Testing an electronic patient-reported outcome platform in the context of Traumatic Brain Injury: the PRiORiTy usability study

Background
Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualised care. Traditional paper-based assessments can be cumbersome, potentially impeding the regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for TBI patients.

Objectives
This study evaluates the usability of an electronic PRO (ePRO) platform, Atom5™, for individuals with TBI. By analysing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5™ to support ongoing patient-centred care.

Methods
The Atom5™ electronic platform was customised to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK, an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the “Think Aloud” method, encouraging them to verbalise their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. Additionally, user satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale (SUS). Usability outcomes were analysed for critical and non-critical errors, focusing on user experience and overall satisfaction.

Results
Nine participants completed a single usability testing session using the Atom5™ platform, including four men, 4 women and 1 non-binary individual. Four participants were under 55 years old and six had their TBI less than 10 years ago. Finally, eight participants used an Android device. The platform included measures for anxiety (GAD-2), depression (PHQ-2), post-traumatic stress disorder (PCL-2), and TBI-specific quality of life (TBI QOL SF), and a total of 26 questions.
Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Six participants encountered no errors, whilst one participant reported one critical error and two others reported one non-critical error each. Participants rated their overall satisfaction with the platform at an average score of 3.9 (sd=0.49) out of 5.

Conclusion
This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5™ ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future development of ePROs should focus on inclusivity and adaptability to address the diverse needs of TBI patients, ensuring these tools can effectively support a wide range of users.