Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
Lancet Digit Health. 2023 Mar;5(3):e144-e159. doi: 10.1016/S2589-7500(23)00002-X.
Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility.
In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845.
Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant.
SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.
European Union's Horizon 2020 Research and Innovation Programme.
数字健康干预措施对高血压自我管理有效，但目前尚未比较不同干预模式的有效性和实施情况。本研究旨在比较短信、智能手机应用程序和网站干预措施在改善高血压成年人血压方面的效果，并报告其可及性、参与度和可行性。
在这项系统评价和荟萃分析中，我们于 2022 年 5 月 25 日在 CINAHL Complete、Cochrane 对照试验中心注册、Ovid Embase、Ovid MEDLINE 和 APA PsycInfo 上搜索了 2009 年 1 月 1 日至 2009 年 1 月 1 日期间发表的关于数字健康干预措施对降低高血压成年人血压效果的随机对照试验（RCT），以英文发表。使用 Covidence 进行筛选，根据 Cochrane 指南提取数据。主要终点是收缩压的平均值变化。使用 Cochrane 风险偏倚 2 评估风险偏倚。汇总了收缩压和舒张压降低的荟萃分析数据，并以叙述方式总结了可及性、参与度和可行性数据。使用 Grading of Recommendations, Assessment, Development, and Evaluation 标准评估证据水平。该研究已在 PROSPERO CRD42021247845 上注册。
在确定的 3235 条记录中，来自 13 个地区的 29 项 RCT（n=7592 名参与者）被纳入系统评价，其中 28 项 RCT（n=7092 名参与者）被纳入荟萃分析。11 项研究使用短信作为数字健康干预的主要传递模式，13 项研究使用智能手机应用程序，5 项研究使用网站。总体而言，与对照组参与者相比，数字健康干预组参与者的收缩压降低了-3.62mmHg（95%CI-5.22 至-2.02），舒张压降低了-2.45mmHg（-3.83 至-1.07）。对于收缩压（p=0.73）和舒张压（p=0.80）结局，三种不同传递模式之间没有统计学显著差异。智能手机应用程序干预在舒张压方面有统计学意义的降低（-2.45mmHg[-4.15 至-0.74]）；然而，短信干预（-1.80mmHg[-4.60 至 1.00]）或网站干预（-3.43mmHg[-7.24 至 0.38]）并没有统计学显著降低。由于纳入研究之间存在相当大的异质性和一些研究的高偏倚风险，证据水平总体评分为低。干预措施在基线高血压严重程度较高的人群中更有效。短信干预报告了更高的可及性，而智能手机应用研究报告了更高的参与度，但差异无统计学意义。
与常规护理相比，短信、智能手机应用程序和网站干预措施与收缩压和舒张压的统计学和临床显著降低相关，无论干预措施的传递模式如何。但考虑到纳入研究的异质性较大，以及大多数研究的偏倚风险较高，这一结论受到了限制。未来的研究需要详细描述这些干预措施有效性和实施的中介因素和调节因素，以进一步提高其有效性，并提高其可及性、参与度和可行性。
欧盟地平线 2020 研究和创新计划。
