JMIR Publications

ABSTRACT

Background:

Digital health technologies (DHTs) are increasingly used in physical rehabilitation to support individuals to successfully engage with the frequent, intensive, and lengthy activities required to optimise recovery from illness or injury. Despite this, little is known about if, or how DHTs utilise techniques to support and promote behaviour change in physical rehabilitation.

Objective:

Using stroke rehabilitation as an exemplar, this scoping review aimed to identify the frequency and nature of behaviour change approaches utilised within DHT-based physical rehabilitation interventions.

Methods:

Databases (Embase, Medline, PyscINFO, CINAHL, Cochrane Library and AMED) were searched using keywords relating to behaviour change, DHT, physical rehabilitation and stroke. Results were independently screened by two reviewers. Sources were included if they reported a completed primary research study in which a behaviour change approach could be identified within a DHT-based, physical stroke rehabilitation intervention. Data including the study design, DHT utilised, and behaviour change approaches were charted. Specific behaviour change techniques were coded to the behaviour change technique taxonomy (BCTTv1).

Results:

From a total of 1973 identified sources, 103 studies (5%) were included for data charting. The most common reason for exclusion at full text screening, was the absence of an articulated approach to behaviour change (165/245, 67%). Almost half of the included studies (45/103, 44%) were described as pilot or feasibility studies. Virtual reality (VR) was the most frequently identified DHT type (58/103, 56%) and almost two-thirds of studies focused on upper limb rehabilitation (65/103, 63%). Only a limited number of studies (18/103, 17%) included a theoretical rationale for behaviour change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56, 54%), goals and planning (33, 32%), and shaping knowledge (33, 32%). Relationships between feedback and monitoring, and reward and threat were identified with prominent use of both in VR.

Conclusions:

Despite most DHTs being assumed to promote engagement in rehabilitation, this scoping review demonstrates that very few studies of DHT-based physical stroke rehabilitation overtly utilised any form of behaviour change approach. From those studies that did consider behaviour change, most did not report robust underpinning theory. Future development and research of DHT-based rehabilitation needs to explicitly articulate how using DHTs may support the behaviour change required for optimal engagement in physical rehabilitation as well as establish their effectiveness. This understanding is likely to support the realisation of the transformative potential of DHTs in rehabilitation.