Journal of Rehabilitation Medicine 51-3 | Page 5

J Rehabil Med 2019; 51: 151–159 REVIEW ARTICLE EFFECTIVENESS OF HEALTHCARE INTERVENTIONS USING OBJECTIVE FEEDBACK ON PHYSICAL ACTIVITY: A SYSTEMATIC REVIEW AND META- ANALYSIS Hanneke E. M. BRAAKHUIS, MSc 1,2 , Monique A. M. BERGER, PhD 2 and Johannes B. J. BUSSMANN, PhD 1 From the 1 Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, and 2 Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands Objective: To determine the effectiveness of health­ care interventions promoting physical activity, which use objective feedback on physical activity delivered using wearable activity monitors as part of the in­ tervention. Intervention groups are compared with control groups receiving usual care or interventions without objective feedback. Data sources: PubMed, EMBASE, MEDLINE and Co­ chrane Library were searched to identify randomized controlled trials. Study selection: Randomized controlled trials pu­ blished after 2007 with (former) healthcare patients ≥ 21 years of age were included if physical activity was measured objectively using a wearable moni­ tor for both feedback and outcome assessment. The main goal of included studies was promoting phy­ sical activity. Any concurrent strategies were related only to promoting physical activity. Data extraction: Effect sizes were calculated using a fixed-effects model with standardized mean dif­ ference. Information on study characteristics and interventions strategies were extracted from study descriptions. Data synthesis: Fourteen studies met the inclusion criteria (total n  = 1,902), and 2 studies were exclu­ ded from meta-analysis. The overall effect size was in favour of the intervention groups (0.34, 95% CI 0.23–0.44, p  < 0.01). Study characteristics and inter­ vention strategies varied widely. Conclusion: Healthcare interventions using feedback on objectively monitored physical activity have a moderately positive effect on levels of physical acti­ vity. Further research is needed to determine which strategies are most effective to promote physical ac­ tivity in healthcare programmes. Key words: meta-analysis; physical activity; feedback; wear­ able electronic devices. Accepted Jan 16, 2019; Epub ahead of print Mar 5, 2019 J Rehabil Med 2019; 51: 151–159 Correspondence address: Hanneke Elisabeth Maria Braakhuis, Eras- musMC, Department of Rehabilitation Medicine and Physical Therapy, PO Box 2040, 3000 CA Rotterdam, Rotterdam, The Netherlands. E- mail: [email protected] P hysical inactivity is a worldwide problem. In the long-term, active people have lower risk of disease, such as cerebrovascular stroke and cardiac infarction, LAY ABSTRACT Wearable technology is progressively applied in health care and rehabilitation to provide objective insight into physical activity levels. In addition, feedback on phy- sical activity levels delivered by wearable monitors mig- ht be beneficial for optimizing their physical activity. A systematic review and meta-analysis was conducted to evaluate the effectiveness of interventions using feed- back on objectively measured physical activity in patient populations. Fourteen studies including 1902 patients were analyzed. Overall, the physical activity levels of the intervention groups receiving objective feedback on physical activity improved, compared to the control groups receiving no objective feedback. Mostly, a varie- ty of other strategies were applied in the interventions next to wearable technology. Together with wearable technology, behavioral change strategies, such as goal- setting and action planning seem to be an important ingredient to promote physical activity in health care and rehabilitation. and frequent physical activity (PA) is beneficial for health outcomes, such as mental wellbeing, physical fitness and quality of life (1, 2). Short-term effects of PA are also well-established; for example, promoting PA in patients shortly after stroke appears to be bene- ficial for motor and neurological repair (3, 4). With increasing evidence from diverse patient po- pulations of the benefits of being physically active, promoting PA is essential in treatment and rehabilita- tion (5). Unfortunately, promotion of PA in patient populations, such as those with chronic conditions, is challenging, since they are often burdened by several health problems and encounter barriers to physical activity. Therefore, these patients are at greater risk of physical inactivity compared with their healthy peers (6). Medical professionals, especially rehabilitation teams, can play a substantial role in improving PA with regard to patient-specific health behaviours and disease management (5, 6). Knowledge of the most effective way to promote PA in healthcare is needed. A progressively applied tool to support promotion of PA in healthcare is monitoring activity using wearable technology, such as pedometers and accelerometers (7). These “wearables”’ objectively measure PA and, in recent years, their accuracy and validity has increased This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2522