Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review

Online dissemination of Cochrane reviews on digital health technologies: a cross-sectional study

BACKGROUND

This cross-sectional study investigated the online dissemination of Cochrane reviews on digital health technologies.

METHODS

We searched the Cochrane Database of Systematic Reviews from inception up to May 2023. Cochrane reviews with any population (P), intervention or concept supported by any digital technology (I), any or no comparison (C), and any health outcome (O) were included. Data on review characteristics (bibliographic information, PICO, and evidence quality) and dissemination strategies were extracted and processed. Dissemination was assessed using review information on the Cochrane website and Altmetric data that trace the mentions of academic publications in nonacademic online channels. Data were analysed using descriptive statistics and binary logistic regression analysis.

RESULTS

Out of 170 records identified in the search, 100 Cochrane reviews, published between 2005 and 2023, were included. The reviews focused on consumers (e.g. patients, n = 86), people of any age (n = 44), and clinical populations (n = 68). All reviews addressed interventions or concepts supported by digital technologies with any devices (n = 73), mobile devices (n = 17), or computers (n = 10). The outcomes focused on disease treatment (n = 56), health promotion and disease prevention (n = 27), or management of care delivery (n = 17). All reviews included 1-132 studies, and half included 1-10 studies. Meta-analysis was performed in 69 reviews, and certainty of evidence was rated as high or moderate for at least one outcome in 46 reviews. In agreement with the Cochrane guidelines, all reviews had a plain language summary (PLS) that was available in 3-14 languages. The reviews were disseminated (i.e. mentioned online) predominantly via X/Twitter (n = 99) and Facebook (n = 69). Overall, 51 reviews were mentioned in up to 25% and 49 reviews in 5% of all research outputs traced by Altmetric data. Dissemination (i.e. higher Altmetric scores) was associated with bibliographic review characteristics (i.e. earlier publication year and PLS available in more languages), but not with evidence quality (i.e. certainty of evidence rating, number of studies, or meta-analysis performed in review).

CONCLUSIONS

Online attention towards Cochrane reviews on digital health technologies is high. Dissemination is higher for older reviews and reviews with more PLS translations. Measures are required to improve dissemination of Cochrane reviews based on evidence quality.

SYSTEMATIC REVIEW REGISTRATION

The study was prospectively registered at the Open Science Framework ( https://osf.io/mpw8u/ ).

Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews

BACKGROUND

Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD).

OBJECTIVE

This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity.

METHODS

MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics.

RESULTS

Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83%) and acceptance, satisfaction, or adherence (3/30, 10%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps.

CONCLUSIONS

This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results.

TRIAL REGISTRATION

PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/40538.

Conducting a systematic review and evaluation of commercially available mobile applications (apps) on a health-related topic: the TECH approach and a step-by-step methodological guide

OBJECTIVES

To provide an overview of the methodological considerations for conducting commercial smartphone health app reviews (mHealth reviews), with the aim of systematising the process and supporting high-quality evaluations of mHealth apps.

DESIGN

Synthesis of our research team's experiences of conducting and publishing various reviews of mHealth apps available on app stores and hand-searching the top medical informatics journals (eg, The Lancet Digital Health, npj Digital Medicine, Journal of Biomedical Informatics and the Journal of the American Medical Informatics Association) over the last five years (2018-2022) to identify other app reviews to contribute to the discussion of this method and supporting framework for developing a research (review) question and determining the eligibility criteria.

RESULTS

We present seven steps to support rigour in conducting reviews of health apps available on the app market: (1) writing a research question or aims, (2) conducting scoping searches and developing the protocol, (3) determining the eligibility criteria using the TECH framework, (4) conducting the final search and screening of health apps, (5) data extraction, (6) quality, functionality and other assessments and (7) analysis and synthesis of findings. We introduce the novel TECH approach to developing review questions and the eligibility criteria, which considers the Target user, Evaluation focus, Connectedness and the Health domain. Patient and public involvement and engagement opportunities are acknowledged, including co-developing the protocol and undertaking quality or usability assessments.

CONCLUSION

Commercial mHealth app reviews can provide important insights into the health app market, including the availability of apps and their quality and functionality. We have outlined seven key steps for conducting rigorous health app reviews in addition to the TECH acronym, which can support researchers in writing research questions and determining the eligibility criteria. Future work will include a collaborative effort to develop reporting guidelines and a quality appraisal tool to ensure transparency and quality in systematic app reviews.

Different Approaches to Appraising Systematic Reviews of Digital Interventions for Physical Activity Promotion Using AMSTAR 2 Tool: Cross-Sectional Study

High-quality systematic reviews (SRs) can strengthen the evidence base for prevention and health promotion. A 16-item AMSTAR 2 tool allows the appraisal of SRs by deriving a confidence rating in their results. In this cross-sectional study, we aimed to assess and compare two approaches to appraising 30 SRs of digital interventions for physical activity (PA) promotion using AMSTAR 2. Approach 1 (appraisals with 2/16 items) was used to identify SRs with critically low confidence ratings. Approach 2 (appraisals with all 16 items) was used (1) to derive the confidence ratings, (2) to identify SR strengths and weaknesses, and (3) to compare SR strengths among subgroups of SRs. The appraisal outcomes were summarized and compared using descriptive statistics. Approach 1 was quick (mean of 5 min/SR) at identifying SRs with critically low confidence ratings. Approach 2 was slower (mean of 20 min/SR), but allowed to identify SR strengths and weaknesses. Approach 2 showed that confidence ratings were low to critically low in 29/30 SRs. More strengths were identified in SRs with review protocols relative to SRs without review protocols and in newer SRs (published after AMSTAR 2 release) relative to older SRs. Only two items on AMSTAR 2 can quickly identify SRs with critical weaknesses. Although most SRs received low to critically low confidence ratings, SRs with review protocols and newer SRs tended to have more strengths. Future SRs require review protocols and better adherence to reporting guidelines to improve the confidence in their results.

Digital Technologies for Health Promotion and Disease Prevention in Older People: Protocol for a Scoping Review

BACKGROUND

Digital technologies could contribute to health promotion and disease prevention. It is unclear if and how such digital technologies address the health needs of older people in nonclinical settings (ie, daily life).

OBJECTIVE

This study aims to identify digital technologies for health promotion and disease prevention that target the needs of older people in nonclinical settings by performing a scoping review of the published literature. The scoping review is guided by the framework of Arksey and O'Malley.

METHODS

Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The information sources are bibliographic databases (MEDLINE, PsycINFO, CINAHL, and SCOPUS) and bibliographies of any included systematic reviews. Manual searches for additional studies will be performed in Google Scholar and most relevant journals. The electronic search strategy was developed in collaboration with a librarian who performed the search for studies on digital technologies for health promotion and disease prevention targeting the needs of older people. Study selection and data coding will be performed independently by 2 authors. Consensus will be reached by discussion. Eligibility is based on the PCC (Population, Concept, and Context) criteria as follows: (1) older people (population); (2) any digital (health) technology, such as websites, smartphone apps, or wearables (concept); and (3) health promotion and disease prevention in nonclinical (daily life, home, or community) settings (context). Primary studies with any design or reviews with a systematic methodology published in peer-reviewed academic journals will be included. Data items will address study designs, PCC criteria, benefits or barriers related to digital technology use by older people, and evidence gaps. Data will be synthesized using descriptive statistics or narratively described by identifying common themes. Quality appraisal will be performed for any included systematic reviews, using a validated instrument for this study type (A Measurement Tool to Assess Systematic Reviews, version 2 [AMSTAR2]).

RESULTS

Following preliminary literature searches to test and calibrate the search syntax, the electronic literature search was performed in March 2022 and manual searches were completed in June 2022. Study selection based on titles and abstracts was completed in July 2022, and the full-text screen was initiated in July 2022.

CONCLUSIONS

Our scoping review will identify the types of digital technologies, health targets in the context of health promotion and disease prevention, and health benefits or barriers associated with the use of such technologies for older people in nonclinical settings. This knowledge could guide further research on how digital technologies can support healthy aging.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37729.