Quality of Psychoeducational Apps for Military Members With Mild Traumatic Brain Injury: An Evaluation Utilizing the Mobile Application Rating Scale

Abstract

Background Military personnel have an elevated risk of sustaining mild traumatic brain injuries (mTBI) and postconcussion symptoms (PCS). Smartphone apps that provide psychoeducation may assist those with mTBI or PCS to overcome unique barriers that military personnel experience with stigma and access to health care resources. Objective This study aims to (1) use the Mobile Application Rating Scale (MARS) to evaluate smartphone apps purporting to provide psychoeducation for those who have sustained an mTBI or a PCS; (2) explore the relevance, utility, and effectiveness of these apps in facilitating symptom management and overall recovery from mTBI and PCS among military personnel; and (3) discuss considerations pertinent to health care professionals and patients with mTBI when considering the use of mobile health (mHealth), including apps for mTBI psychoeducation. Methods A five-step systematic search for smartphone apps for military members with mTBI or PCS was conducted on January 31, 2020. Cost-free apps meeting the inclusion criteria were evaluated using the MARS and compared with evidence-based best practice management protocols for mTBI and PCS. Results The search yielded a total of 347 smartphone apps. After applying the inclusion and exclusion criteria, 13 apps were subjected to evaluation. Two apps were endorsed by the US Department of Veterans Affairs and the US Department of Defense; all the others (n=11) were developed for civilians. When compared with evidence-based best practice resources, the apps provided various levels of psychoeducational content. There are multiple considerations that health care professionals and those who sustain an mTBI or a PCS have to consider when choosing to use mHealth and selecting a specific app for mTBI psychoeducation. These may include factors such as the app platform, developer, internet requirement, cost, frequency of updates, language, additional features, acknowledgment of mental health, accessibility, military specificity, and privacy and security of data. Conclusions Psychoeducational interventions have a good evidence base as a treatment for mTBI and PCS. The use of apps for this purpose may be clinically effective, cost-effective, confidential, user friendly, and accessible. However, more research is needed to explore the effectiveness, usability, safety, security, and accessibility of apps designed for mTBI management.

Mobile Applications for Advance Care Planning: A Comprehensive Review of Features, Quality, Content, and Readability

“…Furthermore, given the range of available guidelines for mHealth technology development, the design of apps included in our review was unexpectedly poor. However, our findings are consistent with other mHealth research 27 suggesting that app design quality and content are not perfectly correlated and therefore raise important questions about barriers (e.g., cost 28 ) that may preclude apps from performing well in both domains. Among the problems we encountered were broken links, typos, fillable forms that did not fill correctly, inconsistent swipe functions across pages, and non-zoomable screens.…”

Identification and Evaluation of Methodologies to Assess the Quality of Mobile Health Apps in High-, Low-, and Middle-Income Countries: Rapid Review

“…It was used in 38% (15/39) of papers as the sole means of quality evaluation [ 45 - 49 , 52 , 57 , 69 - 71 , 73 - 76 , 78 , 79 ]. MARS was also used in an additional 23% of papers along with other methodologies, such as clinical guidelines [ 46 , 55 , 56 , 58 , 65 , 67 , 68 , 77 , 81 ]. The breakdown of methodologies and the frequency of their use can be viewed in Table 3 .…”

Technology Acceptance and Usability of the BrainFx SCREEN in Canadian Military Members and Veterans With Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: Mixed Methods UTAUT Study

“…Some of the qualitative responses indicated that participants felt this tool was for the purpose of improving their cognition or a brain game. This may be due to the myriad of tablet-based apps currently on the market being advertised as mHealth tools, despite limited evidence of their efficacy for improving cognitive status [ 24 ]. It is also possible that some participants experienced cognitive impairment that hindered their ability to fully comprehend the instructions and explanations.…”

“…Regardless of the potential differences in the relationship between the user and technology in a military context, the use of eHealth and mobile health (mHealth) innovations is becoming widespread within military and veteran populations [ 24 , 25 ]. This has been amplified by the recent COVID-19 pandemic when virtual health solutions have become increasingly common in all health care practices, including those in military environments.…”