Digital Movement Therapy for Axial Spondyloarthritis: A Randomized Controlled Trial on Clinical Outcomes, Usability, and Costs

Background: Axial Spondyloarthritides (axSpAs) are inflammatory diseases of the spine that lead to significant stiffness and physical impairment. Digital health applications (DHAs), particularly those incorporating digital movement therapies (DMT), are increasingly popular for promoting physical activity. This study aimed to assess the impact of DMT using the DHA ViViRA on physical function, disease activity and quality of sleep compared to standard physiotherapy. We also evaluated the feasibility of ViViRA and conducted a cost analysis for both treatment approaches. Methods: axSpA patients participated in a randomized controlled trial and were assigned to either the DHA ViViRA (exercise app for lower back pain) intervention (series of exercises min. 15 minutes 2–3 x weekly) or continued conventional physiotherapy (min. 30 minutes once weekly). Questionnaires to physical function, sleep quality, disease activity, usability and acceptance were measured at baseline and after 12 weeks. The respective costs for physiotherapy and the use of the DHA ViVRA were determined from the perspective of statutory health insurance. Results: Data analysis of 59 participants (71.2% female, mean age 45.2 ± 11.18 years) revealed improvements in physical limitations (BASFI: 3.4 [2.7–4.1]; 3 [2.4–3.7]; p = 0.041, HAQ: 0.73 [0.58–0.88]; 0.65 [0.5–0.8]; p = 0.046), disease activity (ASDAS: 2.57 [2.28–2.86]; 2.24 [1.95–2.53], p = 0.005) and sleep quality (PSQI: 9.7 [8.5–11]; 8.8 [7.6–10]; p = 0.0181) in both groups from baseline to follow-up. A subgroup analysis of the ViViRA group indicated high usability (SUS: 82.58 ± 15.00) and acceptance (7.85/10 points) of the app. An exemplary cost analysis suggested potential cost savings for the ViViRA group. Conclusion: DMT utilizing the ViViRA app positively influenced physical function and sleep quality in axSpA patients. In terms of user experience, the app was rated as user-friendly and well-received. While our preliminary analysis suggests that ViViRA may reduce direct costs, further research is necessary to comprehensively evaluate its full cost-effectiveness. Trial registration German clinical trial register (DRKS) ViPA, DRKS00031254, https//drks.de/search/en/trial/DRKS00031254, 10.02.2023