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Can smartphones diagnose brain tumours... or at least give us a huge prompt?

The details below are carefully disguised for confidentiality reasons, but the principles are correct.

A 65-year-old man with type 2 diabetes was reviewed because of poor glucose control. During the consultation, he noted that he had felt “unsteady” since an ear infection 6 months previously. He added that his smartphone had alerted him to his “walking steadiness” going to “low” and then “very low” for the last few months. Examination revealed a wide-based gait (walking with the legs marginally parted) but no cerebellar signs or other abnormalities.

The neurology team were contacted and asked if the patient should be sent for clinic review or if a scan should be done in the community. They wondered whether the unsteadiness could be due to nerve damage caused by the poorly controlled diabetes. A scan was undertaken, the result revealed a probable meningioma (a benign brain tumour), and the man was referred urgently on to the brain cancer pathway. In short, then, the app had prompted the diagnosis.

So how good are smartphone apps at assessing balance? In adults, evidence would suggest that they are indeed accurate.

The smartphone works by analysing metrics like walking speed, step length, and double support time (when both feet are on the ground), while being carried in a pocket or a holster near the waist. Notifications can be sent if your steadiness is low or very low.

The significant element in the case presented above was the gradual deterioration in walking steadiness score.

GPnotebook provides a summary of the technology and evidence.

Other highlights in this month’s email include a description of the Spurling test, a review of the use of nasal sprays in respiratory tract infections, and the association between human papillomavirus and oropharyngeal cancer.

• Spurling test: This test is often used by our practice-based physiotherapist. The result of a positive Spurling test is stated as a reproduction of cervical radiculopathy symptoms. Is the sensitivity of this test 30%, 60% or 90%?
• Gliptins, GLP-1 mimetics and Parkinson’s disease: Is there evidence suggesting that the use of dipeptidyl peptidase-4 inhibitors (gliptins) and glucagon-like peptide-1 (GLP-1) mimetics is associated with a higher or a lower rate of Parkinson’s disease compared with the use of other oral antidiabetes drugs?
• Candidozyma auris: Candida auris, which was first isolated from the external ear canal of a patient in Japan in 2009, was included in the genus Candidozyma in 2024 and named Candidozyma auris. C. auris is a yeast fungus that shows resistance to many antifungals. The implications of C. auris infection are summarised on GPnotebook.
• Human papillomavirus and oropharyngeal cancer: This association is summarised on GPnotebook.
• Nasal sprays in respiratory tract infections: What is the evidence here? This is summarised on GPnotebook.
• Balance and gait algorithms on a smartphone: How does a smartphone assess gait and balance? Is a smartphone-based assessment a valid and reliable method to assess standing balance?