1. Developing a concussion assessment mHealth app for certified Athletic Trainers
Design and Development of mHealth Applications
S81
Scott McGrath, MS
Biomedical Informatics Doctoral Candidate
University of Nebraska at Omaha

2. Disclosure
Our group has no relevant relationships with commercial interests to disclose.
Lead author’s (Scott McGrath) spouse contributed to this work as a 2nd author (Melanie McGrath)
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3. Learning Objectives
After participating in this session the learner should be better able to:
Apply the Center for eHealth Research (CeHRes) roadmap in the formulation, planning, and development of mHealth apps.
Identify why rural ATCs are a desirable target for mHealth and telehealth applications.
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4. Outline Introduce ATConnect, our mHealth telehealth app
Review the CeHRes holistic roadmap for mHealth app development
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5. Concussions: Scale of the problem
million concussions occur from sports and recreational activity in the United States annually1
Concussions account for 5-9% of all sports injuries, which often translate into visits to the emergency room2
From , there has been a 62% increase in non-fatal traumatic brain injuries1
Studies have shown Certified Athletic Trainers (ATC) increase the rate of detection of concussions and lower the rate of injury3
However, coverage is a problem, 30% of public secondary schools in the United States have no ATCs and 24% of sporting events have no medical coverage4
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6. Coverage gaps in Nebraska
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7. ATConnect proposed flowchart
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8. mHealth app based solution
Sports Concussion Assessment Tool (SCAT3)
ATConnect
Parent/Coach
Initialize case
ATC Retrieves &
Completes assessment
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9. Roadmap for eHealth development
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10. Contextual Inquiry – Define the problem
Specify the healthcare problem (ATC coverage)
What are the different challenges to this problem?
Categorize the challenges (efficiency, effectiveness, timely, safety, etc.)
Prioritize the elements of the problem
Identify Stakeholders (ATCs, Coaches, Athletes)
Invite key stakeholders to discuss the problem
What roles do stakeholder have?
Addendum
Construct a preliminary budget with developers and build mock-ups
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11. Value Specification – Meet stakeholders
Focus Group (ATCs, medical software developer)
Have stakeholders rank the 10 E’s of Eysenbach:
Efficiency, Enhancing quality of care, Ethics, Extending scope of care, Evidence Based, Empowerment, Encouragement, Education, Equity, & Enabling
Capture user requirements from stakeholders
How can stakeholders contribute?
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12. Design – Building the app
App development
Cognitive walkthrough
Persuasive design
Persuade & motivate without being coercive
Prototyping
Usability
Testing
Expert testing
Target group testing
Addendum
iOS & Android development and beta testing planning
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13. Operationalization – Marketing the app
Business Model
Internal product
Offered to the public
Planning and actions for:
Dissemination
Adoption
Integration
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14. Summative Evaluation – Reflection
mHealth uptake
Usage behavior
Profile of users
User motivation
mHealth impact
Impact on health delivery
Impact on patient health & well being
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15. Future work Continue to develop ATConnect
Revise app to include newly released SCAT5 protocol (released April 2017)5
Integrate feedback from targeted users
Conduct a pilot program
Seek grants and funding to build the components originally envisioned for the app
Conduct a study to evaluate impact and uptake of the mHealth app
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16. You can find me at: smcgrath@unomaha.edu
Thank you!
You can find me at:
@McGrathSPro

17. References
[1] Broglio, S. P., Pontifex, M. B., O'Connor, P., & Hillman, C. H. (2009). The persistent effects of concussion on neuroelectric indices of attention. Journal of neurotrauma, 26(9),
[2] Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y. (2011). Trends in concussion incidence in high school sports a prospective 11-year study. The American journal of sports medicine, 39(5),
[3] Fletcher, E. N., McKenzie, L. B., & Comstock, R. D. (2014). Epidemiologic comparison of injured high school basketball athletes reporting to emergency departments and the athletic training setting. Journal of athletic training, 49(3), 381.
[4] Kutcher, J. S., McCrory, P., Davis, G., Ptito, A., Meeuwisse, W. H., & Broglio, S. P. (2013). What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery?. British journal of sports medicine, 47(5),
[5] Echemendia, R. J., Meeuwisse, W., McCrory, P., Davis, G. A., Putukian, M., Leddy, J., ... & Schneider, K. (2017). The Sport Concussion Assessment Tool 5th Edition (SCAT5). Br J Sports Med, bjsports-2017.