Mobile Health Apps for Systemic Lupus Erythematosus and Lupus Nephritis

A Critical Appraisal

Akshara Ramasamy; Poojitha Dugyala; Chandra Mohan

Disclosures

Arthritis Res Ther. 2022;24(110) 

In This Article

Results

Screening Results for SLE Apps

Of the 841 apps that were returned by our search, only 17 mHealth applications qualified for inclusion (Figure 1). The common reasons for the exclusion of apps were duplicates, irrelevance to the topic of this study, and lack of function. Within the 17 apps ultimately included, nine were found exclusively in Google Play, and eight were found in both Google Play and App Store. Lupus (SLE) and Lupus Diary, priced at $3.99 and $4.99, respectively, needed to be purchased. Of note, our iOS screening for the search term "SLE" did not yield any additional hits. Of the 17 apps, fourteen provided educational information about the disease, four allowed for tracking patient-reported symptoms, and three included discussion forums. App characteristics are discussed in detail in Table 1.

MARS Results

On a scale of 1–5, the mean (SD) MARS app quality score for all 17 apps included was 2.7 (± 0.4 SD) out of 5. The majority of the apps scored poorly on the basis of engagement and aesthetics but highly in functionality. As most apps only provided information about the disease with few opportunities for user engagement, the mean MARS engagement subscale score was 2.5 (± 0.5 SD). With most of the apps being straightforward and simple to use, apps scored high on the functionality aspect of the scale, receiving a MARS functionality subscale score of 3.5 (± 0.3 SD). The mean MARS aesthetics subscale score was 2.4 (± 0.6 SD) as most applications had poor visual designs, low-resolution images, and inconsistent styles. The vast majority of apps lacked credibility as the disease-related information provided on the app was not referenced or traceable to a credible information source or web page. Hence, they scored a mean MARS information subscale rating of 2.6 (± 0.5 SD). Table 2 details the individual and the overall mean MARS scores of each app.

Highest Scoring SLE Apps

Lupus Ohio, Lupie Diary, and Lupus Corner Health Manager were the three highest scoring SLE applications. The Lupus Ohio app was developed by the Lupus Foundation of America and designed for members of the Greater Ohio Chapter, but the app can be used by any SLE patient. The app provides lupus-related information with a high level of credibility. Users of the app could also look for support groups and reach out to a health expert for any personal questions. Lupie Diary helps patients make and maintain their medical records. Lupus Corner Health Manager allows patients to track their symptoms and offered an interactive online community with discussion forums. All three applications offered adequate levels of user engagement, visual appeal, and content.

Lupus Ohio (Overall MARS Score 3.03). Lupus Ohio is the official app of the Greater Ohio Chapter of the Lupus Foundation of America. This app provides patients with access to recent research articles and findings about lupus sourced from the website of the Lupus Foundation of America. As the research comes from a legitimate source, SLE patients are given credible information about the disease. The app allows patients to keep track of their medications and doctor visits. By reading the research updates, patients will have an idea of contemporary research and emerging therapies on the horizon. Users are given the opportunity to ask questions about their condition to a health educator through the organization's website. As SLE can take an emotional toll on patients, healthcare providers may utilize this app by referring patients to the support groups offered by the organization. This app could be further optimized by including features for monitoring lupus-related symptoms and a medication reminder system to help with patient adherence to their treatments.

Lupie Diary (Overall MARS Score 3.02). Lupie Diary app was developed to assist SLE patients store medical records, monitor medications, and record treatment plans received from their physicians. Since patients commonly access multiple care providers across different disciplines, and sometimes even across different hospitals, having ready access to one's detailed medical history on the phone will quickly provide physicians with the patient's comprehensive health status and medication history. Other functionalities include medication reminders and self-management tips sourced from credible sites. The app also provides basic information about SLE drawn from the Lupus Foundation of America. However, this app could be further optimized by offering recent news about lupus, doctor's appointment reminders, and including features for lupus-related symptom tracking.

Lupus Corner Health Manager (Overall MARS Score 2.96). By answering four questions on a 5-level scale, users can track their energy and general symptoms such as discomfort, fatigue, or pain. Users can also report side effects and the severity of their symptoms. The app also provides a scheduled medication reminder system. Users may also participate in an online discussion forum within the app, where they can seek support, ask questions, and get answers from other users through comments. The app also includes the latest news regarding SLE and alerts the user when new articles are published. This app could be further optimized by including features for communication with a healthcare expert in the field or patient-centered feedback based on the survey responses of users. Of note, none of the above apps allowed patients to monitor their renal disease status, either based on symptoms or based on point-of-care tests.

Screening Results for LN apps

Our search yielded 1152 apps, and only two were ultimately included (Figure 2). The majority of the apps were excluded because they were not designed for LN patients and were irrelevant to the purpose of this study. Within the two apps that were included, Glomerulonephritis Disease was found solely in the Google Play Store and KidneyWell was found on both app stores. Of the two apps, Glomerulonephritis Disease provided educational content and KidneyWell offered telehealth services. Of note, KidneyWell is no longer available on both app stores. However, those that had downloaded the app prior to removal are still able to use it. App characteristics are further discussed in detail in Table 3.

KidneyWell (Overall MARS Rating 2.76). The KidneyWell app allows individuals diagnosed with kidney illness or disorders to meet virtually with renal specialists from a private setting, using a HIPAA-secure connection. The app offers credibility to patients as it was created the Dallas Nephrology Associates. Although this app is useful in a clinical setting by offering virtual appointments with a physician, the app does not provide any information about LN or allow for other types of patient engagement. Although this app is not designed specifically for patients with LN, we included it as LN patients could potentially use it for consultation purposes.

Glomerulonephritis Disease (Overall MARS Rating 2.28). The Glomerulonephritis Disease app presented educational information about the condition. In addition to providing an overview of the disease, the app listed the common symptoms associated with LN and offered information about the diagnosis of the disease. The app also explained the differences between proliferative and non-proliferative glomerulonephritis. The information was not referenced to a legitimate source.

MARS Results

The mean (SD) MARS app quality score for the two apps included was 2.6 (± 0.4 SD) out of a maximum score of 5. The Glomerulonephritis Disease app scored the lowest in the sections of engagement and aesthetics. The KidneyWell app scored poorly in the engagement and information sections. The mean MARS engagement subscale score was 2.2 (± 0.5 SD) as opportunities for user engagement were very limited for both apps. Both apps scored high on the functionality section, receiving a MARS functionality subscale score of 3.5 (± 0.2 SD). The mean MARS aesthetics subscale score was 2.2 (± 0.7 SD), with KidneyWell offering a more pleasant visual appeal than Glomerulonephritis Disease. As Glomerulonephritis Disease came from a questionable source, KidneyWell had a higher information rating with both apps scoring a mean MARS information subscale rating of 2.4 (± 0.1 SD). Individual and overall mean MARS ratings for the two apps are shown in Table 4.

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