Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 26, 2025
Open Peer Review Period: Jun 27, 2025 - Aug 22, 2025
Date Accepted: Oct 17, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Adherence to Actigraphic Devices in Elementary School Aged Children: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
For actigraphic devices to collect valid and reliable data from children and young people, consistent wear is essential. Adherence in primary-school aged children may be particularly challenging due to developmental factors and designs considerations. Despite the growing use of these devices in research and clinical settings, no previous review has attempted to quantify adherence in this age group.
Objective:
To provide the first pooled-estimate of adherence to actigraphic devices in primary-school aged children and examine the impact of sociodemographic, clinical and device related factors on adherence rates.
Methods:
The electronic databases Embase, MEDLINE, PsycInfo, Social Policy and Practice, Education Resources Information Center, British Education Index and CINAHL were queried using database specific pre-defined search strategies. Empirical studies that reported on wearable actigraph adherence in children (aged 5-11 years old) were included in this review. Data were extracted for 235 studies, which were all narratively synthesised. Of these, 135 studies contained adherence data which were pooled in a proportional meta-analysis. Meta-regression was used to examine the impact of individual, device-specific and study-related factors on adherence. The main outcome was actigraphic device adherence derived as the proportion of children that met the analytic analysis wear-time threshold compared to the number of children invited to use the device at baseline.
Results:
Overall adherence, measured over a range of 1 to 140 days, was 81.6% (95% CI: 78.7%–84.4%). Children with a health diagnosis, particularly neurodevelopmental, demonstrated higher adherence to these devices (b=.395, p =.004, 95% CI = [.125-.665]). No other individual, device- or study-related factors had a statistically significant impact on adherence.
Conclusions:
This review demonstrates high adherence to actigraphic devices in 5-11 years old children, and more so in those with health conditions. However, questions remain about long-term adherence, particularly due to the over-reliance on commercial devices and methodological reporting quality. Clinical Trial: PROSPERO registration: CRD42021232466
Citation
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Copyright
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