Availability, Quality, and Evidence-Based Content of mHealth Apps for the Treatment of Nonspecific Low Back Pain in the German Language: Systematic Assessment

Abstract

Background Nonspecific low back pain (NSLBP) carries significant socioeconomic relevance and leads to substantial difficulties for those who are affected by it. The effectiveness of app-based treatments has been confirmed, and clinicians are recommended to use such interventions. As 88.8% of the German population uses smartphones, apps could support therapy. The available apps in mobile app stores are poorly regulated, and their quality can vary. Overviews of the availability and quality of mobile apps for Australia, Great Britain, and Spain have been compiled, but this has not yet been done for Germany. Objective We aimed to provide an overview of the availability and content-related quality of apps for the treatment of NSLBP in the German language. Methods A systematic search for apps on iOS and Android was conducted on July 6, 2022, in the Apple App Store and Google Play Store. The inclusion and exclusion criteria were defined before the search. Apps in the German language that were available in both stores were eligible. To check for evidence, the apps found were assessed using checklists based on the German national guideline for NSLBP and the British equivalent of the National Institute for Health and Care Excellence. The quality of the apps was measured using the Mobile Application Rating Scale. To control potential inaccuracies, a second reviewer resurveyed the outcomes for 30% (3/8) of the apps and checked the inclusion and exclusion criteria for these apps. The outcomes, measured using the assessment tools, are presented in tables with descriptive statistics. Furthermore, the characteristics of the included apps were summarized. Results In total, 8 apps were included for assessment. Features provided with different frequencies were exercise tracking of prefabricated or adaptable workout programs, educational aspects, artificial intelligence–based therapy or workout programs, and motion detection. All apps met some recommendations by the German national guideline and used forms of exercises as recommended by the National Institute for Health and Care Excellence guideline. The mean value of items rated as “Yes” was 5.75 (SD 2.71) out of 16. The best-rated app received an answer of “Yes” for 11 items. The mean Mobile Application Rating Scale quality score was 3.61 (SD 0.55). The highest mean score was obtained in “Section B–Functionality” (mean 3.81, SD 0.54). Conclusions Available apps in the German language meet guideline recommendations and are mostly of acceptable or good quality. Their use as a therapy supplement could help promote the implementation of home-based exercise protocols. A new assessment tool to obtain ratings on apps for the treatment of NSLBP, combining aspects of quality and evidence-based best practices, could be useful. Trial Registration Open Science Framework Registries sq435; https://osf.io/sq435

Assessing the accessibility and quality of mobile health applications for the treatment of obesity in the German healthcare market

“…This additional dimension as well as the subjective quality of the app are not included in the overall mean score ( 31 , 32 ). The MARS-G tool showed similar interrater reliability (ICC = 0.83) as the MARS tool (ICC = 0.84) and proved a good internal consistency ( ω = 0.82) ( 28 ). The raters (PMS and LK) trained using the MARS-G tool according to a training video ( 33 ).…”

“…The two reviewers (PMS and LK) discussed uncertainties regarding the reviewed applications, and if they could not agree, the third reviewer (SAMM) was consulted to reach a consensus. The assessment was methodically adapted from similar studies ( 28 , 29 , 30 ).…”

The Efficacy of the Smartphone App for the Self-Management of Low Back Pain: A Systematic Review and Assessment of Their Quality through the Mobile Application Rating Scale (MARS) in Italy

“…Additionally, the absence of data regarding patients’ acceptance of mHealth apps for LBP self-management, as well as details regarding the intensity and frequency of app usage, further restricts the generalizability of our findings. Furthermore, it is worth noting a significant limitation in the assessment using MARS, as highlighted in a study on mHealth Apps conducted in the German language [ 30 ]. These apps are primarily judged based on acceptable or good quality, despite recent findings indicating otherwise [ 31 ].…”