A Digital Rehabilitation plan: Evaluating a Tool Designed for facilitating Shared Decision-Making

A Digital Rehabilitation plan: Evaluating a Tool Designed for facilitating Shared Decision-Making | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Digital Rehabilitation plan: Evaluating a Tool Designed for facilitating Shared Decision-Making Jo Inge Gåsvær, Ilona Heldal, Tobba Sudmann This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7793313/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Medical Informatics and Decision Making → Version 1 posted 10 You are reading this latest preprint version Abstract Background Through a partnership and collaborative design process between technologists and healthcare professionals, a web platform including a digital rehabilitation plan was developed. This design process addresses recognized challenges in rehabilitation information and communication technology, e.g., fragmented data flows and low-quality user interfaces. The digital rehabilitation plan facilitated shared decision-making, allowing the patient to personalize their plan while providing healthcare professionals with access to support the patient's journey. This study evaluated end-user healthcare professionals’ and patients’ experiences with the plan’s usability and potential areas for improvement. Methods Semistructured focus-group interviews were conducted with three different groups: i) patients, ii) healthcare professionals, and iii) patients and healthcare professionals. The discussions delved into the preadmission phase, the inpatient period, rehabilitation plans, inpatient stays, evaluations, and outpatient follow-ups. The recorded files were transcribed and thematically analyzed to identify patterns, paradoxes, and dilemmas. Results Patients and healthcare professionals appreciated the digital rehabilitation plan. However, patients requested a wider range of digital support tools for inpatient rehabilitation and follow-up, e.g., a "my page" with access to relevant information, chat support, educational tools, and videos. In peer groups, professionals are reluctant to expand the use of the web platform due to past negative experiences with information and communication technology, and hence have less motivation to change work processes. Discussions in the third focus group shifted the professionals’ perspective, revealing the potential for improved collaboration and patient-provider communication. Conclusions This study demonstrated that involving patients in the design and implementation of a web platform can uncover bias, identify barriers, create new ideas, enhance usability, and increase the use of digital communication in rehabilitation. Healthcare professionals face barriers to using the web platform because of established procedures and previous experiences, whereas patients’ drivers are facilitated by their everyday technology use. Patients’ eagerness to use digital communication tools surprised the professionals. Bringing patients and professionals together changed professionals' views and revealed barriers and drivers for further development of a web platform for rehabilitation. Trial registration This study was approved by the Norwegian Agency for Shared Services in Education and Research, Data Protection Services for Research, reference number 116434. Digital rehabilitation shared decision-making patient participation patient–provider communication implementation collaborative design rehabilitation plan 1. Background In this paper, we present healthcare professionals’ and patients’ experiences with the development and implementation of a digital rehabilitation plan for an inpatient rehabilitation program. The plan is a component of a configurable web platform that can be customized to meet end-user needs and integrated with electronic health records. Upon acceptance into a person-tailored programme in a specialized rehabilitation institution in Norway, patients begin with a 5-day prestay to make plans for a later 3-week full programme. During prestay, they are introduced to the web platform and the digital rehabilitation plan and encouraged to detail their personal goals and means and outline their participation strategies. During the 4-week home period between the prestay and main stay, patients are encouraged to further develop their plans. During the main stay, the multidisciplinary team supports the patient by adjusting the plan to ensure that goals and means are relevant to the patient’s functional needs and the rehabilitation institution’s resources. To ensure person-tailored services and shared decision-making, professionals do not have permission to edit the rehabilitation plan on the web platform. Instead, they have access to digital copies of the plan, as it is stored in the electronic health record and serves as a reference for outcome evaluations. The patient and the multidisciplinary team evaluate goal achievement at the end of the main stay. This digital rehabilitation plan, and the web platform it is a part of, potentially addresses some of the reported challenges with communication technology in healthcare and rehabilitation, such as a lack of real-time updated information ( 1 ), organizational boundaries ( 2 ), inflexible user interfaces, incompatibility with electronic health records ( 3 – 5 ), and limited opportunities to consider end-user needs ( 6 ). In this study, we acknowledge that patients are rarely involved in the design and implementation of digital communication tools and question how their needs and preferences can be safeguarded and responded to. Technologists and healthcare providers may hold differing opinions on the usability and design of a web platform and digital communication for shared decision-making. This study explores how bringing all stakeholders together can bring forward new perspectives on the design and implementation of new digital communication tools for rehabilitation processes. This study is guided by the following question: How do patients, healthcare professionals, and other stakeholders evaluate the potential of a digital rehabilitation plan for shared decision-making during a rehabilitation process? 2. Methods A qualitative exploratory design ( 7 , 8 ) was chosen for this study. This design rests upon a philosophy of science where knowledge and comprehension are formed through active engagement and interpretive processes rather than objective metrics. This research design can provide rich and detailed material that can be used to refine design, implementation, and end-user appropriation. All participants provided written informed consent. Norwegian Social Science Data Services (SIKT) approved ethical concerns and privacy protection measures, reference number 116434. 2.1 Participants and recruitment Health care professional participants were approached and informed by leaders at an inpatient rehabilitation institution. They were given oral and written information about the study. The professional recruited patients. In total, the participants included ten persons from Norway familiar with the digital rehabilitation plan; six patients (Table 1 ) and four healthcare professionals (Table 2 ). Table 1 Patient characteristics Gender Age Education Profession Work status Female 35 High school Healthcare worker Sick leave 100% Female 30 Primary school Shop worker Work assessment allowance Male 25 High school Electrician Sick leave 100% Female 60 Primary school Kindergarten assistant Work assessment allowance Female 45 High school Health secretary Disability benefit 80% Female 50 University Environmental healthcare professional Sick leave 30% Table 2 Healthcare professional characteristics Gender Age Profession Expertise Female 40 Nurse Cancer nursing Female 25 Physiotherapist Master Health Sciences Female 55 Nurse Cognitive Behavioral (CBT)- and Acceptance and Commitment (ACT) Therapy Female 50 Social worker Personal economy, CBT, ACT 2.2 Data production Semistructured focus mini-group discussions ( 9 ) were conducted with pairs of i) Norwegian patients, ii) healthcare professionals, and iii) a combination of groups i) and ii). In total, six patients and four healthcare professionals were interviewed. Two of the professionals served as patient coordinators for four of the patients. In total, eight focus groups were conducted, consisting of the following configurations: three groups of patient pairs, two groups of healthcare professional pairs, and three groups combining patients and their affiliated professionals. Semistructured interviews were chosen because of the method’s flexibility, where predefined themes are set; however, further exploration can be performed based on participants' answers. Open-ended questions and prompts enabled the interviewees to disclose their knowledge, experiences, and perspectives. This is useful in an exploratory study where understanding nuanced perspectives is important. The venue for focus groups was provided by the rehabilitation institution. The group discussions followed a topic guide (supplementary 1). Following a patient-centered approach, focus groups with patients were carried out before focus groups with professionals. Joint groups were held last. Each group discussion lasted between 60 and 90 minutes and was audio recorded with a Dictaphone. 2.3 Data analysis The focus group discussions were transcribed verbatim in Norwegian by JIG and anonymized continuously. The transcripts were categorized via NVivo 14 software (QSR International Pty Ltd., Victoria, Australia). The initial codes were grouped into broader themes and further reviewed and refined by rechecking against the original transcripts to ensure that they reflected the dataset. Special consideration was given to balancing the use of codebooks and ensuring coding reliability while embracing the subjective nature of reflexive thematic analysis ( 10 ). Excerpts from the interviews used in this paper were translated into English and edited for readability by the authors. Below are examples of some key codes and their associated themes: Operational challenges: Some patients need the plan in paper – duplicated efforts, limited time to read patient updates on the plan along the way. Enhanced communication and engagement: Support for physical meetings, more lively plan, younger patients are very satisfied, patients manage their time better outside meetings with the professional staff. 3. Results We employed a multifaceted analytic strategy in this study to gain a nuanced understanding of participants' perspectives on digital rehabilitation plans, highlighting the complexity of their experiences. We first analyzed the perspectives of patients and professionals separately to identify unique experiences, desires, and internal variations. This approach allowed us to uncover specific errors, gaps, suggestions for improvement, and areas of contention within each group's narratives. We subsequently examined the commonalities and differences between the groups to determine where their interests aligned, where disagreements arose, and how they might ultimately converge on shared insights. This allowed for an understanding of the participants' views on the digital rehabilitation plan (3.1), stakeholders' experiences with digital solutions that support the rehabilitation process in general (3.2 and 3.3), and the discovery of further technological solutions needed to work toward digital support for shared decision-making (3.4). 3.1 Patients and healthcare professionals held positive views of the digital rehabilitation plan. Both healthcare professionals and patients conveyed a generally positive perception of the digital rehabilitation plan. The patients unanimously approved the digital rehabilitation plan for setting goals and means. They underscored their own tech-savviness, raised concerns about demands for e-health literacy, and recommended that paper-based rehabilitation plans should be available when needed. “You get a bit of pressure when you must write on paper.., you kind of feel like you just must get something dotted down. But when you do this on the web platform, you can go back later and finish it or change it. It makes it a lot easier” -patient Healthcare professionals view the digital rehabilitation plan as support for the treatment process. They recognized that the plan functioned as a "living document" that could be dynamically updated, enhancing both patient engagement and document usability. The digital plan provided support for the physical meetings, and the professionals became better at using the digital solutions through increased use. Healthcare professionals identified several barriers related to the user interface, including the absence of real-time notifications for updates, the availability of templates exclusively in Norwegian, and challenges associated with navigating various user interfaces. “I guess it depends a bit on age, too. For young people, it's not a problem. However, for those who are 60-plus, maybe. In addition, some have problems with their cell phone, so they cannot access the web platform. We believe that this might be related to outdated software or older devices, but we do not know. I do not always understand that” – professional 3.2 Patients: There is no comprehensive approach to support the digital rehabilitation process Patients are required to submit the digital rehabilitation plan on their first day of prestay at the rehabilitation institution. For the patients, this was at odds with previous experiences from healthcare, where treatment decisions were largely made by professionals. Being active and taking initiative, hence, was unfamiliar. As a result, they struggled to initiate the rehabilitation plan. “I felt a lot of stress upon arriving at the institution and in the first few days. I didn´t know where I was going, what to expect, or what the treatment consisted of. In addition, since I was accustomed to just being told what to do, the concept of overseeing my rehabilitation plan was difficult… I also struggle with memory and cognition, so even though I was given information about how to work with the rehabilitation plan, I could neither remember nor do it myself” - patient The customization of the digital rehabilitation plan positively influenced patients’ experiences. However, patients were surprised that healthcare professionals did not provide follow-up on the plan as extensively as anticipated following its mandatory creation. Furthermore, the patients suggested several uses of digital tools to improve their rehabilitation experience. As tech-savvy users, they sought access to digital information before the inpatient period, including videos and details about the institution and directions for arrival. They proposed a “my page” feature that would provide essential information, training programs, survey responses with explanations of the results, timetables, appointments, and tasks. Additionally, they expressed concern about the period following their stay and requested digital follow-up, self-management support, and opportunities for contact with the rehabilitation institution as needed. “It is a lot that is connected to the rehabilitation plan. Lectures, appointments, handouts, and everything… With my fatigue and memory loss, everything becomes more complicated, and it is hard… » - patient Patients were highly satisfied with the inpatient program, valuing both the collaboration with professionals and the peer support provided by fellow patients. They expressed strong scepticism regarding the idea of replacing inpatient rehabilitation with digital follow-up alone. Instead, they advocated for digital solutions that could support and enhance, rather than replace, the existing rehabilitation process. 3.3 The professionals: We do as we usually do, even though we like the digital rehabilitation plan Healthcare professionals appreciated the reduced amount of paperwork; printing, punching patient input, scanning documents to the EHR, and time saved for looking for paper versions. Despite this apprehension, the professionals voiced scepticism toward technology and the need to keep up treatment as usual. Professionals stressed that patient‒provider interaction must be analogous and warned that digital solutions could hamper this. The professionals did not discuss how digital solutions could support the rehabilitation process. “I feel that bringing a PC into patient meetings can be a bit disrespectful. Therefore, when I meet with patients, I prefer to have important points written down in advance. I’m also concerned that discussing things digitally might lead to missing crucial information during conversations.” - professional 3.4 When healthcare professionals and patients understand each other, they can explore possible solutions. The dialog between patients and healthcare professionals changed professionals’ perspectives after patients shared their experiences with unsatisfactory digital support throughout the rehabilitation process. First, the professionals acknowledged a suboptimal patient-centeredness through low patient follow-up on the patient´s digital rehabilitation plan. “We have the rehabilitation plan up on the wall in the team meetings, but maybe we are not transferring this clearly enough to the patient when we talk with them” - professional Second, the healthcare professionals acknowledged that they did not routinely check whether patients’ progress was according to plan. Thirdly, the healthcare professionals noted a lack of coordination between the development of the rehabilitation plan and the implementation of ACT. This disconnect led stakeholders to focus more on ACT, resulting in difficulties integrating it into the rehabilitation plan. In this joint group, professionals reflected more on how technology could enhance their work compared to the perspectives shared in the professionals-only group. They became responsive to the patients' wants and their suggestions for ICT to facilitate communication between patients and providers, as well as for planning, evaluation, and feedback from assessments: “We find it difficult to absorb all the information in the first days of the stay; therefore, it is hard to make a rehabilitation plan” - patient “…but we bring it up at the welcome meeting” – professional “Yes, but then we have already arrived” -patient “Yes, you just get thrown into everything, and then it is straight into individual meetings with the professionals, and from then on, it is a rush to get through everything at the start of the stay. So yes, I can see that it can be a lot for you” - professional Further negotiations and possible solutions emerged through these discussions, which focused on patient-centredness and collaboration: When talking about the new possibilities : “All the data we collect, it must be of importance to you, and we must explain more to you… To see development on scores can be valuable for the patient – have I become more robust? » - professional “Yes, we want to be able to compare” – patient “Yes, that is exciting, both for us, you, and for research… It is very good that this comes up, it is new for us – we are in a transition process” - professional The patients expressed considerable trust in the professionals, highlighting that collaboration on challenging issues fostered both trust and a sense of teamwork, despite experiencing inadequate digital support throughout the process. In contrast, these feelings of trust and teamwork were less pronounced in their interactions with the GP (general practitioner) and the broader healthcare system. This observation was corroborated by the professionals, who engaged in further discussions focused on utilizing digital solutions to enhance collaboration and strengthen the rehabilitation process. These results highlight the intricate dynamics of the digital rehabilitation process. Despite having access to relevant data for the involved stakeholders, employing flexible ICT solutions, and utilizing a collaboratively designed digital rehabilitation plan to facilitate shared decision-making, significant challenges persist at the intersection of stakeholders, organizational boundaries, and technology. 4. Discussion Anchored in social constructivism and employing a multifaceted analytic strategy to explore the complex experiences surrounding the design and implementation of technological solutions in rehabilitation, this study revealed a high level of appreciation for a digital rehabilitation plan among patients and healthcare professionals. However, patients experienced challenges related to its initiation and follow-up. Healthcare professionals became responsive to this need during discussions with patients, demonstrating both troubleshooting capabilities and enthusiasm. They engaged with patients, reflecting on the patient-centered focus and the practical possibilities with technology to enhance patient-centredness and satisfaction. 4.1 At first, eyesight: digital rehabilitation was a success The implementation of a digital rehabilitation plan was well received by both patients and healthcare professionals, reflecting the rehabilitation institution's commitment to fostering shared decision-making. This positive reception is consistent with the literature, which underscores the importance of involving key stakeholders in the design and deployment of technological solutions to ensure that they effectively meet the needs of end-users. ( 6 ). Even though data access and, hence, participation for other relevant stakeholders (e.g., GPs, next of kin, employers) was not possible ( 11 ), at least access to pertinent information was possible for patients and healthcare professionals inside this part of the health service ( 1 ), enabling effective use of the digital rehabilitation plan. 4.2 Shared decision-making through technology is dependent on both technology and stakeholders In our study, patients highlighted several barriers that obstructed the effectiveness of the digital rehabilitation plan. These challenges arose from a disconnect between individual patient experiences and the standardized healthcare framework that guided the design of the system ( 5 , 12 , 13 ). Specifically, the lack of patient-centered care within the larger healthcare infrastructure constrained patients' autonomy in initiating their rehabilitation plans. Furthermore, cognitive and memory impairments significantly impeded the ability to develop personalized strategies, thereby undermining the principles of shared decision-making. The fragmented healthcare system has resulted in limited collaboration between primary and specialist care ( 2 , 5 ). This was evident, as healthcare professionals often overlooked the challenges patients faced, highlighting a significant discrepancy in perspectives. While patients seek assistance regardless of organizational constraints, professionals focus on care within their established boundaries ( 2 , 6 ). This divergence complicates the creation of digital support tools that meet patient needs, as solutions favored by professionals may not align with patient desires, ultimately reducing collaboration and shared decision-making. Furthermore, the reliance on paper-based information sharing and fragmented digital communication exacerbates this divide. This highlights the complexities in technology design for rehabilitation settings, where heterogeneous stakeholders can possess diverse values, ambitions, and perspectives ( 4 ). 4.3 Joint conversations uncover insights into digital solutions' role in patient-centered care An interesting finding in this study was the shift in attitudes and focus when healthcare professionals discussed with patients. As in the separate interviews, the patients shared their reflections on the challenges they faced in initiating the digital rehabilitation plan and dealing with other cumbersome solutions. Patients proposed suggestions for leveraging technology to enhance patient-centredness and to deliver integrated, proactive healthcare with digital support ( 14 ). The shift in the professionals´ perspectives through the dialog with the patients in the joint interview settings fostered a sense of partnership, allowing professionals to better understand patients' experiences and needs. The joint conversations shifted the narrative for the professionals from a predominantly clinical perspective to one that emphasized possibilities with technology to support and strengthen the rehabilitation process. This collaborative approach not only empowered patients to voice their insights but also encouraged professionals to consider new perspectives on care delivery, going beyond their existing context and boundaries and partnering in promoting a patient-centered focus on technology supporting the rehabilitation process. The joint meetings between patients and healthcare professionals were instrumental in uncovering insights that might have remained obscured in separate discussions. Without these sessions, the study would likely have highlighted only the existing discord between patients and professionals regarding their perceptions of the challenges and opportunities presented by ICTs in the digital rehabilitation process. However, these dialogs fostered a deeper understanding among professionals, empowering patients to influence the future design of ICT solutions that support the rehabilitation process. 4.4 Collaboration in technology for rehabilitation should involve end-users Considering our findings, we advocate for greater involvement of end users in the design process. Such engagement could lead to significant improvements in digital support services and transform the rehabilitation framework ( 12 , 13 ). The first-hand experiences and insights gathered from patients are invaluable for creating effective and user-friendly health technologies. Furthermore, patients, drawing from their familiarity with technology in various aspects of their lives, are ideally positioned to offer innovative solutions to the challenges identified and enhance the services provided. Therefore, it is essential to recognize patients as vital stakeholders and actively invite them to participate in the collaborative design and implementation of healthcare technology. While our findings highlight the positive impact of involving all stakeholders in the design process of the rehabilitation plan on everyday technology use, several barriers persist. The broader context of technology and healthcare is influenced by factors such as mergers, acquisitions, shifting political priorities, and budget constraints. At the local level, tender regulations can complicate collaborative efforts, often limiting the meaningful participation of patients. In many cases, patients are either excluded from the stakeholder process altogether or are included only superficially as “hostages,” serving as mere user representatives without genuine input. ( 15 ). Finally, local adaptations and customization of technology require substantial resources from technology designers and may not yield the anticipated economic benefits. The siloed structure of the Norwegian healthcare system, characterized by incompatible administrative and health-related systems, creates significant barriers to data access and limits stakeholders' digital engagement in the design, implementation, and everyday use of technology. 5. Conclusion In conclusion, this study highlights patients' and end-user professionals´ appreciation for a digital rehabilitation plan to promote shared decision-making among end-users and uncover barriers in design and day-to-day use. The larger context of the rehabilitation institution creates barriers to furthering a collaborative process of design and local adaptations. The focus group discussions between patients and healthcare professionals provided a window of opportunity for learning and sharing knowledge and experiences, prompting professionals to shift their perspectives toward the importance of integrating patients’ knowledge and ideas into technology design. A collaborative design process may facilitate new usage patterns and ideas for further development. When unforeseen capabilities and applications of the technology are detected, the implicit design script can be changed. However, siloed healthcare organisations and regulatory constraints can still hinder the implementation and day-to-day use of any technology. Despite the identified barriers to acknowledging and including patients as stakeholders in design and implementation processes, there is no other alternative if patient-centredness is to be obtained. Limitations Semistructured mini-focus group interviews were chosen to generate interactions among participants and explore diverse perspectives and idea generation in and between stakeholder groups. However, this method has several challenges. Dominant personalities can skew discussions, and conformity pressure can inhibit the expression of differing perspectives ( 16 ). To prevent the impact of such processes, the size of the focus groups was small, the moderator of the groups ensured that all participants were engaged in the discussion, and the moderator shared lessons learned in previous groups, from clinical practice, and from the literature, to prompt discussions when needed. Focus groups facilitate deliberation to a greater extent than individual interviews do, which is demonstrated by the reported change in positions through the discussions. The first author of this study declares a vested interest, as he is affiliated with the design company. However, the active participation of coauthors/senior researchers (social scientists and computer scientists) contributed to a critical appraisal of the study design, material, analysis, and knowledge contribution. Abbreviations ACT Acceptance and Commitment Therapy CBT Cognitive Behavioral Therapy GP General Practitioner ICT Information and Communication Therapy SIKT The Norwegian Social Science Data Services Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Norwegian Agency for Shared Services in Education and Research, Data Protection Services for Research, reference number 116434. Concent for publication Verbal and written informed consent were obtained from the participants for their anonymized information to be published before they were interviewed. Availability of data and materials Data supporting this study cannot be made publicly available owing to the risk of breaking anonymity among study participants. Competing interests We declare that the first author of this study is an industrial Ph.D. candidate financed by the Norwegian Research Council. He worked part-time at Carasent Norge AS when the material for this study was produced. Industrial Ph.D. candidates are expected to add value to their employers' products and commercial interests. The first author is no longer affiliated with Carasent Norge AS. The other authors declare that they have no conflict of interest. Funding The industrial Ph.D. trajectory for the first author is financed by the Norwegian Research Council, grant number 317063. Authors' contributions JIG collected the data in this study, and all the authors contributed to the design of the study, data analysis, interpretation of the results, and writing of the manuscript. Acknowledgments The authors sincerely thank the staff and patients at Sørlandets Rehabiliteringssenter Eiken AS, Norway, for graciously granting us access to their valuable insights and experiences. Their willingness to share their time and stories was instrumental in conducting this research. References Ellingsen G, Arntzen C, Forslund L, Nikolaisen M, Eliassen M, Gramstad A et al. Designing digital systems for rehabilitation practices. Tidsskrift omsorgsforskning. 2023(2):67–78. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:1–13. Nguyen H, Butow P, Dhillon H, Sundaresan P. A review of the barriers to using Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs) in routine cancer care. J Med Radiat Sci. 2020. Rittel HW, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973;4(2):155–69. Sørhaug C, Fugletveit R. 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The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16(1):103–21. Additional Declarations Competing interest reported. Ad described in the article, we declare that the first author of this study is an industrial Ph.D. candidate financed by the Norwegian Research Council. He worked part-time at Carasent Norge AS when the material for this study was produced. Industrial PhD candidates are expected to add value to their employers' products and commercial interests. However, the active participation of coauthors/senior researchers (social scientists and computer scientists) contributed to a critical appraisal of the study design, material, analysis, and knowledge contribution. The first author is no longer affiliated with Carasent Norge AS. The other authors declare that they have no conflict of interest. Supplementary Files Additionalfile1.docx Information about additional material File name: additional file 1 File format: .docx Title of data: Interview guide Description of data: Interview topic guide Cite Share Download PDF Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Medical Informatics and Decision Making → Version 1 posted Editorial decision: Revision requested 20 Jan, 2026 Reviews received at journal 18 Jan, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 17 Oct, 2025 Reviewers invited by journal 15 Oct, 2025 Editor assigned by journal 09 Oct, 2025 Submission checks completed at journal 09 Oct, 2025 First submitted to journal 06 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:14:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":233182,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7793313/v1/f6d0b186-68b3-4ac3-b3b2-4093c55859f8.pdf"},{"id":94686456,"identity":"cb6cab1c-4633-42fb-b0ff-5197b9fd5921","added_by":"auto","created_at":"2025-10-29 15:34:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22092,"visible":true,"origin":"","legend":"\u003cp\u003eInformation about additional material\u003c/p\u003e\n\u003cp\u003eFile name: additional file 1\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Interview guide\u003c/p\u003e\n\u003cp\u003eDescription of data: Interview topic guide\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7793313/v1/eeb5260f2598f43fae1f83be.docx"}],"financialInterests":"Competing interest reported. Ad described in the article, we declare that the first author of this study is an industrial Ph.D. candidate financed by the Norwegian Research Council. He worked part-time at Carasent Norge AS when the material for this study was produced. Industrial PhD candidates are expected to add value to their employers' products and commercial interests. However, the active participation of coauthors/senior researchers (social scientists and computer scientists) contributed to a critical appraisal of the study design, material, analysis, and knowledge contribution. The first author is no longer affiliated with Carasent Norge AS. The other authors declare that they have no conflict of interest.","formattedTitle":"A Digital Rehabilitation plan: Evaluating a Tool Designed for facilitating Shared Decision-Making","fulltext":[{"header":"1. Background","content":"\u003cp\u003eIn this paper, we present healthcare professionals\u0026rsquo; and patients\u0026rsquo; experiences with the development and implementation of a digital rehabilitation plan for an inpatient rehabilitation program. The plan is a component of a configurable web platform that can be customized to meet end-user needs and integrated with electronic health records.\u003c/p\u003e\u003cp\u003eUpon acceptance into a person-tailored programme in a specialized rehabilitation institution in Norway, patients begin with a 5-day prestay to make plans for a later 3-week full programme. During prestay, they are introduced to the web platform and the digital rehabilitation plan and encouraged to detail their personal goals and means and outline their participation strategies. During the 4-week home period between the prestay and main stay, patients are encouraged to further develop their plans. During the main stay, the multidisciplinary team supports the patient by adjusting the plan to ensure that goals and means are relevant to the patient\u0026rsquo;s functional needs and the rehabilitation institution\u0026rsquo;s resources. To ensure person-tailored services and shared decision-making, professionals do not have permission to edit the rehabilitation plan on the web platform. Instead, they have access to digital copies of the plan, as it is stored in the electronic health record and serves as a reference for outcome evaluations. The patient and the multidisciplinary team evaluate goal achievement at the end of the main stay.\u003c/p\u003e\u003cp\u003eThis digital rehabilitation plan, and the web platform it is a part of, potentially addresses some of the reported challenges with communication technology in healthcare and rehabilitation, such as a lack of real-time updated information (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), organizational boundaries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), inflexible user interfaces, incompatibility with electronic health records (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and limited opportunities to consider end-user needs (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, we acknowledge that patients are rarely involved in the design and implementation of digital communication tools and question how their needs and preferences can be safeguarded and responded to. Technologists and healthcare providers may hold differing opinions on the usability and design of a web platform and digital communication for shared decision-making. This study explores how bringing all stakeholders together can bring forward new perspectives on the design and implementation of new digital communication tools for rehabilitation processes. This study is guided by the following question:\u003c/p\u003e\u003cp\u003eHow do patients, healthcare professionals, and other stakeholders evaluate the potential of a digital rehabilitation plan for shared decision-making during a rehabilitation process?\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eA qualitative exploratory design (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) was chosen for this study. This design rests upon a philosophy of science where knowledge and comprehension are formed through active engagement and interpretive processes rather than objective metrics. This research design can provide rich and detailed material that can be used to refine design, implementation, and end-user appropriation. All participants provided written informed consent. Norwegian Social Science Data Services (SIKT) approved ethical concerns and privacy protection measures, reference number 116434.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants and recruitment\u003c/h2\u003e\u003cp\u003eHealth care professional participants were approached and informed by leaders at an inpatient rehabilitation institution. They were given oral and written information about the study. The professional recruited patients. In total, the participants included ten persons from Norway familiar with the digital rehabilitation plan; six patients (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and four healthcare professionals (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWork status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHealthcare worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSick leave 100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eShop worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWork assessment allowance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eElectrician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSick leave 100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKindergarten assistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWork assessment allowance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHealth secretary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDisability benefit 80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnvironmental healthcare professional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSick leave 30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealthcare professional characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExpertise\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCancer nursing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysiotherapist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaster Health Sciences\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCognitive Behavioral (CBT)- and Acceptance and Commitment (ACT) Therapy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePersonal economy, CBT, ACT\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data production\u003c/h2\u003e\u003cp\u003eSemistructured focus mini-group discussions (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) were conducted with pairs of i) Norwegian patients, ii) healthcare professionals, and iii) a combination of groups i) and ii). In total, six patients and four healthcare professionals were interviewed. Two of the professionals served as patient coordinators for four of the patients. In total, eight focus groups were conducted, consisting of the following configurations: three groups of patient pairs, two groups of healthcare professional pairs, and three groups combining patients and their affiliated professionals.\u003c/p\u003e\u003cp\u003e Semistructured interviews were chosen because of the method\u0026rsquo;s flexibility, where predefined themes are set; however, further exploration can be performed based on participants' answers. Open-ended questions and prompts enabled the interviewees to disclose their knowledge, experiences, and perspectives. This is useful in an exploratory study where understanding nuanced perspectives is important.\u003c/p\u003e\u003cp\u003eThe venue for focus groups was provided by the rehabilitation institution. The group discussions followed a topic guide (supplementary 1). Following a patient-centered approach, focus groups with patients were carried out before focus groups with professionals. Joint groups were held last. Each group discussion lasted between 60 and 90 minutes and was audio recorded with a Dictaphone.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data analysis\u003c/h2\u003e\u003cp\u003eThe focus group discussions were transcribed verbatim in Norwegian by JIG and anonymized continuously. The transcripts were categorized via NVivo 14 software (QSR International Pty Ltd., Victoria, Australia). The initial codes were grouped into broader themes and further reviewed and refined by rechecking against the original transcripts to ensure that they reflected the dataset. Special consideration was given to balancing the use of codebooks and ensuring coding reliability while embracing the subjective nature of reflexive thematic analysis (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Excerpts from the interviews used in this paper were translated into English and edited for readability by the authors.\u003c/p\u003e\u003cp\u003eBelow are examples of some key codes and their associated themes:\u003c/p\u003e\u003cp\u003eOperational challenges: Some patients need the plan in paper \u0026ndash; duplicated efforts, limited time to read patient updates on the plan along the way.\u003c/p\u003e\u003cp\u003eEnhanced communication and engagement: Support for physical meetings, more lively plan, younger patients are very satisfied, patients manage their time better outside meetings with the professional staff.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eWe employed a multifaceted analytic strategy in this study to gain a nuanced understanding of participants' perspectives on digital rehabilitation plans, highlighting the complexity of their experiences. We first analyzed the perspectives of patients and professionals separately to identify unique experiences, desires, and internal variations. This approach allowed us to uncover specific errors, gaps, suggestions for improvement, and areas of contention within each group's narratives. We subsequently examined the commonalities and differences between the groups to determine where their interests aligned, where disagreements arose, and how they might ultimately converge on shared insights. This allowed for an understanding of the participants' views on the digital rehabilitation plan (3.1), stakeholders' experiences with digital solutions that support the rehabilitation process in general (3.2 and 3.3), and the discovery of further technological solutions needed to work toward digital support for shared decision-making (3.4).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Patients and healthcare professionals held positive views of the digital rehabilitation plan.\u003c/h2\u003e\u003cp\u003eBoth healthcare professionals and patients conveyed a generally positive perception of the digital rehabilitation plan. The patients unanimously approved the digital rehabilitation plan for setting goals and means. They underscored their own tech-savviness, raised concerns about demands for e-health literacy, and recommended that paper-based rehabilitation plans should be available when needed.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;You get a bit of pressure when you must write on paper.., you kind of feel like you just must get something dotted down. But when you do this on the web platform, you can go back later and finish it or change it. It makes it a lot easier\u0026rdquo; -patient\u003c/em\u003e\u003c/p\u003e\u003cp\u003eHealthcare professionals view the digital rehabilitation plan as support for the treatment process. They recognized that the plan functioned as a \"living document\" that could be dynamically updated, enhancing both patient engagement and document usability. The digital plan provided support for the physical meetings, and the professionals became better at using the digital solutions through increased use. Healthcare professionals identified several barriers related to the user interface, including the absence of real-time notifications for updates, the availability of templates exclusively in Norwegian, and challenges associated with navigating various user interfaces.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I guess it depends a bit on age, too. For young people, it's not a problem. However, for those who are 60-plus, maybe. In addition, some have problems with their cell phone, so they cannot access the web platform. We believe that this might be related to outdated software or older devices, but we do not know. I do not always understand that\u0026rdquo; \u0026ndash; professional\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Patients: There is no comprehensive approach to support the digital rehabilitation process\u003c/h2\u003e\u003cp\u003ePatients are required to submit the digital rehabilitation plan on their first day of prestay at the rehabilitation institution. For the patients, this was at odds with previous experiences from healthcare, where treatment decisions were largely made by professionals. Being active and taking initiative, hence, was unfamiliar. As a result, they struggled to initiate the rehabilitation plan.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I felt a lot of stress upon arriving at the institution and in the first few days. I didn\u0026acute;t know where I was going, what to expect, or what the treatment consisted of. In addition, since I was accustomed to just being told what to do, the concept of overseeing my rehabilitation plan was difficult\u0026hellip; I also struggle with memory and cognition, so even though I was given information about how to work with the rehabilitation plan, I could neither remember nor do it myself\u0026rdquo; - patient\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe customization of the digital rehabilitation plan positively influenced patients\u0026rsquo; experiences. However, patients were surprised that healthcare professionals did not provide follow-up on the plan as extensively as anticipated following its mandatory creation.\u003c/p\u003e\u003cp\u003eFurthermore, the patients suggested several uses of digital tools to improve their rehabilitation experience. As tech-savvy users, they sought access to digital information before the inpatient period, including videos and details about the institution and directions for arrival. They proposed a \u0026ldquo;my page\u0026rdquo; feature that would provide essential information, training programs, survey responses with explanations of the results, timetables, appointments, and tasks. Additionally, they expressed concern about the period following their stay and requested digital follow-up, self-management support, and opportunities for contact with the rehabilitation institution as needed.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It is a lot that is connected to the rehabilitation plan. Lectures, appointments, handouts, and everything\u0026hellip; With my fatigue and memory loss, everything becomes more complicated, and it is hard\u0026hellip; \u0026raquo; - patient\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePatients were highly satisfied with the inpatient program, valuing both the collaboration with professionals and the peer support provided by fellow patients. They expressed strong scepticism regarding the idea of replacing inpatient rehabilitation with digital follow-up alone. Instead, they advocated for digital solutions that could support and enhance, rather than replace, the existing rehabilitation process.\u003c/p\u003e\u003cp\u003e3.3 The professionals: We do as we usually do, even though we like the digital rehabilitation plan\u003c/p\u003e\u003cp\u003eHealthcare professionals appreciated the reduced amount of paperwork; printing, punching patient input, scanning documents to the EHR, and time saved for looking for paper versions. Despite this apprehension, the professionals voiced scepticism toward technology and the need to keep up treatment as usual. Professionals stressed that patient‒provider interaction must be analogous and warned that digital solutions could hamper this. The professionals did not discuss how digital solutions could support the rehabilitation process.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I feel that bringing a PC into patient meetings can be a bit disrespectful. Therefore, when I meet with patients, I prefer to have important points written down in advance. I\u0026rsquo;m also concerned that discussing things digitally might lead to missing crucial information during conversations.\u0026rdquo; - professional\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.4 When healthcare professionals and patients understand each other, they can explore possible solutions.\u003c/h2\u003e\u003cp\u003eThe dialog between patients and healthcare professionals changed professionals\u0026rsquo; perspectives after patients shared their experiences with unsatisfactory digital support throughout the rehabilitation process. First, the professionals acknowledged a suboptimal patient-centeredness through low patient follow-up on the patient\u0026acute;s digital rehabilitation plan.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We have the rehabilitation plan up on the wall in the team meetings, but maybe we are not transferring this clearly enough to the patient when we talk with them\u0026rdquo; - professional\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSecond, the healthcare professionals acknowledged that they did not routinely check whether patients\u0026rsquo; progress was according to plan. Thirdly, the healthcare professionals noted a lack of coordination between the development of the rehabilitation plan and the implementation of ACT. This disconnect led stakeholders to focus more on ACT, resulting in difficulties integrating it into the rehabilitation plan.\u003c/p\u003e\u003cp\u003eIn this joint group, professionals reflected more on how technology could enhance their work compared to the perspectives shared in the professionals-only group. They became responsive to the patients' wants and their suggestions for ICT to facilitate communication between patients and providers, as well as for planning, evaluation, and feedback from assessments:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We find it difficult to absorb all the information in the first days of the stay; therefore, it is hard to make a rehabilitation plan\u0026rdquo; - patient\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;but we bring it up at the welcome meeting\u0026rdquo; \u0026ndash; professional\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, but then we have already arrived\u0026rdquo; -patient\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, you just get thrown into everything, and then it is straight into individual meetings with the professionals, and from then on, it is a rush to get through everything at the start of the stay. So yes, I can see that it can be a lot for you\u0026rdquo; - professional\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFurther negotiations and possible solutions emerged through these discussions, which focused on patient-centredness and collaboration:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWhen talking about the new possibilities\u003c/em\u003e:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;All the data we collect, it must be of importance to you, and we must explain more to you\u0026hellip; To see development on scores can be valuable for the patient \u0026ndash; have I become more robust? \u0026raquo; - professional\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, we want to be able to compare\u0026rdquo; \u0026ndash; patient\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, that is exciting, both for us, you, and for research\u0026hellip; It is very good that this comes up, it is new for us \u0026ndash; we are in a transition process\u0026rdquo; - professional\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe patients expressed considerable trust in the professionals, highlighting that collaboration on challenging issues fostered both trust and a sense of teamwork, despite experiencing inadequate digital support throughout the process. In contrast, these feelings of trust and teamwork were less pronounced in their interactions with the GP (general practitioner) and the broader healthcare system. This observation was corroborated by the professionals, who engaged in further discussions focused on utilizing digital solutions to enhance collaboration and strengthen the rehabilitation process.\u003c/p\u003e\u003cp\u003eThese results highlight the intricate dynamics of the digital rehabilitation process. Despite having access to relevant data for the involved stakeholders, employing flexible ICT solutions, and utilizing a collaboratively designed digital rehabilitation plan to facilitate shared decision-making, significant challenges persist at the intersection of stakeholders, organizational boundaries, and technology.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAnchored in social constructivism and employing a multifaceted analytic strategy to explore the complex experiences surrounding the design and implementation of technological solutions in rehabilitation, this study revealed a high level of appreciation for a digital rehabilitation plan among patients and healthcare professionals. However, patients experienced challenges related to its initiation and follow-up. Healthcare professionals became responsive to this need during discussions with patients, demonstrating both troubleshooting capabilities and enthusiasm. They engaged with patients, reflecting on the patient-centered focus and the practical possibilities with technology to enhance patient-centredness and satisfaction.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e4.1 At first, eyesight: digital rehabilitation was a success\u003c/h2\u003e\u003cp\u003eThe implementation of a digital rehabilitation plan was well received by both patients and healthcare professionals, reflecting the rehabilitation institution's commitment to fostering shared decision-making. This positive reception is consistent with the literature, which underscores the importance of involving key stakeholders in the design and deployment of technological solutions to ensure that they effectively meet the needs of end-users. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Even though data access and, hence, participation for other relevant stakeholders (e.g., GPs, next of kin, employers) was not possible (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), at least access to pertinent information was possible for patients and healthcare professionals inside this part of the health service (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), enabling effective use of the digital rehabilitation plan.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Shared decision-making through technology is dependent on both technology and stakeholders\u003c/h2\u003e\u003cp\u003eIn our study, patients highlighted several barriers that obstructed the effectiveness of the digital rehabilitation plan. These challenges arose from a disconnect between individual patient experiences and the standardized healthcare framework that guided the design of the system (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Specifically, the lack of patient-centered care within the larger healthcare infrastructure constrained patients' autonomy in initiating their rehabilitation plans. Furthermore, cognitive and memory impairments significantly impeded the ability to develop personalized strategies, thereby undermining the principles of shared decision-making.\u003c/p\u003e\u003cp\u003eThe fragmented healthcare system has resulted in limited collaboration between primary and specialist care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This was evident, as healthcare professionals often overlooked the challenges patients faced, highlighting a significant discrepancy in perspectives. While patients seek assistance regardless of organizational constraints, professionals focus on care within their established boundaries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This divergence complicates the creation of digital support tools that meet patient needs, as solutions favored by professionals may not align with patient desires, ultimately reducing collaboration and shared decision-making. Furthermore, the reliance on paper-based information sharing and fragmented digital communication exacerbates this divide.\u003c/p\u003e\u003cp\u003eThis highlights the complexities in technology design for rehabilitation settings, where heterogeneous stakeholders can possess diverse values, ambitions, and perspectives (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Joint conversations uncover insights into digital solutions' role in patient-centered care\u003c/h2\u003e\u003cp\u003eAn interesting finding in this study was the shift in attitudes and focus when healthcare professionals discussed with patients. As in the separate interviews, the patients shared their reflections on the challenges they faced in initiating the digital rehabilitation plan and dealing with other cumbersome solutions. Patients proposed suggestions for leveraging technology to enhance patient-centredness and to deliver integrated, proactive healthcare with digital support (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The shift in the professionals\u0026acute; perspectives through the dialog with the patients in the joint interview settings fostered a sense of partnership, allowing professionals to better understand patients' experiences and needs. The joint conversations shifted the narrative for the professionals from a predominantly clinical perspective to one that emphasized possibilities with technology to support and strengthen the rehabilitation process. This collaborative approach not only empowered patients to voice their insights but also encouraged professionals to consider new perspectives on care delivery, going beyond their existing context and boundaries and partnering in promoting a patient-centered focus on technology supporting the rehabilitation process.\u003c/p\u003e\u003cp\u003eThe joint meetings between patients and healthcare professionals were instrumental in uncovering insights that might have remained obscured in separate discussions. Without these sessions, the study would likely have highlighted only the existing discord between patients and professionals regarding their perceptions of the challenges and opportunities presented by ICTs in the digital rehabilitation process. However, these dialogs fostered a deeper understanding among professionals, empowering patients to influence the future design of ICT solutions that support the rehabilitation process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Collaboration in technology for rehabilitation should involve end-users\u003c/h2\u003e\u003cp\u003eConsidering our findings, we advocate for greater involvement of end users in the design process. Such engagement could lead to significant improvements in digital support services and transform the rehabilitation framework (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The first-hand experiences and insights gathered from patients are invaluable for creating effective and user-friendly health technologies. Furthermore, patients, drawing from their familiarity with technology in various aspects of their lives, are ideally positioned to offer innovative solutions to the challenges identified and enhance the services provided. Therefore, it is essential to recognize patients as vital stakeholders and actively invite them to participate in the collaborative design and implementation of healthcare technology.\u003c/p\u003e\u003cp\u003eWhile our findings highlight the positive impact of involving all stakeholders in the design process of the rehabilitation plan on everyday technology use, several barriers persist. The broader context of technology and healthcare is influenced by factors such as mergers, acquisitions, shifting political priorities, and budget constraints. At the local level, tender regulations can complicate collaborative efforts, often limiting the meaningful participation of patients. In many cases, patients are either excluded from the stakeholder process altogether or are included only superficially as \u0026ldquo;hostages,\u0026rdquo; serving as mere user representatives without genuine input. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Finally, local adaptations and customization of technology require substantial resources from technology designers and may not yield the anticipated economic benefits. The siloed structure of the Norwegian healthcare system, characterized by incompatible administrative and health-related systems, creates significant barriers to data access and limits stakeholders' digital engagement in the design, implementation, and everyday use of technology.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, this study highlights patients' and end-user professionals\u0026acute; appreciation for a digital rehabilitation plan to promote shared decision-making among end-users and uncover barriers in design and day-to-day use. The larger context of the rehabilitation institution creates barriers to furthering a collaborative process of design and local adaptations. The focus group discussions between patients and healthcare professionals provided a window of opportunity for learning and sharing knowledge and experiences, prompting professionals to shift their perspectives toward the importance of integrating patients\u0026rsquo; knowledge and ideas into technology design. A collaborative design process may facilitate new usage patterns and ideas for further development. When unforeseen capabilities and applications of the technology are detected, the implicit design script can be changed. However, siloed healthcare organisations and regulatory constraints can still hinder the implementation and day-to-day use of any technology. Despite the identified barriers to acknowledging and including patients as stakeholders in design and implementation processes, there is no other alternative if patient-centredness is to be obtained.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eSemistructured mini-focus group interviews were chosen to generate interactions among participants and explore diverse perspectives and idea generation in and between stakeholder groups. However, this method has several challenges. Dominant personalities can skew discussions, and conformity pressure can inhibit the expression of differing perspectives (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). To prevent the impact of such processes, the size of the focus groups was small, the moderator of the groups ensured that all participants were engaged in the discussion, and the moderator shared lessons learned in previous groups, from clinical practice, and from the literature, to prompt discussions when needed. Focus groups facilitate deliberation to a greater extent than individual interviews do, which is demonstrated by the reported change in positions through the discussions.\u003c/p\u003e\u003cp\u003eThe first author of this study declares a vested interest, as he is affiliated with the design company. However, the active participation of coauthors/senior researchers (social scientists and computer scientists) contributed to a critical appraisal of the study design, material, analysis, and knowledge contribution.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcceptance and Commitment Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCBT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCognitive Behavioral Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeneral Practitioner\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInformation and Communication Therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIKT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe Norwegian Social Science Data Services\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Norwegian Agency for Shared Services in Education and Research, Data Protection Services for Research, reference number 116434.\u003c/p\u003e\n\u003ch2\u003eConcent for publication\u003c/h2\u003e\n\u003cp\u003eVerbal and written informed consent were obtained from the participants for their anonymized information to be published before they were interviewed.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eData supporting this study cannot be made publicly available owing to the risk of breaking anonymity among study participants.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eWe declare that the first author of this study is an industrial Ph.D. candidate financed by the Norwegian Research Council. He worked part-time at Carasent Norge AS when the material for this study was produced. Industrial Ph.D. candidates are expected to add value to their employers\u0026apos; products and commercial interests. The first author is no longer affiliated with Carasent Norge AS. The other authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe industrial Ph.D. trajectory for the first author is financed by the Norwegian Research Council, grant number 317063.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eJIG collected the data in this study, and all the authors contributed to the design of the study, data analysis, interpretation of the results, and writing of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors sincerely thank the staff and patients at S\u0026oslash;rlandets Rehabiliteringssenter Eiken AS, Norway, for graciously granting us access to their valuable insights and experiences. Their willingness to share their time and stories was instrumental in conducting this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEllingsen G, Arntzen C, Forslund L, Nikolaisen M, Eliassen M, Gramstad A et al. Designing digital systems for rehabilitation practices. Tidsskrift omsorgsforskning. 2023(2):67\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLong JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen H, Butow P, Dhillon H, Sundaresan P. A review of the barriers to using Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs) in routine cancer care. J Med Radiat Sci. 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRittel HW, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973;4(2):155\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS\u0026oslash;rhaug C, Fugletveit R. Introduction: The Need for Implementing a Digital Welfare Critique From an Assemblage Analytical Approach. In: Fugletveit R, S\u0026oslash;rhaug C, editors. Lost in Digital Translations: Studies of Digital Resistance and Accommodation to the Welfare State in Practice. Oslo, Norway: Cappelen Damm Akademisk; 2023. p. 199.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNicolas B, Leblong E, Fraudet B, Gallien P, Piette P. Telerehabilitation solutions in patient pathways: An overview of systematic reviews. Digit Health. 2024;10:20552076241294110.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYin RK. Case study research: Design and methods. sage; 2009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCreswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. Sage; 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eToner J. Small is not too small: Reflections concerning the validity of very small focus groups (VSFGs). Qualitative Social Work. 2009;8(2):179\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Res Psychol. 2021;18(3):328\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHauge HN. Den digitale helsetjenesten [The digital health service]. Oslo: Gyldendal Akademisk; 2017. p. 417.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkrich M, Callon M, Latour B, Monaghan A, THE KEY TO, SUCCESS IN INNOVATION PART II: THE ART OF CHOOSING GOOD SPOKESPERSONS. Int J Innov Manag. 2002;06(02):207\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkrich M, Callon M, Latour B, Monaghan A. The key to success in innovation part I: the art of interessement. Int J Innov Manag. 2002;6(02):187\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerntsen G, Strisland F, Malm-Nicolaisen K, Smaradottir B, Fensli R, R\u0026oslash;hne M. The Evidence Base for an Ideal Care Pathway for Frail Multimorbid Elderly: Combined Scoping and Systematic Intervention Review. J Med Internet Res. 2019;21(4):e12517.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGagnon M-P, Desmartis M, Gagnon J, St-Pierre M, Rhainds M, Coulombe M, et al. Framework for user involvement in health technology assessment at the local level: Views of health managers, user representatives, and clinicians. Int J Technol Assess Health Care. 2015;31(1\u0026ndash;2):68\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKitzinger J. The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16(1):103\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Digital rehabilitation, shared decision-making, patient participation, patient–provider communication, implementation, collaborative design, rehabilitation plan","lastPublishedDoi":"10.21203/rs.3.rs-7793313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7793313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThrough a partnership and collaborative design process between technologists and healthcare professionals, a web platform including a digital rehabilitation plan was developed. This design process addresses recognized challenges in rehabilitation information and communication technology, e.g., fragmented data flows and low-quality user interfaces. The digital rehabilitation plan facilitated shared decision-making, allowing the patient to personalize their plan while providing healthcare professionals with access to support the patient's journey. This study evaluated end-user healthcare professionals\u0026rsquo; and patients\u0026rsquo; experiences with the plan\u0026rsquo;s usability and potential areas for improvement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eSemistructured focus-group interviews were conducted with three different groups: i) patients, ii) healthcare professionals, and iii) patients and healthcare professionals. The discussions delved into the preadmission phase, the inpatient period, rehabilitation plans, inpatient stays, evaluations, and outpatient follow-ups. The recorded files were transcribed and thematically analyzed to identify patterns, paradoxes, and dilemmas.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePatients and healthcare professionals appreciated the digital rehabilitation plan. However, patients requested a wider range of digital support tools for inpatient rehabilitation and follow-up, e.g., a \"my page\" with access to relevant information, chat support, educational tools, and videos. In peer groups, professionals are reluctant to expand the use of the web platform due to past negative experiences with information and communication technology, and hence have less motivation to change work processes. Discussions in the third focus group shifted the professionals\u0026rsquo; perspective, revealing the potential for improved collaboration and patient-provider communication.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThis study demonstrated that involving patients in the design and implementation of a web platform can uncover bias, identify barriers, create new ideas, enhance usability, and increase the use of digital communication in rehabilitation. Healthcare professionals face barriers to using the web platform because of established procedures and previous experiences, whereas patients\u0026rsquo; drivers are facilitated by their everyday technology use. Patients\u0026rsquo; eagerness to use digital communication tools surprised the professionals. Bringing patients and professionals together changed professionals' views and revealed barriers and drivers for further development of a web platform for rehabilitation.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eThis study was approved by the Norwegian Agency for Shared Services in Education and Research, Data Protection Services for Research, reference number 116434.\u003c/p\u003e","manuscriptTitle":"A Digital Rehabilitation plan: Evaluating a Tool Designed for facilitating Shared Decision-Making","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 15:34:36","doi":"10.21203/rs.3.rs-7793313/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-20T06:38:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T01:06:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108763679846884100248947718690144950734","date":"2026-01-18T23:16:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-27T16:31:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249552547032058055813610921072951343182","date":"2025-12-15T08:29:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193729382909114153511529571993278471515","date":"2025-10-17T17:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-15T15:08:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-09T05:34:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-09T05:31:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Informatics and Decision Making","date":"2025-10-06T17:10:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9819ca13-0b4b-45d7-ab59-142fbf1a0b24","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:12:50+00:00","versionOfRecord":{"articleIdentity":"rs-7793313","link":"https://doi.org/10.1186/s12911-026-03506-0","journal":{"identity":"bmc-medical-informatics-and-decision-making","isVorOnly":false,"title":"BMC Medical Informatics and Decision Making"},"publishedOn":"2026-04-21 15:57:57","publishedOnDateReadable":"April 21st, 2026"},"versionCreatedAt":"2025-10-29 15:34:36","video":"","vorDoi":"10.1186/s12911-026-03506-0","vorDoiUrl":"https://doi.org/10.1186/s12911-026-03506-0","workflowStages":[]},"version":"v1","identity":"rs-7793313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7793313","identity":"rs-7793313","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}