A Framework Analysis of Electronic Bladder Diary Apps: Suitability for Clinical Decision-Making and Comparison to Validated Paper Diaries.

INTRODUCTION: Bladder diaries aid physicians in diagnosis and treatment of lower urinary tract symptoms and bladder conditions, but perceived burden of documentation can compromise completion of paper diaries. Perceived benefits of electronic diaries over paper diaries include ease of use and the option to export and share data. The aim of this study was to evaluate the suitability of electronic bladder diary applications for patient use, clinical decision-making, and compare them to validated paper diaries. METHODS: An online search using keywords (bladder, voiding, tracker, diary, incontinence) identified English-language bladder diary apps. Four independent reviewers used a modified version of the APPLICATIONS Scoring System to assess the strength of apps via domains for accuracy and functionality. The score generated (maximum 15) included app comprehensiveness, subjective presentation, navigation ease, and 7 other objective features. In addition, the content of all apps was compared against International Consultation on Incontinence Questionnaires (ICIQ), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and American Urological Association (AUA) paper diaries. RESULTS: A total of 10 apps with the ability to track 3 or more days were identified; 90% were freely available. The mean score of the apps was 6.9/15, (range 4-10); Only 4 were fully congruent with AUA paper diary domains. 2/10 listed professional involvement; 1 cited literature; 1 included a medical disclaimer, 3 had health education incorporated and had custom reminders via electronic notification; 7 had exportable data via email; 4 had password protection; none had multi-language capability. None combined bowel/bladder tracking. CONCLUSIONS: Most bladder tracking apps lack important clinical domains, professional involvement or support, and security of health information. Further app development is required for congruency with validated paper diaries.