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Currently submitted to: JMIR mHealth and uHealth

Date Submitted: Sep 25, 2019
(currently open for review)

Mobile health solutions in orthopaedics and trauma surgery: Development protocol and user evaluation of the “ankle joint app”

  • Florian Dittrich; 
  • David Alexander Back; 
  • Anna Katharina Harren; 
  • Marcus Jäger; 
  • Stefan Landgraeber; 
  • Felix Reinecke; 
  • Sascha Beck; 



Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients' young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis.


In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile Health (mHealth) based rehabilitation-programs after ankle sprains are rare and essential issues of the development of medical apps as well as associated risks are mostly unclear.


The “ankle joint app” development process was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n = 20) and voluntary athletes (n = 20).


A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos and a log function. Excellent interrater reliability (ICC=0.92, 95% CI: 0.86-0.96) was obtained. The mean overall score for the “ankle joint app” was 4.4 (SD 0.5). The mean subjective quality score was 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had a mean score of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6).


Gained data demonstrate that mHealth based rehabilitation-programs might be an adequate tool for patient education and collection of personal data. The achieved (u)MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to gain funded evidence for the ankle joints app´s effects on economical and medical aspects in comparison to established non-digital therapy paths.


Please cite as:

Dittrich F, Back DA, Harren AK, Jäger M, Landgraeber S, Reinecke F, Beck S

Mobile health solutions in orthopaedics and trauma surgery: Development protocol and user evaluation of the “ankle joint app”

JMIR Preprints. 25/09/2019:16403

DOI: 10.2196/16403


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