36 Chapter 2 METHODS This systematic review was conducted in line with the Cochrane Handbook for Systematic Reviews of Interventions version 6.0 and reported according to PRISMA 2020.11 This study was registered in Open Science Framework (number X56RA). Studies were considered eligible if they assessed or described mobile apps used in a gastrointestinal surgery setting and were published in 2010 or later. The search was last updated October 6th 2022. A mobile app is defined as a software program which operates only on a smartphone or tablet (and thus, not web-based software). Keywords related to mobile apps and gastrointestinal surgery were incorporated into the search strategy. The search string is presented in the appendix. The included articles were cross-referenced to identify any additional relevant studies. Studies were excluded if (1) the described mobile app was only used to register study outcomes (e.g., number of complications and operation time), (2) the articles were conference proceedings or study abstracts, as they do not provide adequate insights into the app or its evaluation, (3) reviews, and (4) the results were published in a language other than English. Two reviewers (SvdS and MB) independently assessed all titles and abstracts according to the inclusion and exclusion criteria in the software tool “Rayyan”. Studies were included in the full-text evaluation when both reviewers agreed on inclusion. Disagreements were resolved through appraisal by a third reviewer (EB). The methodological quality of the randomized controlled trials was assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB-2).12 This tool determines the overall risk of bias that is based on the randomization process, deviations from intended interventions, missing outcome data, measurement of outcomes and selection of reported results. The ROBINS-I tool was used to determine the methodological quality of nonrandomized studies, in which the overall risk of bias is based confounding, participant selection, intervention classification, deviations from intended interventions, missing outcome data, measurement of outcomes, and selection of reported results.13 Data were extracted independently by two reviewers (SvdS and MB) in a standardized form that included: year of publication, country, study design, number of participants, characteristics of included participants, type of surgery, name of the app, platform of the app, functionalities of the app, and study outcomes. All study outcomes on usability, satisfaction and clinical outcomes were included because apps may have heterogeneous aims and functionalities. Conflicts among reviewers were resolved by consensus. The results of studies were summarized according to the apps described. The apps were categorized based on their functionalities to provide a structured overview of available apps. The apps were described within these categories and were assessed on their outcome evaluations.
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