How are the website and the exercises created?

Background

Through several years of clinical work with musculoskeletal patients and course activities with general practitioners, the need for simple self-managed exercises for different patient categories has become clear. Searches via Google and in medical databases yielded some Norwegian and some international hits in the area. Many of these sites had texts and videos of exercises focusing on certain specific diagnoses or regions (neck, back, etc.). Some of the sites were aimed at patients, most at healthy people. There was in general some need for equipment such as rubber bands or weights in the programmes. Very few were evidence-based and none focused on multiple regions.

The aim of this project was to create a website with knowledge-based exercises for all body regions with simple exercises that the patients could do even without aids. 

The project was financed by the Norwegian Medical Association's Fund for quality and patient safety.

Method

  • A systematic literature search were done in collaboration with a librarian from the University Library after studies on the effects of various exercises. A Google search for websites with exercises for different body regions and individual diagnoses were also conducted. You can find the references here: References used in START-exercises.

  • We extracted exercises with no need for equipment and with a level of difficulty that matched self-training.

  • The choice of exercises was discussed with an experienced group of physiotherapists from the department of physical medicine and rehabilitation at Oslo University Hospital, with the content manager at ExorLive and physiotherapist Kjetil Sandsten..

  • Programming of a website with comprehensive design and simple menu options were executed and we created content consisting of sparse text and with a focus on practical use.

Content

  • In terms of content, the site has a consistent focus on making the pain feel harmless, reassurement and mastering for the user. Activity to maintain mobility and function, as well as limiting belief in rest and inactivity are emphesized.

  • The programs are not diagnosis-specific as the exercises mainly aim at better function. Therefore specific tissue diagnoses such as osteoarthritis in joints, tendinitis etc. are not used. When reviewing articles after the literature search, we found that there are few conditions that get a better treatment effect from specific exercises than general exercises (which was chosen here).

  • 18 program packages with 3 to 6 exercises have been developed. All body regions are included at the START level and 7 regions also have a Next level. The programs are printable as 1-page PDFs with QR codes for playing individual videos and the entire training program

  • Short videos (5-10 minutes) have been produced for all programmes

  • Supplementary material as a menu choice on painrelated topics (imaging, pain, other self-treatment, dangerous conditions and work) may be read online or printed.

  • All texts are translated into English and the program has a language option.

User testing

  • GPs, the UiO college at the department of general medicine and physiotherapists and doctors at OUS, department of physical medicine were consulted several times about design and functionality.

  • Independent GPs carried out a user test.

  • Patients have done user test of the program at three different timepoints to ensure that the exercises were easy to carry out and that using the website was easy.

Completion

  • The website underwent technical testing and was published on exorlive.com in september 2023 after adjustments.

  • Norsk Helseinformatikk (NHI) created a portal for START exercises in the Norwegian electronic medical handbook (NEL) in 2023.

HelseNorge.no created a menu selection (START exercises for musculoskeletal problems) under training and physical activity https://www.helsenorge.no/trening-og-fysisk-aktivitte/