Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials.
Sabine Lang, Colin McLelland, Donnie MacDonald and 1 others
PMID 36184611WHAT IT FOUND
Digital add-ons (apps, texts, phone calls) increased home exercise adherence in 7 of 10 trials, mostly where follow-up was under 6 weeks.
Three found no difference and longer-term benefit was uncertain. All used self-reported adherence; most were at high risk of bias.
Key findings
01Seven of the ten included trials found that adding a digital element (app, text messages, phone calls or video) to a physiotherapist-prescribed home exercise programme significantly increased adherence; the other three found no difference between groups.
02The positive results were concentrated in the trials with the shortest follow-up: all four trials following up for under 6 weeks reported a benefit, two of four at 8 to 12 weeks did, and at 24 months only one of the two trials did.
03The reviewers rated the overall quality of the included trials poor, with eight of ten at high risk of bias because participants and staff were not blinded, and all ten measuring adherence by self-report using six different measures with no established reliability or validity.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The trials were too different from each other in what the digital intervention was and how adherence was measured for the results to be combined, so this is a count of positive and null trials rather than a pooled estimate of effect. The overall quality of the ten trials was poor: eight of ten were at high risk of bias because participants and staff were not blinded, and blinding of the people assessing outcomes was also poor. Adherence was measured by self-report in every trial, using six different measures, none of which had established reliability or validity. Patients may overstate their compliance, particularly to please their therapist. Only ten trials were found, and intervention groups ranged from 20 to 152 participants, so the evidence base is small. Everyone in the included trials was still taking part in a prescribed programme; there is no information here about people who stop attending or who are more disabled. Populations were mostly musculoskeletal and stroke, and the mean age range was wide (37.5 to 79.5 years), so the results may not apply to other conditions or age groups. The review did not collect clinical outcomes, so it cannot say whether the extra adherence translated into better function, less pain or better quality of life.
Declared interests
The article text provided contains no funding statement and no conflict of interest declaration, so there is nothing to report on who paid for or shaped this work.
The easy way to misread this
Do not read the seven positive trials as proof that digital add-ons produce lasting gains in exercise adherence. All ten trials measured adherence by self-report, using six different measures with no established reliability or validity, and eight of the ten were at high risk of bias because participants and staff knew who was getting what. The positive results also clustered in the trials with the shortest follow-up. This review does not show that better adherence improved pain, function or any other clinical outcome, because it did not measure those.
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