The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients

Figures & data

Figure 1. Overview of mixed-methods: data sources and research questions.

Overview of how different data sources are used in the study. For patients, the qualitative data from the interviews on the experience and added value of Physitrack can be compared to the quantitative data from the modified telemedicine satisfaction and usefulness questionnaire. The qualitative data from the patients can also be compared to the qualitative data from the orofaciale physical therapists, to identify if they have the same experience and same idea of added value.

Table 1. Basic characteristics of orofacial physical therapists.

Characteristic	OPT001	OPT002	OPT003	OPT004	OPT005	OPT006	OPT007	OPT008	OPT009	OPT010
Age (years)	33	39	29	32	41	40	34	29	36	32
Gender	m	m	f	m	m	m	f	m	m	m
Work setting:
Private practice	x	x	x	x	x		x	x	x	x
Dental department	x	x
Headache clinic								x
Hospital						x
Work hours per week	36	40	32	28	55	12	28	28	30	32
Working experience (years)
Physical therapy	9	15	8	9	19	17	12	6	12	8
TMD specific	2	9	2	2	7	10	5	1	6	2
Moment of starting with Physitrack
Before COVID-19		x	x		x				x
During COVID-19	x			x		x	x	x		x
Included patients	y	y	y	n	y	n	n	n	n	n

TMD: temporomandibular disorder; OPT: Orofacial Physical Therapist; m: male; f: female; COVID-19: coronavirus disease 2019; y: yes; n: no.

Table 2. Used functions of the Physitrack application prior to the interview.

Participant	Exercise videos	Information	Push-notifications	Pain scores	Video consult	Chat function
Patients (N = 10)
Pt001	✓
Pt002	✓
Pt003	✓	✓	✓	✓
Pt004	✓		✓	✓
Pt005	✓
Pt006	✓				✓
Pt007
Pt008	✓
Pt009	✓				✓
Pt010	✓
Orofacial physical therapists (N = 10)
OPT001	✓			✓	✓	✓
OPT002	✓	✓	✓		✓	✓
OPT003	✓				✓
OPT004	✓			✓	✓	✓
OPT005	✓	✓			✓
OPT006	✓		✓	✓	✓
OPT007	✓	✓			✓
OPT008	✓		✓		✓
OPT009
OPT010	✓			✓	✓	✓

Pt: patient; OPT: orofacial physical therapist; n: number of participants.

The grey marked areas indicate the functionalities offered by the OPT, the checkmarks indicate the actual usage of the functionality by the patient.

Table 3. Basic characteristics patients with TMD.

Characteristic	pt001	pt002	pt003	pt004	pt005	pt006	pt007	pt008	pt009	pt010
Age (years)	42	62	62	49	60	27	76	52	34	59
Gender	f	f	f	f	f	f	f	f	f	f
Pain-related TMD:
Myalgia	X	X				X		X	X
Other		X	X	X	X				X	X
Function-related TMD:
Anterior disc displacement						X	X
Other										X
Other orofacial complaints
Bruxism	X							X
Limited mouth opening										X
Headache	X	X		X			X		X	X
Number of treatment sessions*
Face-to-face	6	4	3	6	3	4	5	5	3	3
Online	0	0	3	2**	2**	1	2**	0	0	0
TMD pain intensity (0–10)
Before treatment	4	8	4	7	6	5	7	5	3	6
After treatment	1	0	2	1	1	1	1	1	1	2
Headache pain intensity			n/a		n/a	n/a		n/a
(0–10)
Before treatment	8	8		8			5		6	3
After treatment	1	0		7			4		0	3
OPT	OPT05	OPT05	OPT02	OPT02	OPT02	OPT01	OPT03	OPT03	OPT01	OPT02

TMD: temporomandibular disorder; f: female; n/a: not applicable; * number of treatment sessions was collected after the interview; ** at the time of the interview the patient did not use e-Health, afterwards she did have two online consults.

Figure 2. Model of interaction between sub-themes identified by orofacial physical therapists and patients. Green: sub-themes identified by both orofacial physical therapists (OPTs) and patients; orange: sub-themes identified by patients; blue: sub-themes identified by OPTs; grey: major themes.

Mind-map figure that shows important themes and sub-themes identified by orofacial physical therapists and patients, describing the general success factors for therapy, their experience with physitrack and the additional value of physitrack.

Table 4. Overview of themes for both patients and orofacial physical therapists.

Patients (supportive quotes)				Orofacial physical therapists (supportive quotes)
	General determinants for success
“I think you always need to involve people in their own healing process, what they can do themselves, even if it is only positive thinking, but also dieting and exercises, and well, medication, everything you can do by yourself. Make people think about it and let them work on their own healing” (Pt02)		Professionalism OPT	X	“Everything depends on the intake, your history-taking. It is how you handle the conversation. It is just that we are health care professionals and we want one thing: to help, help, help. Just listen to what your patient wants!” (OPT02)
	X	Interpersonal skills OPT
		Good care	X
		Support	X
	X	Shared decision making	X
	X	Mutual trust & responsibility
	X	Communication
	X	Contribution of needs	X
	Experience Physitrack
“But it was very easy, so I had it [PhysiApp] on my phone very quickly, easy to use, so yeah, it was not a lot of trouble for me” (Pt03).	X	User-friendliness	X	“It is a nice coat rack, and then you can hang your own things to it” (OPT06) “The videos are fantastic and for people it is really something tangible to see” (OPT07)
		Investment	X
		Content	X
	X	Personal contact	X
	X	Convenience
	X	Clarity
	Additional value Physitrack
“After two, three days, especially the first week, I could see ‘am I doing it right, do I look right, did I do the exercise right’, while otherwise I would have phoned the practice like ‘I don’t remember exactly’, or I would have waited till the next appointment” (Pt10)		Motivation	X	“I do not know if I would think it is worth it, that long trip in the car every time, but then this [Physitrack] is a real solution” (OPT03)
	X	Efficiency	X
		Accessibility	X
	X	Self-efficacy/ -sustainability patient	X
	X	Adherence
	X	Reassurance

Table 5. Results of the telemedicine satisfaction and usefulness questionnaire.

	Mean ± SD (range)
Subscale: Satisfaction e-Health/Physitrack (n = 8; range 10–50)	20.5 ± 4.0 (16–27)
In general, I am satisfied with physical therapy through e-Health (n = 9)	1.4 ± 0.5 (1–2)
My health is better than it was before I used e-Health (n = 9)	2.2 ± 1.0 (1–4)
I am more involved in my care using e-Health (n = 9)	1.6 ± 0.5 (1–2)
E-Health helps me to better manage my health (n = 9)	1.8 ± 0.8 (1–3)
E-Health helps monitor my health condition (n = 9)	2.6 ± 1.0 (2–5)
My physical therapist uses information from the e-Health application during evaluation moments (n = 8)	3.1 ± 1.2 (2–5)
I follow my physical therapist’s advice better since working with e-Health (n = 9)	1.8 ± 1.0 (1–3)
The e-Health system is easy to use (n = 9)	1.2 ± 0.4 (1–2)
I can always trust the e-Health system to work (n = 9)	1.8 ± 0.8 (1–3)
It was easy to learn to use the e-Health system (n = 9)	1.3 ± 0.7 (1–3)
Subscale: Satisfaction communication (n = 6; range 11–55)	28.8 ± 4.0 (23–34)
Talking to my physical therapist on the phone, through email or during a video visit is as satisfying as talking in person (n = 7)	4.6 ± 0.8 (3–5)
A physical therapist can get a good understanding of my problem during a video-, phone-, or email conversation (n = 7)	3.6 ± 1.1 (2–5)
My privacy is protected during video-, phone-, or email conversations (n = 7)	2.6 ± 0.8 (1–3)
I can explain my medical problems well enough during a video-, phone-, or email conversation (n = 7)	3.1 ± 1.3 (1–5)
I miss the physical contact during a video-, phone-, or email conversation (n = 7)	1.7 ± 1.0 (1–3)
Video-, phone-, or email conversations are a convenient form of physical therapeutic care delivery for me (n = 6)	4.2 ± 0.8 (3–5)
Video-, phone-, or email conversations save me time (n = 6)	2.5 ± 1.5 (1–5)
Video-, phone-, or email conversations make it easier for me to contact the physical therapist (n = 6)	3.2 ± 1.2 (2–5)
My physical therapist answers my questions (n = 6)	1.2 ± 0.4 (1–2)
My physical therapist deals with my problems adequately (n = 6)	1.2 ± 0.4 (1–2)
My physical therapist engages me in my care (n = 6)	1.0 ± 0.0 (1–1)
Subscale: Usefulness of the e-Health system (n = 6; range 9–45)	15.8 ± 5.0 (9–23)
PhysiApp application (n = 9)	1.2 ± 0.4 (1–2)
The exercise program (n = 9)	1.3 ± 0.5 (1–2)
Instructions of the exercises (n = 9)	1.3 ± 0.7 (1–3)
Instruction videos of the exercises (n = 9)	1.0 ± 0.0 (1–1)
Using the pain scores (n = 6)	2.2 ± 1.6 (1–5)
Using the feedback screen (n = 6)	2.5 ± 1.5 (1–5)
The questionnaires (n = 7)	2.7 ± 1.3 (1–5)
Contact with the physical therapist (n = 9)	1.1 ± 0.3 (1–2)
Tracking the progress of the results (n = 7)	1.9 ± 0.9 (1–3)
Total score TSUQ (n = 5; range 30–150)	67.4 ± 9.4 (56–76)

SD: standard deviation; n: number of participants; not all participants filled out each part of the questionnaire and therefore the n differs per item and per subscale. Five out of nine participants filled out every item of the questionnaire. Range of each question (1 through 30) was 1–5.

Figure 3. Strength of motivation to use Physitrack for patients with a temporomandibular disorder related to the expectation theory.

Informative figure that displays the motivation strength in using physitrack for patients, according to the expectation theory. Motivation strength is described as expectancy, instrumentality, and valence.

Table

Background information
Types of complaints (Why did you visit this physical therapist?)
Physical therapy
Experience (what interventions did you receive, what did you find most important, what was your impression of your PT?) Expectations (what expectations did you have of yourself and of your PT?)
Physitrack
First impression (what did you think when your PT suggested using Physitrack?) Facilities used (what components were used during the intervention, what was your experience, what did you use of those offered to you and why) Additional value (did Physitrack add anything to your values, experience or expectations of the treatment? What other advantages were there with using Physitrack? Were there negative aspects present?) Usability (was the program easy in use, would you want to add or change anything?) E-health in general (what is your opinion about e-Health in general?) Use after physical therapy (would you want to keep using Physitrack when you are done with the PT, and if so, why?)
Closure
Anything to add?

Table

Background information
Specialisation (which one and why?) Graduation / experience (when did you graduate, how long have you seen pts with OFP?) Patient population (what is your patient population, how many pts with TMD?
Before Corona (all interviews were during the corona pandemic)
Important aspects of TMD treatment (what was the regular practice, what interventions, what was most important?) Home exercises or instructions (how did you communicate home exercises or instructions with your patients, did you use paper or an app, was additional information needed?)
Physitrack
When and why (since when are you using physitrack, why e-Health and why physitrack?) First impression (what was your first impression of physitrack?) User-friendliness (what can you say about the user-friendliness of physitrack for you as a physio, what did your patients say?) Content (what content did you use, why, for which populations, why only specific functions, what did you miss, what was good and why?) Additional value (what was the additional value of physitrack? Why, how?) Influence of physitrack on treatment (do you think physitrack influences your treatment or treatment outcomes? In what way?) Future use (do you keep using it after corona, why would you or why wouldn’t you?)
Future of orofacial physical therapy and TMD
Future OPT (what will it look like? What do we do?) Role of e-Health (will e-Health or physitrack play a role in the future? In what way?)
Closure
Anything to add?