Theory-Based Digital Interventions to Improve Psychosocial Outcomes in People With Neurological Disorders: Systematic Review and Meta-Analysis

PURPOSE: Neurological disorders affect nearly one billion people worldwide (WHO, 2006), requiring effective self-management to manage symptoms and physical and psychosocial consequences while engaging in daily life activities (AOTA, 2015). Compared to traditional self-management programs, digital interventions minimize geography and time barriers to enhance treatment accessibility and adherence. This study aimed to (1) investigate the effectiveness of theory-based digital self-management interventions to improve psychosocial outcomes in people with neurological disorders, (2) examine various theories applied to the development of digital interventions that impact psychosocial outcomes, and (3) identify the optimal mode of intervention delivery.

DESIGN: A systematic review and meta-analysis.

METHOD: Electronic databases (SCOPUS, MEDLINE, EMBASE, CINAHL, Cochrane Library, and Clinicaltrials.gov) were searched systematically using predetermined terms. Two investigators independently screened studies for inclusion criteria and extracted data. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean difference (SMD) in scores of depression, anxiety, fatigue, and self-efficacy for each study were calculated as the main outcome measure. Data were aggregated using random-effects models.

RESULTS: Fourteen randomized controlled trials were included in this review. All studies were of sufficient quality (mean PEDro score = 6.7/10). The most commonly cited theories were cognitive behavioral therapy (CBT) (43%) and social cognitive theory (SCT) (29%). The pooled effect estimate suggested that theory-based digital self-management interventions were effective in reducing depression (SMD = -0.77, 95% CI = -1.04–-0.49), anxiety (SMD = -0.88, 95% CI = -1.54–-0.21), and fatigue (SMD = -0.61, 95% CI = -0.90–-0.32) and in enhancing self-efficacy (SMD = 1.15, 95% CI = 0.11–2.18) compared to control. Further analyses revealed that CBT-based interventions were effective in reducing fatigue (SMD = -0.75, 95% CI = -0.97–-0.54), depression (SMD = -0.81, 95% CI = -1.22–-0.39), and anxiety (SMD = -1.15, 95% CI = -1.85–-0.44) and in improving self efficacy (SMD = 0.84, 95% CI = 0.63–1.05), whereas SCT-based interventions were effective in reducing depression only (SMD = -0.73, 95% CI = -1.17–-0.28). Partial digital interventions were found to be more effective than fully digital interventions.

CONCLUSION: This review supports the effectiveness of theory-based digital self-management interventions to improve psychosocial outcomes in people with neurological disorders. Our findings reveal that the use of different theories for digital self-management interventions exhibits different effects on specific outcomes. This study highlights the use of appropriate theory to guide the design and development of digital interventions to improve psychosocial outcomes in people with neurological disorders.

References

American Occupational Therapy Association Fact Sheet. (2015). The role of occupational therapy in chronic disease management. Retrieved from https://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/HW/Facts/FactSheet_ChronicDiseaseManagement.pdf

World Health Organization Department of Mental Health, Substance Abuse, & Disease Control Priorities Project. (2006). Disease control priorities related to mental, neurological, developmental and substance abuse disorders. Geneva, Switzerland: World Health Organization.