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48 Usability testing of a musculoskeletal digital assessment routing tool: an iterative convergent mixed methods study
  1. Cabella Lowe1,
  2. Mitchell Browne1,
  3. William Marsh2,
  4. Dylan Morrissey1
  1. 1Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, E1 4DG,, UK
  2. 2Risk and Information Systems Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London, 2 Newark Street, E1 2AT,, UK


Introduction Digital technologies improving clinical outcomes and efficiency are prioritized for development. We have developed a musculoskeletal Digital Assessment Routing Tool (DART) directing users to right care, first time. DART requires usability testing prior to clinical trials.

Materials and Methods An iterative-convergent mixed-methods design was used to assess and mitigate DART usability issues. 22 participants used 50 musculoskeletal presentations across 4 DART iterations during 5 testing rounds. Recruitment quotas for age, habitual internet use and English language ability were used. Constructs of the ISO 9241-210-2019 standard defined quantitative data collection, with user satisfaction measured by the system usability scale. Study endpoints were mitigation of significant usability problems and a mean satisfaction score of 80+ across a minimum of 3 testing rounds.

Results All test assessments gave a recommendation with no system errors. Usability problems reduced from 12 to zero. Mean assessment time was 5 minutes (range 1–18), 6 minutes for non-native English speakers. Differences in satisfaction scores were present between groups, expert internet users having the highest mean score (86.5, SD 4.48, CI 90% 1.78), compared with non-native English speakers (78.1, SD 4.60, CI 90% 9.17) and less experienced internet users scoring the lowest (70.8, SD 5.44, CI 90% 3.79). The mean score across all groups was 84.3 (84.3, SD 12.73, CI 90% 4.67), with qualitative data from all participants confirming DART was simple to use.

Conclusion With all significant usability problems addressed DART can proceed to a randomized controlled trial assessing safety and effectiveness against a usual care comparator.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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