A Framework Analysis Evaluating Bladder Diary Apps for Clinical Use

Objectives: Bladder diaries, recommended for use in clinical guidelines, are now becoming available in the form of Apps for self-completion. However, previous studies have identified that health related Apps tend to have unappealing layouts, lack of navigation ease, and have sub optimal content. The study is a formal framework analysis review of application-based electronic bladder diaries for tracking lower urinary tract symptoms (LUTS) to evaluate their suitability for clinical decision making.

Methods: An online search identified English language bladder diary Apps. This framework analysis assessed the domains of: accuracy, functionality, and features using a modified version of the validated APPLICATIONS Scoring System used for App evaluation. The searched used a combination of the terms: bladder, voiding, tracker, diary, incontinence. The APPLICATIONS system scores points for defined parameters including accuracy, comprehensiveness, subjective presentation, navigation ease, and security to provide a score from 0-19 (Table 1). Apps were assessed by 4 independent reviewers and scores were averaged.

Results: 10 English-language Apps with the ability to track for 3 or more days were identified (Table 2). Apps were anonymized. 90% were freely available. All Apps scored poorly. The two Apps with the highest scores had 9.75/19. The mean score was 7.6 (range 9.75 - 5.25). Identified deficiencies were: Only 20% had health professional oversight; 10% had literature cited; 3 had health education incorporated, and 1 included a medical disclaimer. Importantly, the data security domain frequently did not meet current recommendations for health data collection and transfer. For example, in half of the Apps, no password or personal security identifier was required, allowing any person to open, enter or change health data.

Conclusions: The majority of bladder tracking Apps are unsuited to clinical use based on low scores using the modified APPLICATIONS scoring system, with most applications being poorly designed, and lacking important domains. Our findings provide actionable changes that can be incorporated into future App development to meet patient demand for this form of data collection while conforming to clinical guidelines. This will enable Apps to be of higher quality and maximise their utility for diagnosis and management of LUTS.