Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 6, 2023
Date Accepted: Apr 29, 2024
Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients with Hip Fractures after Surgery: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Digital health interventions (DHIs) have been used to improve post-operative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population.
Objective:
This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery.
Methods:
We conducted a systematic review and meta-analysis following PRISMA guidelines. Three electronic medical databases (PubMed, EMBASE, and Cochrane) were searched up until January 3, 2023. We included clinical trials and randomized control trials in English involving home-based DHIs for post-operative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly utilizing DHIs, or with inaccessible full-text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data. Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and healthcare provider. Functional outcomes assessed included Time Up and Go test (TUG), Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% confidence intervals. Study quality was assessed using the risk-of-bias 2 assessment tool.
Results:
Out of 2023 identified studies, 16 were included in the systematic review, involving 1,467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and tele-rehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile applications. Physical therapists were the main healthcare providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared to usual care, with decreased TUG scores (mean difference = -7.89, 95% CI: -10.34 to -5.45, P=<.001, I2 0.00%), significantly increased SPPB scores (mean difference = 1.11, 95% 95% CI: 0.51 to 1.72, P=<.001, I2 61.50%), and increased FIM scores (mean difference = 7.98, 95% CI: 5.73 to 10.24, P=<.001, I2 12.62%).
Conclusions:
Home-based DHIs that integrate communication and feedback, education, and tele-rehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population. Clinical Trial: PROSPERO registration number is CRD42022370550
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