Systematic Review and Meta-analysis of Interactive Digital Self-management Interventions for Adults with Chronic Respiratory Disease in Randomized Controlled Trials.

BACKGROUND

Interactive digital self-management (IDSM) interventions may help individuals with chronic respiratory disease self-manage their condition.

OBJECTIVE

This review aimed to summarize the characteristics and effectiveness of IDSM interventions for this population.

METHODS

Reviewers systematically screened titles, abstracts, and full texts of randomized controlled trials (RCTs) examining applications or wearable devices for IDSM in adults with chronic respiratory diseases. Study and intervention characteristics and outcomes were extracted. Meta-analysis was conducted in a subset of studies.

RESULTS

The search generated 109,900 unique records and 34 relevant RCTs were identified. These studies evaluated 2,320 individuals with asthma, 1,766 with chronic obstructive pulmonary disease (COPD; FEV1 % predicted 36 to 69), and 33 with cystic fibrosis. In asthma, median (range) intervention length was 12 (1-52) weeks. In COPD, median (range) intervention length was 24 (2-48) weeks. In COPD, IDSM interventions showed greater effect than control for health status (COPD Assessment Test score mean difference [95% CI]: -1.6 [-3.2, 0.0], p < 0.05, very low quality of evidence), physical activity (steps per day: 937.9 [95% CI: 311.5, 1,564.4], p < 0.05, very low quality of evidence), and exercise capacity (six-minute walk test distance mean difference [95% CI]: 5.6 [1.7, 9.4], p < 0.05, low quality of evidence). In asthma, no statistically significant effect was observed for asthma control or quality of life and only one RCT in cystic fibrosis was identified.

CONCLUSION

Interventions were heterogeneous and yielded very low to moderate quality evidence. In COPD, IDSM interventions were associated with statistically significant improvements in health status, physical activity, and exercise capacity; however, findings should be interpreted cautiously due to low or very low certainty of evidence. Evidence in asthma and cystic fibrosis remains limited and inconsistent. At present, IDSM tools should be considered adjunctive options rather than replacements for established self-management strategies.