Can Remote Digital Health Interventions Improve Rehabilitation Following Major Trauma? Results of a Systematic Review

Objective: To identify the effectiveness of remote digital health (DH) interventions in supporting physical and/or psychosocial rehabilitation in patients with major physical trauma. 

Data Sources: This review was conducted between 2000 and 2023 following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to identify relevant studies by searching 5 databases: MEDLINE, EMBASE, AMED, CINAHL Plus, and PsycInfo. Searches were limited to randomized controlled trials and peer-reviewed journals. Bibliographies of included studies and relevant reviews were searched for relevant articles. 

Study Selection: Inclusion criteria consisted of randomized controlled trials that investigated remote DH interventions to enhance physical, and/or psychosocial rehabilitation of adults subjected to major physical trauma (eg, traumatic brain injury or spinal cord injury [SCI]). Screening of retrieved studies was conducted by 2 reviewers. Disagreements were resolved by discussion or by consulting a third reviewer. 

Data Extraction: Data were extracted by one reviewer and independently checked by another. Risk of bias (ROB) was independently conducted by 2 reviewers using ROB2 tool. Disagreements were resolved by discussion or by consulting a third reviewer. 

Data Synthesis: Results were reported following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Seven studies were included, of which 5 had adequate power to detect a significant treatment effect. Studies included mostly men of White race. Included interventions targeted traumatic brain injuries or SCIs, and were delivered using numerous pathways (eg, video conferencing, virtual reality), with/without human support. Positive findings were generally reported with significant effects only reported by 3 studies targeting people with SCIs, reflecting improvements in physical and psychosocial outcomes. ROB ranged from low (n=3); some concern (n=2), and high (n=2). 

Conclusions: Overall positive findings were reported with strong evidence only reported by 3 studies targeting SCIs. Future studies should be adequately powered and include diverse populations to measure the effectiveness and cost effectiveness of DH interventions in comparison with usual care.