158
H. E. M. Braakhuis et al.
In some studies the PA outcome parameter differed
from the PA feedback parameter (23, 24, 26, 28, 33).
For example, Dorsch et al. (28) used the number of
steps as feedback parameter and the walking time as
outcome measure. Attempting to attain a goal based
on a certain number of steps per day (amount of PA)
is a different approach to measuring walking time (PA
duration). This can lead to a mismatch between target
parameters of PA promotion during the intervention
and evaluation of PA.
Publication bias might have influenced the current
results to some extent. Since congress abstracts, com-
mentary articles and languages other than English were
excluded, some studies with negative results regarding
PA might have been missed. The methodological qua-
lity of the included studies was moderate; none of the
studies scored “low risk” on all bias items. However,
small sample sizes of a considerable proportion of the
included studies, procedures of blinding of assessors,
and incomplete data reporting limits the quality of evi-
dence regarding intervention effects. Therefore, these
results should be interpreted with caution.
Despite these limitations, this review provides useful
indications for the use of wearable technology in reha-
bilitation programmes. One of the indications is that,
next to BCT, human interaction is recognized as an
important feature, since contact with a coach or therapist
in real life consultations or by phone calls was present
in a large proportion of the included studies. Adopting
innovative technologies, such as wearable monitoring,
in rehabilitation therefore requires tight tuning with
therapy programmes. Blended interventions may offer
a solution; innovative technological advancements, such
as integrated goal-setting, automatic feedback functions,
and real-time tele-consulting, can make human interac-
tion and other BCT components more feasible, and less
expensive, partly by reduction of the therapists’ wor-
kload (37). In addition, a systematic review by Geraedts
et al. showed that remote contact seems an acceptable-
to-good alternative for real-life contact in PA interven-
tions. A further advantage, according to Chiauzzi et al.
(39), is that PA self-tracking has the potential to lead to
positive patient engagement in healthcare interventions.
Furthermore, patients are now becoming increasingly
familiar with self-tracking technology (39, 40). Overall,
application of wearable technology has the potential to
contribute to health behaviour and self-management
of patients, which may contribute to a more efficiently
organized and financially attractive healthcare system.
Further research is needed to determine the most effec-
tive intervention strategies, with regard to the amount
and type of therapist contact and BCT components for
specific patient populations. Literature studies with less
heterogeneity in terms of study characteristics, interven-
tion strategies and methodology are required.
www.medicaljournals.se/jrm
Conclusion
Overall, healthcare interventions that provide objective
feedback about PA, delivered by wearable monitors,
compared with other strategies promoting PA showed
a moderately positive effect on PA. Study characteris-
tics and intervention strategies varied widely. Future
research should focus on determining which interven-
tion strategies are most effective in promoting PA in
healthcare programmes.
The authors have no conflicts of interests to declare.
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