Evert Verhagen

Department of Public and Occupational HealthEMGO+ Institute for Health and Care Research

VU University Medical Center Amsterdam, Netherlands

Australian Centre for Research into Injury in Sport and its Prevention (ACRISP)Federation University Australia, Ballarat (VIC) Australia

Mobile apps for sports injury prevention and treatment

an essential tool in team physicians’ and players’ pockets?!

CONFLICT DISCLOSURE INFORMATION

Developer of Ankle app, which is a not-for-profit application. I do not

benefit financially from the sale of this product.

I have no relevant financial or nonfinancial relationships in any of the

other products or services described, reviewed, evaluated or

compared in this presentation.

80% of the world’s populationhas a cellphone

There are a total of 7.4 billion activecellphones in the world

Of all cellphones 1.6 billion are smartphones

There are more phones in use than

the globalpopulation

Apple

1% ZTE

5%

5%

5%

5%

5%

1%

HTC

Nokia

RIM

Samsung

Other

20%

14%

5%

4%

27%

Nokiafeature

Samsungfeature

LGfeature

ZTEfeature

Otherfeature

Smartphones

Feature phones

13%

3%

6%

5%

Series 019%

Otherfeature

19%

Android

BlackberryOS

iOS

Symbian

Operating systems

Handset OEM

http://thenextweb.com/mobile/2011/11/29/report-smartphones-account-for-just-27-of-all-mobile-phones-worldwide/#!Bhss9

28

109

37

153

145

139

63

172

109

603

Latin America

North America

Africa Middle East

Europe

Asia-Pacific

Smartphones

Feature phones

OVER 50% SMARTPHONE PENETRATION IN DEVELOPED MARKETSMobile sales volumes per region (millions of units, estimated)

http://thenextweb.com/mobile/2011/11/29/report-smartphones-account-for-just-27-of-all-mobile-phones-worldwide/#!Bhss9

63%

37%

51%49%

19%

81%

18%

82%

17%

83%North America Europe Asia Pacific Africa Middle East Latin America

Penetration

http://blog.flurry.com/bid/109749/Apps-Solidify-Leadership-Six-Years-into-the-Mobile-Revolution

~1 million Apps for each platform

iPhone35,811

iPad11,314

Health & Fitness, Medical, Sports

InjuryPrevention

Rehabilitation

Potential Apps325

Included28

Excluded297

Not injury related n=246

Duplicates n=7

Diary n=3

Reference n=41

van Mechelen et all. Br J Sports Med 2013;:bjsports–2012–092136. doi:10.1136/bjsports-2012-092136

SHORT OVERVIEW

Platform: iPhone 24, iPad 2, + 2

Categories: Health & Fitness 18Medical 7Sports 3

Aim: Prevention 14Treatment 14

Price range: 7 freemean price 3,4$ (0.99 - 9.99)

Mentioning of evidence base: 1

Use of best evidence: 3

van Mechelen et all. Br J Sports Med 2013;:bjsports–2012–092136. doi:10.1136/bjsports-2012-092136

Mobile platforms provide a strong base for the dissemination of research evidence on the prevention and treatment of sports and PA related injuries

Through Apps one can implement evidence interactively and directly to a variety of stakeholders

Although there are numerous Apps available in the App-store only a small portion actually target the prevention or treatment of sports and PA related injury

The evidence base used in the available Apps is shallow and not mentionedin most Apps

13

Ankle is most commonly

injured body part

~ 650,000 per year in NL

NEUROMUSCULAR TRAINING AFTER USUAL CARE

Reduces the risk of recurrent anklesprain by as much as 50%eg. Hupperets BMJ 2009; Verhagen & Bay 2010

Reduces the prevalence of residualcomplaintseg. Van Rijn et al. Brit J Gen Pr 2007

Provides a cost-efficient secondarypreventive measureHupperets et al. AJSM 2010; Verhagen et al. BJSM 2004

MIXED EVIDENCE BASE IN APPS

~2,50€ / ~4,00$

Developed by Swedish physiotherapists with ample practical expertise

REACH

The number of downloads as a proportion of the total number of ankle sprains sustained over the follow-up period

A total of 25,781 Downloads

iOS - 20,262 downloads

Android - 5,519 downloads

Totals correspond to a reach of 2.6% within the target population that sustained 975,000 ankle sprains during the follow-up period

Vriend et al. Br J Sports Med 2014;:bjsports–2013–092896. doi:10.1136/bjsports-2013-092896

ADOPTION

Survey respondents

38% (n=31 of 82) did not actively use the App

29% (N=24 of 82) report infrequent use of the App

33% (n=27 of 82) used the App frequently (i.e. multiple times per week)

Google Analytics

Mean of 3.3 App sessions per unique user

Number lies far below the 24 prescribed exercise sessions embedded in the program

Mean usage time per App visit was 16:25 minutes

One set of exercises will take 15-20 minutes on average

Vriend et al. Br J Sports Med 2014;:bjsports–2013–092896. doi:10.1136/bjsports-2013-092896

LOYALTY BY APPLICATION CATEGORY

streaming music

social games

communication

dating

social networkingnews

sports scores

weather

reference

trvael

utilities

single player games

productivity

health & fitness

banking &payments

entertainment

educationbusiness

Food & drinkretail

personalization

medical

photo & video

9

8

7

1

2

3

4

5

6

fre

qu

en

cyo

f u

sep

er

we

ek

55% 55% 55% 55% 55% 55% 55% 55% 55%

retention over 90 days

NO HOLY GRAIL

Giving the target population access toan interactive iteration of an evidencebased ankle sprain prevention program via a contemporary andpopular mobile platform does notlead to widespread adoption

Targeted efforts within a practical context are required to ensure proper uptake and usage of an App by the target population

ARE APPS A CASH-COW?!

Medical iRehab

Medical iRehab Plantar Fasciitis

Medical iRehab Rotator Cuff

Medical iRehab Ankle Sprain

$2.99 each

CONCLUSION

“The surge in availability of apps in an unregulated market raises concerns as to the appropriateness of their content for different groups of end users. The consolidation of best-practice concussion instruments now provides a framework to inform the development of future apps.”

Lee et al. Br J Sports Med doi:10.1136/bjsports-2013-092930

Apps are an essential tool in team physicians’ and players’ pockets!

Apps are available foranyone with a mobile phone and an account

Some Apps containinformation that can aid

(onsite) medical care, PTsor physicians

Apps can not replace appropriate medical care

or rehabilitation by trained professionals

Not all Apps containinformation that can or should be used by the masses

COMPUTING POWER

CPU: Qualcomm® Snapdragon™ 801, quad-core CPU’s

Total memory: 16 GB, beschikbare capaciteit varieert

RAM: 2GB DDR3

Connectivity: Bluetooth® 4.0 with aptX™ enabled; Wi-Fi®: IEEE 802.11 a/b/g/n/ac (2.4 & 5 GHz)

PHONES?

CPU: Qualcomm® Snapdragon™ 801, quad-core CPU’s

Total memory: 16 GB, beschikbare capaciteit varieert

RAM: 2GB DDR3

Connectivity: Bluetooth® 4.0 with aptX™ enabled; Wi-Fi®: IEEE 802.11 a/b/g/n/ac (2.4 & 5 GHz)

Tri-axial accelerometer

Proximity sensor

Ambient light sensor

Gyro sensor

Barometer sensor

Dual camera (12Mp / 5Mp)

GPS

THE C3 LOGIX SYSTEMAn Integrated Concussion Management System

http://www.c3logix.com/

StakeholdersATCs MDs PTs Researchers

> follow-up

return to play

> incident

incidentreport

> follow-up

follow-upassessment

sports medicine

review &decision support

baseline

pre-seasonassessment

injureFree

Thank you for your attention

@evertverhagen

facebook.com/SLHAmsterdam

e.verhagen@vumc.nl

www.slhamsterdam.com

Evert Verhagen

Department of Public and Occupational HealthEMGO+ Institute for Health and Care ResearchVU University Medical Center Amsterdam, Netherlands

Australian Centre for Research into Injury in Sport and its Prevention (ACRISP)Federation University Australia, Ballarat (VIC) Australia