A Scoping Review of Frameworks Evaluating Digital Health Applications: Scale-Up4Rehab Project

Background:

Rehabilitation is crucial for enhancing population health and health system efficiency. Virtual Reality offers an opportunity for efficient, location-independent rehabilitation, however, current virtual rehabilitation therapies often lack scalability. The Scale-Up4Rehab project is establishing an open North-West Europe virtual rehabilitation 'clinic' to scale up existing virtual reality therapies. One of the initial activities of the Scale-Up4Rehab project will be to create an approval process for the rehabilitation applications that will be hosted on the virtual ‘clinic’. To inform the criteria for this, a scoping review was undertaken to identify existing high-quality frameworks for evaluating digital health applications and analyze those frameworks for insights into designing criteria.



Methodology:

This scoping review included a search strategy of relevant keywords which encompass terms for the domains of interest: ‘evaluation frameworks’ and ‘digital health applications’. Articles obtained following the literature search were exported and saved into an online review management platform (Rayyan). Titles and abstracts of studies were independently screened for inclusion and exclusion criteria by two reviewers. Full texts of the remaining studies were reviewed independently by two reviewers for their eligibility. The data extracted from the papers included: authors and dates of publication, source affiliation, country of origin, name of framework, description of framework, intended users and categories/questions of assessment used to evaluate the application. In addition, a search of the grey literature was conducted to identify any additional evaluation frameworks not captured in the scoping review search.



Results:

A total of 5151 potentially relevant articles were found through a literature search across seven databases: ACM, IEEE, Pubmed, Cinahl, Scopus, Embase, and SportsDiscus. In the process of study selection, screening based on inclusion and exclusion criteria resulted in 165 articles. Following a review of the full texts, 19 articles fulfilled the inclusion criteria. National and international frameworks evaluating digital health applications were identified in the included articles. They included a broad spectrum of categories and sub-categories for example evaluation of regulatory approval, technical stability, clinical assurance/safety and application effectiveness.



Conclusion:

The large number of digital health application frameworks identified in the review highlighted the broad scope of categories that are considered necessary for the effective evaluation of digital health applications. The results from this scoping review will contribute to the criteria development for the approval process for online rehabilitation applications within the Scale-Up4Rehab project.