Background: Distal upper limb musculoskeletal disorders (DUL-MSDs) are common conditions affecting the hand, wrist, and elbow, often making daily activities difficult and reducing quality of life. Despite their prevalence, few effective self-management tools are available. The Digital-My Arm Pain Programme (D-MAPP) was designed to address this gap by developing and evaluating a digital rehabilitation programme to support people living with DUL-MSDs (pwDUL-MSDs).

Objectives: This study aimed to mobilise knowledge of Behaviour Change Techniques (BCTs) and evidence synthesised in prior studies to support co-production of the D-MAPP intervention ahead of evaluation in a multi-centred RCT.

Methods: An Experience-Based Co-Design (EBCD) approach was employed to develop the D-MAPP intervention. Creative methods, including prototypes and trigger films, were developed to mobilise evidence and theory effectively. Findings from a qualitative study with 15 pwDUL-MSDs and 13 healthcare professionals (HCPs), exploring barriers and facilitators to using a digital self-management, were shared via a trigger film. The animated films communicated the key barriers and facilitators using four personas. The outcome of a Delphi survey with 19 pwDUL-MSDs and 23 HCPs, to gain consensus on the intervention components required for inclusion in the intervention, were presented at the co-design workshops. Alongside each intervention component deemed critical to include, exemplars from other self-management interventions were shared to generate discussion and facilitate attendees to consider how the component should be implemented in D-MAPP. Placeholder Behaviour Change Techniques (BCTs) and paper prototypes facilitated participants to integrate theory into the co-production process. Participants identified key challenges, or “touchpoints,” in self-management, and these informed the iterative development of intervention features.

Results: 12 pwDUL-MSDs and 8 HCPs joined the D-MAPP co-design group. Initially, it was intended that co-designing the intervention could be completed in four workshops, lasting two and a half hours each, run over a four-month period. However, after completion of this first set of workshops, which were conducted virtually, it became apparent that this amount of time was inadequate. By the end of the first four workshops, the outcome was a high-level description of four features of the intervention, which lacked depth. Therefore, it was decided to run five additional, all day, in-person workshops. This significant investment of time, totalling over 90 hours, resulted in a digital intervention deeply informed by lived experiences, theory and evidence. The depth of involvement ensured that every detail, however minor, was designed through co-production. Creative methods fostered collaboration and shared understanding between participants, allowing for an equitable integration of lived experience and existing knowledge. Key challenges included maintaining engagement during online workshops and allocating sufficient time between workshops to develop materials that reflected participants’ input. Building trust and mutual respect among attendees and the research team was essential for creating a shared vision.

Conclusion: The D-MAPP project illustrates the potential of EBCD in developing meaningful, patient-centred digital self-management interventions for MSDs. It also highlights the need for significant resources, creativity, and adaptability to achieve successful co-production. These insights inform best practices for future research and intervention development.

REFERENCES: NIL.

Acknowledgements: Thanks to the advice and support of the D--MAPP research team.

Disclosure of Interests: Lucy Brading: None declared, Jo Rimmer: None declared, Samantha Mason: None declared, Sarah Kingsbury: None declared, Philip G. Conaghan Eli Lilly and Sandoz, Eupraxia, Formation Bio, Genascence, GlaxoSmithKlein (GSK), Grunenthal, Janssen, Kolon TissueGene, Levicept, Medipost, Moebius, Novartis, Pacira, Stryker, and Takeda, Novartis, Ian Kellar: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.