Mobile health apps, what’s the evidence behind them?
In the last few years, we have seen incredible technological advancements in health and wellness wearable devices. With the mass adoption of wearables such as the Fitbit and Apple Watch, consumers are now able to track their activity all day, set goals to stay motivated and be more active to lead a healthy life. Wearable devices and modern algorithms have created a world where a person can take ownership of their own activity and health data by looking at their general movement metrics. Yet - these modern and innovative approaches have not been adopted for the neurological rehabilitation space.
People who struggle with movement due to neurological impairments are among those who could benefit the most from tracking specialized information about their rehabilitation. People with neurological impairments can benefit greatly from wearables with mobile health apps (mHealth apps) which can empower them to take ownership of their rehabilitation through data. The most common functionalities of mHealth applications include symptom monitoring, real-time data capture, real-time access to information about navigating the community, social connectedness through peer-to-peer support, and bidirectional communication with clinicians. Below we will discuss the current research for mHealth apps for people with neurological impairments.
Challenges of mHealth apps
mHealth apps developers have identified a few challenges to the creation and adoption of new apps which include the following:
There are a lot of free, mHealth apps available, but the majority are not evidence-based. There are no clear guidelines or quality standards for mHealth apps, therefore there could be hesitation about recommending or using the app.
Research shows that the use of mHealth apps often declines over time. There might be initial curiosity and excitement about the app, but it wears off.
Technology is evolving at an ever-increasing pace, yet for the healthcare space, moving from development to adoption is a long and complex process. It is also an important process, as healthcare apps require a high level of security and research. However, by the time a pilot is concluded the app’s design and functionalities may already be outdated.
Despite these challenges, mHealth apps are being used and downloaded every day. What is the evidence behind the benefits of using a mobile health app? We wanted to know, so researched the latest in mHealth apps for people with neurological impairments.
Benefits of mHealth Apps in Parkinson’s Disease
An article on the use of mHealth apps to help persons with Parkinson’s Disease cited many positive benefits to mHealth apps. They stated that real-time, rather than delayed, feedback can help maintain positive behavioral change. Real-time feedback means the immediate or quick responses from healthcare professionals regarding one's health, rather than waiting longer to be seen for appointments for health advice. Easier, continuous contact with a healthcare professional through messaging features can improve overall health and lead to more frequent adjustments of individually tailored programs. The study explored the safety, effectiveness and acceptance of an mHealth-mediated exercise program designed to promote sustained physical activity in people with Parkinson’s Disease. It concluded that adding an mHealth app to someone’s exercise program benefited everyone who used it, but especially those in the study that were less active at baseline.
mHealth App use After Stroke
Studies have shown that people who have had a stroke can have a higher risk for health risks that could lead to rehospitalization or a reduced quality of life. There is a need to determine how to use advancing technologies to help address these risk factors. One study found that mHealth apps specifically designed for persons post-stroke have significantly increased since 2019, with around 60% of the studies they reviewed being published in 2019 or 2020. These mHealth apps have the potential to play a role in reducing risk factors post-stroke, and as more studies are completed, more will be learned about the role they can play in reducing certain risk factors.
One consideration when selecting an app is to determine whether or not it has the information most beneficial to you. Some apps monitor physical measures, such as how many steps you take per day or completing daily exercises. Some apps focus on mental health measures, such as mood and sleep. However, the study mentioned above found that there is a lack of these mental measures in most apps designed for use after stroke. Depression and fatigue post-stroke are important considerations when looking at preventing health decline and improving quality of life.
Multiple Sclerosis and mHealth
Persons with Multiple Sclerosis (MS) have similar life expectancies to the general population and learn to manage their symptoms over a long period. mHealth apps are an important part of symptom management for persons with MS. mHealth apps designed for persons with MS can include a variety of features. Because MS can result in both physical and mental difficulties, mHealth apps should incorporate ways of monitoring both of these impairments. Several studies have started over the past few years looking into the role mHealth apps can play in symptom management in MS. As these studies conclude, they will provide us with more scientific data on how effective they can be long term.
Studies in mHealth App Use after Spinal Cord Injury
mHealth apps also have many potential helpful tools for people after spinal cord injury (SCI). These include medication management, urinary and bowel programs, skincare tracking, mood tracking and messaging with a clinician.
One research study involved relevant stakeholder groups in the early stages of app development to assess the promotion and impediment to the adoption of a new app for someone after SCI. They found that persons who recently suffered a spinal cord injury and are early on in their rehab could particularly benefit from an app as a complementary measure to traditional education. The app would allow someone to process information at their own pace and in their own time and could help with improving autonomy and self-determination.
Another study was a randomized control trial that looked at an mHealth system to determine if using the system would lead to improvement in health and psychosocial outcomes. One group was seen by a physician on an intermittent basis with follow-up as needed. The other group was given a smartphone with an mHealth app in addition to seeing a physician. They found that use of the app resulted in a significant reduction in UTIs compared to the group that did not use the app and that users spent, on average, 34 minutes per month using the app.
Not Just for Mobility Impairment
mHealth apps also have potential benefits for caregivers and loved ones. Apps can help friends and family better understand the diagnosis and provide better support by increasing knowledge and skills. Most health information is provided in bulky information brochures, and the ability to use an app on the go can help novice caregivers save time when looking for information, and potentially even encourage them to do so more often. Hence the importance of apps providing evidence-based and factual information.
A Tool for Self-Management
By incorporating mHealth apps into your life you are adding a tool for self-management of your health. mHealth can help promote self-care rather than always requiring care from a medical professional, which is so important to be able to take control of your life.
With the continued growth of the Internet and the use of smartphones, the development of digital health applications can significantly broaden rehabilitation and health care opportunities for patients. We are optimistic this technology has the potential to reach a large number of people with disabilities who exhibit a range of physical and psychosocial secondary health conditions and provide them with an effective dose of interventions and information. The full potential of digital health technologies has yet to be realized and no doubt there will be continued research and developments in this area.
Today we provided you with the current scientific research in mHealth apps to show the many ways they can have a positive impact on your life. For the next few weeks, we will be discussing mHealth apps, with everything from app design to choosing the right app for you. Check back to learn more about this evolving technology!
Edited by Andrew Ekelem and Pierluigi Mantovani.
Sources:
Please cite this article as: Burns S, Terblanche M, Perea J, Lillard H, DeLaPena C, Grinage N,MacKinen A, Cox E, mHealth Intervention Applications for Adults Living with the Effects of Stroke: A Scoping Review Archives of Rehabilitation Research and Clinical Translation (2021), doi: https://doi.org/10.1016/j.arrct.2020.100095
Giunti G, Guisado Fernández E, Dorronzoro Zubiete E, Rivera Romero O. Supply and Demand in mHealth Apps for Persons With Multiple Sclerosis: Systematic Search in App Stores and Scoping Literature Review. JMIR Mhealth Uhealth. 2018 May 23;6(5):e10512. doi: 10.2196/10512. PMID: 29792295; PMCID: PMC5990860.
Ellis TD, Cavanaugh JT, DeAngelis T, Hendron K, Thomas CA, Saint-Hilaire M, Pencina K, Latham NK. Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study. Phys Ther. 2019 Feb 1;99(2):203-216. doi: 10.1093/ptj/pzy131. PMID: 30715489.
https://pubmed.ncbi.nlm.nih.gov/31464189/: Kryger MA, Crytzer TM, Fairman A, Quinby EJ, Karavolis M, Pramana G, Setiawan IMA, McKernan GP, Parmanto B, Dicianno BE. The Effect of the Interactive Mobile Health and Rehabilitation System on Health and Psychosocial Outcomes in Spinal Cord Injury: Randomized Controlled Trial. J Med Internet Res. 2019 Aug 28;21(8):e14305. doi: 10.2196/14305. PMID: 31464189; PMCID: PMC6737885.
https://pubmed.ncbi.nlm.nih.gov/31011881/ : Mortenson WB, Singh G, MacGillivray M, Sadeghi M, Mills P, Adams J, Sawatzky B. Development of a Self-Management App for People with Spinal Cord Injury. J Med Syst. 2019 Apr 22;43(6):145. doi: 10.1007/s10916-019-1273-x. PMID: 31011881.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758166/#ref14 : Amann J, Fiordelli M, Scheel-Sailer A, Brach M, Rubinelli S. Opportunities and Challenges of a Self-Management App to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Qualitative Study. JMIR Mhealth Uhealth. 2020;8(12):e22452. Published 2020 Dec 9. doi:10.2196/22452
