Di Lorito Claudio, Bosco Alessandro, Rai Harleen, Craven Michael, McNally Donal, Todd Chris, Booth Vicky, Cowley Alison, Howe Louise, Harwood Rowan H
School of Medicine, University of Nottingham, Nottingham, UK.
School of Health Sciences, University of Manchester, Manchester, UK.
Int J Geriatr Psychiatry. 2022 Jun;37(6). doi: 10.1002/gps.5730.
Digital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI.
METHODS/DESIGN: Searches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta-analyses were performed to pool data on intervention effectiveness.
Twenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = -0.03 to 0.76; I = 61%), and a negative moderate effect on basic ADLs (SMD = -0.40; 95% CI = -0.86 to 0.05; I = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions.
Supervised intervention delivery is linked to greatest benefits. A mix of remote and face-to-face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end-users must be pre-requisites for the development of future successful services.
数字健康干预能够提供远程服务，以支持痴呆症和轻度认知障碍（MCI）患者。本系统综述旨在收集证据，以证明数字健康干预对痴呆症和MCI患者的身体、认知、行为和心理结果以及日常生活活动的有效性。
方法/设计：2021年11月，使用九个数据库进行了检索。两名作者使用批判性评估技能计划清单进行研究筛选/评估。通过Cochrane干预系统评价手册的数据提取表提取研究特征。通过干预描述与复制模板（TIDieR）清单和指南提取数字健康干预的数据。通过效应量确定干预效果。进行荟萃分析以汇总干预效果的数据。
本综述纳入了20项研究，这些研究涉及多种干预措施、交付方式、活动、持续时间、长度、频率和强度。与对照组相比，这些干预措施对认知能力产生了中等程度的影响（标准化均数差[SMD]=0.36；95%可信区间[CI]=-0.03至0.76；I²=61%），对基本日常生活活动产生了中等程度的负面影响（SMD=-0.40；95%CI=-0.86至0.05；I²=69%）。步行动作游戏对身体和认知能力产生的效应量最大。有监督的训练比无监督的干预产生的效应量更大。
有监督的干预交付带来的益处最大。远程和面对面交付相结合可以使益处最大化并优化成本。数字干预对最终用户的可及性、可接受性和可持续性必须成为未来成功服务发展的先决条件。
