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Paganini S, Terhorst Y, Sander LB, Catic S, Balci S, Küchler AM, Schultchen D, Plaumann K, Sturmbauer S, Krämer LV, Lin J, Wurst R, Pryss R, Baumeister H, Messner EM. Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth 2021; 9:e22587. [PMID: 34106073 PMCID: PMC8262667 DOI: 10.2196/22587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/30/2020] [Accepted: 01/05/2021] [Indexed: 01/23/2023] Open
Abstract
Background Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers. Objective This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed. Methods A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps. Results Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not. Conclusions Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers.
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Affiliation(s)
- Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Selma Catic
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sümeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Katrin Plaumann
- Institute of Media Informatics, Ulm University, Ulm, Germany
| | - Sarah Sturmbauer
- Chair of Health Psychology, Department of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lena Violetta Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jiaxi Lin
- Department of Psychiatry and Psychotherapy Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport Psychology, Institute of Sports and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Kahnbach L, Lehr D, Brandenburger J, Mallwitz T, Jent S, Hannibal S, Funk B, Janneck M. Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps. J Med Internet Res 2021; 23:e27989. [PMID: 33890867 PMCID: PMC8174558 DOI: 10.2196/27989] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. Since then, several countries have released COVID-19 contact tracing apps. OBJECTIVE This study's primary aim is to investigate the quality characteristics of national European COVID-19 contact tracing apps, thereby shifting attention from user to app characteristics. The secondary aim is to investigate associations between app quality and adoption. Finally, app features contributing to higher app quality were identified. METHODS Eligible COVID-19 contact tracing apps were those released by national health authorities of European Union member states, former member states, and countries of the European Free Trade Association, all countries with comparable legal standards concerning personal data protection and app use voluntariness. The Mobile App Rating Scale was used to assess app quality. An interdisciplinary team, consisting of two health and two human-computer interaction scientists, independently conducted Mobile App Rating Scale ratings. To investigate associations between app quality and adoption rates and infection rates, Bayesian linear regression analyses were conducted. RESULTS We discovered 21 national COVID-19 contact tracing apps, all demonstrating high quality overall and high-level functionality, aesthetics, and information quality. However, the average app adoption rate of 22.9% (SD 12.5%) was below the level recommended by simulation studies. Lower levels of engagement-oriented app design were detected, with substantial variations between apps. By regression analyses, the best-case adoption rate was calculated by assuming apps achieve the highest ratings. The mean best-case adoption rates for engagement and overall app quality were 39.5% and 43.6%, respectively. Higher adoption rates were associated with lower cumulative infection rates. Overall, we identified 5 feature categories (symptom assessment and monitoring, regularly updated information, individualization, tracing, and communication) and 14 individual features that contributed to higher app quality. These 14 features were a symptom checker, a symptom diary, statistics on COVID-19, app use, public health instructions and restrictions, information of burden on health care system, assigning personal data, regional updates, control over tracing activity, contact diary, venue check-in, chats, helplines, and app-sharing capacity. CONCLUSIONS European national health authorities have generally released high quality COVID-19 contact tracing apps, with regard to functionality, aesthetics, and information quality. However, the app's engagement-oriented design generally was of lower quality, even though regression analyses results identify engagement as a promising optimization target to increase adoption rates. Associations between higher app adoption and lower infection rates are consistent with simulation study results, albeit acknowledging that app use might be part of a broader set of protective attitudes and behaviors for self and others. Various features were identified that could guide further engagement-enhancing app development.
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Affiliation(s)
- Leonie Kahnbach
- Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
- Competencies for Digitally-Enhanced Individualized Practice Project, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | | | - Tim Mallwitz
- Institute for Interactive Systems, Technische Hochschule Lübeck, Lübeck, Germany
| | - Sophie Jent
- Department for Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - Sandy Hannibal
- Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Monique Janneck
- Institute for Interactive Systems, Technische Hochschule Lübeck, Lübeck, Germany
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Kleinert S, Bartz-Bazzanella P, von der Decken C, Knitza J, Witte T, Fekete SP, Konitzny M, Zink A, Gauler G, Wurth P, Aries P, Karberg K, Kuhn C, Schuch F, Späthling-Mestekemper S, Vorbrüggen W, Englbrecht M, Welcker M. A Real-World Rheumatology Registry and Research Consortium: The German RheumaDatenRhePort (RHADAR) Registry. J Med Internet Res 2021; 23:e28164. [PMID: 34014170 PMCID: PMC8176344 DOI: 10.2196/28164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
Real-world data are crucial to continuously improve the management of patients with rheumatic and musculoskeletal diseases (RMDs). The German RheumaDatenRhePort (RHADAR) registry encompasses a network of rheumatologists and researchers in Germany providing pseudonymized real-world patient data and allowing timely and continuous improvement in the care of RMD patients. The RHADAR modules allow automated anamnesis and adaptive coordination of appointments regarding individual urgency levels. Further modules focus on the collection and integration of electronic patient-reported outcomes in between consultations. The digital RHADAR modules ultimately allow a patient-centered adaptive approach to integrated medical care starting as early as possible in the disease course. Such a closed-loop system consisting of various modules along the whole patient pathway enables comprehensive and timely patient management in an unprecedented manner.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany.,Medizinische Klinik 3, Rheumatology/Immunology, Universitätsklinik Würzburg, Würzburg, Germany
| | | | - Cay von der Decken
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany.,Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hanover Medical School, Hanover, Germany
| | - Sándor P Fekete
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Matthias Konitzny
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Germany
| | | | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
| | | | | | | | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
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Klemm P, Kleyer A, Tascilar K, Schuster L, Meinderink T, Steiger F, Lange U, Müller-Ladner U, Knitza J, Sewerin P, Mucke J, Pfeil A, Schett G, Hartmann F, Hueber AJ, Simon D. A Virtual Reality-Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study. JMIR Serious Games 2021; 9:e23835. [PMID: 33973858 PMCID: PMC8150404 DOI: 10.2196/23835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/23/2020] [Accepted: 03/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography–generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the χ2 or Fisher test was used as appropriate. Two-sided P values ≤.05 were regarded as significant. Results A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions The data show that IA-targeting innovative teaching approaches based on VR technology are feasible.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus-Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Louis Schuster
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Timo Meinderink
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Florian Steiger
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Uwe Lange
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus-Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus-Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johanna Mucke
- Department and Hiller Research Unit for Rheumatology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Pfeil
- Department of Internal Medicine 3, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Hartmann
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Sektion Rheumatologie, Sozialstiftung Bamberg, Bamberg, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Chahal S, Biln N, Clarke B. Patient Perspectives on a Digital Mobile Health Application for RA. Open Access Rheumatol 2021; 13:63-71. [PMID: 33935522 PMCID: PMC8080430 DOI: 10.2147/oarrr.s296541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Emerging evidence suggests that patients are increasingly willing to use digital mobile health applications for rheumatoid arthritis (RA apps). The development and diffusion of RA apps open the possibility of improved management of the disease and better physician–patient interactions. However, adoption rates among apps have been lower than hoped, and research shows that many available RA apps lack key features. There is little research exploring patient preferences for RA apps or patients’ habits and preferences for app payment, which are likely key factors affecting adoption of this technology. This study seeks to understand characteristics of RA patients who have adopted RA apps, their preferences for app features, and their willingness to pay for, and experiences with app payment. Methods Data for this study come from a 33-question online survey of patients with RA in Canada and the United States (N=30). Information on demographics, diagnosis and management of RA, current use and desired features of RA apps, and prior experience with and willingness to pay for an app was collected. Descriptive statistics are reported, and bivariate analyses (chi-square, point-biserial correlation, and ANOVA) were performed to understand relationships between variables. Results Respondents showed a clear preference for certain app features, namely symptom tracking, scheduling appointments, and reminders. Physician recommendation for an app and patient tracking of symptoms with an app were significantly related to patient adoption of an RA app. Years since diagnosis with RA, physician recommendation for an RA app, and current use of a non-RA health tracking app were significantly related to patients’ willingness to pay a subscription for an RA app. Conclusion RA patients appear to prefer task support features in an RA app, notably symptom tracking, appointment scheduling, and reminders, over other features such as those related to dialogue support and social support. The choice of whether an RA app will be free or based on a subscription, pay-per-service, or one-time purchase model may also play a role in eventual adoption. Similarly, physician recommendation appears to influence patients’ decision to use an RA app as well as their willingness to pay a subscription for an app.
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Affiliation(s)
- Simran Chahal
- Augurex Life Sciences Corp., Vancouver, British Columbia, Canada
| | - Norma Biln
- Augurex Life Sciences Corp., Vancouver, British Columbia, Canada
| | - Bruce Clarke
- B2 Consulting, Kelowna, British Columbia, Canada
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Tucker L, Villagomez AC, Krishnamurti T. Comprehensively addressing postpartum maternal health: a content and image review of commercially available mobile health apps. BMC Pregnancy Childbirth 2021; 21:311. [PMID: 33879089 PMCID: PMC8059182 DOI: 10.1186/s12884-021-03785-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health (mHealth) apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated the quality of existing mHealth tools targeted to this time period in terms of sufficiency of maternal health information, inclusivity of people of color, and app usability. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were evaluated for extent and quality of maternal health information and inclusivity of people of color using an a priori coding scheme. App usability was evaluated using the Mobile Application Rating Scale (MARS) score. RESULTS Of the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The coverage of maternal health information and inclusivity of people of color in app imagery both correlated positively with the MARS usability score of the app. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between MARS usability score and number of app users, as estimated by number of ratings for the app available on the app store. In addition, apps with evidence-based maternal health information had greater MARS engagement, information, and aesthetics scores. However, presence of evidence-based information did not correlate with greater numbers of app users. CONCLUSIONS Current commercially available peripartum apps range widely in quality. Overall current app offerings generally do not provide adequate maternal health information and are not optimally accessible to the target users in terms of inclusivity of women of color or app usability. Apps delivering evidence-based information and more usable design are more likely to meet these standards but are not more likely to be downloaded by users.
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Affiliation(s)
- Laura Tucker
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
| | - Alan Cuevas Villagomez
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Miró J, Llorens-Vernet P. Assessing the Quality of Mobile Health-Related Apps: Interrater Reliability Study of Two Guides. JMIR Mhealth Uhealth 2021; 9:e26471. [PMID: 33871376 PMCID: PMC8094021 DOI: 10.2196/26471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/29/2021] [Accepted: 03/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background There is a huge number of health-related apps available, and the numbers are growing fast. However, many of them have been developed without any kind of quality control. In an attempt to contribute to the development of high-quality apps and enable existing apps to be assessed, several guides have been developed. Objective The main aim of this study was to study the interrater reliability of a new guide — the Mobile App Development and Assessment Guide (MAG) — and compare it with one of the most used guides in the field, the Mobile App Rating Scale (MARS). Moreover, we also focused on whether the interrater reliability of the measures is consistent across multiple types of apps and stakeholders. Methods In order to study the interrater reliability of the MAG and MARS, we evaluated the 4 most downloaded health apps for chronic health conditions in the medical category of IOS and Android devices (ie, App Store and Google Play). A group of 8 reviewers, representative of individuals that would be most knowledgeable and interested in the use and development of health-related apps and including different types of stakeholders such as clinical researchers, engineers, health care professionals, and end users as potential patients, independently evaluated the quality of the apps using the MAG and MARS. We calculated the Krippendorff alpha for every category in the 2 guides, for each type of reviewer and every app, separately and combined, to study the interrater reliability. Results Only a few categories of the MAG and MARS demonstrated a high interrater reliability. Although the MAG was found to be superior, there was considerable variation in the scores between the different types of reviewers. The categories with the highest interrater reliability in MAG were “Security” (α=0.78) and “Privacy” (α=0.73). In addition, 2 other categories, “Usability” and “Safety,” were very close to compliance (health care professionals: α=0.62 and 0.61, respectively). The total interrater reliability of the MAG (ie, for all categories) was 0.45, whereas the total interrater reliability of the MARS was 0.29. Conclusions This study shows that some categories of MAG have significant interrater reliability. Importantly, the data show that the MAG scores are better than the ones provided by the MARS, which is the most commonly used guide in the area. However, there is great variability in the responses, which seems to be associated with subjective interpretation by the reviewers.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili; Department of Psychology, Centre de Recerca en Avaluació i Mesura de la Conducta, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Pere Llorens-Vernet
- Universitat Rovira i Virgili; Department of Psychology, Centre de Recerca en Avaluació i Mesura de la Conducta, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
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Maccioni G, Giansanti D. Medical Apps and the Gray Zone in the COVID-19 Era: Between Evidence and New Needs for Cybersecurity Expansion. Healthcare (Basel) 2021; 9:430. [PMID: 33917202 PMCID: PMC8068074 DOI: 10.3390/healthcare9040430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 12/25/2022] Open
Abstract
The study focuses on emerging problems caused by the spread of medical apps. Firstly, it reviews the current role of cybersecurity and identifies the potential need to widen the boundaries of cybersecurity in relation to these apps. Secondly, it focuses on the pivotal device behind the development of mHealth: the smartphone, and highlights its role and current potential for hosting wearable medical technology. Thirdly, it addresses emerging issues regarding these apps, which are in a gray zone. This is done through an analysis of the important positions of scholars, and by means of a survey report on the increased use of various categories of apps during the COVID-19 pandemic, highlighting an accentuation of the problem. The study ends by explaining the reflections and proposals that emerged after performing the analysis.
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Terhorst Y, Messner EM, Schultchen D, Paganini S, Portenhauser A, Eder AS, Bauer M, Papenhoff M, Baumeister H, Sander LB. Systematic evaluation of content and quality of English and German pain apps in European app stores. Internet Interv 2021; 24:100376. [PMID: 33718002 PMCID: PMC7933737 DOI: 10.1016/j.invent.2021.100376] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/05/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pain spans a broad spectrum of diseases and types that are highly prevalent and cause substantial disease burden for individuals and society. Up to 40% of people affected by pain receive no or inadequate treatment. Providing a scalable, time-, and location-independent way for pain diagnostic, management, prevention and treatment mobile health applications (MHA) might be a promising approach to improve health care for pain. However, the commercial app market is rapidly growing and unregulated, resulting in an opaque market. Studies investigating the content, privacy and security features, quality and scientific evidence of the available apps are highly needed, to guide patients and clinicians to high quality MHA.Contributing to this challenge, the present study investigates the content, quality, and privacy features of pain apps available in the European app stores. METHODS An automated search engine was used to identify pain apps in the European Google Play and Apple App store. Pain apps were screened and checked for systematic criteria (pain-relatedness, functionality, availability, independent usability, English or German). Content, quality and privacy features were assessed by two independent reviewers using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality on four objectives (engagement, functionality, aesthetics, information quality) and two subjective scales (perceived impact, subjective quality). RESULTS Out of 1034 identified pain apps 218 were included. Pain apps covered eight different pain types. Content included basic information, advice, assessment and tracking, and stand-alone interventions. The overall quality of the pain apps was average M = 3.13 (SD = 0.56, min = 1, max = 4.69). The effectiveness of less than 1% of the included pain apps was evaluated in a randomized controlled trial. Major problems with data privacy were present: 59% provided no imprint, 70% had no visible privacy policy. CONCLUSION A multitude of pain apps is available. Most MHA lack scientific evaluation and have serious privacy issues, posing a potential threat to users. Further research on evidence and improvements privacy and security are needed. Overall, the potential of pain apps is not exploited.
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Affiliation(s)
- Yannik Terhorst
- Department of Research Methods, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081 Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081 Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Sarah Paganini
- Department of Sport Psychology, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Alexandra Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081 Ulm, Germany
| | - Anna-Sophia Eder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081 Ulm, Germany
| | - Melanie Bauer
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Mike Papenhoff
- Pain Medicine Clinic, BG Klinikum Duisburg, Grossenbaumer Allee 250, D-47249 Duisburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081 Ulm, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelberger Str. 41, 79106 Freiburg im Breisgau, Germany
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Muehlensiepen F, Knitza J, Marquardt W, Engler J, Hueber A, Welcker M. Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study. J Med Internet Res 2021; 23:e23742. [PMID: 33690147 PMCID: PMC8042540 DOI: 10.2196/23742] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
Background The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. Objective The goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. Methods A nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period. Results A total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%). Conclusions Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.
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Affiliation(s)
- Felix Muehlensiepen
- KV Consult- und Managementgesellschaft mbH, Potsdam, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen- Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wenke Marquardt
- KV Consult- und Managementgesellschaft mbH, Potsdam, Germany
| | - Jennifer Engler
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Axel Hueber
- Sektion Rheumatologie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
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Sociodemographic Characteristics and Interests of FeverApp Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063121. [PMID: 33803541 PMCID: PMC8002853 DOI: 10.3390/ijerph18063121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
The FeverApp Registry is a model registry focusing on pediatric fever using a mobile app to collect data and present recommendations. The recorded interactions can clarify the relationship between user documentation and user information. This initial evaluation regarding features of participants and usage intensity of educational video, information library, and documentation of fever events covers the runtime of FeverApp for the first 14 months. Of the 1592 users, the educational opening video was viewed by 41.5%, the Info Library was viewed by 37.5%, and fever events were documented by 55.5%. In the current sample, the role of a mother (p < 0.0090), having a higher level of education (p = 0.0013), or being registered at an earlier date appear to be cues to take note of the training video, Info Library, and to document. The FeverApp was used slightly less by people with a lower level of education or who had a migration background, but at the current stage of recruitment no conclusion can be made. The user analyses presented here are plausible and should be verified with further dissemination of the registry. Ecological momentary assessment is used more than the information option, in line with the task of a registry. Data collection via app seems feasible.
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Evaluating the quality and safety of health-related apps and e-tools: Adapting the Mobile App Rating Scale and developing a quality assurance protocol. Internet Interv 2021; 24:100379. [PMID: 33777705 PMCID: PMC7985461 DOI: 10.1016/j.invent.2021.100379] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whilst apps and e-tools have tremendous potential as low-cost, scalable mental health intervention and prevention tools, it is essential that consumers and health professionals have a means by which to evaluate their quality and safety. OBJECTIVE This study aimed to: 1) adapt the original Mobile App Rating Scale (MARS) in order to be appropriate for the evaluation of both mobile phone applications as well as e-tools; 2) test the reliability of the revised scale; and 3) develop a quality assurance protocol for identifying and rating new apps and e-tools to determine appropriateness for use in clinical practice. METHODS The MARS was adapted to include items specific to health-related apps and e-tools, such as the availability of resources, strategies for self-management, and quality information. The 41 apps and e-tools in the standard youth configuration of the InnoWell Platform, a digital tool designed to support or enhance mental health service delivery, were independently rated by two expert raters using the A-MARS. Cronbach's alpha was used to calculate the internal consistency and interclass correlation coefficients were used to calculate interrater reliability. RESULTS The A-MARS was shown to be a reliable scale with acceptable to excellent internal consistency and moderate to excellent interrater reliability across the subscales. Given the ever-increasing number of health information technologies on the market, a protocol to identify and rate new apps and e-tools for potential clinical use is presented. CONCLUSIONS Whilst the A-MARS is a useful tool to guide health professionals as they explore available apps and e-tools for potential clinical use, the training, time, and skill required to use it effectively may be prohibitive. As such, health professionals and services are likely to benefit from including a digital navigator as part of the care team to assist in selecting and rating apps and e-tools, increasing the usability of the data, and technology troubleshooting. When selecting, evaluating and/or recommending apps and e-tools to consumers, it is important to consider: 1) the availability of explicit strategies to set, monitor and review SMART goals; 2) the accessibility of credible, user friendly information and resources from reputable sources; 3) evidence of effectiveness; and 4) interoperability with other health information technologies.
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Kernder A, Morf H, Klemm P, Vossen D, Haase I, Mucke J, Meyer M, Kleyer A, Sewerin P, Bendzuck G, Eis S, Knitza J, Krusche M. Digital rheumatology in the era of COVID-19: results of a national patient and physician survey. RMD Open 2021; 7:rmdopen-2020-001548. [PMID: 33622673 PMCID: PMC7907631 DOI: 10.1136/rmdopen-2020-001548] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To analyse the impact of the COVID-19 pandemic on rheumatic patients' and rheumatologists' usage, preferences and perception of digital health applications (DHAs). METHODS A web-based national survey was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League against Rheumatism. The prospective survey was distributed via social media (Twitter, Instagram and Facebook), QR code and email. Descriptive statistics were calculated, and regression analyses were performed to show correlations. RESULTS We analysed the responses of 299 patients and 129 rheumatologists. Most patients (74%) and rheumatologists (76%) believed that DHAs are useful in the management of rheumatic and musculoskeletal diseases (RMDs) and felt confident in their own usage thereof (90%; 86%). 38% of patients and 71% of rheumatologists reported that their attitude had changed positively towards DHAs and that their usage had increased due to COVID-19 (29%; 48%). The majority in both groups agreed on implementing virtual visits for follow-up appointments in stable disease conditions. The most reported advantages of DHAs were usage independent of time and place (76.6%; 77.5%). The main barriers were a lack of information on suitable, available DHAs (58.5%; 41.9%), poor usability (42.1% of patients) and a lack of evidence supporting the effectiveness of DHAs (23.2% of rheumatologists). Only a minority (<10% in both groups) believed that digitalisation has a negative impact on the patient-doctor relationship. CONCLUSION The COVID-19 pandemic instigated an increase in patients' and rheumatologists' acceptance and usage of DHAs, possibly introducing a permanent paradigm shift in the management of RMDs.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Harriet Morf
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Philipp Klemm
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Immunology, Osteology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Diana Vossen
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, St. Elisabeth Hospital, Meerbusch, Germany
| | - Isabell Haase
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Johanna Mucke
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Marco Meyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Bad Bramdsted Hospital, Bad Bramstedt, Germany
| | - Arnd Kleyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Philipp Sewerin
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | | | - Sabine Eis
- Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
| | - Johannes Knitza
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Martin Krusche
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany .,Deaprtment of Rheumatology and Clinical immunology, Charite Medical Faculty Berlin, Berlin, Germany
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Sekhon M, White C, Godfrey E, Amirova A, Revenäs Å, King S, Pedro J, Quailey J, Bearne L. Effectiveness of web-based and mobile health interventions designed to enhance adherence to physical activity for people with inflammatory arthritis: a systematic review. Rheumatol Adv Pract 2021; 5:rkab016. [PMID: 33928212 PMCID: PMC8058395 DOI: 10.1093/rap/rkab016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/15/2021] [Indexed: 12/28/2022] Open
Abstract
Objective The aim of this systematic review was to assess the evidence from randomized controlled trials (RCTs) and cohort studies for the effectiveness of digital interventions designed to enhance adherence to physical activity (PA) for people with inflammatory arthritis and describe the intervention content using established coding criteria. Methods Six electronic databases were searched for published and unpublished studies. Independent data extraction and quality assessment (Cochrane risk of bias II or ROBINS-I) were conducted by two reviewers. The primary outcome was self-reported adherence to PA post-intervention. Secondary outcomes included self-reported adherence to PA at other time points, level of PA or engagement with intervention at any follow-up time point. Intervention content was assessed using the Consensus on Exercise Reporting Template and the Behaviour Change Techniques Taxonomy version 1. Results From 11 136 citations, four moderate risk of bias studies (three RCTs and one cohort study) including 1160 participants with RA or JIA were identified. Owing to heterogeneity of outcomes, a narrative synthesis was conducted. Only one RCT reported a small between-group difference in adherence to PA [mean difference (95% CI) −0.46 (−0.82, −0.09)] in favour of the intervention. There were no between-group differences in any secondary outcomes. Interventions included between 3 and 11 behaviour change techniques but provided minimal information on exercise prescription. Conclusion There is currently limited moderate-quality evidence available to provide confident evaluation of the effect of web-based and mobile health interventions on adherence to PA or level of PA post-intervention in people with inflammatory arthritis.
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Affiliation(s)
- Mandeep Sekhon
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Claire White
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Emma Godfrey
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Aliya Amirova
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Åsa Revenäs
- Centre for Clinical Research, Region Västmanland-Uppsala University.,School of Health, Care and Social Welfare, Mälardalen University.,Orthopedic Clinic, Västmanland Hospital Västerås, Västerås, Sweden
| | - Sinead King
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joshua Pedro
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jamaal Quailey
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lindsay Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Portenhauser AA, Terhorst Y, Schultchen D, Sander LB, Denkinger MD, Stach M, Waldherr N, Dallmeier D, Baumeister H, Messner EM. Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores. JMIR Aging 2021; 4:e23313. [PMID: 33605884 PMCID: PMC8081158 DOI: 10.2196/23313] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps.
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Affiliation(s)
- Alexandra A Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.,Department of Psychological Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, University of Ulm, Ulm, Germany
| | - Natalie Waldherr
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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Magnol M, Eleonore B, Claire R, Castagne B, Pugibet M, Lukas C, Tournadre A, Vergne-Salle P, Barnetche T, Truchetet ME, Ruyssen-Witrand A. Use of eHealth by Patients With Rheumatoid Arthritis: Observational, Cross-sectional, Multicenter Study. J Med Internet Res 2021; 23:e19998. [PMID: 33512320 PMCID: PMC7880811 DOI: 10.2196/19998] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/11/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background The use of eHealth tools (eg, the internet, mobile apps, and connected devices) in the management of chronic diseases and for rheumatoid arthritis is growing. eHealth may improve the overall quality of care provided to patients with chronic diseases. Objective The primary objective of this study was to describe eHealth use by patients with rheumatoid arthritis in France. The secondary objectives were to identify associations between patient demographics and disease characteristics and the use of eHealth tools, and assess their expectations of eHealth. Methods In this cross-sectional, multicenter study, patients with rheumatoid arthritis, according to the 2010 ACR/EULAR classification criteria, were recruited from 5 university hospitals (Bordeaux, Clermont-Ferrand, Limoges, Montpellier, and Toulouse). Patients completed an anonymous self-questionnaire, including demographic data, evaluating their eHealth use (ie, access, support, frequency of use, type of use, and reason for use). The rheumatologist in charge of each patient completed an independent medical questionnaire on disease characteristics, activity of rheumatoid arthritis, and treatments. Data were collected between December 2018 and July 2019. Results Questionnaires were completed by 575 participants, with a mean age of 62 (SD 13) years, 447 (77.7%) of whom were female. Overall, 82.2% (473/575) of the participants had access to eHealth through a computer (402/467, 86.1%), tablet (188/467, 40.2%), or smartphone (221/467, 47.3%). Of these, 36.4% (170/467) of the participants used the internet for health in general, and 28.7% (134/467) used it specifically for rheumatoid arthritis–related reasons. All these 134 patients used eHealth to learn about disease pathology, and 66.4% (89/134) of them used it as a tool to help monitor rheumatoid arthritis. Most patients (87/125, 69.6%) had a paper file, 19.2% (24/125) used a digital tool (spreadsheets, 10/125, 8%; mobile app, 9/125, 7.2%; or website, 5/125, 4%), and 24.8% (31/125) did not use any tools for monitoring. Few patients (16/125, 12.8%) used tools for treatment reminders. About 21.6% (27/125) of the patients using eHealth used a specific app for rheumatoid arthritis. Univariate analysis showed that age, education level, employment status, treatment, comorbidities, membership of a patient association, and patient education program were associated with eHealth use for rheumatoid arthritis. Multivariate analysis showed that membership of a patient association (odds ratio [OR] 5.8, 95% CI 3.0-11.2), use of biologic disease-modifying antirheumatic drugs (OR 0.6, 95% CI 0.4-1.0), and comorbidities (OR 0.7, 95% CI 0.6-0.8) remained associated with eHealth use for rheumatoid arthritis. Recommendation by a doctor (225/330, 68.2%), ease of use (105/330, 31.8%), and data security (69/330, 20.9%) were factors favoring the use of eHealth. Conclusions To date, few patients have used eHealth for disease management. The use of a reliable and validated eHealth tool for rheumatoid arthritis could therefore be promoted by rheumatologists and could optimize therapeutic adherence.
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Affiliation(s)
- Marion Magnol
- Rheumatology Department, Toulouse University Hospital, Toulouse, France
| | - Berard Eleonore
- Rheumatology Department, Bordeaux University Hospital, Bordeaux, France
| | - Rempenault Claire
- Rheumatology Department, Montpellier University Hospital, Montpellier, France
| | - Benjamin Castagne
- Rheumatology Department, Le-Puy-En-Velay Hospital, Le-Puy-En-Velay, France
| | - Marine Pugibet
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - Cédric Lukas
- Rheumatology Department, Montpellier University Hospital, Montpellier, France
| | - Anne Tournadre
- Rheumatology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Thomas Barnetche
- Rheumatology Department, Bordeaux University Hospital, Bordeaux, France
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Dantas LO, Carvalho C, Prando BC, McAlindon TE, da Silva Serrão PRM. Mobile health technologies for the management of rheumatic diseases: a systematic review of online stores in Brazil. Clin Rheumatol 2021; 40:2601-2609. [PMID: 33389312 DOI: 10.1007/s10067-020-05561-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic diseases are serious conditions with a low uptake of conservative treatments. Mobile health (mHealth) applications (apps) offer potential to assist the self-management of rheumatic diseases. Our goal was to perform a systematic review of available mHealth apps for rheumatic diseases in Brazil. We focused on the most prevalent rheumatic diseases: osteoarthritis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, osteoporosis, and axial spondylarthritis. Google Play Store and AppStore in Brazil were queried by two independent reviewers on September 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Of the 3173 mHealth apps found, five were eligible for inclusion. Two for fibromyalgia and two for axial spondylarthritis offered exercise, educational content, and tools to track patient-reported symptoms; and one for osteoporosis offered educational content and tracking tools only. The included apps scored moderately on the MARS quality scale, with a mean score (SD) of 3.1 (0.7) on a 0-5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. There is growing interest in the development of mHealth technologies to support rheumatic diseases patients. Although the majority of the included apps came from non-profit organizations, they are still of poor quality and limited functionality. This study is a call for to the development of new user-centered mHealth apps that can empower rheumatic diseases patients in Brazil, especially in the area of osteoarthritis, rheumatoid arthritis, and lupus, since no apps were found.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Cristiano Carvalho
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Beatriz Cardinal Prando
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
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Wright A. Evaluation of two mobile health apps for patients with breast cancer using the Mobile Application Rating Scale. Mhealth 2021; 7:60. [PMID: 34805391 PMCID: PMC8572758 DOI: 10.21037/mhealth-20-161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Breast cancer is one of the most frequently diagnosed cancers worldwide. Screening, education about signs and symptoms, and improved access to treatment has helped reduce mortality. An understanding of the informational needs of women with breast cancer can help identify areas where mobile apps can further improve the experience of this patient group. METHODS Personas are a commonly used tools in user centred design to help represent particular user archetypes. Knowledge of existing informational needs and prior research using personas in breast cancer app design were used to create two different personas through which to source apps for evaluation. The Mobile Application Rating Scale, a common evaluation framework, was used to evaluate the mobile apps across several important domains. RESULTS Becca and OWise, two apps for breast cancer, were found through a discovery process in line with the personas described. Overall, both apps scored highly on the Mobile Application Rating Scale. Both apps had limited or no research to support their use in this patient group, and had issues related to data privacy. Becca scored particularly highly in domains related to accessibility while OWise's extensive range of features scored highly for functionality. CONCLUSIONS Both apps demonstrate the ability to fill an informational needs gap as evidenced in the existing literature. As with many mobile health apps, more clinical evidence and improved data handling would help support the widespread recommendation of their use in women who are undergoing or have completed treatment for breast cancer.
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Assessment of the Quality of Mobile Applications (Apps) for Management of Low Back Pain Using the Mobile App Rating Scale (MARS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249209. [PMID: 33317134 PMCID: PMC7763508 DOI: 10.3390/ijerph17249209] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
Digital health interventions may improve different behaviours. However, the rapid proliferation of technological solutions often does not allow for a correct assessment of the quality of the tools. This study aims to review and assess the quality of the available mobile applications (apps) related to interventions for low back pain. Two reviewers search the official stores of Android (Play Store) and iOS (App Store) for localisation in Spain and the United Kingdom, in September 2019, searching for apps related to interventions for low back pain. Seventeen apps finally are included. The quality of the apps is measured using the Mobile App Rating Scale (MARS). The scores of each section and the final score of the apps are retrieved and the mean and standard deviation obtained. The average quality ranges between 2.83 and 4.57 (mean 3.82) on a scale from 1 (inadequate) to 5 (excellent). The best scores are found in functionality (4.7), followed by aesthetic content (mean 4.1). Information (2.93) and engagement (3.58) are the worst rated items. Apps generally have good overall quality, especially in terms of functionality and aesthetics. Engagement and information should be improved in most of the apps. Moreover, scientific evidence is necessary to support the use of applied health tools.
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Schultchen D, Terhorst Y, Holderied T, Stach M, Messner EM, Baumeister H, Sander LB. Stay Present with Your Phone: A Systematic Review and Standardized Rating of Mindfulness Apps in European App Stores. Int J Behav Med 2020; 28:552-560. [PMID: 33215348 PMCID: PMC8384800 DOI: 10.1007/s12529-020-09944-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mindfulness-based interventions show positive effects on physical and mental health. For a better integration of mindfulness techniques in daily life, the use of apps may be promising. However, only a few studies have examined the quality of mindfulness apps using a validated standardized instrument. This review aims to evaluate the content, quality, and privacy features of mindfulness-focused apps from European commercial app stores. METHODS An automated search engine (webcrawler) was used to identify mindfulness-focused apps in the European Apple App- and Google Play store. Content, quality, and privacy features were evaluated by two independent reviewers using the Mobile Application Rating Scale (MARS). The MARS assesses the subscales engagement, functionality, aesthetics, and information quality. RESULTS Out of 605 identified apps, 192 met the inclusion criteria. The overall quality was moderate (M = 3.66, SD = 0.48). Seven apps were tested in a randomized controlled trial (RCT). Most of the apps showed a lack of data security and no privacy policy. The five apps with the highest ratings are from a credible source, include a privacy policy, and are also based on standardized mindfulness and behavior change techniques. CONCLUSIONS The plethora of often low-quality apps in commercial app stores makes it difficult for users to identify a suitable app. Above that, the lack of scientific verification of effectiveness and shortcomings in privacy protection and security poses potential risks. So far, the potential of mindfulness-focused apps is not exploited in commercial app stores.
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Affiliation(s)
- Dana Schultchen
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany.
| | - Yannik Terhorst
- Research Methods, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, Germany.,Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, Germany
| | - Tanja Holderied
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, Ulm University, James-Franck-Ring, 89081, Ulm, Germany
| | - Eva-Maria Messner
- Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, Germany
| | - Lasse B Sander
- Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University of Freiburg, Engelbersger Str. 41, 79085, Freiburg, Germany
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Pförringer D, Ansorg J, Osterhoff G, Dittrich F, Scherer J, de Jager U, Back DA. [Digitalization in orthopedics and trauma surgery: current status of clinical and practical aspects 2020]. Unfallchirurg 2020; 123:830-835. [PMID: 33067694 PMCID: PMC7566994 DOI: 10.1007/s00113-020-00895-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Der vorliegende Beitrag behandelt aus Sicht von Orthopädie und Unfallchirurgie den aktuellen Stand Mitte 2020 im klinischen sowie im Praxisumfeld. Es wird auf Risiken, Schwierigkeiten ebenso wie Potenziale und Chancen im Detail eingegangen. Spezifisch werden die folgenden Themenbereiche erörtert: Telematikinfrastruktur, Apps und „mobile health“, Onlinevideosprechstunde, elektronische Patientenakte sowie Datenschutz. Es wird auf die Vor- und Nachteile und den jeweils aktuellen Stand im Spezialfall der Orthopädie und Unfallchirurgie eingegangen. Zudem werden 7 sinnvolle Beispiele aus dem Bereich der digitalen Anwendung genannt. Eine Mitgliederbefragung des Berufsverbandes der Orthopäden und Unfallchirurgen, BVOU, wird beschrieben und analysiert. Im abschließenden Ausblick werden die aktuellen Hürden und künftig zu klärende Themenbereiche adressiert.
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Affiliation(s)
- Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Jörg Ansorg
- Berufsverband für Orthopädie und Unfallchirurgie e. V. (BVOU e. V.), Straße des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Florian Dittrich
- Klinik und Poliklinik für Orthopädie, Universität des Saarlandes, Kirrberger Str. 100, 66424, Homburg, Deutschland
| | - Julian Scherer
- Klinik für Traumatologie, UniversitätsSpital Zürich, Rämistr. 100, 8091, Zürich, Schweiz
| | - Uwe de Jager
- Orthopädische Praxis Dr. Uwe de Jager, Lauterbadstr. 4, 72250, Freudenstadt, Deutschland
| | | | - David A Back
- Klinik für Unfallchirurgie und Orthopädie, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13, 10115, Berlin, Deutschland
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Salehinejad S, Niakan Kalhori SR, Hajesmaeel Gohari S, Bahaadinbeigy K, Fatehi F. A review and content analysis of national apps for COVID-19 management using Mobile Application Rating Scale (MARS). Inform Health Soc Care 2020; 46:42-55. [PMID: 33164594 DOI: 10.1080/17538157.2020.1837838] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The expansion of mobile health apps for the management of COVID-19 grew exponentially in recent months. However, no study has evaluated these apps. The objective of this study was to develop a reliable measure and rate the quality of COVID-19 mobile health apps, to eventually provide a roadmap for future mHealth app development. In this study, we used COVID-related keywords to identify apps for iOS and Android devices. 13 apps (13.5% of the total number of apps identified) were selected for evaluation. App quality was assessed independently using MARS by two reviewers. Search queries yielded a total of 97 potentially relevant apps, of which 13 met our final inclusion criteria. Kendall's coefficient of concordance value for the inter-rater agreement was 0.93 (p = .03). COVID-19 GOV PK app had the highest average MARS score (4.7/5), and all of the apps had acceptable MARS scores (> 3.0). This study suggests that most COVID-related apps meet acceptable criteria for quality, content, or functionality, and they must highlight esthetic and interesting features for overall quality improvement to be welcomed by users.
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Affiliation(s)
- Simin Salehinejad
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences , Tehran, Iran
| | - Sadrieh Hajesmaeel Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences , Kerman, Iran
| | - Farhad Fatehi
- Centre for Online Health, The University of Queensland , Brisbane, Australia.,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences , Tehran, Iran
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Terhorst Y, Philippi P, Sander LB, Schultchen D, Paganini S, Bardus M, Santo K, Knitza J, Machado GC, Schoeppe S, Bauereiß N, Portenhauser A, Domhardt M, Walter B, Krusche M, Baumeister H, Messner EM. Validation of the Mobile Application Rating Scale (MARS). PLoS One 2020; 15:e0241480. [PMID: 33137123 PMCID: PMC7605637 DOI: 10.1371/journal.pone.0241480] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Instruments for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA. Only few validation studies investigated its metric quality. No study has evaluated the construct validity and concurrent validity. OBJECTIVE This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS. METHODS Data was pooled from 15 international app quality reviews to evaluate the metric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. Construct validity was evaluated by assessing related competing confirmatory models by confirmatory factor analysis (CFA). Non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices were used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations to another quality assessment tool (ENLIGHT) were investigated. Reliability was determined using Omega. Objectivity was assessed by intra-class correlation. RESULTS In total, MARS ratings from 1,299 MHA covering 15 different health domains were included. Confirmatory factor analysis confirmed a bifactor model with a general factor and a factor for each dimension (RMSEA = 0.074, TLI = 0.922, CFI = 0.940, SRMR = 0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC = 0.82). MARS correlated with ENLIGHT (ps<.05). CONCLUSION The metric evaluation of the MARS demonstrated its suitability for the quality assessment. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
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Affiliation(s)
- Yannik Terhorst
- Department of Research Methods, Institute of Psychology and Education, University Ulm, Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Paula Philippi
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Lasse B. Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Karla Santo
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
| | - Johannes Knitza
- Department of Internal Medicine 3 – Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Gustavo C. Machado
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Schoeppe
- School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Queensland, Australia
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Alexandra Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Benjamin Walter
- Department of Internal Medicine I, Gastroenterology, University Hospital Ulm, Ulm, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
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74
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Vaezipour A, Campbell J, Theodoros D, Russell T. Mobile Apps for Speech-Language Therapy in Adults With Communication Disorders: Review of Content and Quality. JMIR Mhealth Uhealth 2020; 8:e18858. [PMID: 33118953 PMCID: PMC7661246 DOI: 10.2196/18858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Communication disorders are impairments in the ability to communicate effectively, that is, sending, receiving, processing, and comprehending verbal and nonverbal concepts and symbols. Such disorders may have enduring impacts on employment, social participation, and quality of life. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy to treat communication disorders. However, ensuring that apps are evidence-based and of high quality is critical for facilitating safe and effective treatment for adults with communication disorders. Objective The aim of this review is to identify mobile apps that are currently widely available to adults with communication disorders for speech-language therapy and to assess their content and quality using the validated Mobile App Rating Scale (MARS). Methods Google Play Store, Apple App Store, and webpages were searched to identify mobile apps for speech-language therapy. Apps were included in the review if they were designed for the treatment of adult communication disorders after ABI, were in English, and were either free or for purchase. Certified speech-language pathologists used the MARS to assess the quality of the apps. Results From a total of 2680 apps identified from Google Play Store, Apple App Store, and web searches, 2.61% (70/2680) apps met the eligibility criteria for inclusion. Overall, 61% (43/70) were available for download on the iPhone Operating System (iOS) platform, 20% (14/70) on the Android platform, and 19% (13/70) on both iOS and Android platforms. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, SD 0.6, ranging between 2.1 and 4.5, with functionality being the highest-scored subscale (4.3, SD 0.6), followed by aesthetics (3.8, SD 0.8), information (3.4, SD 0.6), and engagement (3.3, SD 0.6). The top 5 apps were Naming Therapy (4.6/5), Speech Flipbook Standard (4.6/5), Number Therapy (4.5/5), Answering Therapy, and Constant Therapy (4.4/5). Conclusions To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders after sustaining ABI. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps with a focus on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.
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Affiliation(s)
- Atiyeh Vaezipour
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Jessica Campbell
- Queensland Aphasia Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Deborah Theodoros
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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Abstract
Der Ausbruch der COVID-19-Pandemie geht mit tief greifenden Einschnitten im Alltag und im Berufsleben einher – sowohl gesamtgesellschaftlich als auch speziell im Gesundheitswesen. Im Fokus der Pandemieeindämmung haben sich vielerorts rheumatologische Routineabläufe verändert. Um den entsprechenden Infektionsschutz der Patienten und des medizinischen Personals gewährleisten zu können, wurde hier verstärkt Telemedizin (insbesondere Telefon- und Videosprechstunde) eingesetzt. Weiterhin stehen durch die Digitale-Gesundheitsanwendungen-Verordnung (DiGAV) voraussichtlich in den kommenden Monaten neue, abrechnungsfähige telemedizinische Anwendungsmöglichkeiten wie Apps und Wearables zur Verfügung. Der Artikel soll einen Überblick über telemedizinische Versorgungsmöglichkeiten in der Rheumatologie (mit besonderem Fokus auf die Videosprechstunde) geben. Weiterhin wird Bezug auf die vorhandene Evidenzlage sowie Chancen und Limitation der Telemedizin im Fachgebiet genommen.
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76
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Seppen BF, Wiegel J, L'ami MJ, Duarte Dos Santos Rico S, Catarinella FS, Turkstra F, Boers M, Bos WH. Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies. JMIR Form Res 2020; 4:e20165. [PMID: 32955447 PMCID: PMC7536594 DOI: 10.2196/20165] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/16/2023] Open
Abstract
Background Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app—an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients’ perspectives on app usage and its intended purpose. Methods This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients’ perspectives and the promoters and barriers of app usage. Results In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61% (17/28) and 37% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that “experiencing more grip on their disease” and “improved communication with their physician” were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway.
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Affiliation(s)
- Bart F Seppen
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Jimmy Wiegel
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Rheumatology, VU Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Merel J L'ami
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | | | | | - Franktien Turkstra
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Maarten Boers
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wouter H Bos
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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77
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Knitza J, Callhoff J, Chehab G, Hueber A, Kiltz U, Kleyer A, Krusche M, Simon D, Specker C, Schneider M, Voormann A, Welcker M, Richter JG. [Position paper of the commission on digital rheumatology of the German Society of Rheumatology: tasks, targets and perspectives for a modern rheumatology]. Z Rheumatol 2020; 79:562-569. [PMID: 32651681 DOI: 10.1007/s00393-020-00834-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.
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Affiliation(s)
- J Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - G Chehab
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Hueber
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.,Sektion Rheumatologie, Sozialstiftung Bamberg, Klinikum Bamberg, Bamberg, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - D Simon
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - M Welcker
- Geschäftsführung, MVZ für Rheumatologie Dr. Martin Welcker GmbH & RheumaDatenRhePort (rhadar), Planegg, Deutschland
| | - J G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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78
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Abstract
The increasing use of smartphones is accompanied by a significant increase in the use of mobile applications (apps). Chronically ill patients could permanently profit from this development.This development is fuelled by the Digital Healthcare Act (DVG), whereby patients have a legal claim to certain apps, so-called digital health applications (DiGAs), which are reimbursed by the statutory health insurance companies. Especially in the field of rheumatology, there are various opportunities to implement apps in the management of chronic diseases and their comorbidities. Furthermore, rheumatic patients and rheumatologists are becoming interested in apps and are willing to use them in the daily routine. This article tries to shed light on the chances and risks of apps and gives a first insight into the digital landscape of rheumatology apps in Germany.
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79
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Ho L, Macnab A, Matsubara Y, Peterson K, Tsang B, Stothers L. Rating of Pelvic Floor Muscle Training Mobile Applications for Treatment of Urinary Incontinence in Women. Urology 2020; 150:92-98. [PMID: 32890617 DOI: 10.1016/j.urology.2020.08.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify pelvic floor muscle therapy mobile health applications (apps) targeting women with urinary incontinence (UI), and evaluate them in a standardized fashion. METHODS A systematic search of English language apps on the Canadian App Store (iOS) and Google Play (Android) Store was performed. Eligible apps were evaluated independently by 5 reviewers using the validated Mobile App Rating Scale (MARS) tool. Descriptive characteristics were summarized and MARS subscale and overall quality scores werereported. RESULTS Of 139 mobile health apps identified, 20 unique apps were included for full review, of which there were 7 iOS only apps, 6 Android only apps, and 7 apps available in both stores. At the time of analysis, most apps had been updated within the last year (60%). Only 1 app had been trialed and verified by evidence in scientific literature. The majority of apps were free to download (80%). The median (interquartile range) MARS overall quality score was 3.7 (0.8) on a 0-5 scale, ranging from 2.7 to 4.1. The highest-rated subscale was "functionality" with a median score of 4.1 (0.6); the lowest-rated was "information" with a median score of 3.4 (0.6). The median MARS subjective quality score was 2.9 (1.0). CONCLUSION There are both free and paid apps available on-line that deliver pelvic floor muscle therapy programs. Evaluation using the MARS tool identified that many apps are not of high quality, and only 1 was evidence-based and has been trialed clinically. This knowledge is relevant to the choice of apps by both patients and caregivers.
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Affiliation(s)
- Louisa Ho
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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80
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Mehdi M, Stach M, Riha C, Neff P, Dode A, Pryss R, Schlee W, Reichert M, Hauck FJ. Smartphone and Mobile Health Apps for Tinnitus: Systematic Identification, Analysis, and Assessment. JMIR Mhealth Uhealth 2020; 8:e21767. [PMID: 32808939 PMCID: PMC7463412 DOI: 10.2196/21767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background Modern smartphones contain sophisticated high-end hardware features, offering high computational capabilities at extremely manageable costs and have undoubtedly become an integral part in users' daily life. Additionally, smartphones offer a well-established ecosystem that is easily discoverable and accessible via the marketplaces of differing mobile platforms, thus encouraging the development of many smartphone apps. Such apps are not exclusively used for entertainment purposes but are also commonplace in health care and medical use. A variety of those health and medical apps exist within the context of tinnitus, a phantom sound perception in the absence of any physical external source. Objective In this paper, we shed light on existing smartphone apps addressing tinnitus by providing an up-to-date overview. Methods Based on PRISMA guidelines, we systematically searched and identified existing smartphone apps on the most prominent app markets, namely Google Play Store and Apple App Store. In addition, we applied the Mobile App Rating Scale (MARS) to evaluate and assess the apps in terms of their general quality and in-depth user experience. Results Our systematic search and screening of smartphone apps yielded a total of 34 apps (34 Android apps, 26 iOS apps). The mean MARS scores (out of 5) ranged between 2.65-4.60. The Tinnitus Peace smartphone app had the lowest score (mean 2.65, SD 0.20), and Sanvello—Stress and Anxiety Help had the highest MARS score (mean 4.60, SD 0.10). The interrater agreement was substantial (Fleiss κ=0.74), the internal consistency was excellent (Cronbach α=.95), and the interrater reliability was found to be both high and excellent—Guttman λ6=0.94 and intraclass correlation, ICC(2,k) 0.94 (95% CI 0.91-0.97), respectively. Conclusions This work demonstrated that there exists a plethora of smartphone apps for tinnitus. All of the apps received MARS scores higher than 2, suggesting that they all have some technical functional value. However, nearly all identified apps were lacking in terms of scientific evidence, suggesting the need for stringent clinical validation of smartphone apps in future. To the best of our knowledge, this work is the first to systematically identify and evaluate smartphone apps within the context of tinnitus.
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Affiliation(s)
- Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Constanze Riha
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Patrick Neff
- Clinic and Policlinic for Psychiatry and Psychotherapy, Regensburg, Germany.,URPP Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Winfried Schlee
- Clinic and Policlinic for Psychiatry and Psychotherapy, Regensburg, Germany
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Franz J Hauck
- Institute of Distributed Systems, Ulm University, Ulm, Germany
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81
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Knitza J, Simon D, Lambrecht A, Raab C, Tascilar K, Hagen M, Kleyer A, Bayat S, Derungs A, Amft O, Schett G, Hueber AJ. Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study. JMIR Mhealth Uhealth 2020; 8:e19661. [PMID: 32678796 PMCID: PMC7450373 DOI: 10.2196/19661] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. Objective The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. Methods Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. Results Of the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. Conclusions Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Antonia Lambrecht
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christina Raab
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sara Bayat
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Derungs
- Chair of Digital Health, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Amft
- Chair of Digital Health, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
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82
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Kernebeck S, Busse TS, Böttcher MD, Weitz J, Ehlers J, Bork U. Impact of mobile health and medical applications on clinical practice in gastroenterology. World J Gastroenterol 2020; 26:4182-4197. [PMID: 32848328 PMCID: PMC7422538 DOI: 10.3748/wjg.v26.i29.4182] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.
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Affiliation(s)
- Sven Kernebeck
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Theresa S Busse
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Maximilian D Böttcher
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jürgen Weitz
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
| | - Jan Ehlers
- Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten 58455, Germany
| | - Ulrich Bork
- Department of GI-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden 01307, Germany
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83
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Bearne LM, Sekhon M, Grainger R, La A, Shamali M, Amirova A, Godfrey EL, White CM. Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis. JMIR Mhealth Uhealth 2020; 8:e18495. [PMID: 32706727 PMCID: PMC7404016 DOI: 10.2196/18495] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA. OBJECTIVE This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise. METHODS A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14). RESULTS A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified. CONCLUSIONS This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.
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Affiliation(s)
- Lindsay M Bearne
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mandeep Sekhon
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | | | - Anthony La
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mehrdad Shamali
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Aliya Amirova
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Emma L Godfrey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Claire M White
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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84
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Krusche M, Klemm P, Grahammer M, Mucke J, Vossen D, Kleyer A, Sewerin P, Knitza J. Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study. JMIR Mhealth Uhealth 2020; 8:e18117. [PMID: 32390592 PMCID: PMC7400039 DOI: 10.2196/18117] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.
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Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Philipp Klemm
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus Liebig University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | | | - Johanna Mucke
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Vossen
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Rheinisches Rheumazentrum Meerbusch, St Elisabeth Hospital, Meerbusch, Germany
| | - Arnd Kleyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Sewerin
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology and Hiller Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Knitza
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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85
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Trecca EMC, Lonigro A, Gelardi M, Kim B, Cassano M. Mobile Applications in Otolaryngology: A Systematic Review of the Literature, Apple App Store and the Google Play Store. Ann Otol Rhinol Laryngol 2020; 130:78-91. [PMID: 32659107 DOI: 10.1177/0003489420940350] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although the last few years have seen an increased number of smartphone applications (apps) disseminated in the field of Otolaryngology (ORL), these apps vary widely in quality. The aim of this paper, therefore, is to systematically review ORL apps directed towards patients in mobile app stores and the current literature. METHODS The Google Play Store, Apple App Store and PubMed were searched for ORL apps for patients using various keywords pertaining to different ORL subspecialties. Apps not relevant to the scope of this research and/or duplicates, educational apps, apps promoting a business, apps requiring specific separate hardware, and apps in non-English were excluded. In PubMed, keywords pertaining to the subspecialties were combined with "mobile app" in a search query; literature reviews, editorials, case reports, conference papers, duplicate articles, and articles irrelevant to ORL apps were excluded. The quality of apps with the highest number of reviews was assessed using the "Mobile App Rating Scale" (MARS), while the quality of the articles was rated using "The Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) Statement. RESULTS After searching the app stores, 1074 apps were included and grouped according to their ORL subspecialties. The overall MARS score of the ten most popular apps in each category was 3.65 out of 5. A total of 636 articles were identified in the literature, and 193 were included. The mean adherence percentage of the articles to the STROBE checklist was of 84.37%. CONCLUSIONS Although the apps currently available need further development, their application in ORL appears promising. Further dialogue between physicians and patients, as well as formal support from professional and scientific associations, should be encouraged.
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Affiliation(s)
- Eleonora M C Trecca
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy
| | - Antonio Lonigro
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy
| | - Matteo Gelardi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michele Cassano
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy
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86
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Knitza J, Knevel R, Raza K, Bruce T, Eimer E, Gehring I, Mathsson-Alm L, Poorafshar M, Hueber AJ, Schett G, Johannesson M, Catrina A, Klareskog L. Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project. JMIR Mhealth Uhealth 2020; 8:e17507. [PMID: 32348258 PMCID: PMC7260666 DOI: 10.2196/17507] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/10/2020] [Accepted: 03/22/2020] [Indexed: 11/13/2022] Open
Abstract
Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Karim Raza
- Department of Rheumatology, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Tor Bruce
- Ocean Observations, Stockholm, Sweden
| | | | | | | | | | - Axel J Hueber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Martina Johannesson
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anca Catrina
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Klareskog
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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87
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Dittrich F, Beck S, Harren AK, Reinecke F, Serong S, Jung J, Back DA, Wolf M, Landgraeber S. Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the "Needle in a Haystack". JMIR Mhealth Uhealth 2020; 8:e17085. [PMID: 32379054 PMCID: PMC7319594 DOI: 10.2196/17085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. Objective This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. Methods We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. Results The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. Conclusions The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice.
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Affiliation(s)
- Florian Dittrich
- Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Sascha Beck
- Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.,Sportsclinic Hellersen, Lüdenscheid, Germany
| | - Anna Katharina Harren
- Department of Plastic, Reconstructive & Aesthetic Surgery, Specialized Clinic Hornheide, Münster, Germany
| | - Felix Reinecke
- Center for Orthopedics and Traumatology, University Medicine Essen, Essen, Germany
| | - Sebastian Serong
- Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Jochen Jung
- Department for Orthopedics, Diakonie Hospital Bad Kreuznach, Bad Kreuznach, Germany
| | - David Alexander Back
- Clinic of Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Milan Wolf
- Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Stefan Landgraeber
- Department for Orthopaedics and Orthopaedics Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
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Eisenhut K, Sauerborn E, García-Moreno C, Wild V. Mobile applications addressing violence against women: a systematic review. BMJ Glob Health 2020; 5:e001954. [PMID: 32399255 PMCID: PMC7204921 DOI: 10.1136/bmjgh-2019-001954] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/15/2019] [Accepted: 01/13/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Violence against women is a pressing global health problem that is being met with a new intervention strategy—mobile applications. With this systematic review, we provide an initial analysis and functional categorisation of apps addressing violence against women. Methods We conducted a systematic online search conforming with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify apps addressing violence against women in five World Bank regions (Europe and Central Asia; North America, Latin America and the Caribbean; Middle East and North Africa; South Asia; and sub-Saharan Africa). Applications with location of initiation in mentioned regions and ≥100 downloads were included. Data on sector, target group(s), year of release, location of initiation and implementation were extracted. By means of a structured qualitative content analysis, applications were then categorised according to their main functions. Results Of 327 relevant applications, 171 were included into the systematic review and assigned to one of five identified categories of main functions, respectively: emergency, avoidance, education, reporting and evidence building, and supporting apps. The largest proportion (46.78%) consisted of emergency apps, followed by education, reporting and evidence building, supporting and avoidance apps in descending order. With regards to the geographical distribution of app categories, significant (χ2(20)=58.172; p=0.000) differences among the included regions were found. Conclusion A vast proportion of apps addressing violence against women primarily draw on one-time emergency or avoidance solutions, as opposed to more preventative approaches. Further research is necessary, critically considering questions of data security, personal safety and efficacy of such mobile health interventions.
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Affiliation(s)
- Katharina Eisenhut
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Ela Sauerborn
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Claudia García-Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Verina Wild
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilians University Munich, Munich, Germany
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89
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Messner EM, Terhorst Y, Barke A, Baumeister H, Stoyanov S, Hides L, Kavanagh D, Pryss R, Sander L, Probst T. The German Version of the Mobile App Rating Scale (MARS-G): Development and Validation Study. JMIR Mhealth Uhealth 2020; 8:e14479. [PMID: 32217504 PMCID: PMC7148545 DOI: 10.2196/14479] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/29/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The number of mobile health apps (MHAs), which are developed to promote healthy behaviors, prevent disease onset, manage and cure diseases, or assist with rehabilitation measures, has exploded. App store star ratings and descriptions usually provide insufficient or even false information about app quality, although they are popular among end users. A rigorous systematic approach to establish and evaluate the quality of MHAs is urgently needed. The Mobile App Rating Scale (MARS) is an assessment tool that facilitates the objective and systematic evaluation of the quality of MHAs. However, a German MARS is currently not available. OBJECTIVE The aim of this study was to translate and validate a German version of the MARS (MARS-G). METHODS The original 19-item MARS was forward and backward translated twice, and the MARS-G was created. App description items were extended, and 104 MHAs were rated twice by eight independent bilingual researchers, using the MARS-G and MARS. The internal consistency, validity, and reliability of both scales were assessed. Mokken scale analysis was used to investigate the scalability of the overall scores. RESULTS The retranslated scale showed excellent alignment with the original MARS. Additionally, the properties of the MARS-G were comparable to those of the original MARS. The internal consistency was good for all subscales (ie, omega ranged from 0.72 to 0.91). The correlation coefficients (r) between the dimensions of the MARS-G and MARS ranged from 0.93 to 0.98. The scalability of the MARS (H=0.50) and MARS-G (H=0.48) were good. CONCLUSIONS The MARS-G is a reliable and valid tool for experts and stakeholders to assess the quality of health apps in German-speaking populations. The overall score is a reliable quality indicator. However, further studies are needed to assess the factorial structure of the MARS and MARS-G.
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Affiliation(s)
| | - Yannik Terhorst
- Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett-Ingolstadt, Germany
| | | | - Stoyan Stoyanov
- Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia
| | - Leanne Hides
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - David Kavanagh
- Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Rüdiger Pryss
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
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