Clinical effectiveness, feasibility, acceptability, and usability of mobile health applications for epilepsy: A systematic review

Abstract

Mobile applications are widely used in epilepsy, although their impact on clinical effectiveness (CE) and their feasibility, acceptability, and usability (FAU) remain unclear. We conducted a systematic review investigating CE and FAU of epilepsy mobile applications using MEDLINE and Embase from database inception to June 21, 2024. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. The protocol was registered on PROSPERO (CRD42019134848). In duplicate, we determined study quality using the Newcastle–Ottawa Quality Assessment Scale (NOQAS) and the Joanna Briggs Critical Appraisal Checklist (to determine eligibility for inclusion), risk of bias using the Cochrane Risk of Bias tool, and usability study quality using the 15-point Silva scale. We identified 8953 studies, of which 20 were included. Twelve (60.0%) addressed CE, nine (45.0%) acceptability, five (25.0%) usability, and eight (40.0%) feasibility. Five (25.0%) evaluated CE and FAU. Studies comprised prospective cohort (n = 9, 45.0%), pilot (n = 3, 15.0%), randomized controlled trial (n = 7, 35.0%), and pre/post (n = 1, 5.0%) designs. Most apps were used for self-management or to enhance education or communication between patients and providers. Cohort studies demonstrated fair quality (median NOQAS score = 5, interquartile range [IQR] = 5.0–5.8), whereas of seven randomized controlled trials, four (57.1%) had some concern for bias. Usability studies demonstrated high quality (median Silva score = 10, IQR = 10–11). Apps were predominantly intended for patient use (n = 9, 75.0%). Symptom reporting and medication management were the most common app targets in both CE and FAU studies (n = 8, 66.7%; n = 9, 69.2%), although FAU studies more frequently used monitoring or tracking (n = 10, 76.9%) and reminder setting (n = 10, 76.9%) than CE apps (n = 7, 58.3%). Investigations of application use most commonly studied CE and patient-facing apps. Additional high-quality evidence is necessary to evaluate the CE and FAU of app use in epilepsy to work toward the standardization of FAU metrics and development of implementation guidelines.