Evaluation of temporomandibular disorder self-management apps in Australia: A systematic review to inform clinical use.

Abstract

Background: This study aimed to systematically evaluate apps with temporomandibular disorder (TMD) self-management content available in Australia for quality, clinical safety, self-management support functions, and contributors to app development.

Methods: A systematic search of the App Store (iOS) and Google Play (Android) was conducted on 18 April 2023 (and updated 26 July 2023) to identify apps that had TMD self-management content. Two raters independently assessed app quality, clinical safety, self-management support, and contributors to app development for the involvement of people living with TMD and clinicians. Quality was evaluated using the Mobile App Rating Scale (MARS) for engagement, functionality, aesthetics, and information quality scored using a 5-point Likert scale. App clinical safety was assessed using MARS functionality (item 6) and information quality items for accuracy/relevance (item 15), scope (item 16), and visual information accuracy/clarity (item 17) (scored on a Likert scale), and the M-Health Index and Navigation Database framework questions: does the app provide any warning for use? Does the app have a crisis management feature? Can the app cause harm? (scored yes/no). Self-management support was evaluated using the Self-Management Support (SMS-14) checklist (scored yes/no). Included apps, app store descriptions and linked websites were qualitatively evaluated to determine the contributors to app development.

Results: Seven apps with TMD self-management content were available in Australia. Overall, the included apps were of acceptable quality (mean=3.25/5) but scored poorly for engagement (2.71/5) and information (2.92/5). Clinical safety limitations identified were the inability to identify and/or direct users to support services in a crisis and inconsistent TMD information. One app (Do I Grind or Snore) was deemed potentially harmful as sleep sounds suggestive of obstructive sleep apnoea were interpreted as snoring by the app. Overall, the inclusion of self-management support functions was variable (range 1-9; mean=4.71/14), with pain/TMD education (71%) and self-monitoring (71%) the most common. Only one app had development input from a person with lived experience of TMD.

Conclusion: The quality and self-management support of apps with TMD self-management content is variable. TMD apps with activating self-management strategies and higher engagement scores are more likely to be effective. Concerningly, one app was found to be potentially harmful, and overall apps lacked user safeguards. Only one app involved a person with TMD in its development, and the authors recommend using co-design in future TMD app development to improve app quality, clinical safety and impact.