JMIR Publications

ABSTRACT

Background:

Mobile health interventions delivered through mobile applications (apps), are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimise the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite its importance, behavior change strategies are often missing in patient management. Evaluating mobile applications that physiotherapists can employ to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps, and exploring their key features that can support behaviour change and physiotherapy care, are important aspects of such an evaluation.

Objective:

The primary aim of the present study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs and their behavior change potential.

Methods:

A systematic review of mobile apps in app stores was undertaken. The Apple Store and Google Play were searched using a two-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion/exclusion criteria were applied: apps had to be intended for use by patients, and be self-contained (or, stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1 (BCTTv1). App quality was assessed using the Mobile Application Rating Scale (MARS) and the App Behavior Change Scale (ABACUS) was used to assess the app’s potential to change behavior.

Results:

1240 apps were screened, and 35 were included. Of these apps, 22/35 (63%) were available on both Apple App Store and Google Play platforms. 24/35 (69%) were general in their focus (e.g. not condition specific), with the remaining 11/35 (31%) being more specific (e.g. knee rehabilitation, pelvic floor training). Mean app quality score (MARS) was 3.7 (SD 0.4) out of 5 (range: 2.8 to 4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were: Instruction on how to perform a behavior (32/35 apps), action planning (30/35), and self-monitoring of behavior (28/35). Mean behavior change potential score (ABACUS) was 8.5 (SD 3.1) out of 21 (range: 3-15).

Conclusions:

Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, potential for behavior change varied widely across apps.