Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke. DATA SOURCES: A systematic literature search was conducted in 6 databases from January 2000 to May 2018. STUDY SELECTION: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies. DATA EXTRACTION: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable. DATA SYNTHESIS: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low. CONCLUSIONS: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.

Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study.

BACKGROUND: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. OBJECTIVE: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology-based treatment in 12 months of cardiac rehabilitation. METHODS: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. RESULTS: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95% CI -90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95% CI -585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD -87.9 minutes per week, 95% CI -379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95% CI -75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95% CI -2099.6 to 3833.9; P=.55). CONCLUSIONS: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. TRIAL REGISTRATION: ISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589.

Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking. DATA SOURCES: A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included. METHODS: Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted. RESULTS: The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.79; p < 0.00001) compared to control group with usual care, minimal treatment, and no treatment. A large effect was also observed on physical activity (SMD 0.59; 95% CI 0.34 to 0.83; p < 0.00001) when compared to no treatment alone. There were no differences in walking and the subanalysis of technologies. CONCLUSIONS: Technology-based distance physical rehabilitation increased physical activity among persons with MS, but further research on walking in MS is needed. Implications for Rehabilitation Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS. Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.

Effectiveness of physical activity promoting technology-based distance interventions compared to usual care. Systematic review, meta-analysis and meta-regression.

INTRODUCTION: Technology has been thought to have strong potential for promoting physical activity, but the evidence has remained unclear. The aim of this study was to examine whether a technology-based distance intervention promoting physical activity is more effective than a physical activity intervention without the use of technology. This systematic review is registered in Prospero (CRD42016035831). EVIDENCE ACQUISITION: A systematic literature search of studies published between January 2000 to December 2015 was conducted in CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OT-Seeker, WOS and PEDro. Studies were selected by two independent authors applying the following PICOS criteria P) adults, I) technology-based distance intervention promoting physical activity, C) distance intervention promoting physical activity without technology, O) physical activity, S) RCT. Quality was assessed following the guidelines of Cochrane Back Review Group. Meta-analysis and meta-regression were performed using R. EVIDENCE SYNTHESIS: From 3 031 studies, 23 randomized controlled trials with a total of 4 645 participants were included in the meta-analysis. The quality of the studies was moderate (mean 6 out of the maximum 12, with range of 4-9). Technology-based interventions were 12% more effective than similar or minimal control interventions in increasing physical activity (RR: 1.12; 95% CI: 1.01 to 1.25, P=0.03). Compared to minimal control interventions, technology-based interventions were 19% more effective (RR: 1.19; 95% CI 1.05 to 1.35, P=0.0096). In the interventions targeting patients, use of technology was 25% more effective than non-use (P=0.027). No differences were observed in physical activity between the effectiveness of interactive, non-interactive and self-monitoring technologies. Study quality, intervention duration and whether the measures used were subjective or objective were not significantly related to the amount of physical activity engaged in. CONCLUSIONS: Technology-based delivery of interventions seems to be more effective than usual care in promoting physical activity, particularly in the interventions targeting patients. Future research should investigate the cost-effectiveness of the use of distance technology for this purpose. Technology benefits rehabilitation, and can be considered for use in clinical practice, may adequately replace face-to-face meetings and stimulate more intensive rehabilitation in daily life.

Effectiveness of technology-based distance interventions promoting physical activity: Systematic review, meta-analysis and meta-regression.

OBJECTIVE: To determine the effectiveness of technology-based distance interventions for promoting physical activity, using systematic review and meta-analysis. METHODS: A literature search of studies published between 2000 and 2015 was conducted in the following databases: CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OTseeker, WOS and PEDro. Studies were selected according to the PICOS framework, as follows: P (population): adults; I (intervention): technology-based distance intervention for promoting physical activity; C (comparison) similar distance intervention without technology, O (outcomes) physical activity; S (study design) randomized controlled trial. Physical activity outcomes were extracted and quality was assessed by 2 independent authors. RESULTS: Eight studies were included in the meta-analysis. The mean (standard deviation; range) me thodological quality score of the studies was 6 (1.3; 4-8). Technology-based distance interventions were not more or less effective than conventional treatment whether measured as steps/day (mean difference 1,657; 95% confidence interval (95% CI) -1,861 to 5,176, p = 0.18), physical activity min/week (mean difference 0.34; 95% CI -146.3 to 146.9, p = 0.92), or as overall physical activity (response ratio 1.1; 95% CI 0.8-1.4, p = 0.65). No associations between the intervention duration or study quality and physical activity outcomes were found. Data were statistically and clinically heterogeneous. CONCLUSION: The effectiveness of technology-based distance interventions for promoting physical activity is similar to that of conventional treatment.