JMIR Publications

ABSTRACT

Background:

The world is ageing on a global scale, triggering vulnerability for chronic multimorbidity, balance disturbances and falls. These illnesses represent a significant social, economic, and public health challenge that needs to be addressed. Elderly falls resulting in injuries are the main cause of accidental death in this population, representing a relevant public health problem. One major risk factor is balance disorder that is known to increase linearly with age and represents one of the most frequent causes of healthcare demand. It is estimated that about 30% of the individuals above 60 years old present vertigo and dizziness, increasing to 50% for elderly above 85 years old. This is creating an increasing on demand pushing the health services to the limits. The use of Information Systems and Technologies represents an opportunity to improve the access and the quality of healthcare services. During last years it has observed an increasing in studies that address the potential of remote tools to assess balance status and fall risk of older people. In home-rehabilitation has been explored to promote better physical and balance performance.

Objective:

This paper aims at studying the current state of eHealth services and technology on providing objective assessment to better diagnosis and management in the clinical context of balance disorders with fall risk of older people.

Methods:

A systematic review was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). The quality of the evidence to respond the research question was assessed using Joanna Briggs Institute Critical Appraisal for Experimental Studies (RCT) and the Critical Appraisal Checklist for Quasi-Experimental Studies (QES). The included RCTs were assessed using the Cochrane risk of bias tool. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis about eHealth contribution to balance disorders was also obtained from the results.

Results:

From 1058 unduplicated articles, a total of 21 articles were included in the review. Twelve studies explored different technology devices to obtain remote data about balance and fall risk of older participants. Nine studies focused on different balance exercises training. It was observed a wide range of clinical tests, functional scales, faller classifications, sensor-based tasks, intervention protocols and follow-up time.

Conclusions:

Despite of the growing and interesting, most included researches did not present standardized procedures nor address real clinical settings. It has not been possible to compare the studies due to diversity of targeted population studied and time of follow-up, lack of homogeneity of study methodology and different use of remote technologies. No cost estimation data was observed. It was also observed a gap between research and clinical use. More comparability among studies is required.