SKIP (Supporting Kids with diabetes In Physical activity): Feasibility of a randomised controlled trial of a digital intervention for 9-12 year olds with type 1 diabetes mellitus

Effect of wearable activity trackers on physical activity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical inactivity in children and adolescents has become a pressing public health concern. Wearable activity trackers can allow self-monitoring of physical activity behaviour and promote autonomous motivation for exercise. However, the effects of wearable trackers on physical activity in young populations remain uncertain.

METHODS

In this systematic review and meta-analysis, we searched PubMed, Embase, SPORTDiscus, and Web of Science for publications from database inception up to Aug 30, 2023, without restrictions on language. Studies were eligible if they were randomised controlled trials or clustered randomised controlled trials that examined the use of wearable activity trackers to promote physical activity, reduce sedentary behaviours, or promote overall health in participants with a mean age of 19 years or younger, with no restrictions on health condition or study settings. Studies were excluded if children or adolescents were not the primary intervention cohort, or wearable activity trackers were not worn on users' bodies to objectively track users' physical activity levels. Two independent reviewers (WWA and FR) assessed eligibility of studies and contacted authors of studies if more information was needed to assess eligibility. We also searched reference lists from relevant systematic reviews and meta-analyses. Systematic review software Covidence was used for study screening and data extraction. Study characteristics including study setting, participant characteristics, intervention characteristics, comparator, and outcome measurements were extracted from eligible studies. The two primary outcomes were objectively measured daily steps and moderate-to-vigorous physical activity. We used a random-effects model with Hartung-Knapp adjustments to calculate standardised mean differences. Between-study heterogeneity was examined using Higgins I2 and Cochran Q statistic. Publication bias was assessed using Egger's regression test. This systematic review was registered with PROSPERO, CRD42023397248.

FINDINGS

We identified 9619 studies from our database research and 174 studies from searching relevant systematic reviews and meta-analyses, of which 105 were subjected to full text screening. We included 21 eligible studies, involving 3676 children and adolescents (1618 [44%] were female and 2058 [56%] were male, mean age was 13·7 years [SD 2·7]) in our systematic review and meta-analysis. Ten studies were included in the estimation of the effect of wearable activity trackers on objectively measured daily steps and 11 were included for objectively measured moderate-to-vigorous physical activity. Compared with controls, we found a significant increase in objectively measured daily steps (standardised mean difference 0·37 [95% CI 0·09 to 0·65; p=0·013]; Q 47·60 [p<0·0001]; I2 72·7% [95% CI 53·4 to 84·0]), but not for moderate-to-vigorous physical activity (-0·08 [-0·18 to 0·02; p=0·11]; Q 10·26 [p=0·74]; I2 0·0% [0·0 to 53·6]).

INTERPRETATION

Wearable activity trackers might increase daily steps in young cohorts of various health statuses, but not moderate-to-vigorous physical activity, highlighting the potential of wearable trackers for motivating physical activity in children and adolescents. More rigorously designed trials that minimise missing data are warranted to validate our positive findings on steps and to explore possible long-term effects.

FUNDING

The Hong Kong University Grants Committee and Seed Fund for Basic Research of the University of Hong Kong.

Behavior Change Techniques Involved in Physical Activity Interventions for Children With Chronic Conditions: A Systematic Review

BACKGROUND

Behavior change techniques (BCTs) have been extensively used in physical activity interventions for children, however, no systematic reviews have synthesized their effects.

PURPOSE

The present review aimed to identify the most promising BCTs used in physical activity interventions associated with (i) increased physical activity behavior and (ii) positive psychosocial outcomes in children with chronic conditions.

METHODS

A systematic search of 6 databases identified 61 articles as eligible for inclusion. Data, including BCTs, were extracted from these studies and analyzed descriptively. Due to the heterogeneity of interventions, chronic conditions, and outcome measures, a meta-analysis was not conducted.

RESULTS

Social support (unspecified), graded tasks, generalization of target behavior, and credible source were the most commonly reported and most promising (i.e., present in 2+ studies evidencing significant effects) BCTs across all studies. These BCTs were found to be especially relevant to improving psychosocial outcomes in the short- and long-term and improving physical activity behaviors in the long-term. Meanwhile, to improve short-term physical activity behaviors, in addition to social support (unspecified), action planning, goal setting (behavior), and problem solving were found to be promising BCTs.

CONCLUSIONS

The BCTs identified in this review may be relevant to incorporate when planning future interventions to support physical activity and psychosocial outcomes for children with chronic conditions.

Digital health interventions for postoperative recovery in children: a systematic review

BACKGROUND

Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492).

RESULTS

The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%).

CONCLUSIONS

Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO (CRD42022351492).

Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review (Preprint)

BACKGROUND

Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them.

OBJECTIVE

This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people.

METHODS

This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022.

RESULTS

The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described.

CONCLUSIONS

We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.

Physical Activity and Nutrition Interventions for Type 1 Diabetes: A Meta-analysis

BACKGROUND AND OBJECTIVES

Current evidence is lacking on physical activity and nutrition-based interventions focusing on the management of type 1 diabetes mellitus (T1DM) and health-related quality of life among children. To assess the effects of physical activity interventions and nutrition-based interventions for children with T1DM.

METHODS

Data sources include the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, CINAHL through January 2022. Study selection includes randomized controlled trials of children aged 18 years and below with T1DM comparing either a physical activity intervention, a nutrition-based intervention, or hybrid physical activity and nutrition-based intervention with placebo or no-treatment control. Data were pooled using a random-effects model. Primary outcomes were hemoglobin A1c (HbA1c), and health-related quality of life.

RESULTS

Eighteen trials were included. Physical activity compared with the no-treatment group showed a lack of effect on HbA1c (mean difference = -0.58, 95% confidence interval -1.20 to 0.05; P value = .07). Nutrition-based intervention compared with no-treatment control for HbA1c level revealed a lack of effect (mean difference = -0.61, 95% confidence interval -1.48 to 0.26; P value = .17). Limitations include paucity of studies and low quality of evidence caused by the risk of bias.

CONCLUSIONS

Despite the lack of significant evidence, the generally favorable results highlight the potential of such interventions in enhancing glycemic control and health-related quality of life. Additionally, promising results from a single physical activity-nutrition-based hybrid intervention in terms of glycemic control indicate the plausible effectiveness of a mixed intervention.

Effectiveness of technological interventions to improve healthcare communication with children with long-term conditions: A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effectiveness of technological interventions used to improve communication between healthcare professionals (HCPs) and children with long-term conditions (LTCs).

METHODS

PROSPERO: CRD42020221977. Five electronic databases were searched from inception to May 2021 for randomised controlled trials. Study characteristics were described and random-effects meta-analysis was conducted.

RESULTS

Nineteen studies were included, involving 1995 participants. Technological interventions were found to significantly improve participants' knowledge of their condition (standardised mean difference [SMD] 0.39; 95% CI 0.07-0.71; p = 0.02) and lead to a more internal health locus of control (SMD 0.50; 95% CI 0.25-0.76; p < 0.0001). There was no statistically significant improvement in physiological measures or emergency healthcare use.

CONCLUSION

This systematic review showed some benefits of using technology to improve communication between HCPs and children with LTCs. Future primary research should use rigorous methods for subsequent reviews to draw conclusions with greater confidence in the evidence. Establishing a core outcome set within this field of study would enable consistent measurement of outcomes.

PRACTICE IMPLICATIONS

Our findings indicate value in integrating communication technologies in the child health setting, aiming to establish greater continuity of care and maintain patient-clinician relationships between healthcare visits.

Early Nutritional Intervention to Promote Healthy Eating Habits in Pediatric Oncology: A Feasibility Study

This study aims to describe the feasibility of a nutritional intervention that promotes healthy eating habits early after cancer pediatric diagnosis in patients and their parents. Participants were recruited 4 to 12 weeks after cancer diagnosis as part of the VIE study. The one-year nutritional intervention included an initial evaluation and 6 follow-up visits every 2 months with a registered dietician. The feasibility assessment included rates of retention, participation, attendance, completion of study measures, and participants' engagement. A preliminary evaluation of the intervention's impact on the participants' dietary intakes was conducted. A total of 62 participants were included in the study (51.6% male, mean age = 8.5 years, mean time since diagnosis = 13.2 weeks). The retention and attendance rates were 72.6% and 71.3%, respectively. Attendance to follow-up visits declined over time, from 83.9% to 48.9%. A majority of participants had high participation (50.8%) and high engagement (56.4%). Measures of body-mass-index or weight-for-length ratio and dietary 24-h recalls were the procedures with the highest completion rates. Participants with refractory disease or relapse were less likely to complete the intervention. Post-intervention, participants (n = 21) had a lower sodium intake compared to the initial evaluation. These results suggest that a nutritional intervention that involves patients and parents early after a pediatric cancer diagnosis is feasible.

School-Based Physical Activity Intervention: A Qualitative Process Evaluation of a Feasibility Trial in Yangzhou, China

Background: There is an urgent need for children in China to increase their physical activity levels. We first developed a 16-week school-based behavior change intervention based on the Behavior Change Wheel and Theoretical Domains Framework. We then conducted a cluster feasibility non-randomized controlled trial (RCT) among children in Yangzhou, China. Aim: This qualitative process evaluation was embedded within the cluster feasibility non-RCT and aimed to: (1) explore the experiences and perceptions of participants and providers in the intervention and trial; and (2) generate recommendations to inform a future intervention and full-scale cluster RCT. Methods: A qualitative study, using semi-structured interviews with trial participants (n = 20 children: 10 intervention, 10 control), parents (n = 20), and health education providers (n = 2), was conducted in two public schools in Yangzhou, China. Interviews were audio-recorded, transcribed, and translated verbatim from Mandarin to English. Data were analyzed using thematic analysis. Results: Findings believed to reflect experiences and perceptions of participants in the intervention and the trial are presented as eight major themes: (1) perceived high efficacy of the intervention components to help children become more active, (2) appreciation of the intervention features, (3) factors that facilitated or impeded intervention attendance and delivery, (4) positive experiences and feelings gained through the data collection process, (5) satisfaction regarding the organization and implementation of the trial, (6) influences of personal beliefs and emotional responses to the trial, (7) social influences on participatory decision-making, and (8) key barriers to consider regarding the recruitment of participants. Conclusions: The intervention and trial methods were acceptable to children, parents, and health education providers. School-based behavior change intervention was perceived to be a useful approach to increase physical activity in children aged 10–12 years in China. However, there were barriers to intervention delivery and engagement that should be considered when designing a future cluster RCT to assess the intervention efficacy.

The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review

Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some-but largely mixed-evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables' long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.

Effect of a mobile digital intervention to enhance physical activity in individuals with metabolic disorders on voiding patterns measured by 24-h voided volume monitoring system: Kumejima Digital Health Project (KDHP)

Purpose

To evaluate the effect of a mobile digital intervention on voiding patterns, we performed 24-h voided volume monitoring in individuals with metabolic disorders.

Methods

Participants with metabolic disorders were grouped into either the intervention group (n = 17), who had access to a smartphone app (CARADA), or the non-intervention group (n = 11), who did not. Urine monitoring was conducted for 24 h using a novel digital self-health monitoring system for urine excretion (s-HMSU). Body weight, abdominal circumference, blood pressure, and biomarkers were measured.

Results

Physical findings and blood test results at baseline and 6 months indicated no significant between-group differences. Night-time frequency did not change between baseline and 6 months in the intervention group but significantly worsened at 6 months in the non-intervention group, as compared to baseline (1.0 ± 0.7 vs. 1.5 ± 0.5, p < 0.05). The change in night-time frequency over 6 months did not differ between the intervention and non-intervention groups. Furthermore, the change in hours of undisturbed sleep over 6 months did not differ between the two groups. However, compared with baseline, nocturnal polyuria index tended to worsen at 6 months in the non-intervention group.

Conclusion

Our study results suggest that mobile digital intervention might be useful for behavioral therapy to improve night-time frequency and urine production and that s-HMSU might be beneficial for confirming the prevention of progress in individuals with metabolic disorders, which can aid in modifying lifestyle.

Feasibility and Acceptability of Physical Activity Monitoring as an Educational Tool in Management of Pediatric Type 1 Diabetes

OBJECTIVES

The spontaneous, sporadic and sometimes unpredictable nature of children's physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. In this study, we explored the perceptions of physical activity monitoring among health-care professionals and assessed the feasibility and acceptability of using it in the management of pediatric type 1 diabetes.

METHODS

Seven health-care professionals from 1 pediatric diabetes centre in the United Kingdom were involved in a focus group. Data were analyzed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with 13 children aged 7 to 11 years with type 1 diabetes. The primary outcome was feasibility (i.e. recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycemic control, parental self-efficacy for diabetes management and parental fear of hypoglycemia.

RESULTS

Health-care professionals valued having an awareness of the level, type and intensity of children's physical activity. They identified unmet training and resource needs that would facilitate them in being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and the study completion rate was 62%. No adverse events were reported. Physical activity monitoring was considered acceptable by parents.

CONCLUSIONS

Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether health-care professionals are best placed to implement it and what impact it has on health outcomes.