# Mobile Applications for Epilepsy: Where Are We? Where Should We Go? A Systematic Review
## 3 Results
### MARS Ratings  
The process of app rating through MARS can contribute to a better understanding of the the user experience and how the apps differ from one another. Even though we shared with the raters the apps' purpose, the evaluation through MARS was performed with free interpretation from the MARS questionnaire proposed in [23]. Most applications were developed for a single OS, whereas only 9 out of 26 exist for both iOS and Android. This condition precludes raters to evaluate all 26 applications. To evaluate the inter-rater agreement between scores, we analysed the intra-class correlation coefficient within the different OS. The inter-rater agreements were reliable for both Android scores (ICC2k score of 0.83 and 95% confidence interval between 0.5 and 0.95) and iOS scores (ICC2k = 0.85 with 95% CI = [0.62, 0.95]). Moreover, for the 7 apps that were possible to rate by 5 or more raters, the inter-rater agreement was ICC2k = 0.79 with 95% CI = [0.37, 0.95]. This value of agreement indicates a consistent reasoning between our raters. Nonetheless,  
Figure 2: Ratio of apps that provide features related to medication, during seizure and personalisable content. All seizure detection apps contain during seizure, whilst the most prevalent category in self-management apps is medication. the following analyses were performed separately according to the OS, since most apps were only rated for one of the OS. Moreover, it is relevant to acknowledge that even for apps that exist in both OS, the actual design and overall experience may differ, which further justifies this decision. In Table 4 (in the Appendix C), it is disclosed for all selected apps: the number of raters, the average score of each MARS category and overall score. Since these averages were calculated joining both OS, their values may slightly differ from the results discussed in this section. In Figure 4, the average MARS rating is displayed for all rated apps. The left plot corresponds to apps rated for iOS, whereas the right plot contains the apps rated in the Android system. Considering the top five scores of each plot, it is possible to identify two common apps: _helpilepsy_, and _Epilepsy Journal_. With the exception of _Epilepsy Connect_ and _E-Epilepsy Inclusion_, iOS scores present low deviation between the 3 raters (\(0.13\pm 0.06\)). Conversely, in Android, the scoring was more diverse, since deviation was (\(0.24\pm 0.12\)), even after removing the large deviations of _My Epilepsy_ and _Epilepsy--Seizures Diary_. Nonetheless, these values are concordant with ICC2k inter-rater agreements. Moreover, overall scoring in iOS system ranged from 2.9 to 4.5, being consistently higher than the Android system, whose values range from 2.1 to 4.1. On the right side of Figure 4, the second best app, _EpApp_ was only rated by R3, since the login was not successful for the other raters. Therefore, we will not take in account this app further on, since it can be less representative. The same thought was followed in the left side of the plot, where the app _+Control Diario Epilepsyia_ was the best for rater R1 and R2, but it was inaccessible for rater R6. Even though the two raters have a good agreement, the fact that the rater R6 could not login, associated to the last update being in 2016 (last check for updates was in July of 2021) led to the decision of leaving it out of further analysis in iOS. Figure 3: Ratio of apps that provide a particular feature. Note: the ratios are computed within the number of apps that contain the corresponding category of features. To proceed to the analysis of each MARS category, we only considered the top five (top 5) apps of each OS, over the scores of the five bottom (bottom 5) apps. In this manner, we can perform our judgement regarding the effect each category plays in the overall scoring. This analysis is presented in Figures 5 and 6 for the iOS and Android, respectively. In _helpilepsy_, the homepage contains statistics and notifications.