By Evert Verhagen @EvertVerhagen

 Last week I stumbled upon the following blogpost on mhealthwatch.com, — “Mobile Apps for Ankle Sprains? Not Yet… or Ever” [1]. My interest was sparked as the title of the blog suggested there are no apps for ankle sprains available, or at least no proper apps. According to the blog, apps to treat and prevent ankle sprains are the most searched for apps. Yet, the blog (and who can trust blogs!) said that ‘legitimate’ apps that can benefit patients were lacking. As you may know, we developed the ‘Ankle App’ (with support from BJSM), by which we digitized a set of exercises that prevent ankle sprain recurrences [2,3]. So then why did this blog state that therew were no decent Apps? Reading on,  I found two answers to this question.

State of play – what apps are out there?

First, there was no mention of the Ankle App in the blog. Likely, this is our own fault — we may not promote the app sufficiently (although we did tell you where to get it on this previous BJSM blog). Naturally we think our app as being of good quality and one of the few that provides the user with evidence based content. Yet, providing a high quality product is not enough to translate an effective program to the public. An app has more value than the application for the end user; i.e. users don’t care much about any technology that sits in the back end, they just want something that is easy to view, press and swipe. That is why – when you truly look with a professional perspective at what is available – the quality of available apps is very low.

I agree with the mhealthwatch blog’s statement that “practical apps that could do any legitimate good for ankle sprain patients are almost entirely lacking altogether”. We performed a review on this topic [4], and recently another review came out in the BJSM on concussion Apps [5]. Both reviews concluded that “the surge in availability of apps in an unregulated market raises concerns as to the appropriateness of their content for different groups of end users” [5]. In short – between the lines -most apps are just built for the sake of building apps. That is not the way to go forward, especially not when it concerns topics around athletes’ health. We need to start developing more user friendly apps around our evidence to provide users with high quality and appealing solutions.

There’s an App for that?

Secondly, and again I agree with the blog’s message, there is a general misconception that there’s an app for everything. I have always been skeptical about the current trends for the application of technology in healthcare in which a professional positions technology as a replacement for hands-on care. Technology should support healthcare! That’s why we developed the Ankle App — to support the professional to provide the best available care. However, in regards to ankle sprains the blog says it is not worth the effort to download an app offering basic ‘preventive’ advice. I disagree with this. The blog the author points towards contains  preventive advice given on the Wasatch Foot and Ankle clinic website [6]: “To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercising, stretching, and wearing well-fitted shoes.” Ironically, this advice is not fully evidence based in itself as there is no conclusive evidence that shoes or stretching are effective factors in the prevention of ankle sprains [7]. Research has proven the need for neuromuscular exercises after an ankle sprain [7,8], but has also indicated that patients’ compliance with exercises is low [9]. Thus, the outcomes of an effective treatment are diluted. The Ankle App has been specifically designed for the professional to provide patients an interactive and evidence based exercise scheme, boosting compliance and improving clinical outcomes.

Mobile Apps for Ankle Sprains? Yes, they exist and provide benefits! And I would even argue this goes further than ankle sprains alone. Apps provide a valuable platform to support the dissemination of preventive research knowledge to the field.

Listen to more about this app, on the BJSM podcast where Evert Verhagen makes social media and apps intelligible.

References

[1] Essany M. Mobile Apps for Ankle Sprains? Not Yet… or Ever. http://mhealthwatch.com/mobile-apps-for-ankle-sprains-not-yet-or-ever-24411/. Accessed 11/11/14

[2] https://itunes.apple.com/nl/app/ankle/id504536557?mt=8. Accessed 11/11/14

[3] https://play.google.com/store/apps/details?id=com.swigle.Ankle. Accessed 11/11/14

[4] van Mechelen DM, van Mechelen W, Verhagen E. Sports injury prevention in your pocket?! Prevention apps assessed against the available scientific evidence: a review. Br J Sports Med. 2014 Jun;48(11):878–82.

[5] Lee H, Sullivan SJ, Schneiders AG, et al. Smartphone and tablet apps for concussion road warriors (team clinicians): a systematic review for practical users. Br J Sports Med. 2014:bjsports–2013–092930.

[6] http://www.wasatchfai.com. Accessed 11/11/14

[7] Verhagen E, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010 Dec;44(15):1082–8.

[8] Hupperets MDW, Verhagen E, van Mechelen W. Effect of sensorimotor training on morphological, neurophysiological and functional characteristics of the ankle: a critical review. 2009;39(7):591–605.

[9] Verhagen E, Hupperets MDW, Finch CF, et al. The impact of adherence on sports injury prevention effect estimates in randomised controlled trials: looking beyond the CONSORT statement. J Sci Med Sport. 2011 Jul;14(4):287–92.

[10] Fortington LV, Donaldson A, Lathlean T, et al. When “just doing it” is not enough: Assessing the fidelity of player performance of an injury prevention exercise program. J Sci Med Sport. 2014 May 16.