The Science Behind Stroke Apps

International scientists and clinicians agree that digital technologies used for stroke prevention must be scientifically sound and evidence-based. They have developed criteria to gauge the efficacy of new products entering the mHealth apps market.

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The first systematic review of digital technologies currently available for stroke prevention, recently published in the international journal Stroke, yielded 2369 web and mobile apps. Only 20 of those apps met the criteria for stroke prevention digital tools recommended in the article.

“We suggest a criteria for basic, advanced, and ideal digital technologies for stroke prevention, as well as an ecosystem for such technologies to support the transformation of an organisation-centred health care model to a patient-centred health care model,” says the lead author of the article, Valery Feigin Professor of Epidemiology and Neurology at AUT.

“There is a lack of scientifically accurate and valid digital tools specifically aimed at primary stroke prevention and virtually no evidence for the ability of digital tools to improve long-term health behaviours.”

New criteria for stroke prevention digital tools

The review shows that the quality of digital technologies for stroke prevention varies significantly. Most apps only provided information about stroke risks with no functionality or guidance on how to reduce those risks.

“Digital technologies that do not meet the basic criteria, which are not scientifically sound and do not have evidence-based content, should not be used for stroke prevention,” says Feigin.

“Stroke prevention digital tools should be implemented together with prevention strategies for other non-communicable diseases that share many of the same risk factors such as cardiovascular disease.”

The suggested criteria for ‘basic’ CVD and stroke prevention digital tools, as well as the additional requirements for ‘advanced’ and ‘ideal’ digital tools, cover five domains: (1) scientific evidence, (2) target population and purpose of the tool, (3) scalability, (4) interface, useability and privacy protection, and (5) interactivity and engagement.

These criteria, advocated by global experts in neurology and cardiology, can be used by health care professionals, policymakers and regulators to assess the efficacy of new products.

“We think that with some modifications these criteria could apply to the assessment of digital tools in other areas of health,” says Feigin.

mHealth apps and digital stroke prevention tools

In 2020, there were 318,000 health-related apps with an additional 200 new products entering the market each day. Last year the global mHealth apps market was valued at USD$38 billion.

“Companies like Apple and Google should request evidence of the scientific soundness of health-related apps and their content from developers before new products are submitted,” says Feigin.

Digital solutions are now being used in almost every area of health. The growing adoption and acceptance of mobile apps and other digital technologies by the average person and health professionals, combined with their relative accessibility and affordability, makes them one of the most promising strategies to reduce the global burden of stroke.

New Zealand is currently a world leader in this space.

The review shows that, while all 20 apps that met the criteria were properly validated, only three met the requirements for an ‘ideal’ digital tool for primary stroke prevention.

Of those three, only PreventS-MD and the Stroke Riskometer were specifically designed for both primary and secondary stroke prevention, and applied motivational strategies.

In addition, only the Stroke Riskometer developed at AUT was tested in a randomised controlled trial that demonstrated the feasibility, acceptability and efficacy of the app.

Global and national digital health strategies

Recently, the World Health Organisation suggested setting up a Global Action Plan for Digital Health Technologies.

The World Stroke Organisation agreed that ‘every national government needs a digital health strategy to be able to channel the power of digital technologies to tackle the human resources crisis and make health care systems more sustainable’. And the World Heart Federation stated that ‘global health justice, especially in a post-COVID world, cannot be achieved without a critical understanding of digital health’.

New Zealand has the Digital Health Strategic Framework.

“Health professionals should play a central role in digitising health care provision, including clinical trials and evaluation of the feasibility, acceptability and effectiveness of digital tools,” says Feigin.

“Education on digitisation as a means to support health care provision should be included in the health curriculum and advanced training of physicians.”

AUT has introduced Digital Health papers – examining leadership, the future of work, exponential health technologies, and disruption – as part of the Postgraduate Certificate in Health Sciences (Leadership and Management).

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