Evidence Base for the clinical use of apps

Do apps work? Today's modern health care is all about the evidence base. Everything we do is evidence based and we invest a lot of time in ensure that our practice is safe and evidenced. Digital health and telehealth change rapidly and often the evidence and research struggle to keep up with the speed. A quantitative research study on average takes ten years to be completed and published. Technology would look dramatically different during that time. However the evidence base is starting to catch up.

There is more qualitative than quantitative evidence at present. Some randomised controlled trials are emerging or in the pipeline. The majority of the evidence is for speech and language therapy apps. The general trends are based on patient/therapist questionnaires. On the whole they show support for apps.

Overall the research states:

• Apps appear to increase compliance
• the right app needs to be used
• there is a recognised need for further evidence.

Research Studies - RCTs

Literature review - Stroke

Title: iPad use in stroke neuro rehab

Authors: Khalid Ameer and Khalid Ali

Summary: The incorporation of tablet computers to conventional rehabilitation post stroke has the potential to maintain patients interest, improve clinical outcomes and reduce abandonment of tasks.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC63711...

Aphasia app

RecoverNowPilot, Mallet et al 2016.

33 patients with some degree of aphasia issued with an iPad with individualised apps following initial Assessment with SLT for 1 hour day during acute stroke phase. Patients used iPads for a mean of 149 minutes a day.

Conclusion: mobile tablets are a feasible method of delivering individualised communication therapy in acute care setting

LanguageTherappy 4-in-1. Aphasia App.

Title: Improved Language in Chronic Aphasia After Self-Delivered iPad Speech Therapy

Authors: Brielle C Stark et al. Published in: Neuropsychol Rehabilitation.Date: 2018. Summary: Self-delivered speech therapy provides an opportunity for individualised dosage as a complement to the speech-therapy regime in the long-term rehabilitation pathway. Few apps for speech therapy have been subject to clinical trials, especially on a self-delivered platform. In a crossover design study, the Comprehensive Aphasia Test (CAT) and Cookie Theft Picture Description (CTPD) were used to measure untrained improvement in a group of chronic expressive aphasic patients after using a speech therapy app. A pilot study (n = 3) and crossover design (n = 7) comparing the therapy app with a non-language mind-game were conducted. Patients self-selected their training on the app, with a recommended use of 20 minutes per day. There was significant post-therapy improvement on the CAT and CTPD but no significant improvement after the mind-game intervention, suggesting there were language-specific effects following use of the therapy app. Improvements on the CTPD, a functional measurement of speech, suggest that a therapy app can produce practical, important changes in speech. The improvements post-therapy were not due to type of language category trained or amount of training on the app, but an inverse relationship with severity at baseline and post-therapy improvement was shown.

This study suggests that self-delivered therapy via an app is beneficial for chronic expressive aphasia.

https://ichgcp.net/es/clinical-trials-registry/NCT...

Dexteria -Upper limb app

Title: The use of the ipad for post stroke hand rehabilitation.

Authors and date: Kizonyet al (2016) & Rand et al (2013)

App used: Dexteria tap it

Summary: RCT. “Dexteria-Tap it” on post-stroke hand dexterity impairment. Results showed statistically significant correlation between hand weakness & improvement in hand performance.

https://www.researchgate.net/publication/259621292...

Rehab Let - Upper limb app

Title: Rehab-let

Authors: Rand et al

Date: 2015

App used: Rehab-Let

Summary: Comparing traditional self training (GRASP) to improve dexterity of weaker hand vs protocol using game apps on a touch screen. Results pending.

https://trialsjournal.biomedcentral.com/articles/1...

Brain training

Title: Computerised working memory training can improve working memory, cognition &Psychological health.

Authors: Akerlundet al

Date: 2013

App used: WM training

Summary: RCT. Results indicated that computerized WM training can improve working memory, cognition and psychological health.

https://pubmed.ncbi.nlm.nih.gov/24087909/

Medisafe- Medication management app

Title: Association of a Smartphone Application With Medication Adherence and Blood Pressure Control.

Authors: Morawski et al.

Date: 2018

App used: medisafe

Summary: RCT. Whilst using app a small improvement in self reported adherence to blood pressure medication was found.

https://jamanetwork.com/journals/jamainternalmedic...

Mental health

Title: There is a non-evidence-based app for that.

Author: Amit Baumel and John Kane

Date: 2020

Summary: : A systematic review and mixed methods analysis of depression- and anxiety-related apps that incorporate unrecognized techniques.

Depression and anxiety apps incorporating non-evidence-based techniques are viewed less favorably and have more potential to cause harm. However, many users found them helpful mostly in providing in-the-moment relief.

https://www.sciencedirect.com/science/article/abs/...

Medical Apps for Clinicians

Title: Mobile Devices and Apps for Health Care Professionals: Uses and Benefits

Author: C.Lee Ventola.

Date: May 2014

Summary: The use of mobile devices by health care professionals (HCPs) has transformed many aspects of clinical practice. A review of the current practice, pros and cons of using mobile apps to support clinical practice.

www.ncbi.nlm.nih.gov/pmc/articles/PMC40291...