Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK.
PLoS Med. 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362. Epub 2013 Jan 15.
BACKGROUND: Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. METHODS AND FINDINGS: We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. CONCLUSIONS: Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes.
背景:移动技术可能成为为医疗消费者提供个体水平支持的有力媒介。我们进行了系统评价,以评估向医疗消费者提供的基于移动技术的干预措施的效果。
方法和发现:我们使用 MEDLINE、EMBASE、PsycINFO、全球卫生、Web of Science、Cochrane 图书馆、英国 NHS HTA(1990 年 1 月至 2010 年 9 月)搜索了所有针对医疗消费者的基于移动技术的健康干预措施的对照试验。两位作者提取了关于分配隐藏、分配顺序、盲法、随访完整性和效果措施的数据。我们计算了效果估计值,并使用随机效应荟萃分析。我们确定了 75 项试验。59 项试验研究了使用移动技术改善疾病管理的情况,26 项试验研究了使用移动技术改变健康行为的情况。几乎所有的试验都是在高收入国家进行的。四项试验的偏倚风险较低。两项疾病管理试验的偏倚风险较低;其中一项,使用短信减少艾滋病病毒载量(ART)依从性,高病毒载量(>400 拷贝)的相对风险(RR)为 0.85(95%CI 0.72-0.99),但死亡率无统计学意义(RR 0.79 [95%CI 0.47-1.32])。第二项,基于 PDA 的干预措施增加了肺移植患者的自我保健能力得分。两项健康行为管理试验的偏倚风险较低。短信戒烟支持对生物化学验证的戒烟效果的综合效应为(RR 2.16 [95%CI 1.77-2.62])。对于其他疾病,干预措施在某些情况下显示出有益的效果,但结果不一致。在疾病管理或健康行为的漏斗图的视觉或统计检查中,均未显示出发表偏倚的证据。为了解决旧搜索的局限性,我们还审查了最近的文献。
结论:短信干预措施提高了抗逆转录病毒治疗和戒烟的依从性,应考虑将其纳入服务。尽管在其他一些领域有有益的证据,但需要高质量、充分功率的优化干预措施试验来评估对客观结果的影响。
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