Using the NICE evidence standards for digital health technologies to evaluate a digital self-management tool for people with musculoskeletal conditions

Berry, Alice

Abstract

Purpose
getUBetter provides digital self-management for people with musculoskeletal (MSK) conditions across care pathways in England. Digital health technologies (DHT) are being embedded at pace, but we need to determine their effectiveness, value, and suitability. NICE DHT evidence standards were used to identify gaps in getUBetter’s evidence base. An evaluation was then undertaken in Wandsworth, south London to address these gaps.
Methods
Between Oct 2019 and March 2021 the evaluation took a phased approach:
1. Mapping existing evidence for getUBetter against the NICE evidence standards and identifying gaps.
2. A mixed methods evaluation based on evidence gaps was developed with stakeholders then rescoped due to disruption from COVID-19. The evaluation assessed outcomes related to condition, satisfaction, behaviour change, and resource use. An online survey was sent to getUBetter users capturing respondents’ demographic profile and app usage; experiences and satisfaction; condition-related outcomes; and changes in self-management and understanding of their condition. Resource use was determined by a pragmatic health utilisation analysis using EMIS data comparing patients with lower back pain (LBP) with non-users in a sample of 10 GP practices.
Results
getUBetter was identified as a Tier 3a DHT supporting self-management and preventative behaviour change. The mapping exercise against the NICE framework identified a gap in demonstrating evidence of effectiveness.
Fifty getUBetter users responded to the survey, a 13% response rate (50/389). Respondents were mainly female (29/47), white (34/47) and in full-time paid employment (18/ 47) or retired (14/47). 60% rated the app as either good or very good (21/35), reporting they found it easy to register and use the app, an acceptable way to get advice and support, and would recommend it to family and friends. Respondents most liked the app’s ease of use, and its’ support for self-management, giving reassurance and information relevant to recovery stage. Most reported benefits from using getUBetter, the greatest being improved confidence to self-manage (n=28/36), ability to self-manage (n=26/36), and a better understanding of their condition and recovery journey (n=25/36). 19 of 35 reported COVID-19 made them more likely to use the app.
Health utilisation analysis found 835 patients were prescribed getUBetter for LBP, 50% of whom activated their account. Compared to non-users, getUBetter users consumed 4 times fewer GP appointments, 20% less Physiotherapy referrals and over 50% fewer prescriptions and referrals.
Conclusion
The NICE standards provided a structured approach to assessing a DHT evidence-base in a MSK pathway and identifying gaps. Despite the challenge of COVID-19, this pragmatic evaluation showed a reduction in health resources use by patients using getUBetter. Users reported overall high rating for the app, with good patient acceptability and friends and family test scores. The results indicate most respondents got some benefit from using the app in terms of symptoms, function, and confidence and ability to self-manage their recovery. A larger controlled effectiveness study with economic evaluation is required to further strengthen the evidence-base for getUBetter.
Impact
The NICE standards provide a useful decision-making framework to support innovators, commissioners and providers. Better awareness and understanding of using the NICE standards is required.

• Presentation Conference Type: Poster
• Conference Name: VPUK (Virtual Physiotherapy UK)
• Start Date: Nov 5, 2021
• End Date: Nov 5, 2021
• Deposit Date: Dec 6, 2021
• Public URL: https://uwe-repository.worktribe.com/output/8212998