Table 3. Summary of included mHealth in TBI studies.
mHealth: mobile health; EMA: ecological momentary assessment; SPAN: Social Participation and Navigation; PHQ-4: patient health questionnaire 4; EMQ: Everyday Memory Questionnaire; TUQ: Telehealth Usability Questionnaire; YSR: Youth Self Report; CBCL: Child Behavior Checklist; RPQ: Rivermead Post-concussional Questionnaire; PTSD: Post-traumatic stress disorder; LOT-R: Life Orientation Test– Revised; CES-DC: Center for Epidemiological Studies–Depression Child
| Author | mHealth Intervention | Study Type | TBI Severity | Number of Patients | Outcome Measures | Duration of follow-up | Quality | Key Findings |
| Baldwin [9] | Google Calendar on mobile phone | Case report | Severe | One | % target events forgotten; The Beliefs about Memory Aids Questionnaire; Revised Everyday Memory Questionnaire (EMQ) | Six weeks of baseline data and six weeks of intervention data | High | Objective improvement in target events following intervention; Increased personal and treatment beliefs post-intervention; Inappropriate beliefs about memory aids decreased |
| Bos [10] | Mobile apps (Google calendar, Gtasks, SimpleCalendar and Calendar Snooze) | Case Series | Moderate to Severe | Nine | Test of Memory Malingering; The Rivermead Behavioural Memory Test–II; Message time task: place call at the scheduled time; Message content task: address question in a message; Postcard task: send postcard at allocated time; Depression Anxiety and Stress Scales 21 item version; Comprehensive Assessment of Prospective Memory; Community Integration Questionnaire | Eight weeks | Medium | Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods; 86% showed improvements in their ability to perform assigned functional memory tasks using the smartphone; Variable improvement in postcard task between participants; Over 90% performance on both message time and message content was reached by three participants with smartphone |
| Cruz [11] | Mobile application (Google calendar) | Case series | Mild and Severe | Two | Canadian Occupational Performance Measure; Patient Competency Rating Scale; The Hospital Anxiety and Depression Scale; Wechsler Adult Intelligence Scale; Rey Complex Figure Test; Cambridge Prospective Memory Test; Rivermead Behavioural Memory Test – Third Edition; Modified Six Elements Test from the Behavioural Assessment of the Dysexecutive Syndrome | Approximately three months for each participant | Medium | Mobile text reminders led to an improvement in performance and satisfaction; Reminders had to be tailored to the individual to maximise impact; The use of different reminder modalities helps improve the effectiveness |
| Juengst [12] | Tracking mood-related symptoms using a smartphone application (iPerform platform) | Feasibility Study | Mild to Severe | 20 | Compliance measured the total number of completed assessments divided the total number of scheduled assessments; Satisfaction measured with 7-point Likert scale assessing usability and satisfaction with the application; Telehealth Usability Questionnaire (TUQ) | Eight weeks | Medium | Participants correctly completed 73.4% of all scheduled assessments; Participants reported high satisfaction with smartphone applications and found them easy to use; Comparison of assessments obtained via telephone-based interview and EMA demonstrated high correlations; Participants reported high satisfaction across the eight weeks of using the iPerform application |
| Narad [13] | App-based coaching intervention (SPAN) for adolescents with TBI | Case Series | Mild to Severe | Four | Patient/parent satisfaction using a brief questionnaire to assess ease of use and helpfulness of various aspects of the program using a Likert-type scale from one to five; Number and type of goals achieved; Participants completed the Youth Self Report (YSR) and their parents completed the Child Behavior Checklist (CBCL) | Four weeks | Medium | All participants felt app provided appropriate scaffolding for goal setting and management; Two of the four participants completed all steps, achieved their goals and identified additional goals to work after completion of the SPAN program; No statistically significant differences between pre- and post-intervention scores for social competency and social problems |
| Stapleton [14] | Using a ‘reminders’ function on a mobile phone as a compensatory memory aid | Case Series | No data | Five | The Speed and Capacity of Language Processing; The Spot the Word Test; The Rivermead Behavioural Memory Test; The map search from the Test of Everyday Attention; The Tower Test; Individuals and/or their carers recorded their memory successes in achieving the target behaviours throughout the course of the study | Randomization of different lengths of baseline data (2, 3 and 4 weeks) seven weeks of intervention data followed by two weeks of baseline data and another two weeks of intervention data | Medium | For two participants, there was an increase in the target behaviours achieved when the phone was used; The percentage of target behaviours achieved did not return to initial baseline levels when the phone was removed; The participants who did not benefit from the mobile phone differed as they fell in the category of ‘severe memory impairment’, were significantly impaired on an assessment of executive functioning and required 24-hour care. |
| Suffoletto [15] | Timed SMS symptom assessments with self-care support messages in individuals with TBI | Randomised Control Trial | Mild | 43 (18 intervention; 25 control) | Rivermead Post-concussional Questionnaire (RPQ); Primary care post-traumatic stress disorder (PTSD) screen; Anxiety and depression were measured using the PHQ-4; Painkiller use; Participants in the Intervention groups were asked to complete additional survey questions to measure their perception of the SMS program | 14 days | Random sequence generation (low risk), allocation concealment (high risk), blinding of participants and personnel (high risk), blinding of outcome assessment (high risk), incomplete outcome data (low risk) and selective reporting (low risk) | Compared with the control group, intervention participants trended to lower odds of reporting headache, concentration difficulty, and irritability or anxiety; There were no significant differences in RPQ score, proportion meeting post-concussion disease criteria, PTSD, anxiety or depression between intervention and control groups; All of the intervention participants thought that the messages were at least somewhat useful to help them understand their symptoms, and 93% found them at least somewhat useful to help them self-manage their symptoms. |
| Worthen- Chaudhari [16] | A mobile health application that employs elements of social game design as a complement to medical care for unresolved concussion symptoms | Phase I (feasibility study) Phase II (non-randomized, open label, controlled study) | Mild | Phase I: 20; Phase II: 22 (12 intervention; 10 control) | Phase I: Number of participants completing the intervention relative to all enrolled; App use (% Play), expressed as percent of target dose in the first three weeks of intervention; Satisfaction with intervention, rated on a seven-point Likert scale; Barriers to compliance Phase II: SCAT-3 symptom checklist score to assess concussion symptom severity; Optimism, as measured by the Life Orientation Test– Revised (LOT-R); Depression, as measured by the Center for Epidemiological Studies–Depression Child (CES-DC) | Not specified | Medium | A majority of participants completed the intervention (14 of 20) with high use and satisfaction; Significant improvement in symptoms and optimism for the experimental cohort compared to control; There was no significant difference between control and experimental cohort for depression scores |