Usability of Mobile Health Apps for Postoperative Care: Systematic Review

Ben Patel, Arron Thind, Ben Patel, Arron Thind

Abstract

Background: Mobile health (mHealth) apps are increasingly used postoperatively to monitor, educate, and rehabilitate. The usability of mHealth apps is critical to their implementation.

Objective: This systematic review evaluates the (1) methodology of usability analyses, (2) domains of usability being assessed, and (3) results of usability analyses.

Methods: The A Measurement Tool to Assess Systematic Reviews checklist was consulted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was adhered to. Screening was undertaken by 2 independent reviewers. All included studies were assessed for risk of bias. Domains of usability were compared with the gold-standard mHealth App Usability Questionnaire (MAUQ).

Results: A total of 33 of 720 identified studies were included for data extraction. Of the 5 included randomized controlled trials (RCTs), usability was never the primary end point. Methodology of usability analyses included interview (10/33), self-created questionnaire (18/33), and validated questionnaire (9/33). Of the 3 domains of usability proposed in the MAUQ, satisfaction was assessed in 28 of the 33 studies, system information arrangement was assessed in 11 of the 33 studies, and usefulness was assessed in 18 of the 33 studies. Usability of mHealth apps was above industry average, with median System Usability Scale scores ranging from 76 to 95 out of 100.

Conclusions: Current analyses of mHealth app usability are substandard. RCTs are rare, and validated questionnaires are infrequently consulted. Of the 3 domains of usability, only satisfaction is regularly assessed. There is significant bias throughout the literature, particularly with regards to conflicts of interest. Future studies should adhere to the MAUQ to assess usability and improve the utility of mHealth apps.

Keywords: mobile health app; mobile phone; postoperative care; postoperative monitoring; smartphone; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ben Patel, Arron Thind. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 20.07.2020.

Figures

Figure 1
Figure 1
PRISMA summary of the literature search and exclusion process. mHealth: mobile health. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

References

    1. Ericsson Mobility Report. Ericsson website. [2018-05-29]. .
    1. The Growing Value of Digital Health. IQVIA Institute. 2017. Nov 07, [2018-05-29]. .
    1. Byambasuren O, Sanders S, Beller E, Glasziou P. Prescribable mHealth apps identified from an overview of systematic reviews. NPJ Digit Med. 2018;1:12. doi: 10.1038/s41746-018-0021-9.
    1. Armstrong KA, Coyte PC, Brown M, Beber B, Semple JL. Effect of Home Monitoring via Mobile App on the Number of In-Person Visits Following Ambulatory Surgery: A Randomized Clinical Trial. JAMA Surg. 2017 Jul 01;152(7):622–627. doi: 10.1001/jamasurg.2017.0111.
    1. Dahlberg K, Philipsson A, Hagberg L, Jaensson M, Hälleberg-Nyman M, Nilsson U. Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial. Br J Anaesth. 2017 Nov 01;119(5):1039–1046. doi: 10.1093/bja/aex332.
    1. Belarmino A, Walsh R, Alshak M, Patel N, Wu R, Hu JC. Feasibility of a Mobile Health Application To Monitor Recovery and Patient-reported Outcomes after Robot-assisted Radical Prostatectomy. Eur Urol Oncol. 2019 Jul;2(4):425–428. doi: 10.1016/j.euo.2018.08.016.
    1. Hwang Jin Hee, Hee Hwang Jin, Mun Goo-Hyun. An evolution of communication in postoperative free flap monitoring: using a smartphone and mobile messenger application. Plast Reconstr Surg. 2012 Jul;130(1):125–9. doi: 10.1097/PRS.0b013e318254b202.
    1. Chang P, Lin L, Zhang H, Zhao Y, Xie J, Yu Y, Zhao Y. Effect of smartphone application assisted medical service on follow-up adherence improvement in pediatric cataract patients. Graefes Arch Clin Exp Ophthalmol. 2018 Oct;256(10):1923–1931. doi: 10.1007/s00417-018-4080-z.
    1. deBronkart D. From patient centred to people powered: autonomy on the rise. BMJ. 2015 Feb 10;350:h148. doi: 10.1136/bmj.h148.
    1. Constantinos CK, Kim DJ. A Meta-Analytical Review of Empirical Mobile Usability Studies. J Usability Stud. 2011;6(3):117–171. doi: 10.1007/3-540-28144-4_13.
    1. Zapata BC, Fernández-Alemán JL, Idri A, Toval A. Empirical studies on usability of mHealth apps: a systematic literature review. J Med Syst. 2015 Feb;39(2):1. doi: 10.1007/s10916-014-0182-2.
    1. Schnall R, Mosley JP, Iribarren SJ, Bakken S, Carballo-Diéguez A, Brown IW. Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV. JMIR Mhealth Uhealth. 2015;3(3):e91. doi: 10.2196/mhealth.4882.
    1. McCurdie T, Taneva S, Casselman M, Yeung M, McDaniel C, Ho W, Cafazzo J. mHealth consumer apps: the case for user-centered design. Biomed Instrum Technol. 2012 Sep;Suppl:49–56. doi: 10.2345/0899-8205-46.s2.49.
    1. Krebs P, Duncan DT. Health App Use Among US Mobile Phone Owners: A National Survey. JMIR Mhealth Uhealth. 2015 Nov;3(4):e101. doi: 10.2196/mhealth.4924.
    1. Boulos MNK, Brewer AC, Karimkhani C, Buller DB, Dellavalle RP. Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform. 2014;5(3):229. doi: 10.5210/ojphi.v5i3.4814.
    1. Nassar V. Common criteria for usability review. Work. 2012;41 Suppl 1:1053–7. doi: 10.3233/WOR-2012-0282-1053.
    1. Baharuddin R, Singh D, Razali R. Usability Dimensions for Mobile Applications-A Review. RJASET. 2013 Feb 21;11(9):2225–2231. doi: 10.19026/rjaset.5.4776.
    1. ISO 9241. International Organisation for Standardization. [2019-11-08]. .
    1. Harrison R, Flood D, Duce D. Usability of mobile applications: literature review and rationale for a new usability model. J Interact Sci. 2013;1(1):1. doi: 10.1186/2194-0827-1-1.
    1. Lewis JR. IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use. International Journal of Human-Computer Interaction. 1995 Jan;7(1):57–78. doi: 10.1080/10447319509526110.
    1. Brooke J. SUS - A quick and dirty usability scale. Usability Evaluation In Industry. 1996 Jun 11;:189–194.
    1. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015 Mar;3(1):e27. doi: 10.2196/mhealth.3422.
    1. Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS) JMIR Mhealth Uhealth. 2016 Jun 10;4(2):e72. doi: 10.2196/mhealth.5849.
    1. Zhao B, Tai-Seale M, Longhurst C, Clay B. Utilization of Hospital Room Hospitality Features on Patient-Controlled Tablet Computers: Cohort Study. JMIR Mhealth Uhealth. 2019 Jun 20;7(6):e13964. doi: 10.2196/13964.
    1. Shea Beverley J, Reeves Barnaby C, Wells George, Thuku Micere, Hamel Candyce, Moran Julian, Moher David, Tugwell Peter, Welch Vivian, Kristjansson Elizabeth, Henry David A. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017 Sep 21;358:j4008. doi: 10.1136/bmj.j4008.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009 Jul 21;339:b2535. doi: 10.1136/bmj.b2535.
    1. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016 Dec 05;5(1):210. doi: 10.1186/s13643-016-0384-4.
    1. Timmers T, Janssen L, van der Weegen W, Das D, Marijnissen W, Hannink G, van der Zwaard BC, Plat A, Thomassen B, Swen J, Kool RB, Lambers Heerspink FO. The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019 Oct 21;7(10):e15323. doi: 10.2196/15323.
    1. Yadav SK, Jha CK, Mishra SK, Mishra A. Smartphone-Based Application for Tele-follow-up of Patients with Endocrine Disorders in Context of a LMIC: A Compliance, Satisfaction, Clinical Safety and Outcome Assessment. World J Surg. 2020 Feb;44(2):612–616. doi: 10.1007/s00268-019-05212-7.
    1. Ramkumar PN, Haeberle HS, Ramanathan D, Cantrell WA, Navarro SM, Mont MA, Bloomfield M, Patterson BM. Remote Patient Monitoring Using Mobile Health for Total Knee Arthroplasty: Validation of a Wearable and Machine Learning-Based Surveillance Platform. J Arthroplasty. 2019 Oct;34(10):2253–2259. doi: 10.1016/j.arth.2019.05.021.
    1. Argent R, Slevin P, Bevilacqua A, Neligan M, Daly A, Caulfield B. Wearable Sensor-Based Exercise Biofeedback for Orthopaedic Rehabilitation: A Mixed Methods User Evaluation of a Prototype System. Sensors (Basel) 2019 Jan 21;19(2) doi: 10.3390/s19020432.
    1. Brunner TH, DiFortuna K, LeTang M, Murphy J, Stemplewicz K, Kovacs M, DeRosa AP, Gibson DS, Ginex PK. Feasibility of an iPad to Facilitate Communication in Postoperative Patients With Head and Neck Cancer. J Perianesth Nurs. 2018 Aug;33(4):399–406. doi: 10.1016/j.jopan.2016.10.008.
    1. van der Meij E, Huirne JA, Ten Cate AD, Stockmann HB, Scholten PC, Davids PH, Bonjer HJ, Anema JR. A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial. J Med Internet Res. 2018 Jan 02;20(1):e1. doi: 10.2196/jmir.8338.
    1. Felbaum DR, Stewart J, Anaizi A, Sandhu Faheem A, Nair Mani N, Voyadzis Jean-Marc. Implementation and Evaluation of a Smartphone Application for the Perioperative Care of Neurosurgery Patients at an Academic Medical Center: Implications for Patient Satisfaction, Surgery Cancelations, and Readmissions. Oper Neurosurg (Hagerstown) 2018 Mar 01;14(3):303–311. doi: 10.1093/ons/opx112.
    1. Goz V, Anthony C, Pugely A, Lawrence B, Spina N, Brodke D, Spiker WR. Software-Based Postoperative Communication With Patients Undergoing Spine Surgery. Global Spine J. 2019 Feb;9(1):14–17. doi: 10.1177/2192568217728047.
    1. Gunter RL, Fernandes-Taylor S, Rahman S, Awoyinka L, Bennett KM, Weber SM, Greenberg CC, Kent KC. Feasibility of an Image-Based Mobile Health Protocol for Postoperative Wound Monitoring. J Am Coll Surg. 2018 Mar;226(3):277–286. doi: 10.1016/j.jamcollsurg.2017.12.013.
    1. Gustavell T, Langius-Eklöf Ann, Wengström Yvonne, Segersvärd Ralf, Sundberg K. Development and Feasibility of an Interactive Smartphone App for Early Assessment and Management of Symptoms Following Pancreaticoduodenectomy. Cancer Nurs. 2019;42(3):E1–E10. doi: 10.1097/NCC.0000000000000584.
    1. Harder H, Holroyd P, Burkinshaw L, Watten P, Zammit C, Harris PR, Good A, Jenkins V. A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment. J Cancer Surviv. 2017 Dec;11(6):732–742. doi: 10.1007/s11764-017-0630-3.
    1. Higgins J, Semple J, Murnaghan L, Sharpe S, Theodoropoulos J. Mobile Web-Based Follow-up for Postoperative ACL Reconstruction: A Single-Center Experience. Orthop J Sports Med. 2017 Dec;5(12):2325967117745278. doi: 10.1177/2325967117745278.
    1. Highland KB, Tran J, Edwards H, Bedocs P, Suen J, Buckenmaier CC. Feasibility of App-Based Postsurgical Assessment of Pain, Pain Impact, and Regional Anesthesia Effects: A Pilot Randomized Controlled Trial. Pain Med. 2019 Aug 01;20(8):1592–1599. doi: 10.1093/pm/pny288.
    1. Khanwalkar AR, Shen J, Kern RC, Welch KC, Smith SS, Tan BK, Conley DB. Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2019 Apr;9(4):345–351. doi: 10.1002/alr.22273.
    1. Mata J, Pecorelli N, Kaneva P, Moldoveanu D, Gosselin-Tardiff A, Alhashemi M, Robitaille S, Balvardi S, Lee L, Stein BL, Liberman S, Charlebois P, Fiore JF, Feldman LS. A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial. Surg Endosc. 2020 Feb;34(2):742–751. doi: 10.1007/s00464-019-06823-w.
    1. Nilsson U, Dahlberg K, Jaensson M. The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study. JMIR Mhealth Uhealth. 2017 Dec 03;5(12):e188. doi: 10.2196/mhealth.9061.
    1. Pecorelli N, Fiore JF, Kaneva P, Somasundram A, Charlebois P, Liberman AS, Stein BL, Carli F, Feldman LS. An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability. Surg Endosc. 2018 May;32(5):2263–2273. doi: 10.1007/s00464-017-5920-3.
    1. Sousa CS, Turrini R. Development of an educational mobile application for patients submitted to orthognathic surgery. Rev Lat Am Enfermagem. 2019 Jul 18;27:e3143. doi: 10.1590/1518-8345.2904.3143.
    1. Sun T, Dunsmuir D, Miao I, Devoy GM, West NC, Görges Matthias, Lauder GR, Ansermino JM. In-hospital usability and feasibility evaluation of Panda, an app for the management of pain in children at home. Paediatr Anaesth. 2018 Oct;28(10):897–905. doi: 10.1111/pan.13471.
    1. Tsapepas DS, Salerno D, Jandovitz N, Hammad Sara, Jordan Patrick, Mohan Sumit, Hardy Mark, Kotchoubey Helen, Vawdrey David, Fleischut Peter M. Using technology to enhance medication regimen education after solid organ transplantation. Am J Health Syst Pharm. 2018 Dec 01;75(23):1930–1937. doi: 10.2146/ajhp170799.
    1. Scott AR, Alore EA, Naik AD, Berger DH, Suliburk JW. Mixed-Methods Analysis of Factors Impacting Use of a Postoperative mHealth App. JMIR Mhealth Uhealth. 2017 Feb 08;5(2):e11. doi: 10.2196/mhealth.6728.
    1. Warren-Stomberg M, Jacobsson J, Brattwall M, Jildenstål Pether. At-home monitoring after surgery/anaesthesia - a challenge. J Eval Clin Pract. 2016 Dec;22(6):882–886. doi: 10.1111/jep.12551.
    1. Debono B, Bousquet P, Sabatier P, Plas J, Lescure J, Hamel O. Postoperative monitoring with a mobile application after ambulatory lumbar discectomy: an effective tool for spine surgeons. Eur Spine J. 2016 Nov;25(11):3536–3542. doi: 10.1007/s00586-016-4680-4.
    1. Gunter R, Fernandes-Taylor S, Mahnke A, Awoyinka L, Schroeder C, Wiseman J, Sullivan S, Bennett K, Greenberg C, Kent KC. Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring. JMIR Mhealth Uhealth. 2016 Sep 28;4(3):e113. doi: 10.2196/mhealth.6023.
    1. Ponce BA, Brabston E, Zu S. Telemedicine with mobile devices and augmented reality for early postoperative care. 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC); Aug 16-20, 2016; Orlando, FL. 2016.
    1. Jiang Y, Sereika S, Dabbs Annette DeVito, Handler S, Schlenk E. Acceptance and Use of Mobile Technology for Health Self-Monitoring in Lung Transplant Recipients during the First Year Post-Transplantation. Appl Clin Inform. 2016;7(2):430–45. doi: 10.4338/ACI-2015-12-RA-0170.
    1. Chai YJ, Song J, Kang J, Woo J, Song R, Kwon H, Kim S, Choi JY, Lee KE. A comparative study of postoperative pain for open thyroidectomy versus bilateral axillo-breast approach robotic thyroidectomy using a self-reporting application for iPad. Ann Surg Treat Res. 2016 May;90(5):239–45. doi: 10.4174/astr.2016.90.5.239.
    1. Shellmer DA, Dew MA, Mazariegos G, DeVito Dabbs A. Development and field testing of Teen Pocket PATH(®), a mobile health application to improve medication adherence in adolescent solid organ recipients. Pediatr Transplant. 2016 Feb;20(1):130–40. doi: 10.1111/petr.12639.
    1. Sun T, West N, Ansermino JM, Montgomery CJ, Myers D, Dunsmuir D, Lauder GR, von Baeyer CL. A smartphone version of the Faces Pain Scale-Revised and the Color Analog Scale for postoperative pain assessment in children. Paediatr Anaesth. 2015 Dec;25(12):1264–73. doi: 10.1111/pan.12790.
    1. Jaensson M, Dahlberg K, Eriksson M, Grönlund Åke, Nilsson U. The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment. JMIR Mhealth Uhealth. 2015 Sep 11;3(3):e86. doi: 10.2196/mhealth.4649.
    1. Symer MM, Abelson JS, Milsom J, McClure B, Yeo HL. A Mobile Health Application to Track Patients After Gastrointestinal Surgery: Results from a Pilot Study. J Gastrointest Surg. 2017 Sep;21(9):1500–1505. doi: 10.1007/s11605-017-3482-2.
    1. Semple JL, Sharpe S, Murnaghan ML, Theodoropoulos J, Metcalfe KA. Using a mobile app for monitoring post-operative quality of recovery of patients at home: a feasibility study. JMIR Mhealth Uhealth. 2015 Feb 12;3(1):e18. doi: 10.2196/mhealth.3929.
    1. Bini S, Mahajan J. Clinical outcomes of remote asynchronous telerehabilitation are equivalent to traditional therapy following total knee arthroplasty: A randomized control study. J Telemed Telecare. 2017 Feb;23(2):239–247. doi: 10.1177/1357633X16634518.
    1. Smartwatch Market - Growth, Trends, Forecasts. Mordor Intelligence. [2020-01-28]. .
    1. Torous J, Firth J. The digital placebo effect: mobile mental health meets clinical psychiatry. Lancet Psychiatry. 2016 Feb;3(2):100–2. doi: 10.1016/S2215-0366(15)00565-9.
    1. Pham Q, Wiljer D, Cafazzo JA. Beyond the Randomized Controlled Trial: A Review of Alternatives in mHealth Clinical Trial Methods. JMIR Mhealth Uhealth. 2016 Sep 09;4(3):e107. doi: 10.2196/mhealth.5720.
    1. Zhou L, Bao J, Setiawan IMA, Saptono A, Parmanto B. The mHealth App Usability Questionnaire (MAUQ): Development and Validation Study. JMIR Mhealth Uhealth. 2019 Apr 11;7(4):e11500. doi: 10.2196/11500.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren