Evaluating the effectiveness and implementation of digital health interventions for patients with spinal cord injury: A systematic review and meta-analysis.
Aug 2026· Complementary Therapies in Medicine· Vol 102, pp.
103424
· 0 citations
Medicine
TL;DR
Current evidence suggests that digital health technologies, as a supplement to conventional rehabilitation, may help improve certain functional outcomes, psychological health, and quality of life in patients with spinal cord injury, while also alleviating pain to some extent.
Abstract
Objective
To evaluate the effectiveness and implementation of digital health interventions (DHIs) for patients with spinal cord injury (SCI) compared with control groups.
Methods
We conducted a systematic review of relevant randomized controlled trials (RCTs). Five electronic databases were searched from inception to January 1, 2026. The analysis examined the effects of DHIs on patients' clinical symptoms, quality of life, psychological status, and other outcomes. Quantitative analyses were performed using Review Manager software (version 5.4), and the results were presented using forest plots. The Cochrane Risk of Bias (RoB 1.0) tool was used to assess risk of bias, and the GRADE approach was applied to evaluate the overall certainty of evidence.
Results
A total of 26 RCTs were included. The meta-analysis showed that DHIs significantly reduced pain in patients with spinal cord injury (SMD = -0.19, 95% CI -0.38 to -0.00, P = 0.05) and improved independent living ability as measured by the Functional Independence Measure (FIM) (MD = 10.69, 95% CI 9.33 to 12.04, P < 0.00001). DHIs also significantly improved depressive symptoms (SMD = -0.25, 95% CI -0.51 to -0.00, P = 0.05) and anxiety symptoms (MD = -1.11, 95% CI -1.99 to -0.23, P = 0.01). In addition, DHIs significantly improved lower limb function, as reflected by improvements in the Timed Up and Go test (TUG) (MD = -0.92, 95% CI -1.60 to -0.23, P = 0.009) and the 10-Meter Walk Test (10MWT) (MD = -1.61, 95% CI -2.93 to -0.28, P = 0.02), and also enhanced balance ability (MD = 30.61, 95% CI 6.97 to 54.26, P = 0.010). However, no significant improvement was observed in upper limb function. DHIs also improved quality of life in the psychological domain (MD = 2.66, 95% CI -0.03 to 5.36, P = 0.05), social domain (MD = 1.52, 95% CI 0.75 to 2.30, P = 0.0001), and environmental domain (MD = 1.10, 95% CI 0.19 to 2.01, P = 0.02). Among the included studies, the reach of digital health technologies ranged from 14.05% to 100%, feasibility ranged from 58.33% to 100%, and adherence ranged from 51.05% to 100%. Only two studies reported mild adverse events. In this review, seven studies were assessed as having a low risk of bias, while 19 studies were rated overall as having a high risk of bias. The certainty of evidence in this review ranged from very low to moderate.
Conclusion
Current evidence suggests that digital health technologies, as a supplement to conventional rehabilitation, may help improve certain functional outcomes, psychological health, and quality of life in patients with spinal cord injury, while also alleviating pain to some extent. However, the certainty of these findings is limited by multiple factors. Future high-quality studies are needed to further strengthen the evidence in these areas.
OBJECTIVES
To systematically synthesize the evidence on the effect of positive psychology interventions (PPIs) on health and wellbeing outcomes in adults with spinal cord injury (SCI).
DATA SOURCES
We performed a comprehensive search across six electronic databases: Medline, Embase, CINAHL, PsycInfo, SPORTDiscus, and CENTRAL (Cochrane Library).
STUDY SELECTION
We included interventional studies published between 2000 and 2025. Studies were eligible for inclusion if they involved individuals with SCI and implemented PPIs aligned with Seligman's PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model. Studies with all health and wellbeing outcomes were included. The initial search retrieved 8288 studies, of which eight met the eligibility criteria for inclusion in the systematic review.
DATA EXTRACTIONS
Two independent reviewers extracted data on study designs, intervention characteristics, outcome measures, and key findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Meta-analyses were performed for outcomes reported in at least three studies.
DATA SYNTHESIS
The systematic review included eight studies, and the meta-analyses included seven of them. Of the eight studies, seven integrated one or more PPI components within their interventions, whereas only one study was fully grounded in a positive psychology framework. Results from the systematic review suggest the significant positive effects of PPIs on selected physical, emotional, and psychosocial outcomes. In meta-analyses conducted for self-efficacy, life satisfaction, anxiety, and depression outcomes, the standardized mean differences were statistically significant for self-efficacy, life satisfaction, and anxiety. However, evidence on the follow-up or long-term effects of PPIs remains limited or inconsistent.
CONCLUSIONS
The PPIs or PPI-derived components exert beneficial effects on various health and wellbeing outcomes, particularly in emotional or psychological health. Nevertheless, further research using standardized, full-scale PPI and a larger sample is essential to establish these interventions as potential mainstream interventions within SCI rehabilitation.
Background Various digital technologies have been adopted for rehabilitation training and extended care in patients with Parkinson’s disease (PD), yet their effectiveness remains unclear. This review aims to evaluate the effectiveness of digital technology-based interventions on balance and non-motor outcomes (cognitive function, depression, and quality of life) in individuals with PD. Methods We systematically searched six electronic databases (PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO) in March 2026. Two reviewers independently screened randomized controlled trials (RCTs) meeting the inclusion criteria and assessed methodological quality using the Cochrane RoB Tool. We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs) to pool effect sizes for studies with consistent outcome measures, and performed subgroup analyses by intervention type, duration, and frequency. Results We included 29 RCTs with 1,298 PD patients. Meta-analysis revealed that versus the control group, digital technology-based interventions were associated with favorable improvements in balance function (SMD = 0.62, 95%CI 0.16 to 1.09) and cognitive function (SMD = 0.50, 95% CI 0.18 to 0.83) in patients with PD. No significant improvements were found in depression (SMD = −0.17, 95% CI −0.42 to 0.09) or quality of life (SMD = 0.01, 95% CI −0.15 to 0.16). Exploratory subgroup analyses suggested that virtual reality (SMD = 0.88, p = 0.02), robotics (SMD = 0.49, p = 0.03), interventions lasting ≥ 8 weeks (SMD = 2.91, p < 0.0001), 3 weekly sessions (SMD = 0.36, p = 0.03), > 3 weekly sessions (SMD = 2.77, p = 0.002), and active exercise training (SMD = 0.75, p = 0.006) might be associated with improvements in balance function in PD patients. Conclusion Digital technology-based interventions have the potential to enhance balance and cognitive function in PD patients, while their effects on depression and quality of life remain inconclusive. Exploratory subgroup analyses showed that virtual reality, robotic training, intervention duration ≥8 weeks, frequency ≥3 sessions per week, and active exercise training were associated with improvements in balance function, though these findings should be considered hypothesis-generating. Given the high heterogeneity, unstable sensitivity analysis for the primary outcome, high risk of performance bias across all trials, and unclear allocation concealment in most studies, the current evidence remains preliminary, and its clinical value requires confirmation through further high-quality research. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628620, identifier (CRD42024628620).
Bowen Zheng, Wei Wang, Amanda Lee et al.· Frontiers in Neurology· 0 citations
Background No systematic review has examined the clinical effectiveness of mobilization for shoulder impingement syndrome (SIS). We aimed to evaluate clinical effectiveness for the use of mobilization in SIS. Methods PubMed, Embase and the Cochrane Library were searched for studies published up to April 30, 2023. Randomized controlled trials that evaluated the effectiveness of mobilization for SIS were included. Literature was extracted using Endnote 20, and the risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. A meta-analysis was conducted using RevMan 5.4. This study was conducted in accordance with the PRISMA guidelines. Results Nineteen randomized controlled trials (956 participants) were selected based on the inclusion criteria. Adding mobilization to traditional physical therapy reduced pain (mean difference [MD]=1.72, 95% confidence interval [CI]: 0.91 to 2.53, I2 = 97%, p < 0.00001), increased active range of motion (MD = 14.49, 95% CI: 8.46 to 20.53, I2 = 95%, p < 0.00001), and improved the disabilities of the arm, shoulder, and hand (MD = 5.95, 95% CI: 0.01 to 11.90, p = 0.05) and Constant-Murley scores (MD = 5.49, 95% CI: 0.78 to 10.19, p = 0.02). Joint mobilization was more effective in reducing pain (MD = 0.67, 95% CI: 0.15 to 1.19, p = 0.01) and increasing active range of motion (MD = 8.56, 95% CI: 2.31 to 14.82, p = 0.007) compared with sham mobilization. No statistically significant differences were found between physical therapy plus mobilization and physical therapy plus exercise. Conclusion Mobilization may offer adjunctive, short-term benefits in improving the clinical symptoms of SIS when added to conventional treatments. Future studies should focus on evaluating the effects of mobilization as a stand-alone intervention, incorporate larger sample sizes and long-term follow-up, and conduct high-quality comparative trials to identify the most effective specific mobilization techniques.
Gayeong Lee, Hyeonjun Woo, Yunhee Han et al.· PLoS ONE· 0 citations
Abstract Background Digital health interventions may improve clinical outcomes in patients with colorectal cancer (CRC), but their impact on nutritional status (NS) and quality of life (QoL) remains unclear. Objective This study systematically evaluated the impact of digital health interventions on the NS and QoL in patients with CRC. Methods A systematic search was performed across PubMed, Embase, Cochrane, and Web of Science from inception to March 2026 to identify randomized controlled trials evaluating digital health interventions on NS or QoL in CRC. Two reviewers independently performed screening, data extraction, and risk of bias assessment (Cochrane Risk of Bias Assessment Tool [RoB 1.0]). Meta-analysis used a random-effects model to compute standardized mean differences (SMD) or mean differences (MD) with 95% CIs. Heterogeneity was assessed using I² and τ², and subgroup analyses (intervention duration, intervention method, and scale type) explored sources of heterogeneity. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used for evidence quality. Results Eleven RCTs from 7 countries, involving 1210 participants aged 37.7‐69.0 years. The meta-analysis shows that digital health interventions have no significant effect on improving NS (MD 2.23, 95% CI –10.50 to 14.97; P=.27), with high heterogeneity (I²=81.8%). The overall analysis of QoL shows that digital health interventions significantly improve the QoL of patients (SMD 0.67, 95% CI 0.14-1.21; P=.02), with a moderate effect size, but there is high heterogeneity (I²=92.9%; τ²=0.5146; 95% prediction intervals –1.04 to 2.38). Subgroup analysis indicates in terms of intervention duration, the effect is not significant in the group with ≤1 month, while it is significant in the groups with 1-3 months and >3 months, but there is no statistical significance in the differences among subgroups (P=.67); in terms of intervention methods, the group with guided intervention has a significant effect and no heterogeneity (SMD 1.16, 95% CI 1.05-1.28; I²=0%, τ²=0, P=.97), the effect of the unsupervised intervention group is zero, and the effect of the combined intervention group is unstable, with significant differences among subgroups (P<.001); in terms of scale types, different QoL measurement tools have certain effects on the effect size, but the differences among subgroups are not significant (P=.99). Conclusions Digital health interventions have a moderate effect on improving the QoL in patients with CRC, especially when guided interventions are employed, the effect is clearer and more stable. This innovatively identifies “guided intervention models” as a key moderator of efficacy, contrasting with prior reviews that focused solely on technology. Our findings provide new evidence highlighting the importance of interpersonal support in digital health applications. In practice, digital tools should integrate professional medical guidance and supervision rather than being implemented in isolation, to more effectively improve health outcomes in patients with CRC.
Xiujuan Feng, Jinna Wang, Huihui Shi et al.· Journal of Medical Internet...· 0 citations
BACKGROUND
Musculoskeletal (MSK) conditions are leading causes of disability worldwide. Although clinical guidelines recommend non-pharmacological interventions, surgical and invasive procedures remain frequently used, yet their efficacy beyond placebo effects is not well established.
OBJECTIVE
To systematically review the effects of invasive procedures compared with placebo controls in patients with MSK conditions.
METHODS
MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, EMBASE, and Web of Science were searched from inception to August 2024. Eligible studies were RCTs comparing any invasive procedure with a sham or placebo in patients with MSK conditions and measuring pain, disability, function, or quality of life. All analyses were pairwise comparisons. Risk of bias was assessed using the Cochrane RoB Tool and certainty of evidence using GRADE. Random-effects meta-analyses were conducted when at least two trials provided data.
RESULTS
Twenty-three RCTs (2412 participants) were included. In 18 studies (78%), invasive procedures showed no superiority over placebo, with some placebo groups demonstrating better outcomes. Moderate-certainty evidence showed vertebroplasty provided no additional benefit for pain at 1 month (MD 0.42; 95% CI -0.84 to 1.68; I2 = 73%) or 6 months (MD 0.90; 95% CI -0.06 to 1.87; I2 = 0%). Arthroscopic decompression did not improve shoulder function at 6 months (MD -3.68; 95% CI -8.57 to 1.22; low-certainty). Radiofrequency denervation and intradiscal therapies showed no consistent benefit over sham for low back pain (very low-certainty).
CONCLUSIONS
Invasive procedures were not superior to placebo for most non-life-threatening MSK conditions. Further rigorous placebo-controlled trials are needed.
TRIAL REGISTRATION
This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024534187.
Mariane Nunes Pereira Dutra, M. S. Canez, B. R. Pereira et al.· Musculoskeletal Care· 0 citations
Background Overactive bladder (OAB) is a prevalent condition that substantially impairs quality of life (QoL); however, the real-world utility of standard behavioral and pharmacological therapies is often limited by poor long-term adherence. Digital interventions have emerged as a promising strategy to provide accessible and personalized support, but their overall efficacy compared with conventional care remains to be systematically established. Objective This study aimed to evaluate the efficacy of digital interventions compared with conventional care for improving symptoms, QoL, and treatment adherence in patients with OAB. Methods We conducted a systematic review and meta-analysis using data from PubMed, Embase, the Cochrane Library, and other databases from inception to July 2025. Randomized controlled trials (RCTs) assessing technology-based digital interventions for adult patients with OAB were included. The primary outcomes were objective symptom improvement (measured by bladder diaries) and subjective symptom scores, while secondary outcomes included QoL and attrition rates. Data were pooled using a random-effects model, and subgroup analyses were performed according to the delivery and supervision category (automated or app-based therapeutic content, telemedicine-supported care management, or digitally supervised behavioral or rehabilitation support) and intervention duration. Results Seven RCTs involving 544 participants were included. Digital interventions were associated with a significant improvement in overall objective symptom indicators compared with conventional care (mean difference [MD] −1.72, 95% CI −2.61 to −0.83; P<.001), specifically reducing 24-hour urinary frequency (MD −2.55, 95% CI −4.22 to −0.89; P=.003) and urge incontinence episodes (MD −2.07, 95% CI −2.72 to −1.42; P<.001). The pooled analysis of subjective symptom scores did not reach statistical significance (standardized MD [SMD] −1.07, 95% CI −2.18 to 0.05; P=.06). Exploratory subgroup analysis suggested that digitally supervised behavioral or rehabilitation support had the largest point estimate (SMD −2.51, 95% CI −5.03 to 0.01), although the CI crossed the line of no effect, and the finding was based on 2 heterogeneous studies. The prespecified subgroup analysis by intervention duration showed that interventions lasting 6 to 13 weeks were associated with symptom reduction (SMD −1.41, 95% CI −2.70 to −0.11; P=.03), suggesting a potentially favorable duration range. Furthermore, digital interventions significantly improved QoL (SMD 1.47, 95% CI 0.11-2.84; P=.03). No significant difference was observed in dropout rates between digital and conventional care groups (risk ratio 0.92, 95% CI 0.59 to 1.45; P=.72). Conclusions Digital interventions may improve objective symptoms and QoL in patients with OAB, with comparable short-term attrition to conventional care. Interventions with higher-intensity digital supervision may have potential for symptom reduction, but this finding remains uncertain because of the small number of heterogeneous studies. These findings may inform future stepped care models, but further well-designed, longer-term RCTs are needed to confirm optimal implementation strategies. Trial Registration PROSPERO CRD420251164488; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251164488
Ni Wang, Fan Fan, Yuan Ou et al.· Journal of Medical Internet...· 0 citations
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