With the growing number of medical apps continuously being released and the growth of digital health, various disciplines of medicine have completed comprehensive literature reviews to evaluate the use of smartphones and apps for specific diseases and areas of medicine. In fact, we recently wrote a review on a literature review on OB/GYN related apps.
There are over 600 surgery related apps that are available for download on various smartphone and tablet devices, yet, until recently, there has not been a literature review for the use of smartphones and apps in the surgical field.
Mobasheri et al. used a database search of Embase, MEDLINE, Health Management Informatics Consortium and PsychINFO to systematically review studies evaluating smartphones and apps used in surgical fields.
After the screening process, 39 studies evaluating a single smartphone or tablet based intervention were included. The apps targeted over 10 different surgical specialties, the most common being orthopedics, general surgery and ENT. The variety of interventions evaluated by the studies were categorized into 8 different types including:
- Operative navigation
- Operative planning
- Data collection
- Patient education
- Behavior change
This literature review displays the diversity of apps currently available in the surgical field. Surgical apps have been developed for numerous purposes as seen with the 8 categories evaluated by this study. Surgical apps are available to use in the preoperative time period to aid with diagnosis, educate patients and operative planning. In the intra-operative period, apps have been used for telemonitoring and surgical navigation. Apps have also been used to monitor patients post-operatively and for surgical training.
Although, this study shows the vast implications for apps in surgical fields, many of the results from the studies should be evaluated with caution. It was noted that many studies evaluating surgical apps did not include representative control groups. For example, some studies compared the use of surgical apps for diagnosis to gold-standard techniques in healthy patients only. Although, the results of those studied showed that apps were effective modalities to use for diagnosis, it is difficult to extrapolate if the apps would be useful in patients who had abnormal results. A study that evaluated an app called iGoniometer, compared joint angles in healthy patients using the smartphone app compared to a long-arm goniometer. The results did not account for the difficulty in measuring joint angles in patients with pathology or obese patients.
Numerous studies also compared surgical apps to non-gold standard techniques making it difficult to evaluate if smartphone apps in those studies are actually an effective alternative. For example, a study compared smartphone app measurements to protractor measurements of spinal angles, even though computer software has already been shown to be more accurate than protractors. Other studies also measured outcomes based on subjective, rather than objective results. Of the 39 studies, only one randomized control study was identified. In addition, of the 39 studies, only 7 received > 0.8 for their quality assessment score when evaluated by quality checklists from the Alberta Heritage Foundation for Medical Research. This shows us that most studies had low quality assessment scores.
In a world with a growing number of apps with so many uses as demonstrated by this review, it is important that surgeons stay up to date with the evidence related to the use of smartphone apps. This study also showed that, with over 600 surgical apps, there is still a very limited number of quality studies evaluating them. There is clearly a need for more rigorous research to be done on the effectiveness of these apps. In addition, the quality of research involving these apps needs to improve and more randomized controlled trials need to be conducted to provide accurate data and evaluations of these apps.
Source: Mobasheri MH, Johnston M, Syed UM, King D, Darzi A. The uses of smartphones and tablet devices in surgery: A systematic review of the literature. Surgery. 2015;