title: Usability evaluation of the SMART application for youth with mTBI.
abstract: There is a dearth of evidence-based treatments available to address the significant morbidity associated with mild traumatic brain injury (mTBI). To address this gap, we designed a novel user-friendly, web-based application. We describe the preliminary evaluation of feasibility and usability of the application to promote recovery following mTBI in youth, the Self-Monitoring Activity-Restriction and Relaxation Treatment (SMART). SMART incorporates real-time recommendations for individualized symptom management and activity restriction along with training in cognitive-behavioral coping strategies.
  
  
  
  We conducted a usability evaluation to assess and modify the SMART system prior to further study and deployment. Children ages 11-18 years presenting to the emergency department were recruited after symptoms resolved. Usability was assessed using a 60-min think-aloud protocol of teens and parents describing their interaction with the application. Upon completion of the tasks, each participant also completed the system usability scale (SUS).
  
  
  
  We performed tests with 4 parent/child dyads. The average age of the children was 13 years (standard deviation=1.8). The parents were an average of 41.5 years old (standard deviation=6.2). Research revealed that the participants were enthusiastic about the interactive portions of the tool particularly the video based sessions. Parents were concerned about the speed at which their child might move through the program and the children thought that the system required large amounts of reading. Based on user feedback, researchers modified SMART to include an audio file in every module and improved the system's aesthetic properties. The mean SUS score was 85, with high SUS scores (>68) indicating satisfactory usability.
  
  
  
  High initial usability and favorable user feedback provide a foundation for further iterative development and testing of the SMART application as a tool for managing recovery from concussion.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. Electronic address: Judith.Dexheimer@cchmc.org.
authors.forename: Judith W
authors.initials: JW
authors.lastname: Dexheimer
authors.affiliation: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States.
authors.forename: Shilo H
authors.initials: SH
authors.lastname: Anders
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: McClanahan
authors.affiliation: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Lynn
authors.initials: L
authors.lastname: Babcock
mesh_terms: D000293:Adolescent; D000818:Animals; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D002648:Child; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents; D017060:Patient Satisfaction; D012984:Software; D011795:Surveys and Questionnaires; D017216:Telemedicine; D014584:User-Computer Interface
keywords: Adolescents; Brain injuries; Telehealth; User-computer interface