Quantitative perspectives of patients and healthcare professionals to inform the co-design of an mHealth application for knee osteoarthritis management

Knee osteoarthritis (KOA) is a leading cause of disability worldwide, and limited access to physiotherapy presents major barriers to evidence-based management. Mobile health (mHealth) applications can help address these challenges by supporting self-management, rehabilitation, and patient education. However, most existing applications lack robust evidence and demonstrate low adherence. Co-design approaches involving both patients and healthcare professionals may improve usability, engagement, and clinical integration. This study quantitatively examined user perspectives to inform the subsequent co-design and development of an mHealth application for KOA management; the application itself was not developed or evaluated in this study. A cross-sectional survey was conducted in Slovenia using a structured questionnaire, developed from previous studies and piloted with experts, to assess functional preferences, aesthetic preferences, perceived barriers, and perceived benefits of an mHealth application. Responses were rated on 5- or 10-point Likert scales and analysed using descriptive statistics and independent-sample t-tests. A total of 164 patients with symptomatic KOA and 136 healthcare professionals completed the survey. Both groups identified exercise videos, goal setting and progress tracking, written communication with a physiotherapist, and educational content as essential app components, with no significant differences in functional preferences (p > 0.05). However, patients placed greater importance on aesthetic features, including visual clarity (M = 4.59 vs. 4.12, p = 0.001), layout organisation (M = 4.41 vs. 4.09, p = 0.039), and design appeal (M = 4.60 vs. 4.32, p = 0.035). Healthcare professionals reported greater perceived barriers, particularly limited technical literacy and poor internet connectivity, while patients rated motivational and practical benefits, autonomy, convenience, and information accuracy significantly higher (all p < 0.05). The findings highlight the critical importance of participatory co-design approaches that systematically integrate clinical expertise and patient experience in developing digital rehabilitation tools. Although patients and healthcare professionals demonstrated convergence in their evaluation of core functional requirements, their differing perspectives on aesthetic qualities, perceived barriers, and perceived benefits highlight the need to balance user engagement with clinical robustness. These results provide an empirical foundation for designing user-centred and clinically integrated mHealth applications for KOA rehabilitation and contribute to the growing evidence base guiding digital health innovation, implementation, and policy for musculoskeletal rehabilitation.