For people living with spinal cord impairment (SCI), chronic shoulder pain is common and frequently limits community mobility. This leads to loss of independence and reduced quality of life. Evidence has shown that specific exercises, supervised by a physiotherapist, can significantly reduce shoulder pain. However, cost, need for expertise, and transport barriers can limit access to treatment services. Technology is increasingly being used to help bridge this gap and deliver health care services directly to people in their communities. Despite this, there remains a lack of well-designed and evidence-based digital interventions, delivered remotely, that support self-guided exercises to help manage shoulder pain in this population. My doctoral work aimed to develop an evidence-informed and self-guided digital intervention: SPIN (Shoulder Pain Intervention over the interNet) to help people living with SCI (pwSCI) manage their shoulder pain.

The Person-Based Approach (PBA) was used to guide the development of SPIN. This approach involved iterative phases that were informed by a deep understanding of the needs and context of those who would use the intervention (pwSCI who have shoulder pain).

A systematic review and meta-analysis of other digital self-guided physical activity and exercise interventions was conducted early in the research. It found that interventions that were underpinned by a theoretical framework and that incorporated self-regulatory behavioural strategies had a positive effect on physical activity and other health outcomes in people living with chronic health conditions. These findings lent support to the notion of a self-guided intervention and helped inform what features SPIN should incorporate.

Primary evidence was then collected through an Interpretive Descriptive qualitative study, undertaken with pwSCI who have shoulder pain. The purpose was to better understand the factors that would influence engagement, when contemplating and using a self-guided digital intervention. Themes were drawn from the data that represented decision-making steps for pwSCI that occurred at key points. A schematic model was developed: Should I use it? Can I use it? Will I use it?. This work informed the subsequent PBA phase which involved the design and development of SPIN.

Guiding principles were formulated during the design phase, using data from the earlier phase. These shaped the design objectives and intervention features of SPIN, ensuring they continued to meet the identified needs of those who would use the intervention. Initial wireframes were then created. Wireframes are basic screen layouts that demonstrate intervention features, focusing on content, space allocation and flow, without getting distracted by aesthetics. These were refined over the development phase through focus groups with academic and clinical informants and individual ‘think aloud’ sessions with pwSCI. A final SPIN wireframe prototype was produced, ready for the post-doctoral phase of software design and coding.

My doctoral work has developed a digital intervention that is evidence-informed, self-guided and responsive to users’ needs, addressing many of the problems with existing apps. It has been explicit in its development during each phase and has continued to keep users’ identified needs central throughout. The findings from this work have applicability to current clinical practice while addressing many limitations.

NOTE: Chapters 6 and 7, and appendices P, Q, W and X are embargoed until 23 August 2026. Redacted version of the full thesis is available.