An evidence-based evaluation of mobile health apps for the management of individuals with lateral elbow tendinopathy using a systematic review framework

Abstract

Background

Better access to evidence-based health information via mobile health apps could assist in information sharing, screening for severity/triage, and improving early intervention for individuals with lateral elbow tendinopathy (LET).

Objectives

To use a systematic review framework to identify and appraise the utility and quality of mobile health apps for the management of individuals with LET.

Methods

Apple iTunes and Google Play stores were searched using key words. Mobile health apps providing information related to the signs and symptoms, pathophysiology, and management of LET were included. The quality of the included apps was appraised by two reviewers using using the Mobile Application Rating Scale (MARS). Narrative synthesis was used to describe the key information from the included apps and compare the information presented to that of current evidence-based practice.

Major Findings

Seven mobile health apps were included in this review. The mean score for the MARS quality appraisal was 2.5 out of 5 (range 2.0–4.2), with apps scoring poorly in engagement, information, and the subjective scoring subsections. No apps were validated or used as a part of a clinical trial. Of the 37 individually recommended interventions only eight (22%) were supported by empirical evidence. No apps screened individuals for condition severity or used patient inputted data for individualisation of information.

Conclusion

A majority of currently available health apps for LET lack empirical evidence to support the information they provide. Future apps could include a data collection and screening process to help guide appropriate management.

Keywords:

• Lateral epicondylalgia
• tennis elbow
• iPhone
• iPad
• android
• mobile applications

Acknowledgements

Apps were self-funded by the first author.

Declaration of interest statement

The authors declare no competing interests, financial or otherwise.

Additional information

Notes on contributors

Luke J. Heales

Luke Heales is a Senior Lecturer in Musculoskeletal Physiotherapy at Central Queensland University, in Rockhampton Australia. He holds a Bachelor of Health Science (Physiotherapy), a Doctor of Philosophy, and a Postgraduate Certificate in Tertiary Education. Since graduating, Luke has worked as a musculoskeletal physiotherapist in private practice and with various sub-elite sporting clubs, before embarking on his academic career. His research work focuses on lateral elbow tendinopathy and includes clinical trials investigating isometric exercise, as well as various measures of motor control during gripping. In his spare time, Luke works with local clinicians to improve their research knowledge and has gained experience in quantitative and qualitative research methodologies.

Samantha Randall

Mrs Samantha Randall is an Associate Lecturer and Clinical Supervisor in Musculoskeletal Physiotherapy at Central Queensland University, in Rockhampton Australia. She has a Graduate Certificate in Tertiary Education from Central Queensland University, a Masters of Physiotherapy Studies from the University of Queensland, and a Bachelor of Human Movement Science majoring in Exercise Science from Central Queensland University. Since graduating, Samantha has worked as a musculoskeletal physiotherapist in private practice, hospitals, and with various sub-elite sporting clubs in addition to providing academic teaching, and clinical supervision of undergraduate physiotherapy students on clinical placement. Expertise is held in the assessment, clinical diagnosis, and treatment of musculoskeletal pathologies, with clinical interests in injury prevention and animal physiotherapy.

Bill Vicenzino

Bill Vicenzino holds a Chair in Sports Physiotherapy, is the Director of the Masters of Physiotherapy (Musculoskeletal and Sports) program, and is the Director of the Sports Injuries Rehabilitation and Prevention for Health research Unit at the University of Queensland, in Brisbane, Australia. Bill completed his Bachelor of Physiotherapy (1980) at the University of Queensland, where he also obtained his Doctor of Philosophy (2000). He completed his Graduate Diploma in Sports Physiotherapy (Distinction, 1984) and Master of Science (1992) at Curtin University, Perth, Western Australia. Bill's research focusses on physical interventions for musculoskeletal pain and injury. His main focus is on conditions that tend towards persistence, such as tendinopathy of the elbow, hip, knee, and heel; knee cap pain (patellofemoral pain); and ankle injuries. Bill has advised 32 PhD and 2 MPhil students to graduation since 2000 and has over 400 publications relating to his research and teaching subject areas. Some of his more popular work is in the use of corticosteroid injections or physiotherapy in some persistent tendinopathies.

Brooke K. Coombes

Brooke Coombes is a Musculoskeletal Physiotherapist, lecturer in Physiotherapy at Griffith University and active research member of the Musculoskeletal Health & Persistent Pain Research Group. Brooke holds a Bachelor of Physiotherapy, a Masters of Physiotherapy, and a Doctor of Philosophy. She has published > 40 peer reviewed papers, with >1100 citations since 2009. Her work includes clinical trials investigating the clinical efficacy of corticosteroid injections, isometric exercise and online education approaches for various tendinopathies. Using quantitative sensory testing and ultrasound elastography she has gained valuable insight into the effects of tendinopathy, ageing and other diseases including diabetes on pain processing and mechanical properties of tendon. She uses a biopsychosocial approach to identify and tailor treatments to individuals with persistent pain to reduce pain and disability and improve quality of life.

Steven Obst

Steven Obst is a Senior Lecturer in musculoskeletal physiotherapy within the School of Health, Medical and Applied Sciences, Central Queensland University. He holds a Bachelor of Physiotherapy, Bachelor of Exercise and Sports Science, Bachelor of Human Movement Science, and a Doctor of Philosophy. His research has led to the development and validation of novel ultrasound methods to assess muscle and tendon structure, function, and adaptation in vivo. Steven's research focuses on understanding how muscle and tendon tissue adapts to injury, disease, and rehabilitation.