Injury prevention apps: Are they making substantiated claims?

Staying injury-free is an important piece to living a healthy, ongoing and active lifestyle. While taking part in physical activity always puts you at greater risk of injury, research in the past two decades has helped us better understand measures we can take to both better prevent and treat injuries, potentially decreasing some of the risk involved  in physical activity; if that research can be communicated to the public effectively.

The rise in use of smartphones and apps in recent years has offered a new, engaging and direct way to communicate research with the public. Recently, researchers from VU University Medical Center wanted to check up on some of these apps, to see what kind of messages they were relaying to the public. Specifically, they wanted to know if apps that delivered injury prevention messages were backed by existing evidence to see:

  • if research was being put to use
  • if apps were providing reliable information

Methods

The researchers only looked at iPhone and iPad apps. They searched the iTunes Store on 31 October 2012, looking for apps that pertained to injury, prevention and rehabilitation. They sifted through 482 apps that came up in a keyword search, and of those, found 18 apps that met inclusion criteria.

App content was reviewed by the lead author of the study. For each claim, the author searched Cochrane reviews to see if claims were met by findings in a current Cochrane review. If not, other systematic reviews were sought through PubMed, followed by randomized controlled trials if other systematic reviews were not found.

Results

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The researchers found that the overwhelming majority of apps were making claims not backed by current evidence.

Of the 18 apps, only 4 apps made claims that were backed by existing evidence. These apps included:

  • ‘Ankle’ provided advice for neuromuscular training to prevent ankle sprains, which is backed by current evidence.
  • ‘Elastoplast’ recommended use of a mouth guard to prevent dental injury, which is backed by current evidence. The app also recommended taping ankles for previously injured ankles, which is backed by current evidence. However, the app also recommended taping the knee to prevent MCL sprains, a claim for which no evidence exists.
  • ‘iPrevent ACL injuries’ recommended a routine to prevent ACL injury, a routine including warmup, stretching, strengthening, plyometrics and agility. This specific routine has been proven to reduce ACL injuries.
  • ‘Medical iRehab Anklesprain’ also recommended ankle taping for previously injured ankles, which is backed by current evidence. However, this app also made claims on proper shoes and stretching in injury prevention, in which no evidence exists for.

So what apps made non-evidence-based claims?

  • Four other ‘Medical iRehab’ apps.
  • Five apps specific for running: ‘iPrevent Running injuries,’ ‘Kangarun,’ ‘Run Injury Free,’ ‘Runners Injuries: Prevention and treatment,’ and ‘Run Walk’
  • Five other apps: ‘Foam rolling,’ ‘Iron Kids,’ ‘How to end DOMS,’ ‘Motion Doctor,’ and ‘UPMC5 tool trainer’

Conclusions

The authors concluded,

“Our main finding is that only four out of 18 apps contained evidence-based statements…Overall it can be concluded that there is a dearth of evidence-based apps on the prevention of sports and physical activity-related injuries.”

Discussion

Currently, developers build apps with commercial interest. They make money by either selling the app for a price or by general advertising or the advertising of specific goods within the app. Their ability to make money selling the app largely depends on how useful and how usable the app is.

Users likely don’t purchase apps or deem an app usable based on whether the app is making evidence-based claims. Thus, for the being, it is up to app developers to understand evidence-based medicine, make claims with perspective and not overstate or make unsubstantiated claims.

In the future, it may be worth developing an “evidence-based” seal of approval, to let users know which apps are backed by current research and which are not. Apps should not only be usable and well-designed, but they should also provide reliable information. For now, apps for injury prevention are only holding up on one-side of this equation.

Link

van Mechelen DM, van Mechelen W, Verhagen EALM. Sports injury prevention in your pocket?! Prevention apps assessed against the available scientific evidence: a review. Br J Sports Med Published Online First: March 19, 2013 doi:10.1136/bjsports-2012-092136