The use of smartphone apps in clinical practice: A survey of South African physiotherapists

Mobile Apps and Wearable Devices for Cardiovascular Health: Narrative Review

Background

Cardiovascular diseases (CVDs) continue to be the leading cause of global morbidity and mortality. Aiming to reduce the risk of CVD development and better manage them, an increasing number of individuals are adopting mobile health (mHealth) apps and wearable devices (wearables). These technologies provide critical insights into heart health and fitness, supporting users to monitor their lifestyle behaviors and adhere to preventative medication.

Objective

In this review, we aimed to investigate the current state of mHealth apps and wearables designed for cardiovascular health, with a specific focus on the DACH region (Germany, Austria, and Switzerland). We assessed the benefits these technologies provide to clinicians and patients, particularly in addressing unmet needs like sex-specific symptoms, while also examining their potential integration into the broader health care ecosystem.

Methods

To identify heart health apps, a keyword search was performed on both the Swiss Apple App Store and Google Play Stores. A separate search was performed on Google to identify heart health wearables. The identified apps and wearables were evaluated using the foundational and contextual criteria of the sociotechnical framework for assessing patient-facing eHealth tools.

Results

After filtering out apps and wearables that did not meet our inclusion criteria, 20 apps and 22 wearables were included in the review. While all the apps were available in the DACH region, only 30% (6/20) were specifically designed for these countries. Only 25% (5/20) of the apps included sex-specific information; 40% (8/20) provided information from evidence-based research, 35% (7/20) provided general health information without academic and clinical references, and 25% (5/20) did not include any evidence-based or general health information. While 20% (4/20) of the included apps had clinical integration features such as clinician dashboards, only 10% (2/20) had the potential to effectively enhance clinician workflows. Privacy policies were present in 95% (19/20) of the apps, with 75% (15/20) adhering to General Data Protection Regulation (GDPR) regulations; 1 app had no data protection policy. Only 20% (4/20) of the apps were medically certified. For wearables, only 9% (2/22) were tailored to the DACH region, and 40% (9/22) addressed women's health. While around 60% (13/22) offered features to support clinical integration, only 9% (2/22) had the potential to improve clinical workflows. More than half (12/22) of the wearables were medically certified, and 77% (17/22) referenced scientific or peer-reviewed research. All wearables included a privacy policy.

Conclusions

While many mHealth tools for cardiovascular health are available, only a few provide meaningful value to both patients and clinicians or have the potential to integrate effectively into the health care system. Women's sex-specific needs are often overlooked, and the benefits for clinicians are limited. In addition, mHealth apps largely lack robust evidence, whereas wearables showed comparatively stronger support through evidence-based and medical certification.

Physiotherapy Professionals: A Questionnaire for the Evaluation of Telerehabilitation Services in Egypt

Purpose

This study aimed to evaluate the utilization of telerehabilitation services in Egypt and to investigate the concerns and barriers faced by Egyptian physiotherapists for implementation.

Methods

This cross-sectional study recruited 306 Egyptian physiotherapists who were asked to complete an online survey including questions about the utilization of telerehabilitation services, awareness, perception, and attitude.

Results

A total of 299 physiotherapists completed the online survey. Within the sample, 38.5% utilized telerehabilitation at work. Telerehabilitation was used frequently to deliver patient advice (17.6%), follow-up (16%), and exercise prescription (15.2%). Pain (16.2%) was the most common outcome assessed utilizing telerehabilitation. Additionally, 85.3% of physiotherapists agreed that the inclusion of telerehabilitation during the rehabilitation program is effective. The main barriers to implementing telerehabilitation in Egypt were lack of awareness (59.9%) and technical issues (58.2%).

Conclusion

This study sheds light on the trends and challenges in utilizing telerehabilitation and may help in shaping the future of telerehabilitation in Egypt.

Rehabilitation clinicians' use of mainstream wireless technologies in practice: a scoping review

PURPOSE

This scoping review was conducted to understand the barriers, facilitators, and education and training needs of rehabilitation clinicians in their use of mainstream wireless technologies (MWT) to support people with disabilities and older adults. It was also conducted to understand the functional skills of clients that were targeted with MWT use.

MATERIALS AND METHODS

This scoping review was reported using PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the Population (or Participants)/Concept/Context) framework. We searched PubMed; ProQuest to access APA PsycINFO; Web of Science Core Collection; and EBSCOhost to access Cumulated Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE ALL, and Education Resources Information Center (ERIC). Articles published between 2015-2022 were retrieved.

RESULTS

A total of 90 articles were included. Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic on barriers and facilitators was generated as a decision support tool for clinicians when implementing MWT. The topic, format, timing, and source of information clinicians need are also delineated.

CONCLUSION

MWT such as apps, smartphones and tablets are being used by rehabilitation clinicians to address motor, cognitive, and speech skills, most commonly in adults. Clinicians voice a need for more education and training. Barriers and facilitators exist at the clinician-, technology-, client-, institution-, and policy levels.

Speech-Language Pathologists' Feelings and Practices Regarding Technological Apps in School Service Delivery

PURPOSE

Thousands of technological applications (apps) have emerged in the past decade, yet few studies have examined how apps are used by speech-language pathologists (SLPs), their effectiveness, and SLPs' feelings regarding their use. This study explored how SLPs use apps and their feelings regarding their use in schools, as well as considerations made by SLPs prior to implementing apps in therapy sessions.

METHOD

A survey was distributed electronically to school-based SLPs in Ohio, yielding 69 valid responses. The study probed SLP demographics, patterns of app use in schools, and feelings toward their use in a school setting.

RESULTS

Results showed 77% of SLPs reported using apps in their treatment sessions and reported generally positive feelings regarding app use. SLPs considered factors such as age, cognitive ability, and treatment targets when using apps in treatment. SLPs who reported not using apps cited personal preference and price as the most common factors influencing their decision. SLPs also noted concerns about excessive screen time.

CONCLUSIONS

Results of this study carry clinical implications for future development and assessment of technology to be used for service delivery in schools. Given that the majority of school-based SLPs report using apps with their students, research on the role of apps in supporting learning for speech-language services is urgently needed.

mHealth Apps for Musculoskeletal Rehabilitation: State of the Practice Review (Preprint)

Background

The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways.

Objective

The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities.

Methods

A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction.

Results

A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8%) or videos (n=97, 67.4%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8%), communication portal (n=32, 22.2%), patient-reported outcome capture (n=36, 25%), or direct feedback (n=57, 39.6%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34%) and safety advice or disclaimers (n=38, 26.4%).

Conclusions

The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies.

Smartphone and Tablet Software Apps to Collect Data in Sport and Exercise Settings: Cross-sectional International Survey

BACKGROUND

Advances in smartphone technology have facilitated an increase in the number of commercially available smartphone and tablet apps that enable the collection of physiological and biomechanical variables typically monitored in sport and exercise settings. Currently, it is not fully understood whether individuals collect data using mobile devices and tablets, independent of additional hardware, in their practice.

OBJECTIVE

This study aims to explore the use of smartphone and tablet software apps to collect data by individuals working in various sport and exercise settings, such as sports coaching, strength and conditioning, and personal training.

METHODS

A total of 335 practitioners completed an electronic questionnaire that surveyed their current training practices, with a focus on 2 areas: type of data collection and perceptions of reliability and validity regarding app use. An 18-item questionnaire, using a 5-point Likert scale, evaluated the perception of app use.

RESULTS

A total of 204 respondents reported using apps to directly collect data, with most of them (196/335, 58.5%) collecting biomechanical data, and 41.2% (138/335) respondents reported using at least one evidence-based app. A binomial general linear model determined that evidence accessibility (β=.35, 95% CI 0.04-0.67; P=.03) was significantly related to evidence-based app use. Age (β=-.03, 95% CI -0.06 to 0.00; P=.03) had a significant negative effect on evidence-based app use.

CONCLUSIONS

This study demonstrates that practitioners show a greater preference for using smartphones and tablet devices to collect biomechanical data such as sprint velocity and jump performance variables. When it is easier to access information on the quality of apps, practitioners are more likely to use evidence-based apps. App developers should seek independent research to validate their apps. In addition, app developers should seek to provide clear signposting to the scientific support of their software in alternative ways.