Data_Sheet_2_Effectiveness of Self-Monitoring Approach Using Fitness Trackers to Improve Walking Ability in Rehabilitation Settings: A Systematic Review.PDF

Background: A self-monitoring approach utilizing fitness trackers that provide feedback regarding physical activities has been recently applied to rehabilitation patients to promote voluntary walking activities. Although this approach has been proven to increase physical activity, it is uncertain whether the intervention improves walking ability. Aim: This review investigated whether the additional self-monitoring approach using activity trackers would improve walking ability in any type of rehabilitation setting. Methods: A systematic search was performed in four databases [PubMed (MEDLINE), The Cochrane Library, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature] to identify studies that examined the self-monitoring approach combined with rehabilitative intervention vs. the same rehabilitative intervention only in participants with any unhealthy conditions. Two review authors independently assessed the eligibility of all the retrieved English literature published from 2009 to 2019, then discussed the final inclusion. The risk of bias was assessed referring to the criteria of the Cochrane Risk of Bias tool. The key findings were synthesized using narrative synthesis. In addition, a quantitative synthesis was conducted when more than two studies investigating the same disease were identified. Results: Eleven randomized controlled trials satisfied the eligibility criteria, nine of which had a lower risk of bias. The types of diseases included stroke, chronic obstructive pulmonary disease (COPD), cancer, Parkinson's disease, hemophilia, peripheral artery disease, post-total knee arthroplasty, and geriatric rehabilitation. Eight studies reported measures of walking endurance and four reported measures of gait speed. In the quantitative synthesis of two studies investigating COPD, there was a significant between-group difference in terms of changes in the 6-min walking distance from the baseline, which was favorable to the additional self-monitoring intervention group (mean difference: 13.1 m; 95% confidence interval, 1.8–24.5; 2 studies, 124 participants; p = 0.02; I2 = 0%). Other available data revealed no consistent evidence regarding effectiveness of the intervention. Conclusions: The findings indicate that there is little evidence suggesting the effectiveness of the self-monitoring approach in improving walking ability in rehabilitation settings. However, a weak recommendation for patients with stable COPD was implicated in the quantitative synthesis. Further research would be required to explore the best indications for this self-monitoring approach. Systematic Review Registration: CRD 42020157695.研究背景：近年来，利用可提供身体活动反馈的健身追踪器（fitness trackers）开展的自我监测方案已应用于康复患者，以促进其自主步行活动。尽管该方案已被证实可提升身体活动量，但尚不确定该干预手段是否能改善步行能力。 研究目的：本系统综述旨在探究在任何康复场景中，附加活动追踪器的自我监测方案是否能改善患者的步行能力。 研究方法：在PubMed（MEDLINE）、考克兰图书馆（The Cochrane Library）、SPORTDiscus及护理及相关健康文献累积索引（Cumulative Index to Nursing and Allied Health Literature）四个数据库中开展系统检索，以识别对比“联合康复干预的自我监测方案”与“单纯康复干预”在各类疾病患者中应用效果的相关研究。由2名综述作者独立评估2009年至2019年发表的所有检索到的英文文献的纳入资格，随后共同讨论确定最终纳入的研究。采用考克兰偏倚风险工具（Cochrane Risk of Bias tool）的标准对偏倚风险进行评估。核心研究结果采用叙述性合成法进行整合；若检索到2项以上针对同一疾病的研究，则额外开展定量合成分析。 研究结果：共计11项随机对照试验符合纳入标准，其中9项偏倚风险较低。涉及的疾病类型包括脑卒中、慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）、癌症、帕金森病、血友病、外周动脉疾病、全膝关节置换术后康复及老年康复。8项研究报告了步行耐力相关指标，4项研究报告了步速相关指标。针对慢性阻塞性肺疾病的2项研究的定量合成结果显示，6分钟步行距离较基线的变化存在组间显著差异，且附加自我监测干预组获益更优（均数差：13.1 m；95%置信区间：1.8~24.5；2项研究，124名受试者；p=0.02；I²=0%）。其余现有数据未发现该干预手段有效性的一致性证据。 研究结论：本研究结果表明，现有证据极少支持康复场景中自我监测方案可改善步行能力。但定量合成结果提示，对于稳定期慢性阻塞性肺疾病患者，可给出弱推荐意见。未来仍需开展进一步研究，以明确该自我监测方案的最佳适用人群。 系统综述注册信息：CRD 42020157695。