JMIR Publications

ABSTRACT

Background:

Pediatric survivors of critical illness often face persistent psychosocial challenges after PICU (Pediatric Intensive Care Unit) discharge, but follow-up support across hospital, home, community, and school settings remains inconsistent. Digital interventions could help bridge these gaps and support recovery.

Objective:

To systematically review the literature on digital psychosocial follow-up solutions for children who survived critical illness, describing target populations, intervention design, evaluation methods, and psychosocial effects.

Methods:

A systematic literature review was performed using the Scopus database, supplemented by backward citation searches and hand searches of related reviews. Eligible studies included children surviving medical conditions potentially requiring PICU care, implemented a digital intervention (excluding telephone-only), and evaluated psychological or social outcomes; studies published before 2010, in non-English languages, not peer-reviewed, lacking full text, not original research, involving mixed child-adult populations, or with unspecified participant age or diagnosis were excluded. The quality of the included studies was appraised with the MMAT (Mixed Methods Appraisal Tool) 2018. Owing to heterogeneity in populations, interventions, comparisons, outcomes, and study designs, a narrative synthesis was applied.

Results:

Thirty-three publications reporting on 31 unique studies (N=1,717 participants, ages 0–17) were included. The studies spanned North America, Europe, and Asia and were conducted in inpatient, outpatient, home, and school contexts. Interventions comprised web applications (n=9/31), mobile apps (n=7/31), social robots (n=6/31), video games (n=4/31), and mixed modalities (n=5/31). Many studies (n=18/31) engaged guardians as co-participants or co-developers along with children. Target conditions were predominantly cancer (n=11/31), type 1 diabetes (n=8/31), and asthma (n=7/31). Mixed methods designs were most common (n=11/31), followed by nonrandomized quantitative trials (n=7/31) and randomized controlled trials (n=6/31). Most studies reported positive psychosocial effects. Across outcomes, self-management (n=3/31) and quality of life (n=5/31) showed the most statistically significant (P<.05) benefits. Evidence for psychosocial outcomes was less consistent. The certainty of evidence was limited by a single-database search, single-reviewer screening, variable methodological quality, and heterogeneity.

Conclusions:

Digital psychosocial follow-up for childhood critical illness survivors appears feasible and promising, particularly for self-management and quality of life, but the evidence base is heterogeneous and methodologically constrained. To strengthen clinical translation, future work should prioritize rigorous trials, standardized and theory-informed pediatric psychosocial outcome sets, longer follow-up, transparent reporting, and equity-focused designs that integrate family-centered hybrid clinic-home pathways and, where feasible, predictive features. Clinical Trial: PROSPERO CRD42022364703; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022364703