A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications
Abstract
:1. Introduction
2. Research Method
2.1. Research Questions
- RQ1:
- What are the general characteristics of the pain management mobile apps with respect to pain type, targeted population, and outcome measures?
- RQ2:
- What are the technologies adopted by the pain management mobile applications with respect to mobile devices, application platform, and techniques that are involved in the proposed solutions?
- RQ3:
- What are the adopted approaches for data entry of pain management mobile applications?
- RQ3.1:
- What are the types of pain data assessment that are adopted?
- RQ3.2:
- What are the pain data input modes that are involved?
- RQ3.3:
- What are the pain data input methods that are used?
- RQ3.4:
- What is the optimal pain data input frequency?
- RQ4:
- What are the approaches to evaluate the usability of pain management mobile applications?
- RQ4.1:
- What methods are used to evaluate the usability?
- RQ4.2:
- Which usability features are more targeted in the studies?
2.2. Search Strategy
2.3. Information Sources
2.4. Search Terms
2.5. Inclusion and Exclusion Criteria
- The study must be a peer-reviewed publication.
- The study must be published within the timeframe of 2005 to 2017.
- The study must be in English.
- The study subject must be humans with no age limitation.
- The study must include details of the design and development of patient-oriented pain management mobile applications or systems.
- The study must involve a touchscreen portable handheld device such as a smartphone, Personal Digital Assistants (PDA), or tablet, etc.
- The study must involve manual entry or the partial automatic extraction of data by some sensor devices.
- The study must provide information on the usability evaluation method that was involved in that research.
- The study must provide results regarding user feedback on the application, and highlight the usability issues.
- If it does not fulfill the inclusion criteria.
- If the study is not focused on the design, development, and evaluation of the pain management mobile applications.
- If it is a review, commentary, or editorial paper.
- If it involves an ordinary cell phone for reminder services or for voice recognition only.
- If it involves a physician-oriented app for decision support or assessment.
2.6. Study Selection Procedure
2.7. Quality Assessment
2.8. Data Extraction
3. Results and Discussion
3.1. Overview
- RQ1:
- What are the general characteristics of the pain management mobile apps with respect to pain type, targeted population, and outcome measures?
- RQ2:
- What are the technologies adopted by the pain management mobile applications with respect to the mobile devices, application platform, and techniques that are involved in the proposed solutions?
- RQ3:
- What are the adopted approaches for data entry of pain management mobile applications?
- RQ3.1:
- What are the types of pain data assessment adopted?
- RQ3.2:
- What are the pain data input modes involved?
- RQ3.3:
- What are the pain data input methods used?
- RQ3.4:
- What is the optimal pain data input frequency?
3.2. Finding: A Taxonomy of Design Concerns
3.3. Usability of Pain Management Mobile Applications
- RQ4:
- What are the approaches to evaluate the usability of pain management mobile applications?
- RQ4.1:
- What methods are used to evaluate usability?
- RQ4.2:
- Which usability features are more targeted in the studies?
3.4. Finding: Usability Issues and Solutions
3.5. Discussion: A Usability Matrix of Usability Issues
4. Conclusions
Supplementary Materials
Author Contributions
Acknowledgments
Conflicts of Interest
References
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No | Quality Assessment Criteria | Ordinal Response Scale | Grades Acquired by the Studies |
---|---|---|---|
QA1 | Relevancy of research design within the context of the study. | 0 (No)/0.5 (Partially)/1 (Yes) | 26 studies, 98% |
QA2 | Clearly defined aims and objectives of the study. | 0 (No)/0.5 (Partially)/1 (Yes) | 26 studies, 98% |
QA3 | Clearly stated findings and limitations of the study. | 0 (No)/0.5 (Partially)/1 (Yes) | 25 studies, 94% |
QA4 | Valuable contribution of the study, based on the findings. | <20% (No)/20–80% (Partially)/>80% (Yes) | 23 studies, 85% |
Pain Types | Acute Pain | Chronic Pain |
---|---|---|
General pain | - | 3 |
Cancer pain | - | 9 |
Sickle cell pain | - | 4 |
Back pain | - | 2 |
Musculoskeletal pain | - | 1 |
Headache or migraine | - | 2 |
Fibromyalgia pain | - | 1 |
Juvenile idiopathic arthritis | - | 1 |
Dysmenorrhea pelvic pain | - | 1 |
Neck pain | - | 1 |
Postoperative pain | 2 | - |
Characteristics | Definitions | Terminologies Used in the Studies for Usability Evaluations |
---|---|---|
Effectiveness | “Accuracy and completeness with which users achieve specified goals” [61] | error prevention, usefulness, self-care behavior and symptom management, monitoring and managing symptoms, support of behavioral training key targets |
Efficiency | “Resources expended in relation to the accuracy and completeness with which users achieve goals” [61] | completion time |
Satisfaction | “Freedom from discomfort and positive attitudes toward the use of the product” [61] | usefulness, willingness to complete the survey again, self-efficacy, likability, acceptability, feedback |
Appropriateness recognizability/ Understandability | “Degree to which users can recognize whether a product or system is appropriate for their needs” [63] | clarity of content, ease to understand, helpfulness of the tool in understanding the impact of pain, simplicity of the content, clarification of the wording of questions, readability, language, understanding, paraphrasing, comprehension (meaning and understanding of the question), completeness, comprehensiveness of the queries and response set, knowledge |
User interface aesthetics/Attractiveness | “Degree to which a user interface enables a pleasing and satisfying interaction for the user” [63] | font size, color scheme, visual appearance and layout, inconsistency, aesthetics |
Operability | “Degree to which a product or system is easy to operate, control, and appropriate to use” [63] | Navigation, ease of data input, ease of use, User-friendliness, the difficulty of completing the assessment, the responsiveness of the screens to touch, navigation, functionalities (submit, clear, cursor movement), user interaction, navigation of the site, issues with the interface, complexity, knowledge, communication and support, feedback |
Learnability | “Degree to which a product or system enables the user to learn how to use it with effectiveness, efficiency in emergency situations” [63] | memory retrieval (ability to accurately recall the answer), complexity, workload demand |
User error protection | “Degree to which a product or system protects users against making errors” [63] | system protection against making errors, error prevention |
Accessibility | “Degree to which a product or system can be used by people with the widest range of characteristics and capabilities to achieve a specified goal in a specified context of use” [63] | the color scheme for the color blind, accessibility |
Usability Issues | Solutions/Recommendations | |
---|---|---|
1 | The difficulty with the interpretation of the report or confusing reports [24,42]. | Additional reports were added along with the functionality of viewing web-based report and export diary data. It was also recommended to provide comprehensive reports to be viewed within the mobile application rather than be externally viewed [42]. |
2 | Confusion in understanding the terminology or wording [30,34,39,42,45,57]. | The wordings of questions were simplified and in the user manual; definitions of certain words/terminologies were also provided [42,45]. It was also suggested that the wording of the system’s questions and management instructions should be appropriate for the targeted population [30,34,57]. |
3 | Buttons not working properly [34]. | The “clickable” surface area corresponding to the app buttons and cursors was increased [34]. |
4 | Items with overlapping concepts [34,57]. | Keywords were made bold and underlined so that adolescents could easily distinguish the meaning of pain assessment questions [34]. Diary items were refined based on the feedback to remove the overlapping concepts [57]. |
5 | Slow responsiveness of the application [34,42]. | In order to expedite the process of data input and increase the efficiency of the application, some measures were taken, such as an addition of auto text or default values, alphabetically sorting the response set, and the provision of the most frequently entered options at the top of list. Moreover, data will be stored locally to overcome the issue and synchronized with the server simultaneously [42]. |
6 | Patients were forced to complete the entire sequence of questions, irrespective of whether they were not having any pain, as patients didn’t move the slider to the “No Pain” anchor [45]. | The addition of help features at various stages of data input to prevent users from errors e.g. reminding patients to move the slider to the end of the VAS if they are experiencing no pain [45]. |
7 | A few participants missed inputting the medications used, as they did not know the generic names [45]. | Changes were made to the diary by putting the brands as well as the generic names of medications [45]. |
8 | Difficult to locate and identify the triggers due to the complex hierarchal presentation and too many options to choose from [42]. | Relocation of the feature to make it accessible. The question was set to appear on the top of the screen while scrolling down to keep the question in mind during searching. Most of the repeated triggers were listed down in the list of the most frequently used triggers [42]. |
9 | Problem with retrospective entries e.g., past midnight entry without starting a new day or day-long constant pain entry [42]. | Removed the restriction on creating a diary entry if one already existed [42]. |
10 | Difficulty in diary entry due to a few inapplicable symptoms for constant pain [42]. | Option to skip or remove the unusable items was provided [42]. |
11 | Difficulties in setting the start and end time of pain as wake or sleep time [42]. | Default items were set for daily items [42]. |
12 | Difficulty in learning to use the application [39,42]. | Provision of instruction slides on the first launch of the application to explain its working and the addition of help buttons in various modules [42]. In [44], the feature of audio-recorded instructions was also incorporated to increase the accessibility for a wider number of people, e.g., elderly people or people with any visual impairment. |
13 | Failed to review all of the response options due to unseen or a not prominent enough prompt to scroll down for more responses [25]. | All of the response options for a query were presented on one screen to avoid the need for scrolling [25]. |
14 | Application very cumbersome to use [34,38,48] | Navigation was streamlined to minimize the steps to move from one module to the other [34], or the redistribution of items was done to shorten the length of the pain diary [38]. A second response loop was also designed, i.e,. if the answer of a question is marked “yes”, then the diary will proceed to ask the next relevant question for elaboration; otherwise, those nested questions will be skipped [38]. |
15 | Difficulty in handling visual analog scale, the slider was too sensitive and tricky to use [45] | The slider was transformed to be thicker on the VAS so that it would move more easily. In some inputs, the slider was replaced by the radio buttons to make the input easier [45]. |
16 | Problem in using stylus-based input, i.e., inputting number with stylus or selection from word descriptor list [24,25,39,45]. | Some space was added for entering new pain word descriptors. Also, word descriptors were arranged in alphabetical order, and the scroll bar was moved away from the word descriptors for clarity [45]. |
17 | The difficulty with number selection boxes where the tapping of the arrow is required for selection [25] | Replaced the number selection box with a pop-up number pad [25]. |
18 | Missing ‘‘back” button to return to the earlier screens to revise answers [25] | Back button was added to review the answers before submission [25]. |
19 | Frequent crashing/Software malfunction [23,34,58] | The application was reprogrammed and tested internally to resolve the malfunctioning [34]. |
20 | Difficulty in selecting an area on the body image [38] and not enough spots to highlight the problem area on the body diagram [45]. | Zoom function in the body diagram was provided for visual clarity [38]. In [39], it was also suggested to provide 3D visualization. In [45], the presentation location of some of the joints was improved. Also, labeled images of the body diagram were added in the instruction manual. Moreover, navigation assistance indicators were provided to move the body diagram left or right. |
21 | Less effectiveness and safety of a standalone system without active input of the healthcare professional [30]. | It was suggested in [39] that the applications should be connected with the central healthcare systems. The active input of a clinical expert could improve the effectiveness and safety of the system. In that case, a threshold level should be incorporated into the system to trigger an email alert to a registered nurse. The nurse will then contact the adolescent to assist in clinical decision making. Moreover, the threshold level could be established for the system to receive additional advice from the healthcare professional, if no improvement in pain condition is observed [30]. There must be a time-out feature in the system, in case of seeking advice from the healthcare professionals, to communicate with their care providers or other medical aid [30,39]. |
22 | Lack of acknowledgment for the patient [30,39]. | An alert system is also necessary to acknowledge the patient upon successful transmission of pain data to the central system [30,39]. |
23 | Over alerting or repeated notification [41,58]. | No specific solution recommended |
24 | Confusing pop-up screen messages [24]. | No specific solution recommended |
25 | Difficult to control the slider while scrolling down the screen [24]. | No specific solution recommended |
26 | Too small font size [39] | No specific solution recommended |
27 | Color scheme not suitable for color blinds [39]. | No specific solution recommended |
ISO 9241-11 IS0/IEC 25010 | Effectiveness | Efficiency | Satisfaction |
---|---|---|---|
Appropriateness recognizability | A few participants missed inputting the medications used, as they did not know the generic names [45]. Less effectiveness and safety of a standalone system without the active input of the healthcare professional. [30] Lack of acknowledgment to the patient [30,39]. | The difficulty with the interpretation of the report [24]. | Confusing pop-up screen messages [24]. Confusion in understanding the terminology or wording [30,34,39,45,57]. Items with overlapping concepts [34,57]. Over alerting or repeated notification [41,58]. |
Learnability | - | Difficulty in learning to use the application [39]. | |
Operability | - | Difficult to control the slider while scrolling down the screen [24,25]. Application very cumbersome to use [31,48]. Difficulty in handling visual analog scale, the slider was too sensitive, and tricky to use [38,45]. Problem in using stylus-based input i.e., inputting number with stylus or selection from word descriptor list [24,25,39,45]. The difficulty with number selection boxes where tapping of the arrow is required for selection [25]. Missing ‘‘back” button to return to the earlier screens to revise answers [25]. Buttons not working properly [34]. Slow responsiveness of the application [34,42]. Difficult to locate and identify the triggers due to the complex hierarchal presentation and too many options from which to choose [42]. Problem with retrospective entries e.g., past midnight entry without starting a new day or day-long constant pain entry [42]. Difficulty in diary entry due to a few inapplicable symptoms for a constant pain [42]. Difficulties in setting start and end time of pain as wake or sleep time [42]. Failed to review all of the response options due to an unseen or not prominent prompt to scroll down for more responses [25]. Difficulty in selecting an area on the body image [38] and not enough spots to highlight the problem area on the body diagram [45]. | - |
User Error Protection | - | - | Frequent crashing/software malfunction [23,34,58]. Patients were forced to complete the entire sequence of questions, irrespective of the fact they were not having any pain, as patients didn’t move the slider to the “No Pain” anchor [45]. |
User Interface Aesthetics | - | - | Too small font size [39]. |
Accessibility | 1. Color scheme not suitable for color blinds [39] | - | - |
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Shah, U.e.M.; Chiew, T.K. A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications. Symmetry 2019, 11, 400. https://doi.org/10.3390/sym11030400
Shah UeM, Chiew TK. A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications. Symmetry. 2019; 11(3):400. https://doi.org/10.3390/sym11030400
Chicago/Turabian StyleShah, Umm e Mariya, and Thiam Kian Chiew. 2019. "A Systematic Literature Review of the Design Approach and Usability Evaluation of the Pain Management Mobile Applications" Symmetry 11, no. 3: 400. https://doi.org/10.3390/sym11030400