Mobile Health App for Adults with Persisting Postconcussion Symptoms: Development and Usability Study

Diagnostics, treatment, and research of persisting postconcussion symptoms are challenging. Assessing symptoms is essential, but currently implemented methods only allow for retrospective reporting of symptoms. A mobile health (mHealth) symptom mapping app for adults with persisting postconcussion symptoms may be an accessible and cost-efficient alternative.

This study aimed to develop a research-based mobile app for symptom mapping for adults with persisting postconcussion symptoms and investigate its usability, feasibility, and safety.

This was a mixed method development and usability study consisting of three iterative cycles, each including (1) app design and programming, (2) app usability evaluation by the user group, and (3) app review by the clinician group. The outcomes were the mHealth App Usability Questionnaire and Mobile App Rating Scale scores, the number of days with logged symptom data during a home-testing period, and descriptions of adverse events throughout the study period. Semistructured interviews were conducted to explore the user group's experiences further.

Twenty-three adults with persisting postconcussion symptoms (median age 52, IQR 34-59 years; 70% female) were included in the user group. Six clinicians (median age 53, IQR 35-60 years), including 3 (50%) females, with a mean of 13 (SD 7) years of experience working with individuals with persisting postconcussion symptoms, were included in the clinician group. The app received a mean score of 5 (SD 1.1) on the mHealth App Usability Questionnaire (7-point Likert scale) from the user group and 4.1 (SD 0.4) on the Mobile App Rating Scale (5-point Likert Scale) from the clinician group. During the 28-day home-testing period, the adherence rate among the participants in the user group was 89% (IQR 78-96), and two adverse events related to increased symptom awareness were registered. Three themes were created through reflexive thematic analysis of the qualitative data: (1) Visualizing the invisible-Enabling reflection and insight; (2) Personalized yet simple-Balancing relevance and usefulness; and (3) More than just a number-The complexity behind the symptom scores.

We developed a research-based symptom mapping app for people with persisting postconcussion symptoms. The app received high usability ratings from both the user and clinician groups. The app is a feasible alternative to traditional symptom mapping methods, and it is safe to use for its intended purpose.