Assessing telehealth interventions for physical activity and sedentary behavior self-management in adults with type 2 diabetes mellitus: An integrative review.
Chelsea Howland, Bonnie Wakefield
PMID 33091168WHAT IT FOUND
Telehealth programs using websites or apps were linked to increased physical activity in ten of 17 studies, but improvements in blood sugar control were less consistent.
Ask patients to use self-monitoring and feedback, and do not assume sitting time changed.
Key findings
01The review included 17 studies of adults with diabetes, with sample sizes from 20 to 1229.
02Ten studies reported significant improvements in physical activity, four reported significant improvements in glycemic control, and two reported clinically relevant but non-significant A1C changes.
03Higher dropout was common, especially when feedback or interventionist involvement was lacking and in longer studies.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review combined studies with different platforms, content, durations, and outcome measures, so it cannot identify a best telehealth design. Physical activity and sedentary behavior were often measured by self-report, which can overstate or understate actual behavior. Dropout was high in several studies, especially when feedback or interventionist involvement was lacking, so results may reflect only engaged participants. Participants and interventionists could not be blinded in most studies, and many interventions did not clearly use a behavior-change theory. Few studies included rural populations or long-term follow-up, so sustained effects and generalizability are uncertain. The search was limited to English-language, full-text articles within a recent period, so some relevant studies may have been missed.
Declared interests
The authors declared no conflicts of interest. The article is tagged as NIH and non-U.S. government research support, but the supplied text does not describe a specific funder's role.
The easy way to misread this
Do not conclude that nurse-delivered telehealth improves blood sugar control. The review included mostly automated web or app programs, some without an interventionist, and glycemic control improved in only some studies; it did not test a nurse-led model.