Patient experiences with a prescription-based digital health application (DiGA) for knee disorders: a qualitative study in german orthopaedic care

Background Musculoskeletal disorders are among the leading causes of chronic pain, functional limitations, and reduced quality of life worldwide. Prescription-based digital health applications (DiGAs) have the potential to improve outpatient care, enhance treatment adherence, and address structural challenges such as shortages in physiotherapy services. However, real-world evidence on the use of DiGAs from the patient perspective in orthopaedic settings within the German healthcare context remains limited. This study aimed to explore acceptance, perceived potential, and challenges associated with DiGA use among patients with knee joint disorders. Methods An exploratory qualitative study was conducted at an academic outpatient clinic for orthopaedics and trauma surgery in Germany. Ten adult patients (aged 18–65 years) with anterior cruciate ligament rupture or meniscal injury and a prescribed DiGA (“Orthopy”) were recruited. Semi-structured telephone interviews were conducted at the time of prescription ( n = 10) and approximately two to three weeks later ( n = 6; one follow-up interview took place after twelve weeks). All four participants who withdrew completed a dropout questionnaire. Data were analysed using qualitative content analysis according to Kuckartz. Main categories were derived deductively from the research question; subcategories were developed inductively from the data. Baseline and follow-up interviews of the six completing participants were compared within and across cases. Sociodemographic and clinical data were collected to contextualise findings. Trustworthiness was supported by iterative coding, an intra-coder consistency check, and team discussion of the coding frame. Coding was performed by a single researcher. Results Participants were generally open to using the DiGA and valued its flexibility, location independence, and its role in bridging gaps in physiotherapy. The DiGA was primarily perceived as a complementary tool rather than a replacement for conventional therapy. Perceived key strengths included structured exercise guidance, educational content, and easy integration into daily routines, particularly in prehabilitation. Challenges included limited personalisation, insufficient adaptation of feedback, and limited motivational benefit when the app was used without accompanying professional guidance. Additional barriers comprised administrative delays in activation, usability issues among less digitally literate users, and insufficient physician guidance. Data privacy concerns played a minor role. Interviewed participants did not report serious safety concerns during the short observation period. Conclusions Participants perceived the DiGA as a suitable complement to physiotherapy in orthopaedic care, particularly for prehabilitation and continuity of care. Better personalisation, usability, and integration into existing care structures could further enhance its perceived value. Long-term adherence, clinical effectiveness, safety, and sustainable implementation remain to be established. Future research should address these questions and patient-centred design. Trial registration The study was registered in the German Clinical Trials Register (DRKS00036514) on 10 April 2025, after data collection had begun in January 2025 (retrospective registration).