Smartphone App for Adolescents With Idiopathic Scoliosis

This study is a quasi-experimental, one-group pretest-posttest study designed to evaluate the feasibility, acceptability, and preliminary effectiveness of a smartphone application (DinSkoliose) for adolescents with idiopathic scoliosis (AIS).

AIS is a common spinal condition that often requires long-term conservative treatment, including brace use and physiotherapy scoliosis-specific exercises. Treatment success is highly dependent on adherence; however, adherence is often limited by physical discomfort, psychological factors, and lack of continuous support.

The DinSkoliose app is a personalized, theory-informed digital health intervention developed specifically for this study using a user-centered co-design approach. The app is grounded in behavioral theories of motivation and self-management and includes features to support treatment adherence, such as tracking of brace use and exercises, monitoring of symptoms (e.g., pain and mood), educational information, reminders, and structured social support.

Participants will use the app over a 12-week period in their natural environment alongside their usual care, with no additional clinical intervention. Outcomes will be assessed at baseline and post-intervention using validated questionnaires measuring health behaviors, self-management, self-efficacy, social support, and patient activation. App usability, engagement, and acceptability will also be evaluated.

In addition, semi-structured interviews will be conducted after the intervention to explore participants' experiences and identify strengths and areas for improvement. The results will inform further development of the app and future evaluation in larger controlled studies.

• DinSkoliose smartphone application (Device): The intervention consists of the use of the DinSkoliose smartphone application, a personalized digital health tool specifically developed for this study. The app is designed to support adolescents with idiopathic scoliosis in managing their condition and improving adherence to conservative treatment. The app includes features for monitoring brace use and physiotherapy exercises, tracking symptoms such as pain and mood, providing educational content, sending reminders, and offering structured social support. Participants will use the app independently in their everyday environment over a 12-week period alongside their usual care. No additional treatment will be provided.

Primary outcomes

• Change in Health Behaviors Outcome [Baseline to 12 weeks]: Change in health behaviour outcomes, including self-management, knowledge, skills, and confidence, measured using the Patient Activation Measure (PAM). PAM is a validated 13-item questionnaire with scores ranging from 0 to 100, where higher scores indicate greater patient activation and improved health behaviour.
• Change in behavioral impact (such as self-management of AIS) [Baseline to 12 weeks]: Change in self-efficacy, defined as participants' confidence in their ability to manage their condition, perform health-related behaviors, and cope with symptoms, measured using the Chronic Disease Self-Efficacy Scale (CDSES). Scores range from 1 to 10, with higher scores indicating greater self-efficacy.
• Change in motivation for exercise measured by SDT-based Motivation for Exercise questionnaire [Baseline to 12 weeks]: Change in motivation for exercise measured using a Self-Determination Theory (SDT)-based Motivation for Exercise questionnaire, assessing different types of motivational regulation (external, introjected, identified, and intrinsic motivation). Scores reflect the degree of autonomous versus controlled motivation, with higher autonomous motivation indicating more self-determined and sustainable health behaviour.

Secondary outcomes

• User engagement measured by User Engagement Scale (UES) [Week 6 and Week 12]: User engagement measured using the User Engagement Scale (UES), a validated questionnaire assessing multiple dimensions of engagement including focused attention, perceived usability, aesthetic appeal, and reward-related engagement. Responses are rated on a Likert scale, and higher scores indicate greater user engagement with the intervention.
• Change in perceived social support measured by Medical Outcomes Study Social Support Survey (MOS-SSS) [Baseline to 12 weeks]: Change in perceived social support measured using the Medical Outcomes Study Social Support Survey (MOS-SSS), a validated questionnaire assessing emotional/informational support, tangible support, positive social interaction, and affectionate support. Scores are calculated on a Likert scale, with higher scores indicating greater perceived social support.
• App usability and acceptability measured by Mobile App Rating Scale (MARS) [Week 6 and Week 12]: App usability and acceptability measured using the Mobile App Rating Scale (MARS), which evaluates app quality across multiple domains including engagement, functionality, aesthetics, and information quality. Items are rated on a 5-point scale, with higher scores indicating better app quality and acceptability.
• Participant experiences and perceived impact assessed through semi-structured interviews [At 12 weeks (post-intervention)]: Participant experiences, perceptions, and perceived impact of the intervention assessed through semi-structured qualitative interviews. Interviews explore app usability, engagement, perceived effects on health behaviour, self-management, and psychosocial well-being. Data will be analyzed using thematic analysis.

Sex: All, ages: 10 Years to 24 Years

The study population will consist of adolescent patients with AIS.

The Inclusion criteria for participants in our study are those:

1. who are diagnosed with AIS;
2. who give written informed consent,
3. who are at the age between 10 - 24 years old;
4. under 16 years old for whom parental consent has been provided (as required by the National Research Ethics Committee);
5. who can speak, read, and write in Norwegian or English;
6. who have access to and ability to use smart phone;
7. who have internet access.

The Exclusion criteria for participants in our study are those who:

1. have a history of other type of scoliosis (such as congenital, neuromuscular, degenerative);
2. are younger than 10 years old and older than 24 years old;
3. have any additional diagnosis that could affect the intervention outcome (severe mental health disorders or diagnosis of a developmental disorder that prevents understanding and compliance with intervention, leg length discrepancy).

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