting companies or organizations. The Patient Handbook, a Danish government-funded website that provides information to Danes about health, was mentioned as a trustworthy and preferred site when searching for information and advice regarding LBP. Conclusions: This study identified important issues to consider when developing and supplementing existing general practice treatment with Web-based information and advice for patients with LBP. Development of a Web app should consider patient input, and developers should carefully address the following domains: readability, customization, design, credibility, and usability.

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