JMIR Publications

ABSTRACT

Background:

Musculoskeletal (MSK) diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of MSK diseases. As physical exercise is the best clinical practice in the treatment of MSK diseases, digital health intervention which provides physical exercises could have a highly positive impact on MSK diseases, but evidence is lacking.

Objective:

The aim of this systematic review was to evaluate the impact of digital physical health exercises on patients with MSK diseases concerning the localization of the MSK disease, patient-reported outcomes, and medical treatment type.

Methods:

A systematic literature research was performed using the PRISMA guidelines. The search was conducted in the Pubmed, BISp, Cochrane Library, and Web of Science databases. The SIGN checklist was used to assess the study quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was carried out, whereby only studies with at least acceptable methodological quality were included for validity purposes.

Results:

8988 studies were reviewed of which 30 RCTs fulfilled the inclusion criteria and 16 RCTs were of at least acceptable methodological quality, involving 1840 patients (62% female) with various MSK diseases. A total of three different intervention types (app-based applications, internet-based exercises, and telerehabilitation) to provide digital physical health exercises were used. Strong evidence was found for a positive impact of digital physical health exercises on the MSK diseases located at the back. Moderate evidence was found for diseases located at the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located at the knee and hand. For the patient-reported outcomes, strong evidence was found on impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies.

Conclusions:

Strong to moderate evidence was found for a positive impact on MSK diseases located at the back, shoulder, and hip, and also on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of MSK diseases.