The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores.

Janine Koepp,Vanessa Devens Trindade,Luis Manuel Ley Dominguez,Liane Mahlmann Kipper,Cristine Brandenburg,Bartira Ercília Pinheiro Da Costa,Paulo Ricardo Hernandes Martins,Lia Gonçalves Possuelo,Ariane Tieko Frare Kira,Rejane Frozza,Marcus Vinicius De Mello Pinto,Marcelo Carneiro,Miriam Viviane Baron

doi:10.2196/14266

Abstract

BackgroundThe increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information.ObjectiveThe objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics.MethodsThis review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability.ResultsThe search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis.ConclusionsIn this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users.Trial RegistrationPROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137

Highlights

BackgroundA pressure ulcer involves localized damage to the underlying skin or soft tissues, resulting in localized tissue destruction related to lack of blood flow due to increased external pressure on bone prominence or due to the use of a medical device [1].Pressure ulcers negatively impact the quality of life of patients, contribute to pain and suffering, prolong hospitalization, increase workload, and increase costs for health systems [2,3,4,5,6,7,8,9]
In this review, it was observed that all studies involved the initial phase of app development or improvement, and the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached
It is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users

Summary

Introduction

BackgroundA pressure ulcer involves localized damage to the underlying skin or soft tissues, resulting in localized tissue destruction related to lack of blood flow due to increased external pressure on bone prominence or due to the use of a medical device [1].Pressure ulcers negatively impact the quality of life of patients, contribute to pain and suffering, prolong hospitalization, increase workload, and increase costs for health systems [2,3,4,5,6,7,8,9]. Studies in the intensive care units (ICUs) of hospitals in Brazil showed an incidence of pressure ulcers between 17.2% and 41.0% [10,11]. A pressure ulcer is a wound that is characterized by rapid deterioration of soft tissues and a process of chronification that hinders normal healing. In this way, systematic follow-up of the evolution of the wound by a physician and health team is unavoidable. With the emergence of mobile health (mHealth) and the popularity of mobile devices in clinics and hospitals, wound evaluation can be optimized by allowing an interprofessional team to remotely view, analyze, and monitor wound evolution through apps [13]. Numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information

Methods

Results

Discussion

Conclusion