Systematic Evaluation of Smartphone Applications for the Medical Management of Nephrolithiasis - Beyond the Abstract

Recurrence is a hallmark of kidney stone disease (KSD), subjecting patients to the costs and comorbidity of repeat surgical interventions, painful stone events, and negative influence on health-related quality of life. The key to breaking this cycle of recurrence lies in preventive management strategies: intensive dietary counseling, lifestyle modification, and/or medication therapy tailored to an individual’s risks. Whereas the latency of KSD and intermission between stone events are among the many factors that beget poor adherence to prevention strategies, digital health tools such as mobile Health (mHealth) applications (apps) hold great potential to support long-term disease self-management behaviors. However, the dizzying abundance of available apps and lack of standardized methods for evaluating their quality are among the many barriers to meaningful evaluation and integration into clinical practice.


In this study, the authors systematically evaluated mHealth apps that may be used to support the medical management of KSD. To accomplish this, they first proposed a comprehensive framework of core domains by which app quality should be evaluated. The domains included technical quality, usability, clinical value, and privacy/security. Included apps were divided into two categories based on their primary intended functions – (1) fluid management apps and (2) dietary management apps – and evaluated based on the framework.

The analysis found that available fluid management apps offer greater functionality to support long-term disease management compared with dietary apps despite not being targeted to patients with KSD. However, they are limited to fluid intake tracking and their reliance on user-entered data imposes a burden on users and introduces privacy risks. By contrast, dietary apps are targeted to KSD patients but are largely limited to non-interactive, informational tools with minimal intelligent design. Regardless of app category, there is a dearth of evidence or even investigation into the clinical value of such digital health tools.

This study is significant for a number of reasons. For one, it serves as a valuable reference of patient-oriented apps supporting the medical management of KSD for clinicians and patients alike. On a more macro level, it offers a reproducible, comprehensive framework for evaluating mHealth app quality. While such an analysis may have limited utility outside of an academic investigation, it draws attention to important domains of app quality that may be otherwise overlooked by clinicians but should be considered integral to decisions on the use of such digital tools in clinical practice.

Written by: Jared S. Winoker, MD, Assitant Professor of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, Twitter: @jwinokerMD

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