Harriet Morf

Spondyloarthropathies (SpA) are characterized by low back pain and limited mobility. Therefore, physical activity (PA) is an essential part of the treatment, yielding positive effects on clinical symptoms. Digital health applications (DHAs) present new opportunities to promote clinical outcomes, however, their long-term effectiveness is often limited by low adherence and high dropout rates.This study investigates whether integrating personalized or AI-driven coaching enhances the therapeutic benefits of DHA in patients with SpA. SpAs patients were randomized into one of 3 groups. They were instructed to exercise at least 2–3 times per week for 6 months with the DHA according to their group (intervention groups: ViViRA (with personal coaching) or Kaia Health (with AI-based coaching); control group: ViViRA (without coaching)). Personal coaching consisted of a one-time, 30-min online coaching session prior to using DHA, while the AI coaching consisted of video-based AI integrated into DHA to provide movement guidance during each session. At baseline, after 3 and 6 months sociodemographic, questionnaires and mobility were assessed. Data from 78 participants were analyzed (mean age 51 years; 68% female). All three digital interventions showed a significant improvement in mobility (Bath Ankylosing Spondylitis Metrology Index (BASM), range: 0–10, lower scores = better mobility; BL-3 month: mean BASMI change − 0.6 to − 0.7; all p < 0.001). Pain intensity decreased substantially in all arms (PainDETECT, neuropathic pain, range: 0–38, higher scores = more severe pain; BL-6 month: mean reduction − 4.6 to − 6.6 points; all p ≤ 0.006). PAHCO (Physical Activity-related Health Competence) control competence increased over time and reached statistical significance only in the ViViRA + coaching group (PAHCO: higher scores = better physical activity-related health competence; BL-6 month: + 1.02, p = 0.013) but did not exceed the other interventions in a direct comparison. Overall, none of the coaching strategies showed significant superiority over the stand-alone digital therapy. Adherence was the same in all groups after 3 months (2–3 weekly use of DHA). Digital movement therapy with the use of DHA improves mobility and pain independently of coaching in SpAs patients. In contrast, personal coaching has been shown to improve health-related skills which could indicate potential benefits for self-management and long-term treatment adherence. Trial registration The study is registered in the German clinical trial registry (DRKS) under the following ID: DRKS00035191, https://www.drks.de/search/de/trial/DRKS00035191/details, Registration date: 01.10.2024.

Exercise is a key non-pharmacological component of therapy in axial spondyloarthritis (axSpA). Evidence for yoga as a mind–body intervention remains limited. This study aimed to assess the effects of an 8-week yoga program on mobility, function, disease activity, activity-related competences, and psychological outcomes in axSpA compared with physiotherapy and healthy individuals. We conducted a prospective, non-randomized, study (University Hospital Erlangen, May 2021–January 2024). AxSpA patients participated either in weekly yoga sessions for 8 weeks (approximately 60 min; online format) or received standard individual physiotherapy (≥ 30 min/week). A healthy control group completed the same yoga program. Health related outcomes at baseline and follow-up were measured and changes were analysed using linear mixed-effects models. Seventy-six participants were included. In axSpA, spinal mobility improved in the yoga group (BASMI Δ − 0.31; p = 0.002), while the physiotherapy group worsened (Δ + 0.29; p = 0.003). Physical activity related health competency (control competence Δ + 1.10; p = 0.001; self-regulation Δ + 0.72; p = 0.021) and psychological outcomes improved in the yoga group with increased quality of life mental scores (Δ + 6.62; p < 0.001) and reduced kinesiophobia (TSK Δ − 3.25; p = 0.008); physiotherapy showed no meaningful changes. Disease activity showed a significant decrease in the yoga group (BASDAI Δ –0.44; p = 0.049). Healthy individuals showed similar directional changes with smaller effects. An 8-week yoga intervention was associated with improvements in mobility, psychological outcomes and activity-related competences. Findings support yoga as a complementary treatment addressing both physical and psychological dimensions of axSpA. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00025215).

Digital health interventions hold promise for improving self-management in chronic inflammatory diseases such as rheumatoid arthritis (RA). The Fimo Health App was developed to support patients with RA using a multidimensional approach combining educational modules, symptom tracking, and mind–body exercises. This pilot feasibility study aimed to evaluate the usability, adherence, and potential clinical benefit of a prototype version of the app in patients with RA. A further objective was to explore patient subgroups that may particularly gain from the intervention. In a single-arm pilot trial, 31 patients with RA used the app over 12 weeks. Usability was assessed via the System Usability Scale (SUS). Primary clinical outcomes were patient-reported quality of life (SF-36 mental and SF-36 physical = Short-Form 36 Questionnaire), fatigue (FACIT-F), and pain (Visual Rating Scale Pain = VRS Pain), Secondary outcomes included functional impairment (HAQ = Health Assessment Questionnaire), global assessment, fear of motion (TSK = Tampa Scale of Kinesiophobia) and physical activity related-health competency (PAHCO). Subgroup analyses were conducted post hoc based on clinical characteristics. Usability was high (SUS = 74.4) and engagement with core app features strong (97% any use; 70% exercise completion). Across the full cohort (n = 31), changes in the primary outcomes were small overall. Physical quality of life (SF-36) showed a within-person median increase at 6 months (Hodges–Lehmann Δ = + 5.3; r = 0.50), while fatigue (FACIT-F) and pain (VRS) exhibited only small, non-significant numerical improvements (Δ ≈ + 1 to + 4; r ≈ 0.1–0.2). Mental quality of life (SF-36 mental) remained largely stable. In the subgroup of recently diagnosed patients (≤ 2 years; n = 12), trends were more pronounced. Physical quality of life (SF-36 physical) improved consistently at 3 and 6 months (Δ = + 1.3 to + 8.7; r = 0.67–0.85), accompanied by small favorable shifts in fatigue (Δ ≈ –1.5 to + 2; r ≈ 0.2–0.3). Mental quality of life again (SF-36 mental) remained stable over time. The Fimo Health App is a usable and well-accepted digital intervention for patients with RA. Early diagnosed Patients showed signals of potential benefit.. These findings support the value of targeted digital tools early in the RA disease trajectory. Trial Registration number : DRKS00035194, registration date: 01.10.2024, https://drks.de/register/de/trial/DRKS00035194/preview .

While artificial intelligence (AI) is gaining attention in rheumatology, little is known about patient perspectives. This study addresses this gap by examining patients’ experiences and attitudes toward AI. A nationwide, cross-sectional, web-based survey was conducted between March and May 2025 among adult patients with rheumatic diseases in Germany. Data were analyzed descriptively and with cluster analysis. A total of 778 patients completed the survey (70.4% female, mean age 51.3 years). The most common diagnosis was rheumatoid arthritis (31.7%). While 26.8% reported current AI use for health-related purposes, 57.8% expressed interest in using it. Patients were particularly interested in AI-based symptom checkers (64.3%), therapy recommendations (50.6%), and chatbots for medical inquiries (44.5%). 57.6% of patients indicated that they would welcome their rheumatologists using AI-based clinical suppport. The most frequently cited benefits of AI included improved information access (63.5%) and faster diagnosis (57.7%), while concerns centered on faulty AI (74.3%) and reduced human interaction (59.6%). Cluster analysis identified three distinct patient profiles: ‘AI-savvy’ (41.4%), ‘AI-pragmatic’ (44.8%), and ‘AI-skeptical’ (13.8%). Cluster membership was significantly associated with age and education, with younger patients more often belonging to the ‘AI-savvy’ group. Patients with rheumatic diseases showed substantial interest in AI-supported care, although actual use in medical contexts remained limited. Age and education differences highlight the need for tailored implementation strategies to ensure equitable and patient-centered adoption of AI in rheumatology.

Randomized controlled trial to evaluate the effectiveness of a digital health application (Kaia) for the prevention of back pain and improvement of quality of life among nursing staff – Digital applications in the prevention of back pain among nursing staff Introduction: Many healthcare professionals, especially in inpatient settings, frequently report chronic back pain due to high physical workload. There are only a few specific prevention programs in that address this issue. Digital prevention programs are not yet established in occupational medicine in Germany. Objective: The study aims to investigate whether the regular use of the digital health application Kaia Health, compared to standard prevention, leads to improvements in pain, quality of life, physical function, sleep behavior, and mental health in healthcare professionals. Secondarily, the influence of the Kaia Health app on physical-activity-related-health-competency and health competency as well as on spinal mobility and gait is being investigated. Method: In a monocentric, prospective, randomized controlled trial (DRKSID 00036889, registered on 14.05.2025), approximately 120 healthcare professionals with at least five years of professional experience will be equally assigned to either a control group (standard prevention) or an intervention group (Kaia Health app against back pain). The intervention group will complete daily exercise training with the Kaia Health app, while the control group will receive a one-time preventive consultation with exercise recommendations and information on courses and sports programs at the University Hospital Erlangen. Data will be collected at three time points using validated questionnaires on pain intensity, quality of life, sleep quality, mental health, physical-activity-related-health competence and health competence as well as objective measurements using spinal mobility measurement and gait analysis. Expected Results: Based on previous studies on the effectiveness of the Kaia app, a significant improvement in physical and psychological well-being as well as improvement in physical-activity-related-health-competency, mobility and gait is expected in the intervention group. Discussion: This study is among the first occupational medicine randomized controlled trial on the effectiveness of a digital health application (DHA) in nursing staff and thus offers potential for new impulses for a digital prevention strategy in healthcare. Possible limitations arise from recruitment and the time commitment, which can negatively impact willingness to participate. The self-motivation of participants can also significantly influence the study results. Keywords: prevention – digital health application – chronic back pain – nursing staff – digital movement therapy

Digital health applications (DiGAs), prescribable and reimbursed in Germany since 2020, have the potential to enhance patient self-management. This study aimed to assess rheumatology patients’ awareness, willingness to use, suitability, and actual adoption of DiGAs. Between February 17 and April 8, 2025, adult patients attending seven German rheumatology outpatient clinics completed an electronic survey. A total of 246 patients participated (mean age 50.4 years; 71.1% female), with most treated at university hospitals (59.8%). The predominant diagnoses were rheumatoid arthritis (41.1%), psoriatic arthritis (18.3%), and axial spondyloarthritis (10.2%). While only 19.5% reported prior use of medical apps, 39.8% were aware of DiGAs, and 12.6% had used one. Notably, 84.6% reported at least one comorbidity matching an approved DiGA indication, most commonly back pain (54.8%), chronic pain (52.0%), and sleep disorders (35.8%). A majority expressed willingness to regularly use a DiGA (72.4%) and were open to recommendations from their rheumatologists or health insurers (72.8%). Additionally, 76.0% showed interest in a rheumatology-specific DiGA. Despite high interest and relevant comorbidities among patients, current DiGA use was limited. These findings underscore the need for targeted implementation strategies to increase uptake and realize the full potential of digital health applications in rheumatology care. The results also emphasize the need for rheumatologists to actively educate and guide their patients regarding the availability and potential benefits of DiGAs.

Background: The early diagnosis of inflammatory rheumatic diseases (IRDs) is of paramount importance in order to prevent irreversible damage to joints and to optimize treatment outcomes. Nevertheless, conventional care pathways frequently entail diagnostic delays spanning several months. Symptom checkers (SCs) have the potential to provide a solution by offering validated symptom assessments, improving triage systems and expediting diagnostic evaluations. The objective of this mixed-methods study is to assess the usability and acceptability of the SC Rheumatic? among individuals with suspected rheumatic diseases. Methods: A total of 105 individuals with suspected IRDs who were newly presenting at an outpatient rheumatology clinic completed the Rheumatic? symptom checker and an evaluation questionnaire. The questionnaire comprised the System Usability Scale (SUS) and Net Promoter Score (NPS). Additionally, 14 participants were interviewed by telephone in order to gain further insights through the qualitative method. Results: The Rheumatic? symptom checker received a “good” usability score, with an average SUS of 78 ± 16 (range 0-100). Younger participants reported significantly higher usability scores (p < 0.03). However, the NPS was − 15 (range − 100 to 100), indicating lower acceptability. Qualitative data supported the positive usability ratings but emphasized the need for enhancements to increase user engagement and perceived value, such as a current perceived lack of immediate benefit for many users. Their experience varied in terms of impact, with some patients suggesting an increased awareness of their symptoms while others did not notice any difference. Conclusion: Rheumatic? demonstrates good usability, particularly among younger users. Interviews revealed valuable suggestions for improvements, which could enhance overall acceptability and user satisfaction. Implementing Rheumatic? could lead to more efficient triage, potentially reducing diagnostic delays and an optimized allocation of resources. Future iterations should prioritize implementation strategies to maximize user impact and benefit. Clinical trial number: Not applicable.

Background: Spondyloarthritides (SpAs) are a group of common rheumatic diseases that often cause limited mobility and lower back pain. Physiotherapy is an integral part of treatment, but access to physiotherapy limits treatment success. Digital health applications (DHAs) enable home-based physiotherapy and could significantly improve access for SpAs patients. The aim is to investigate the clinical effects of the DHA ViViRA compared with those of standard physiotherapy. Methods: SpAs patients with chronic back pain were enrolled in a randomized controlled trial. The intervention group received ViViRA DHA, whereas the control group received standard physiotherapy. Pain (verbal rating scale, PAIN-Detect), quality of life (SF-36) and mobility (BASMI) were assessed at baseline and after 12 weeks as the primary outcomes. Results: Data from 59 participants (71.2% female, mean age 45.2 years) were analyzed. The intervention group showed a significant improvement in mobility (average BASMI score: baseline: 1.1 [range 0.7–1.5]; follow-up: 1.0 [range 0.5–1.4]; p = 0.05), whereas the control group showed a significant decrease in mobility (baseline: 1.5 [range 1.1–1.9]; follow-up: 1.8 [range 1.4–2.2]; p = 0.00). The intervention group demonstrated lower pain intensity (VRS pain level at week 3.5 ± 2.8) than did the control group (VRS pain level at week 4.5 ± 2) after 12 weeks. Conclusion: Our results highlight the efficacy of DHAs such as ViViRA in the treatment of lower back pain in SpAs patients. Compared with the current gold standard, physiotherapy, DHA use results in superior outcomes. However, further larger studies are needed to confirm these promising results. Trial registration: The study is registered in the German clinical trial registry (DRKS) under the following ID: DRKS00031254.

Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the “Telehealth Usability Questionnaire” (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients—“Telehealth Usability and Perceived Usefulness Short Questionnaire for patients” (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (“perceived usefulness in health care” and “usability”) is sufficient to describe the patient’s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors “perceived usefulness in health care” and “usability” in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546