Can remote digital health interventions improve rehabilitation following major trauma? Results of a systematic review.

Abstract

To identify the effectiveness of remote digital health (DH) interventions in supporting physical and/or psychosocial rehabilitation in patients with major physical trauma. This review was conducted between 2000 to 2023 following PRISMA guidelines to identify relevant studies by searching five databases: MEDLINE, EMBASE, AMED, CINAHL Plus, and PsycInfo. Searches were limited to randomised controlled trials (RCTs) and peer reviewed journals. Bibliographies of included studies and relevant reviews were searched for relevant articles. Inclusion criteria consisted of RCTs that investigated remote DH interventions to enhance physical, and/or psychosocial rehabilitation of adults subjected to major physical trauma (e.g., traumatic brain injury (TBI) or spinal cord injury (SCI)). Screening of retrieved studies was conducted by two reviewers. Disagreements were resolved by discussion or by consulting a third reviewer. Data were extracted by one reviewer and independently checked by another. Risk of bias (ROB) was independently conducted by two reviewers using ROB2 tool. Disagreements were resolved by discussion or by consulting a third reviewer. Results were reported following PRISMA guidelines. Seven studies were included, of which five had adequate power to detect a significant treatment effect. Studies included mostly male participants of White race. Included interventions targeted TBIs or SCIs, and were delivered using numerous pathways (e.g., video conferencing, virtual reality), with/without human support. Positive findings were generally reported with significant effects only reported by three studies targeting people with SCIs, reflecting improvements in physical and psychosocial outcomes. ROB ranged from low (n=3); some concern (n=2) and high (n=2). Overall positive findings were reported with strong evidence only reported by three studies targeting SCIs. Future studies should be adequately powered and include diverse populations to measure the effectiveness and cost effectiveness of DH interventions in comparison to usual care.