Apple App Store Research Articles

An Overview of Chatbot-Based Mobile Mental Health Apps: Insights From App Description and User Reviews.

Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. We found that although chatbots' personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings.

Introducing Privacy Receipts into DLT and eIDAS

The introduction of digital identification (e.g., eIDAS) and wallet standards (e.g., EUDI wallet) require compliance with privacy principles and clear communication of the principles through privacy notice and record of consent in the form of a privacy receipt. Regulation needs standards to help set the bar for reducing the privacy infringement risk. Without a standard-based implementation, solutions will be proprietary and siloed with no concern for interoperability, like privacy labels in Google and Apple app stores. Do existing standards address the gap, or do new ones need to be introduced? This article looks at the standards and regulations in three areas to answer this question: privacy protection standards, blockchain and DLT standards, and digital identification and wallet standards.

An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach

Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. This study aims to describe the development process of the MuMi app. For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.

Dark clouds gather – The development of cloud gaming, and competition agencies’ efforts to enable it on mobile app stores

Abstract Cloud gaming represents a new model of video game distribution. It involves playing games that are streamed from a remote server (the cloud), and has the potential to revolutionize gaming as it is, at least in theory, device-agnostic, allowing high-end or ‘AAA’ games to be played on any device with a connection to the internet. However, Apple blocks the emergence of cloud gaming apps on its Apple App Store, and Google, although not completely blocking them, still imposes restrictions on them. Apple’s prevention of cloud gaming apps has led the UK Competition and Markets Authority to make a Market Investigation Reference, which could lead to remedies being imposed on Apple. However, Apple subsequently successfully appealed the decision to make the Reference. This article provides an introduction to cloud gaming and explains why it is an important development that offers huge potential for competition and innovation in digital markets. It then discusses Apple’s prevention of cloud gaming apps and examines Apple’s stated rationale for this policy, after which it also touches on Google’s approach. This is followed by a section that sets out other reasons why it may be in Apple’s commercial interest to block the emergence of cloud gaming apps, looking in particular at whether this may be linked to a desire to protect its position in the distribution of apps on iOS devices and its revenues from the sale of hardware. After this, the article discusses how these restrictions have led to the UK Market Investigation Reference, and how they may be treated under the forthcoming EU Digital Markets Act.

Closed group private chat application with translation feature with firebase database

Language is crucial in the multilingual workplace. Countless conversation apps are currently accessible on the Google Play and Apple App stores. These applications have a number of features that help the user's tasks. With this project, just experimented with new functionality that allows the user message to be translated based on their choices. This software also has a crucial feature called closed group private chatting. It may be quite useful for debating matters related to their field of study among intellectuals and academics. It is determined by their area of interest.

Female sexual health digital resources: women and health care providers need more options.

Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.

A Contemporary Review of Smart Phone Applications in Bariatric and Metabolic Surgery: an Underdeveloped Support Service.

This study aims to be a contemporary review of mHealth apps in bariatric and metabolic surgery (BMS) to assess their quality using the Silberg scale as well as features, themes, usability, and medical/allied health professional involvement (MAPI). Apps were identified using search terms in the Android and Apple app stores. 52 apps were included. 42 (80.7%) apps main target users were patients. More than half, 27 (52%), targeted US based users. 29 (56%) had payment-restricted content. 42 (81%) had MAPI and the mean Silberg score was 5.2. Compared to previous studies the quality of BMS apps is improving with more MAPI and useful functionality. Wider use of mHealth apps for patient centred follow-up, management and care are yet to be widely implemented and explored.

Evaluating Developer Responses to App Reviews: The Case of Mobile Banking Apps in Saudi Arabia and the United States

Application stores (app stores) enable developers to interact with users by responding to their reviews. Many developers continuously monitor user reviews and seek to respond to them effectively and efficiently to boost user satisfaction, which in the end increases the app’s rating. Thus, it is essential to study developer responses and how to improve them. This research was aimed at evaluating developer responses to user reviews in both the Apple App Store and Google Play Store in the banking domain. Ten Saudi and ten United States (U.S.) bank apps were selected from each store as the sample. Quantitative and qualitative approaches were employed to code and categorize developer responses for each app using content analysis. The study found that developers’ responses can be divided into three types of interaction: interactive response, semi-interactive response, and no response. A main finding is that responses by U.S. bank app developers outperformed those by Saudi bank app developers in terms of the number and quality of responses. This research provides valuable recommendations for users, developers, and app stores to enhance user–developer interaction.

Characterizing Consumer Smartphone Apps for Virtual Reality-Based Exposure Therapy: Content Analysis.

In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions.

Physical Activity Surveillance in Children and Adolescents Using Smartphone Technology: Systematic Review

Self-reported physical activity (PA) questionnaires have traditionally been used for PA surveillance in children and adolescents, especially in free-living conditions. Objective measures are more accurate at measuring PA, but high cost often creates a barrier for their use in low- and middle-income settings. The advent of smartphone technology has greatly influenced mobile health and has offered new opportunities in health research, including PA surveillance. This review aimed to systematically explore the use of smartphone technology for PA surveillance in children and adolescents, specifically focusing on the use of smartphone apps. A literature search was conducted using 5 databases (PubMed, Scopus, CINAHL, MEDLINE, and Web of Science) and Google Scholar to identify articles relevant to the topic that were published from 2008 to 2023. Articles were included if they included children and adolescents within the age range of 5 to 18 years; used smartphone technology as PA surveillance; had PA behavioral outcomes such as energy expenditure, step count, and PA levels; were written in English; and were published between 2008 and 2023. We identified and analyzed 8 studies (5 cross-sectional studies and 3 cohort studies). All participants were aged 12-18 years, and all studies were conducted in high-income countries only. Participants were recruited from schools, primary care facilities, and voluntarily. Five studies used mobile apps specifically and purposely developed for the study, whereas 3 studies used mobile apps downloadable from the Apple App Store and Android Play Store. PA surveillance using these apps was conducted from 24 hours to 4 weeks. Evidence of PA surveillance using smartphone technology in children and adolescents was insufficient, which demonstrated the knowledge gap. Additional research is needed to further study the feasibility and validity of smartphone apps for PA surveillance among children and adolescents, especially in low- and middle-income countries.

Interactive Organic Reaction Trajectory Animation iPhone Application (iORA) and Web Site (webORA)

Organic reaction trajectories show atomic motion and molecular reorganization of reactants during a single product-forming collision. iORA is a free (available from the Apple App Store), easy to use, highly interactive iPhone application that provides on-the-fly 3D rendering of organic reaction trajectories calculated with density functional theory (DFT) direct dynamics simulations. Visualization of trajectories using iORA enables qualitative and quantitative learning about organic reaction pathways. iORA users can interactively zoom, rotate, and translate the reaction animations. Users can track distances, angles, and dihedral angles. Other iORA features include buttons to jump to the transition state, control the animation speed, and 3D image display. Currently available reaction classes include Bronsted acid–base, alkyl substitution, alkene addition, alkyne addition, diene addition, rearrangement, oxidation, reduction, carbonyl addition, radical, pericyclic, and aromatic substitution. WebORA is a web-based site that also displays interactive DFT-based organic reaction trajectory simulations from these reaction classes. It can be used by all web browsers and operating systems. iORA and webORA also offer brief trajectory descriptions.

Use of Behavior Change Techniques and Quality of Commercially Available Inflammatory Bowel Disease Apps.

Inclusion of evidence-based behavior change techniques (e.g., self-monitoring) in mobile health apps has the potential to promote adherence to inflammatory bowel disease treatment. While inflammatory bowel disease management apps exist, the extent to which they incorporate behavior change techniques remains unknown. The present study systematically evaluated the content and quality of free, commercially available inflammatory bowel disease management apps. Apps were identified using a systematic search of the Apple App and Google Play stores. Apps were evaluated using Abraham and Michie's taxonomy of 26 behavior change techniques. A literature search was conducted to identify behavior change techniques specific and relevant for people with inflammatory bowel disease. App quality was assessed using the Mobile App Rating Scale with scores ranging from 1 (Inadequate) to 5 (Excellent). A total of 51 inflammatory bowel disease management apps were evaluated. Apps included 0-16 behavior change techniques (Mean = 4.55) and 0-10 inflammatory bowel disease management behavior change techniques (Mean = 3.43). App quality ranged from 2.03 to 4.62 (Mean = 3.39) out of 5.00. Two apps, My IBD Care: Crohn's & Colitis and MyGiHealth GI Symptom Tracker, included the highest number of overall and inflammatory bowel disease management behavior change techniques along with high-quality scores. Bezzy IBD was the only app with a high number of overall and inflammatory bowel disease management behavior change techniques with a primary focus on social support/change. Most inflammatory bowel disease management apps reviewed included evidence-based inflammatory bowel disease management behavior change techniques.

Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content

BackgroundClinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from...

The Mental Models Training App: Enhancing verbal reasoning through a cognitive training mobile application.

Reasoning is a complex form of human cognition whose nature has long been debated. While a number of neurocognitive mechanisms for deductive reasoning have been offered, one of the most prominent accounts is Mental Model Theory (MMT). According to MMT, humans are able to manipulate and represent information for reasoning and problem solving by leveraging the brain's evolved visuospatial resources. Thus, when solving deductive reasoning problems, reasoners build "mental models" of the essential pieces of information conveyed in the premises, with their relations to each other represented spatially-even when the information contained within a reasoning problem is not intrinsically spatial. Crucially, taking a spatially-based approach, such as building mental models, supports higher accuracy on deductive reasoning problems. However, no study has empirically tested whether explicitly training this mental modeling ability leads to improved deductive reasoning performance. Therefore, we designed the Mental Models Training App, a cognitive training mobile application which requires participants to complete increasingly difficult reasoning problems while using an external mental modeling tool. In this preregistered study (https://osf.io/4b7kn), we conducted a between-subjects experiment (N = 301) which compared the Mental Models Training App to 3 distinct control conditions in order to examine which specific components (if any) of the training were causally responsible for improved reasoning performance. Results demonstrate that, when compared to a passive control condition, the Mental Models Training App led to improvements in adults' verbal deductive reasoning performance both during and after the training intervention. However, contrary to our preregistered hypotheses, the training-induced improvements were not significantly larger than the effects of the active control conditions-one which included adaptive practice of the reasoning problems, and one which included adaptive practice as well as a spatial alphabetization control task. Therefore, while the present results demonstrate the ability of the Mental Models Training App to enhance verbal deductive reasoning, they do not support the hypothesis that directly training participants mental modeling ability yields improved performance beyond the effects of adaptive practice of reasoning. Future research should examine the long-term effects of repeated usage of the Mental Models Training App, as well as transfer effects to other forms of reasoning. Finally, we present the Mental Models Training App as a free mobile application available on the Apple App store (https://apps.apple.com/us/app/mental-models-training/id1664939931), in the hope that this translational research may be utilized by the general public to improve their reasoning ability.

Wissenschaftliche Evidenz und Nutzerqualität von Mobile-Health-Anwendungen für Menschen mit kognitiven Beeinträchtigungen und deren Angehörige

IntroductionThe range of health-related apps is large, but the scientific evidence for them is uncertain. The aim of this study is to evaluate the methodological quality of German-language mobile health apps for people with dementia and their caregivers. MethodsThe app search was conducted according to the PRISMA-P guidelines in the application stores (Google Play Store and Apple App Store) using the terms “Demenz”, “Alzheimer”, “Kognition” and “Kognitive Beeinträchtigung”. A systematic literature search with subsequent assessment of the scientific evidence was performed. The user quality assessment was conducted using “The German Version of the Mobile App Rating Scale” (MARS-G). ResultsScientific studies have been published for only 6 of the 20 apps identified. A total of 13 studies were included in the evaluation, whereby the app itself was the subject of investigation in only two publications. In addition, methodological weaknesses were often observed such as small group sizes, short study duration and/or insufficient comparative treatment. The overall quality of the apps can be rated as acceptable with a mean MARS rating of 3.38. Seven apps were able to achieve a score of over 4.0 and thus a good rating, but just as many apps fell below the acceptable limit of 3.0. DiscussionThe contents of most apps have not been scientifically tested. This identified lack of evidence is consistent with the information in the literature in other indication areas. A systematic and transparent evaluation of health applications is necessary to protect end-users and better support their selection process.

Mobile applications in the Philippines during the COVID-19 pandemic: systematic search, use case mapping, and quality assessment using the Mobile App Rating Scale (MARS)

BackgroundIn the Philippines, various mobile health apps were implemented during the COVID-19 pandemic with very little knowledge in terms of their quality. The aims of this paper were 1) to systemically search for mobile apps with COVID-19 pandemic use case that are implemented in the Philippines; 2) to assess the apps using Mobile App Rating Scale (MARS); and 3) to identify the critical points for future improvements of these apps.MethodsTo identify existing mobile applications with COVID-19 pandemic use case employed in the Philippines, Google Play and Apple App Stores were systematically searched. Further search was conducted using the Google Search. Data were extracted from the app web store profile and apps were categorized according to use cases. Mobile apps that met the inclusion criteria were independently assessed and scored by two researchers using the MARS—a 23-item, expert-based rating scale for assessing the quality of mHealth applications.ResultsA total of 27 apps were identified and assessed using MARS. The majority of the apps are designed for managing exposure to COVID-19 and for promoting health monitoring. The overall MARS score of all the apps is 3.62 points (SD 0.7), with a maximum score of 4.7 for an app used for telehealth and a minimum of 2.3 for a COVID-19 health declaration app. The majority (n = 19, 70%) of the apps are equal to or exceeded the minimum “acceptable” MARS score of 3.0. Looking at the categories, the apps for raising awareness received the highest MARS score of 4.58 (SD 0.03) while those designed for managing exposure to COVID-19 received the lowest mean score of 3.06 (SD 0.6).ConclusionsThere is a heterogenous quality of mHealth apps implemented during the COVID-19 pandemic in the Philippines. The study also identified areas to better improve the tools. Considering that mHealth is expected to be an integral part of the healthcare system post-pandemic, the results warrant better policies and guidance in the development and implementation to ensure quality across the board and as a result, positively impact health outcomes.

Beneath the label: unsatisfactory compliance with ESRB, PEGI and IARC industry self-regulation requiring loot box presence warning labels by video game companies.

Loot boxes in video games are a form of in-game transactions with randomized elements. Concerns have been raised about loot boxes' similarities with gambling and their potential harms (e.g. overspending). Recognizing players' and parents' concerns, in mid-2020, the Entertainment Software Rating Board (ESRB) and PEGI (Pan-European Game Information) announced that games containing loot boxes or any forms of in-game transactions with randomized elements will be marked by a new label stating 'In-Game Purchases (Includes Random Items)'. The same label has also been adopted by the International Age Rating Coalition (IARC) and thereby assigned to games available on digital storefronts, e.g. the Google Play Store. The label is intended to provide more information to consumers and allow them to make more informed purchasing decisions. This measure is not legally binding and has been adopted as industry self-regulation or corporate social responsibility. Previous research has suggested that industry self-regulation might not be effectively complied with due to conflicting commercial interests. Compliance with the ESRB's, PEGI's and IARC's loot box presence warning label was assessed in two studies. The first study found that 60.6% of all games labelled by either the ESRB or PEGI (or 16.1% using a more equitable methodology) were not labelled by the other. The majority of the inconsistencies were caused by the ESRB refusing to apply the measure retroactively. Five instances where one age rating organization culpably failed to accurately identify loot box presence were identified (although only two cases were admitted by the relevant organization). Generally, with newly released games, consumers can rely on the PEGI and ESRB labels. PEGI has retroactively labelled many older games, meaning that consumers can expect the labelling to be accurate. However, due to the ESRB's policies (which it has refused to improve), North American consumers cannot rely on the label for many older games containing loot boxes, unlike their European counterparts. The data suggest that the loot box issue is far more pressing on mobile platforms than console/PC platforms. The second study found that 71.0% of popular games containing loot boxes on the Google Play Store (whose age rating system is regulated through IARC) did not display the label and were therefore non-compliant. The IARC's current policy on the Google Play Store is that only games submitted for rating after February 2022 are required to be labelled. This policy (which the IARC has refused to improve) means that most popular and high-grossing games can be, and presently are, marketed without the label, thus significantly reducing the measure's scope and potential benefit. The Apple App Store still does not allow loot box presence to be disclosed. At present, consumers and parents cannot rely on this self-regulatory measure to provide accurate information as to loot box presence for mobile games. Due to their immense scale, the mobile markets pose regulatory and enforcement challenges that PEGI admits are not yet resolved. The mere existence of this measure cannot be used to justify the non-regulation of loot boxes by governments, given the poor compliance and doubtful efficacy (even if when complied with satisfactorily). Improvements to the existing age rating systems are proposed. Preregistered Stage 1 protocol: https://doi.org/10.17605/OSF.IO/E6QBM (date of in-principle acceptance: 12 January 2023).

Research on the Evaluation System of Interactive Design of Digital Publications for Young Children

This research takes an interactive design of digital publications for young children as the research objective, starting from evaluating the physiological and psychological characteristics of young children, where an analytic hierarchy process is used to construct an evaluation index system framework and refined quantitatively using the Delphi method by interviewing with academic and industry experts quantitatively to select prominent indicators of three digital publications for young children with a large number of downloads on the Apple App Store. Furthermore, we also conducted an empirical analysis on the distribution to industry experts by means of a questionnaire survey. The results show that there is a strong positive correlation between the interaction design of digital publications of young children and their downloads, proving the inherent causal relationship of the former to the latter. This research provides a useful exploration for the evaluation of the interactive design of digital publications for young children, and also has practical significance for improving the quality of these publications.

Do cross-national distances still affect the international penetration speed of digital innovation? The role of the global network effect

This paper provides an improved understanding of the internationalisation speed of innovation in a digital context. It integrates virtual distance into the previous Cultural, Administrative, Geographic, and Economic (CAGE) distance framework. By tracking the penetration in 43 target countries of a unique sample of 102 mobile apps available on Apple's App Store, cultural and economic distances still hinder the penetration speed of digital innovation in a focal country. However, geographic and administrative ones no longer have a significant effect. More importantly, distance does not always act as a barrier, with high virtual spaces promoting international penetration. Therefore, digital innovation developers may overcome challenges presented by cross-national distances by resorting to the global user network effect.

Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps

Background Many apps have been designed to remotely assess clinical status and monitor symptom evolution in persons with multiple sclerosis (MS). These may one day serve as an adjunct for in-person assessment of persons with MS, providing valuable insight into the disease course that is not well captured by cross-sectional snapshots obtained from clinic visits. Objective This study sought to review the current literature surrounding apps used for remote monitoring of persons with MS. Methods A scoping review of published articles was conducted to identify and evaluate the literature published regarding the use of apps for monitoring of persons with MS. PubMed/Medline, EMBASE, CINAHL, and Cochrane databases were searched from inception to January 2022. Cohort studies, feasibility studies, and randomized controlled trials were included in this review. All pediatric studies, single case studies, poster presentations, opinion pieces, and commentaries were excluded. Studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network, when applicable. Key findings were grouped in categories (convergence to neurological exam, feasibility of implementation, impact of weather, and practice effect), and trends are presented. In a parallel systematic search, the Canadian Apple App Store and Google Play Store were searched to identify relevant apps that are available but have yet to be formally studied and published in peer-reviewed publications. Results We included 18 articles and 18 apps. Although many MS-related apps exist, only 10 apps had published literature supporting their use. Convergence between app-based testing and the neurological exam was examined in 12 articles. Most app-based tests focused on physical disability and cognition, although other domains such as ambulation, balance, visual acuity, and fatigue were also evaluated. Overall, correlations between the app versions of standardized tests and their traditional counterparts were moderate to strong. Some novel app-based tests had a stronger correlation with clinician-derived outcomes than traditional testing. App-based testing correlated well with the Multiple Sclerosis Functional Composite but less so with the Expanded Disability Status Scale; the latter correlated to a greater extent with patient quality of life questionnaire scores. Conclusions Although limited by a small number of included studies and study heterogeneity, the findings of this study suggest that app-based testing demonstrates adequate convergence to traditional in-person assessment and may be used as an adjunct to and perhaps in lieu of specific neurological exam metrics documented at clinic visits, particularly if the latter is not readily accessible for persons with MS.