Patient-clinician digital health interventions for the hip fracture population: a scoping review
verfasst von:
Chantal Backman, Steve Papp, Anne Harley, Becky Skidmore, Maeghn Green, Soha Shah, Randa Berdusco, Stéphane Poitras, Paul E. Beaulé, Veronique French-Merkley
Older adults with hip fracture often require extensive post-surgery care across multiple sectors, making follow-up care even more important to ensure an ideal recovery. With the increased adoption of technology, patient-clinician digital health interventions can potentially improve post-surgery outcomes of hip fracture patients by helping them and their caregivers better understand the various aspects of their care, post-hip fracture surgery. The purpose of this study was to examine the available literature on the impact of hip fracture-specific, patient-clinician digital health interventions on patient outcomes and health care delivery processes. We also aimed to identify the barriers and enablers to the uptake and implementation of these technologies and to provide strategies for improved use of these digital health interventions.
Methods
We conducted a scoping review following the six stages of Arksey and O’Malley’s framework and following the PRISMA-ScR reporting format. Searches were conducted in five databases. In addition to hand searching for relevant studies from the references of all included studies, we also conducted a grey literature search to identify relevant primary studies. Screening of titles and abstracts as well as full texts were performed independently by two reviewers. Two reviewers also performed the data extraction of the included studies.
Results
After screening 3,638 records, 20 articles met the criteria and 1 article was identified through hand searching. Various patient-clinician digital health interventions were described including telehealth /telerehabilitation programs (n = 6), care transition /follow-up interventions (n = 5), online resources (n = 2), and wearable devices /sensor monitoring (n = 1). Outcomes were varied and included functional status, gait/mobility, quality of life, psychological factors, satisfaction, survival/complications, caregiver outcomes, compliance, technology-user interactions, and feedback on the use of the digital health interventions. For clinicians, a key barrier to the use of the digital health interventions was the acceptability of the technology. However, the usefulness of the digital health intervention by clinicians was seen as both a barrier and an enabler. For patients and caregivers, all the themes were seen as both a barrier and an enabler depending on the study. These themes included: 1) availability and access, 2) usability, 3) knowledge and skills, 4) acceptability, and 5) usefulness of the digital health intervention.
Conclusion
Many behavioural factors affect the use of patient-clinician digital health interventions. However, a specific attention should be focused on the acceptability of the technology by the clinicians to encourage uptake of the digital health interventions. The results of this scoping review can help to better understand the factors that may be targeted to increase the use of these technologies by clinicians, patients, and caregivers.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Introduction
Hip fractures are a significant health issue among older adults that require cohesive follow up care to ensure ideal recovery. Post-hip fracture surgery care is often provided across multiple health care sectors and typical follow-up care post-surgery can include pain control and management, osteoporosis assessment and treatment, fall risk prevention interventions, physical rehabilitation, assistive walking devices and/or home modifications, as well as follow-up visits with the orthopaedic surgeon and a primary care provider [1].
Digital health interventions have gained attention as potential tools to support patient-clinician interactions and improve outcomes for individuals with hip fractures [2]. With the increased accessibility to technology, patient-clinician digital health interventions are becoming a more viable option to help hip fracture patients and their caregivers as they navigate the modern health care system for their post-hip fracture surgery care [2].
Anzeige
In recent years, the inclusion of digital health technologies into healthcare processes has been identified as a global priority [3]. The term ‘Digital Health’ covers a variety of different tools including clinical decision support systems, electronic health record tools, patient-clinician communication applications, educational tools, and novel artificial intelligence (AI) algorithms [4]. The World Health Organization classifies patient-clinician digital health interventions as “targeted patient/client communication” technologies [5]. This type of technology intervention typically involves the use of various information and communication technologies to support the exchange of knowledge between clinicians and their patients regarding their care [5]. Providing technology-based interventions to patients and their caregivers can help improve healthcare delivery processes by better engaging them in managing their care and preventing hospital readmissions [2].
Recent reviews of digital health interventions for older adults with hip fracture found that interventions mainly supported physicians in improving their delivery of clinical care [6], with another meta-analysis of randomized control trials (n = 5) showing that nurse/physician voice telephone calls and educational videos interventions were two times more effective to prevent secondary fractures when compared to usual care (OR 2.13, CI 1.30–3.48) [7]. However, there is limited information on the specific components of patient-clinician digital health interventions (e.g., web-based applications, mobile applications, wearable devices, etc.) that are optimal to enhance patient engagement for this cohort. The purpose of this study was to examine the available literature on the impact of hip fracture-specific, patient-clinician digital health interventions on patient outcomes and health care delivery processes. We also aimed to identify the barriers and enablers to the uptake and implementation and to provide strategies for improved use of these digital health interventions.
Methods
Design and methodology
We conducted a scoping review following the six stages of Arksey and O’Malley’s framework [8] and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews (PRISMA-ScR) reporting format [9].
We used the Population-Concept-Context (PCC) acronym: P-Population (hip fracture patients 50 years of age or older who had surgical repair), C-concept (post-surgery care (e.g., pain control and management, mobilization, follow-up appointments) using any patient-clinician digital health interventions such as mobile technology, web-based applications, digital communication tools), C-context (care across various health care settings), design (all studies), Language (English or French), and year (all years).
Anzeige
Our protocol was registered in Open Science Framework (https://osf.io/w6a89) [10] and published elsewhere [11].
Patient and public involvement
No patients were involved.
(1) Identifying the research question
The following research questions were identified for this review:
1.
What is the impact of patient-clinician digital health interventions for older adults with hip fracture on patient outcomes and health care delivery processes?
2.
What are the barriers and enablers to the use of patient-clinician digital health interventions for clinicians and patients with a hip fracture?
3.
What strategies exist to improve the use of patient-clinician digital health interventions for hip fracture patients?
(2) Identifying the research studies
An experienced medical information specialist developed and tested the search strategies through an iterative process in consultation with the review team. The MEDLINE strategy was peer-reviewed by another senior information specialist prior to execution using the PRESS Checklist [12].
Using the multifile option and deduplication tool available on the Ovid platform, we searched Ovid MEDLINE® ALL, Embase Classic + Embase, APA PsycInfo, and EBM Reviews (Cochrane Database of Systematic Reviews, CENTRAL and DARE). CINAHL was searched on Ebsco. All searches were performed on May 15, 2022.
The strategies utilized a combination of controlled vocabulary (e.g., “Hip Fractures”, “Telemedicine”, “Rehabilitation”) and keywords (e.g., “broken hip”, “digital health”, “post-surgical care”). Vocabulary and syntax were adjusted across the databases. There were no date or language limits but where possible, animal-only records were removed from the results. Records were downloaded and deduplicated using EndNote version 9.3.3 (Clarivate Analytics) and uploaded to Covidence [13]. We also performed citation searching of the included studies as well as a targeted grey literature search of clinical trial registries. Specific details regarding the search strategies appear in Appendix 1—search strategies.
(3) Screening the studies
Studies were screened by two reviewers (CB, SH) using a two-step process. Specifically, the two reviewers independently screened titles and abstracts (level 1) according to the pre-determined eligibility criteria. For level 2 screening, the same two reviewers independently screened the full texts. Any disagreements were resolved by consensus.
(4) Charting the data
Data were extracted using a piloted Microsoft Excel form. Two reviewers (CB, SH) extracted the data from the eligible studies. This included (1) general data (authors, year of publication, title, journal, country, purpose); (2) methodological data (study design, theoretical approach, type of participants, number of participants, description of the patient-clinician digital health intervention, data analysis); (3) study results/outcomes (patient outcomes, health care delivery processes; and (4) barriers and enablers. We used the Intervention Description and Replication (TIDieR) checklist to extract data about the interventions reported in the included studies [14]. No risk of bias assessment was performed in this scoping review.
(5) Summarizing and collating the data
Anzeige
The general, methodological and results/outcomes of the included studies were analyzed using narrative synthesis to summarise and explain the findings. The data was grouped by interventions, and by outcomes (patient outcomes, health care delivery processes).
The barriers and enablers were analyzed using a qualitative descriptive approach. The Theoretical Domain Framework (TDF) [15, 16] guided the qualitative analysis of the barriers and enablers. Two reviewers (CB, SH) independently grouped the data extracted from the included studies into themes and coded each theme as a barrier or an enabler. The themes were then mapped to each of the TDF domains. For each barrier and enabler, frequency and percentage were reported to identify the top domains. Any disagreements were discussed and resolved by consensus. We identified behavioural change techniques [17] that could address the barriers and enablers identified in the review to help guide the uptake of future patient-clinician digital health interventions for older adults with hip fracture transitioning from hospital to rehabilitation to home. Examples of behavioural change techniques included restructuring the physical and social environments, practicing and giving feedback, providing incentives, identifying social and environmental consequences, utilizing verbal persuasion to boost self-efficacy, explaining pros and cons, providing prompts/cues, and providing appropriate social support.
(6) Consulting with stakeholders
As the last stage of the Arksey and O’Malley’s framework [8], we consulted with a small number of clinical experts on our team (MG, SP, PB, AH, VFM) and a digital health developer (NexJHealth, nexjhealth.com). No additional patient-clinician digital health interventions were identified. Feedback provided about the review findings was incorporated into the discussion.
Results
Study selection
A total of 3,638 records were retrieved from the search, of which 9 were duplicates, and 3,584 were excluded at the title and abstract stage. This resulted in a total of 45 studies assessed for full-text eligibility. A total of 25 studies were excluded for wrong intervention (n = 16), wrong patient population (n = 6), and full-text not available (n = 3). The reasons for exclusion are noted in Appendix 2—list of excluded studies. In addition, a targeted grey literature search of ClinicalTrials.gov (n = 388), International Clinical Trials Registry Platform (ICTRP) (n = 15) and citation searching (n = 42) was performed. Twenty articles from the database searches met our inclusion criteria as well as one additional recent article (published in 2022) was identified through the citation searching. Thus, a total of 21 articles [18‐38] were included in this review (Fig. 1—PRISMA diagram).
Fig. 1
PRISMA diagram
×
Anzeige
Characteristics of included studies
The included articles were conducted in Spain (n = 4) [18‐21], United States (n = 4) [22‐25], Australia (n = 3) [26‐28], China (n = 3) [29‐31], Denmark (n = 2) [32, 33], Netherlands (n = 2) [34, 35], Canada (n = 1) [36], South Korea (n = 1) [37], and Israel (n = 1) [38].
Study designs included randomized controlled trial (n = 4) [30, 31, 35, 38], non-randomized trial (n = 2) [20, 21], quasi-experimental (n = 2) [22, 29], observational/feasibility (n = 5) [24, 28, 34, 36, 37]. In addition, there were qualitative (n = 6) [18, 19, 23, 25, 26, 33], participatory/co-design (n = 1) [32] and mixed methods (n = 1) [27] studies. Majority of studies (81%, n = 17) were published after 2017.
Studies took place in hospital only (n = 2) [27, 37], in both hospital and home (n = 6) [23‐25, 30, 32, 33], in home only (n = 10) [18‐22, 28, 29, 31, 34, 38], in rehabilitation and home (n = 2) [35, 36], or in various settings (n = 1) [26]. Further details are available in Table 1.
To explore family caregivers' perspectives of the recovery process of older adults with hip fracture and describe experiences from caregivers who: (1) used the online intervention, or (2) received home-based care provided by the Andalusian Public Health Care System
To design a home-based multidisciplinary tele-rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home-based usual outpatient rehabilitation protocol
To test the effects of the @ctivehip telerehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture
To assess impact of home-based telerehabilitation of community dwelling older adults in post-acute phase of recovery after hip fracture on mobility, psycho-behavioral factors, quality of life, and satisfaction with care; and to estimate acceptance of the telerehabilitation system and adherence to the exercise program
To discuss our recruitment process and the lessons learned
Qualitative study
Hospital and Home
36 dyads (1 patient-1 caregiver)
Online hip fracture caregiver resource center (OHRC)
Web-based resources
Coping with the CG role, care needs during hospitalization, care needs in rehab, care needs at discharge to home or facility, prevention of future fractures
Caregivers, nurses
Informational continuity The OHRC was developed to provide CGs with the anticipatory knowledge and skills that they need to manage upcoming caregiving situations and cope with the potential challenges
To develop a theory-based online hip fracture caregiver (CG) resource center (OHRC) program for caregivers and to conduct a feasibility study to test the OHRC for a future randomized controlled trial
Feasibility study
Hospital and Home
36 dyads (1 patient-1 caregiver)
Online hip fracture caregiver resource center (OHRC)
Web-based resources
Coping with the CG role, care needs during hospitalization, care needs in rehab, care needs at discharge to home or facility, prevention of future fractures
Caregivers, nurses
Informational continuity The OHRC was developed to provide CGs with the anticipatory knowledge and skills that they need to manage upcoming caregiving situations and cope with the potential challenges
To explore the caregivers’ experiences in taking care of their care recipients while they were using the OHRC resource center over the 8-week period through the analysis of discussion board postings
Qualitative study
Hospital and Home
36 dyads (1 patient-1 caregiver)
Online hip fracture caregiver resource center (OHRC)
Web-based resources
Coping with the CG role, care needs during hospitalization, care needs in rehab, care needs at discharge to home or facility, prevention of future fractures
Caregivers, nurses
Informational continuity The OHRC was developed to provide CGs with the anticipatory knowledge and skills that they need to manage upcoming caregiving situations and cope with the potential challenges
To understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model
Descriptive qualitative
Multiple health settings
24 clinicians
Digital patient health hub
Web-based resources
Personalized patient education
Patients, caregivers and clinicians
Management and Informational continuity The digital health hub was designed to improve education, service integration, data exchange and engagement of all stakeholders including patients and clinicians
To understand the perspectives of older patients with hip fracture and their family members and residential aged caregivers on the feasibility of developing a model of care using a personalized digital health hub
Mixed methods
Hospital
55 patients, 13 family members, 32 facility caregivers
Digital patient health hub (Not developed at time of study)
Web-based resources
Pain management, medication management, rehabilitation exercises, pressure ulcer prevention, care needs during hospitalization, care needs at discharge follow-up community appointments
Patients, caregivers, and residential aged care staff
Management and Informational continuity This proposed web-based health information portal, or a website, is intended for patients who can access all relevant information about their hip fractures
To evaluate the provision of tele-rehabilitation to older people with recent hip or pelvic fractures as they are discharged from hospital and enter a home rehabilitation service
Prospective observational study
Home
52 patients
Telerehabilitation (TR)
Telerehabilitation
Rehabilitation exercises (Physical Therapy, Occupational Therapy), fall prevention, medication management
Patients, nurses, allied health including physiotherapy
Management and Informational continuity Deliver remote prescription of exercises with demonstration videos, and videoconferencing with clinicians
To investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong
Randomized controlled trial
Hospital and Home
31 patients
Caspar Health e-system
Telerehabilitation
Rehabilitation exercises (Occupational Therapy)
Patients, occupational therapist
Management and Informational Continuity Deliver exercise program and facilitate communication between patient-clinician
To test the effectiveness of a mobile app in delivering home-based rehabilitation program for improving functional outcomes and reducing caregiver stress with enhancing adherence among the elderly patients with hip fracture
Randomized controlled trial
Home
50 patients
Mobile App
Telerehabilitation
Rehabilitation exercises (Physiotherapy), general knowledge post-hip fracture management, community resources, caregiver skill and information
Patients, caregivers, physiotherapists
Management and Informational continuity The mobile app was developed to facilitate the implementation of a home-based rehabilitation program. Participants could use this mobile app to follow home-based exercises prescribed by their physiotherapists, track their exercise progress and obtain relevant information about hip fracture re-habilitation
To investigate whether a user-driven approach in a participatory design can provide a solution to bridge the gap between what the healthcare system provides and what patients need after being treated for a hip fracture, during a short period of hospitalisation
Participatory co-design
Hospital and Home
Phase 1: 10 patients and 4 caregivers
Phase 2: 3 patients
My Hip Fracture Journey
Mobile application
Self-care Post-hip fracture rehab education
Patients, caregivers, unspecified clinical staff
Management and Informational continuity Support for clinical staff in the daily provision of oral and written information and education of patients in accordance with local clinical guidelines
To investigate whether a tele-health solution, an "app" presented on a tablet, can assist patients in their recovery following a hip fracture and accommodate individual learning and health literacy needs to support them in self-care and empowerment
Qualitative study
Hospital and Home
20 patients
My Hip Fracture Journey
Mobile application
Self-care Post-hip fracture rehab education
Patients, caregivers, unspecified clinical staff
Management and Informational continuity
Support for clinical staff in the daily provision of oral and written information and education of patients in accordance with local clinical guidelines
To test the effects of an intervention involving sensor monitoring informed occupational therapy on top of a cognitive behavioral treatment (CBT) based coaching program on patient-reported daily functioning in older patients after hip fracture
Three-armed randomized stepped wedge trial
Rehabilitation and Home
240 patients
Sensor monitoring system
Wearable device and motion sensors
Rehabilitation (Occupational Therapy), Fall Management
Patients, occupational therapists
Management Continuity Sensor monitoring informed occupational therapy on top of cognitive-behavioral treatment (CBT) based coaching program
To develop and test the feasibility of a novel web-based application called MyPath to Home that can be used to manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home
Feasibility study
Rehabilitation and Home
34 patients, 19 caregivers, 20 clinicians
MyPath to Home
Web-based application
Pain management, fall prevention, medication management, information about geriatric rehabilitation, follow-up with clinicians, community resources, equipment needs
Patients, caregivers, clinicians (physiotherapists, social workers, occupational therapists, physicians, nurses)
Management and Informational Continuity MyPath to Home web-based application was developed to serve as a digital care transition record for geriatric patients with hip fractures
To examine the effects of a 6-week telerehabilitation program on the mobility of people following hip surgery and compare the results with those who only received an exercise booklet
Feasibility pilot randomized control study
Home
40 patients
Telerehabilitation program based on a video platform for therapy software program
Telerehabilitation
Rehabilitation exercises (Physiotherapy)
Patients
Management continuity Deliver pre-recorded physiotherapy exercises through online platform
Patient-clinician digital health interventions
Several types of patient-clinician digital health interventions to facilitate patient-clinician interactions were identified. These included:
1) Telehealth /telerehabilitation programs (n = 6): @ctivehip [18‐21], Hip Hat System [22], Telerehab (TR) [28], CASPAR Health e-system [30], Telerehabilitation program based on a video platform for therapy software program [38], and Mobile App [31]. These programs allow for virtual consultations and enabling timely follow-ups. Real-time video conferencing facilitates direct communication between patients and clinicians, allowing for the assessment of progress, medication management, and addressing concerns or questions.
2) Care transition /follow-up interventions (n = 5): My Hip Fracture Journey [32, 33], Mobile App for post-op monitoring [34], MyPath to Home [36], WeChat Group [29], Rehabilitation instructions after hip fracture [37]. Mobile applications and web-based applications can deliver personalized reminders and notifications regarding medication schedules, appointments, and rehabilitation exercises, fostering adherence and continuity of care.
3) Web-based resources (n = 2): Online hip fracture caregiver resource center [23‐25], and Digital patient health hub [26, 27]. These educational resources can be in the form of videos, and educational modules, providing patients with information about their condition, treatment options, rehabilitation exercises, and self-care practices.
4) Wearable devices /sensor monitoring (n = 1) [35]. Remote monitoring devices enable clinicians to remotely assess patients' vital signs, activity levels, and adherence to treatment protocols.
Anzeige
Interventions focused on the post-surgery care, including rehabilitation exercises (n = 13), follow-up and management (n = 9), post-hip fracture education and self-care (n = 4), and caregiver needs (n = 3).
Digital health tools used were primarily tele-rehabilitation software (n = 9), web-based applications (n = 6), mobile applications (n = 4), wearable devices (n = 1), and chat software (n = 1).
Functions of the digital health tools
The digital health tools’ functions were grouped according to the 3 categories of the continuity of care framework [39]. The continuity of care framework is defined as “the degree to which a series of discrete healthcare events is experienced as coherent and connected and consistent with the patient's medical needs and personal context” ([39], p.1221). The framework consists of these 3 categories: 1) informational continuity (use of information available to all clinicians to make care appropriate for each patient), 2) management continuity (consistent and coherent coordination between all involved in the care that is responsive to a patient’s needs), and 3) relational continuity (a trusting therapeutic relationship between a patient and at least one caring clinician) as key components of high-quality care. Most studies were focused on management continuity (n = 7) or informational continuity (n = 3) only. A total of 11 studies focused on both management and informational continuity. Details of the interventions are found in Table 2.
Table 2
Description of digital health interventions (following TIDierR checklist) [14]
Lead author (year)
Brief name of digital health intervention
Why?
What?
Who provided?
How?
Where?
When?
How much?
Tailoring?
How well?
Telerehabilitation programs (defined as the delivery of rehabilitation using telecommunication technologies (nT= 6)
The @ctivehip intervention consisted of: (i) web-based information to increase family caregivers’ knowledge and skill development; (ii) a supported exercise and ADL program for older adults (delivered by the family caregiver); (iii) a specific section on family caregivers’ health; and (iv) an option for family caregivers to video conference with health professionals
Occupational therapist and physiotherapist
Web-based
Home
12 weeks post-discharge
5 online-based sessions per week each lasting 50–60 min
Four levels (Beginners, Moderate, Advanced 1, and Advanced 2)
Ariza-Vega 2021a: At the follow-up call, 3 caregivers did not answer the telephone after several attempts, and 4 caregivers withdrew from the study. Thus, in total, 44 caregivers were interviewed, representing 21 older adults with hip fracture from the intervention group and 23 older adults with hip fracture from the control group
Ariza-Vega 2021b: Ten of twenty-one caregivers completed the program as intended (high fidelity at 12 weeks), and an additional six participants completed 8 weeks or more of the program (76% in total). Half of the caregivers (10/21; 48%) stated their older family member completed the program, and then continued doing the exercises for a few more months. However, the remaining caregivers reported their family member stopped doing the exercises before the end of the 12 weeks. Most family caregivers (20/21; 95%) expressed 12 weeks was long enough to learn the program, or they believed their family member did not require rehabilitation beyond 12 weeks
Ortiz-Pina 2021: We observed variation for adherence to the tele-rehabilitation program, but in general, it decreased over time. In our study, only 15% of patients completed the full program (50–60 sessions), but 22 patients (63%) completed > 20 sessions. Mora-Traverso 2022: The adherence was 17% (n = 6) to the full @ctivehip rehabilitation program (50–60 sessions), 69% (n = 24) to at least 20 sessions and 89% (n = 31) to at least 10 sessions
Home Automated Telemanagement (HAT) system including home unit (HU), HAT server and clinician unit, any web-enabled device
HAT system was used to support an individualized exercise program (home unit guides patients, patient information reported back to physiotherapist) and a self-paced multimedia education module
Physiotherapist
Web-based
Home
30 days
30 sessions, 1 h/daily
The patient settings were individualized and were adjusted by the physiotherapist at the HAT website based on patient performance
Overall, 14 patients with confirmed diagnosis of the hip fracture were recruited to test the telerehabilitation system at their homes. One patient withdrew from the study and three patients moved out of town. Adherence to the exercise regimen was assessed using real-time exercise logs. Adherence to Exercises per Day over a 30 day monitoring: 89% Adherence to Sessions per day over a 30 day monitoring: 88% Adherence to Exercises per session per day over a 30 day monitoring: 87% Adherence to number of Sets per exercise per day over a 30 day monitoring: 97% Adherence to number of repetitions per set per exercise per session per day over a 30 day monitoring: 91%
Patients who received telerehabilitation are loaned a 4G enabled tablet on an adjustable stand. The tablet is configured with commercially available apps and a videoconferencing platform that can be used to provide all or some of the rehabilitation interventions. The exercise app allows the remote prescription of standard exercises accompanied by a demonstration video and the ability for clinicians to track adherence. Clinicians introduced the tablet during their first visit to the patient and provided basic training to the patient and their carer. A simple instruction booklet acts as a reminder for tasks such as turning the tablet on and off, opening apps and how to participate in a video call. Clinicians, supported by an IT professional, then used clinic-based VC equipment including desk top and wall mounted screens, cameras, microphones, and headsets. Remote access to tablet-based apps via a mobile device manager was available
Nurses, Allied Health including physiotherapy
Web-based
Home
Average 12.09 ± 3.62 days
TR substituted an average of 3 home visits for virtual visits
Together, clinicians and patients decide when and how frequently TR interventions are provided based on rehabilitation goals and progress
Of those, 35 (67%) patients were considered suitable for TR and agreed to receive their rehabilitation services by using TR (TR group). The remainder 17 (33%) HRS patients did not receive TR (nTR group). Of those in the nTR group, 6 patients lived in residential care, 2 were readmitted within 48 h, and 6 were considered by the therapists as unsuitable for TR due to hearing, vision or language deficits. An additional 3 people refused TR. Reasons for refusal were a dislike of new technology, a preference for face-to-face home visits only and feeling overwhelmed on discharge from hospital
Telerehabilitation was delivered through the Caspar Health e-system (CASPAR Health, Berlin, Germany), a German designed Internet system for desktop and a mobile app for both iOS and Android smartphones which enables patients to interact directly with and seek advice from the hospital or to do exercise anywhere according to the therapists’ treatment plan through digital communication. (1) Therapists set a tailormade TR programme for each patient through the e-system calendar, and data, such as exercise videos and frequency, are transferred to the patient’s mobile phone or tablet through the Caspar Health App. (2) The patient performs the home-based training using the videos, pictures and written and verbal instructions shown on the app, with or without assistance from their caregivers. (3) After practice, the patient uploads their training video or verbal feedback to the therapists so that the therapists can update the home programme according to the patient’s progress. The Caspar Health e-system also allows therapists to review patients’ attendance records and communicate with them if needed
Occupational Therapists
Web-based
Hospital and Home
3-week period intervention, post-intervention follow-up at 6 weeks
Not described
The contents of the home programme in both groups were tailor-made according to the needs of each case by occupational therapists who were not blinded to the treatment
Thirty-one patients were successfully recruited between June 2018 and May 2019. We identified several reasons for patients refusing to participate in the study: problems related to the procedures of the study (difficulty understanding the consent form and using the mobile app); fear of over-exercising apart from attending the standardised treatment in the day hospital; feeling overwhelmed in adapting to the standardised treatment in the day hospital; feeling fatigued after the study intake; and a feeling of uncertainty about joining the research. Eventually, 15 patients were allocated to the experimental group, and 16 patients were assigned to the control group. All patients completed the training programme, and 30 of them attended the follow-up session. One patient in the control group did not attend the follow-up session because of readmission to hospital
A high adherence rate in terms of completing 90% of the home programme was found for both the experimental group (87%) and the control group (86%). Two patients in the experimental group only completed 50% of the home programme due to technical problems in using the app in the initial stage of the study. Two patients in the control group did not commit to the majority of the home programme due to low motivation and readmission to hospital, respectively
Telerehabilitation program based on a video platform for therapy software program
No theoretical framework provided
After an initial examination at the hospital, the therapist recommended an exercise program by selecting specific exercises according to the patient’s physical ability and in accordance with the rehabilitation goals. For the present study, only exercises relating to movement, strength of the lower limbs, and balance performance were included. The software allowed the therapist to adjust the number of repetitions and performance pace for each exercise. The therapist received on request, a report from the dedicated software, as to whether the patient performed the exercise program together with information relating to each exercise
The software includes short video clips of common rehabilitation exercises (e.g. squats, lunges, heel rises, etc.) and an audio clip describing the different phases of the exercise and a depiction of correct versus incorrect performances
18 sessions, 3 sessions/week, and 40–50 min/session
Following each session, the patient was asked for feedback as to the difficulty of the exercises (e.g. easy, hard, and very hard) who was then sent to the therapist by the web site. According to the patient’s feedback, the therapist would readjust or change the program
Five participants from the telerehabilitation group and three from the control group withdrew from the program within the first 2 weeks owing to difficulties in arriving at the evaluation sessions/sickness/and need to return to work
In terms of adherence, according to the self-report diary, 10 (out of 15) participants in the telerehabilitation group performed at least 15 training sessions, three performed between 10 and 14 sessions, and two performed up to 10 training drills. As for the control group, seven (out of 17) performed at least 15 training sessions, two between 10 and 14 sessions, and eight performed up to 10 training drills
A briefing session was arranged for all participants with their caregivers before hospital discharge
The features of the app include: the exercise program, progress summary, push reminders, rehab knowledge, caregiver skills videos, support information
The home-based rehabilitation program for hip fracture patients involved a combination of training focused on strength, coordination and functional movements of geriatric hip fracture patients
Physiotherapists
Web-based
Home
Follow-up 6 months post discharge
1x/daily for 20–30 min
Prescribed exercises based on assessments and progression of exercises monitored by weekly home visits
Eleven participants withdrew from the study, with eight participants refusing home visits, one participant having deterioration of medical condition and two participants being unable to contact
Patients participating in the test phase were given both oral and written information concerning the hip fracture treatment and according to local guidelines—and the tablet
The app contained four main features: 1. pictographs, 2. video clips, 3. illustrated exercises, and 4. written information. Information on typical treatment pathway, video clips provided narratives from other patients, Information or education concerning the LOS and rehabilitation, pre-recorded exercise videos, FAQs
Clinical staff (discipline unspecified)
Mobile app
Hospital and Home
Not described
Not described
The ‘‘My Hip Fracture Journey’’ app aimed to accommodate individual needs and learning styles
A total of 25 patients who met the inclusion criteria were included in the test period. Five participants dropped out due to changing their mind about participation
The test phase ended in May 2018 with 20 patients having tested the app using the tablet in hospital and at home. Five of these patients had only used the tablet at the hospital, and, of these, only two were able to recall the contents. The same five patients also did not remember being introduced to how to use the tablet
Participants were provided verbal and written instructions for using the app. No further description of the content of the app is provided
Nurses
Web-based
Home
6-months post discharge
Not described
Not described
Of the participants (29/110, 26.4%) who downloaded the mobile app, only 1 (1/29, 3.4%) completed the app questionnaire (used to measure usability of app)
Use of a user-centered design process, integrated with a modern agile software development methodology
Patients, caregivers, and clinicians received training on how to use the MyPath to Home web-based application prior to obtaining access to it. With the application, patients and their caregivers were able to securely access the discharge records and to access them seamlessly across a number of mobile devices, including smartphones, tablet computers, and laptop computers. The records were synchronized between these devices, helping the patients and their caregiver stay up to date. The five key features included (1) access to a discharge plan upon admission to geriatric rehabilitation; (2) sharing of preferences and needs with the “circle of care” team members; (3) access to multiple resources through the health library (ie, workbooks) on their dashboard; (4) access to their personal rehabilitation goals of care; and (5) access to personalized discharge information including discharge date, follow-up appointments, who to contact, equipment needs, home accommodation, community resources, and list of medications
Patients, caregivers, clinicians (physiotherapists, social workers, occupational therapists, physicians, nurses)
Web-based
Home
30 days post-discharge
Not described
Clinicians can review each of their patient’s specific preferences and needs during their rounds, assign specific resources to the health library (ie, workbooks), and upload all individualized discharge information and resources
When control group patients were discharged from the hospital, they were given the usual paper discharge instructions and rehabilitation exercise guidance. In addition to these measures for the observation group, the doctors also added the patients’ WeChat and joined the WeChat group chat formed by the medical team. Doctors transmitted text, pictures, voice and video to the group to guide and urge patients to perform rehabilitation exercises, such as correct sitting posture, when to use abduction, and when to abandon it; patients could also consult their condition and upload their own rehabilitation results through WeChat
Physicians
Web-based
Home
60 days post-discharge
Not specified
For special patients, doctors would provide personalized and targeted guidance, for example, patients who were used to putting the affected limb on the other leg to prevent the prosthesis from coming out were send pictures or videos of correct posture and prohibited actions through WeChat
Rehabilitation instructions after hip fracture surgery
No theoretical framework provided
The contents of the mobile application include rehabilitative exercises, activities of daily living (ADL), pain management, nutrition management, fall prevention, and hospital visits. The selection of rehabilitative exercises and ADL was evidence-based after the first and second authors reviewed the literature and discussed the exercises required after hip fracture surgery. The rehabilitative exercises also include goal setting in which older adults can set a count for bed and standing exercises and a duration for walking exercises for every day. The ADL includes advice on how to use a bed and a toilet, correct posture, and postures to avoid while sitting in a chair, picking up things, taking a shower, cleaning, lying down, wearing pants, washing hair, and sitting in a car. The actions of using a bed and a toilet were shown using a video format, and correct postures and postures to avoid in the form of pictographs for easier understanding. The information on pain and nutrition management, fall prevention, and hospital visits was based on literature reviews and designed as static images and concise, large-sized characters
Clinicians (clinical instructors, orthopedic surgeon, head nurses, orthopedic nurses)
Online hip fracture caregiver resource center (OHRC) program for caregivers
The program was developed in conformance with the stress, appraisal, and coping theory and self-efficacy theory
The online hip fracture CG resource program included seven self-learning modules, moderated discussion boards, an Ask-the-Experts section, and a virtual library
Nurses
Web-based
Hospital and Home
8 weeks
1–2 modules per week
During the orientation session, the project manager (PM), a nurse who had expertise in hip fracture care, and the CG participant developed a weekly course plan based on the specific caregiving needs
Nahm 2012a: A total of 41 dyads were eligible and 36 dyads were enrolled. (See Fig. 1 for an enrollment flow diagram.) Reasons for CR and/or CG refusal to participate in the study during the screening process, which occurred for 37 potentially eligible dyads, are presented in Table 2. The most frequent reasons for refusal for CRs were “not interested” (n = 10) and “concerned about CG burden” (n = 6), whereas the most frequent reason for CG refusal was “being too busy” (n = 12). Other reasons for CG refusal included concerns about additional burden and situations that required the CR’s readmission to the acute care hospital. Nahm 2012b: Among 70 potentially eligible CGs and CRs, three CRs did not respond to follow-up calls for the baseline interviews and 17 CGs and 12 CRs refused to participate in the study. Of the 41 eligible CGYCR dyads, 36 dyads were enrolled (five CRs refused later due to changes in health conditions) and 27 dyads completed the follow-up survey. Most frequent withdrawal reasons were illness of the CR or other family members. Nahm 2013: The majority (n 25; 92.6%) accessed the discussion boards, but only 19 CGs (70.4%) actively posted their thoughts on the discussion topic
Health behavior change supporting systems (HBCSS) in Yadav 2021a No theoretical framework provided in Yadav 2021b
This proposed web-based health information portal, or a website, is intended for patients who can access all relevant information about their hip fractures. It includes details in multimedia formats of diagnosis and treatment options, medications, wound management and rehabilitation exercises, potential problems encountered during the hospital admission and post discharge, information on how to deal with difficulties, as well as how and when to attend follow-up appointments or seek more help from the health care team
Patients, Caregivers, and non-specified clinicians
Web-based
Multiple settings
Not described/applicable
Not described/applicable
It is interactive, enabling patients and their caregivers to provide both targeted and patient-initiated information to their health care clinician
Cognitive behaviour theory and Bandura’s self-efficacy theory
Three pairs of skilled nursing facilities were randomised to one of three fixed sequences Each sequence started with providing care as usual (the control condition), followed by CBT-based occupational therapy and ending with CBT-based occupational therapy with sensor monitoring. Patients in CBT-based occupational therapy with sensor monitoring received the same occupational therapy programme as the first intervention group as well as sensor monitoring
The sensor monitoring system consists of a wearable physical activity monitor (PAM AM300) (http://www.coach.com), motion sensors (Molite sensor Z wave Benext, https://www.benext.eu/) placed in the main spaces in the patients’ house and a gateway (Raspberry Pi with a Z-wave shield Model B + quad core CPU, 1024 MB RAM). The PAM measures body movement expressed by the PAM-score and communicates with the gateway via a Bluetooth adaptor (WR300-E). The motion sensors communicate wirelessly through a Z-wave protocol with the gateway. Via a web-application, users can see the visualisations
Occupational Therapists
Face to face and telephone consultations. Monitored activity through web-based app
Rehabilitation and Home
2 ½ months intervention, monitored for 6 months post-discharge
While in the skilled nursing facility, patients received weekly coaching. After discharge, the patients received four home visits followed by four telephone consultations over two and a half months
Not described
Total n = 240 at start. During the study, 47, 43 and 22 patients had dropped out after 1, 3 and 6 months, respectively. During admission to the skilled nursing facility, 97.6% patients in the care as usual, 100% patients in the CBT-based occupational therapy and 95.8% patients in the group CBT-based occupational therapy with sensor monitoring received the occupational therapy sessions. The median inpatient number of sessions was 4 (IQR 2–5) for the care as usual, 4 (IQR 2–6) for the CBT-based occupational therapy and 2.5 (IQR 1–5) for the CBT-based occupational therapy with sensor monitoring. At home, the median number of occupational therapy sessions (range 1–4) was 2 (IQR 0–4) for CBT-based occupational therapy and 4 (IQR 2–4) for CBT-based occupational therapy with sensor monitoring. The median duration of sessions at home was 41 (IQR 0–60) minutes for CBTbased occupational therapy and 45 (IQR 38.5–60) minutes for CBT-based occupational therapy with sensor monitoring
Outcome measures
The quantitative outcomes reported consisted of patient-related functional outcomes (n = 6), gait/mobility (n = 7), quality of life (n = 2), psychological factors (n = 3), and survival/complications (n = 1). Other quantitative reported outcomes included compliance (n = 2), technology-user interactions (n = 4), and caregiver outcomes (n = 3). The qualitative results from 6 studies [18, 26, 27, 33, 36, 37] included feedback from participants on the use of the digital health interventions. Overall, the feedback provided areas for improvement as well as benefits to the use of these interventions. Specifically, three studies included feedback from clinicians [27, 36, 37], two explored specifically the needs of caregivers [19, 25] and one study described the challenges with the study recruitment processes [23]. All the study outcomes are found in Table 3, 4 and 5.
Technology readiness index (TRI) 2.0 3.26 / 5, moderate level of technological adoption
Satisfaction easy to understand (21/23, 91%), helpful (21/23, 91%), helped to understand what they needed to do to prepare for discharge (22/23, 96%), helped to identify the skills they needed to have for a successful discharge (20/23, 87%)
78% (18/23) found that the organization of the application made sense and that it was easy to navigate
91% (21/23) would recommend this application to other patients
(1) the telerehab program was perceived to be useful for older adults’ functional recovery without being onerous for family
(2) there was room for improvement in the telerehab program (regular checking and monitoring by health professionals, more variety of exercises, difficulty of exercises, limited internet access in some locations, no (3) positive points to program (good for communication with health professionals, easy to use, helpful)
Needs of caregivers (Perceptions regarding the hip fracture and recovery process and reasons for choosing or declining the telerehab program)
Caregivers’ responses to the hip fracture and recovery process:
(1) concern about survival and recovery
(2) uncertainty, anxiety, and stress
(3) communication and resources: looking for answers
The reasons for choosing the telerehab program were:
(1) to enhance recovery after fracture, (2) gain knowledge for managing at home, and (3) the convenience of doing exercises at home
The reasons for declining the telerehab program were:
(1) perceived challenges with technology; (2) lack of time to support family member (with hip fracture) with technology, for example, navigating the website; (3) caregivers’ perception that family members would not want to complete exercises at home; (4) preference of in-person rehab, even if it had associated costs; or (5) no expected need for the program
Online hip fracture caregiver resource center (OHRC)
Patients and caregivers
Challenges and strategies to recruiting older adult hip fracture patients, and caregivers
Challenges: Identifying eligible dyads: we found that locating family CGs often required additional assistance from the clinical staff since CGs were often not present when the research nurse visited the patient on the unit and the clinical; Composite Eligibility Criteria for the Dyad: During the early recruitment phase, we found that the number of eligible dyads in the selected three inner-city hospitals was smaller than expected; Brief Hospital length of stay: Enrollment of older adult hip fracture patients and their CGs in this acute phase is challenging and resource intensive. Usually, our research nurse did not have an opportunity to introduce the study to the patient until the second visit; Caregivers’ Stress Level and Busy Schedule: These CGs were stressed and physically and mentally exhausted. Thus, some CGs perceived participation in an online study to be an additional stressor and burden
Strategies: Identifying eligible dyads: Informing necessary clinical staff about the study and establishing rapport between the study field staff and the clinical staff are critical in recruiting dyads; Composite Eligibility Criteria for the Dyad: Our investigative team confirmed the importance of monitoring and developing strategies for the recruitment process; Brief Hospital length of stay: Support from the hospital staff was especially helpful in dealing with the patient’s short hospital stay and the dyads’ busy schedules; Caregivers’ Stress Level and Busy Schedule: Field research nurses must be appropriately trained to understand the situation and make proper judgments when they approach participants
Online hip fracture caregiver resource center (OHRC)
Caregivers
Needs of caregivers (Description of caregiver activities, strategies and coping mechanisms used by caregivers)
(1) Description of caregiving activities
help with ADLs or physical therapies; environmental adjustment; provision of direct care related to the surgery (e.g., medications, care of localized infection site); and use of assistive devices
(2) Strategies Used by Caregivers to Prevent Hip Fractures
The most frequently discussed strategies related to safety, such as becoming aware of surroundings and being careful not to fall (nine units) “I am trying very hard to keep my hubby from falling again. I know that I am being very overprotective, but he just can’t afford another fall.” The impact of knowledge gained by caregivers also expanded to themselves, as well as to their family members
(3) Coping Mechanisms Used by the Caregivers to Handle Stress
Several caregivers (four units) reported that support from their family and friends helped them a great deal to cope with the stressful situation (“I’ve found that lots of family support and visits from friends helped both of us to cope”). Others found that relaxation techniques, exercise or taking a walk, or reading helped them cope with the stress (five units)
(1) Context patient characteristics such as frailty, digital literacy, and patient or carer participation, social support, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovation and holistic models of care
(2) Content importance of targeted patient education and behavior change
(3) System personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change
Feedback on the application (Barriers and facilitators influencing the use of the application)
(1) Capability: Some patients recognized that possessing the necessary knowledge and skills while accessing digital devices can help explore relevant web-based health information, which could enable a better understanding of their health condition. Conversely, there were caregivers who lacked confidence in using digital devices
(2) Opportunity: Patients and their family members considered their personal environment and the affordability of resources, such as digital devices, as a major limiting factor. Caregivers saw digital health platforms as an opportunity to provide general health information, including healthy lifestyle, diet, and exercise
Motivation: Being older was identified by both patients and their family members as one of the main hurdles. (3) Caregivers identified lack of time in their existing role, which is currently not a part of their job. Participants across all 3 categories identified their existing capabilities as a limiting factor. However, they were also positive about the potential capabilities of a digital solution, such as the availability of information that would reduce the need to visit a physician and access to trustworthy interventions. Staff thought that a digital health solution could potentially improve handover processes through a better exchange of information between specialists and caregivers. Most participants were optimistic about the range of functions that a digital health platform could provide; however, some had reservations such as preferring phone conversations or maintaining conventional face-to-face interactions with the physician. Emotionally, some consumers were unhappy with the services provided through technology-based solutions in comparison with face-to-face interactions. One of the patients identified a potential lack of reinforcement in terms of someone who could teach or handhold, which could be a barrier to using a digital solution. Conversely, some patients thought that it could help them achieve more peace of mind and service satisfaction
Feedback on the application (Perspectives of participants on feeling supported or not by the technological solution)
(1) regaining physical ability, (2) support of autonomy, (3) the issue of getting old, (4) usability of the tablet and app, and (4) uncertainty about the future and general attitude toward life
Feedback on the application (Challenges and benefits to the use of the application)
Participants described that an application, like MyPath to Home, was essential to help manage the personalized needs of geriatric rehabilitation patients during their transition from the hospital to home
(1) Challenges included the application adding to their workload, a need for more education about the application, and a need for the app to be more user-friendly and accessible on more devices
(2) Benefits included providing the patient with opportunities to be involved in their care
Rehabilitation instructions after hip fracture surgery
Clinicians
Feedback on the application
1) The application is concise and simple, 2) The video of rehabilitation exercises is easy and helpful for older adults to follow, 3) A function to replay the rehabilitation exercise video is needed, 4) It is necessary to reorganize the exercises by dividing bed exercises into lying and sitting exercises, 5) Goal setting can be difficult for older adults. 6) It is necessary to maximize the font size for goal setting, 7) Some of the video quality needs to be improved, 8) The background color of the application is suitable, but the yellow text is not easy to read
Barriers and enablers
Sixteen studies identified key barriers and enablers to the use of digital health interventions [18‐20, 23‐31, 33, 34, 36, 37]. For clinicians, a key barrier to the use of the digital health interventions was the acceptability of the technology [27, 36]. However, the usefulness of the digital health intervention by clinicians was seen as both a barrier and an enabler [26, 27, 29, 37]. For patients and caregivers, all the themes were seen as both a barrier and an enabler depending on the study. Some patients and caregivers saw the lack of availability and access to the digital health intervention as a barrier [18, 26, 27, 30, 31, 33, 36] but others had no problems with the availability or access to the intervention [18, 26]. Patients and caregivers described limited usability of the technology [19, 30, 34] where others had no concerns with the usability [18, 24, 28, 36, 37]. There were also conflicting views with the patients and caregivers perceived knowledge and skills to the use the technology, as a barrier [18, 19, 23, 24, 26‐28, 30, 31, 33, 34] or an enabler [18, 20, 28]. Patients and caregivers described mixed views on the acceptability of the technology as a barrier [19, 26‐28] or enabler [19, 25‐27, 33] and the usefulness of the information as a barrier [18, 19, 26, 31, 37] or enabler [18, 19, 24, 25, 36]. Details of the barriers and enablers as well as the proposed behavioural change techniques are described in Table 6.
Table 6
Barriers and enablers to the use of patient-clinician digital health interventions for older patients with a hip fracture transitioning from hospital to rehabilitation to home
Themes
TDF Domains
Barriers
Enablers
BCTs (Behaviour Change Techniques)
Patients and Caregivers
Availability and access to the digital health intervention
No access to technology or internet in some locations
Additional responsibilities for caregivers, lack of time to support family member, caregivers stress level and busy schedule, participation as an extra burden during an already difficult time, residential caregivers note time constraints
Preference for face-to face for all patients, preference of in-person rehab, even if it had associated costs, no expected need for the program, desiring traditional rehab instead
Chat feature allowed clinicians to guide and urge patients to exercise, and answer their doubts, and reduce the pressure of patients with medical difficulties
A total of 21 studies were included in this scoping review. Of the 21 studies, we identified 14 distinct patient-clinician digital health interventions for post-surgery hip fracture patients including telehealth /telerehabilitation programs (n = 6), care transition /follow-up interventions (n = 5), online resources (n = 2), and wearable devices /sensor monitoring (n = 1). Many interventions focused only on a few post-hip fracture surgery care components such as rehabilitation exercises (n = 13), follow-up and management (n = 9), post-hip fracture education and self-care (n = 4), and caregiver needs (n = 3) rather than on more comprehensive post-care efforts. In addition, we found that the interventions all existed within a specified team within a particular organization rather than across different organizations, similarly to what others found [40]. Furthermore, these interventions often (or all) lacked complete descriptions following the TidieR guidelines [14] to allow clinicians to use or to allow researchers to replicate the studies. Overall, more clear descriptions of the interventions are needed so that they can be replicated.
In terms of the functions of the digital health tools used in the included studies, the interventions focused primarily on management and informational categories of the continuity of care framework [39]. However, future studies should consider incorporating the relational continuity as an important component of continuity of care.
Although only 3/21 studies in our review specifically included methods to improve clinician engagement, one recent rapid review of transition-focused digital health interventions specifically highlighted the importance of involving clinicians in the design and implementation of these interventions to ensure better uptake [41]. Similarly, another review recommended to better engage clinicians in the design and implementation of technologies [42]. Further considerations should also be made to inform patients on how to use digital health technology, provide appropriate training to clinicians, and ensure that the adoption of the technology will allow clinicians more time to care for patients [42].
In our scoping review, we were also able to identify key barriers and enablers to the uptake of digital health interventions. The unique key barrier was the acceptability of the technology by the clinicians. Thus, the behavioural change techniques [17] related to this barrier are practicing and giving feedback and utilizing verbal persuasion to boost self-efficacy. The behavioural change techniques [17] were also matched to the other barriers and enablers and consist of restructuring the physical and social environments, providing incentives, identifying social and environmental consequences, explaining pros and cons, providing prompts/cues, and providing appropriate social support. Future studies should consider the inclusion of these behavioural change techniques in the implementation strategies of digital health interventions.
Strengths and limitations
The broad inclusion criteria for this scoping review allowed us to examine a wide variety of patient-clinician digital health interventions for the hip fracture population. However, the studies lacked detailed description of the interventions. However, despite the wide-ranging inclusion criteria, it is possible that some studies with non-significant results were not published.
Conclusion
In our scoping review, we identified existing patient-clinician digital health interventions. The findings highlighted many behavioural factors that could affect the uptake and use of these patient-clinician digital health interventions. However, a specific attention should be focused on the acceptability of the technology by the clinicians to encourage uptake of the digital health interventions. The results of this scoping review can help researchers and clinicians to better understand the key factors that can be targeted to help increase the uptake of technology-based intervention use by clinicians, patients, and caregivers. Further research is needed to look at patient-clinician digital health interventions in different patient populations that span across different health care sectors.
Acknowledgements
We thank Kaitryn Campbell, MLIS, MSc (St. Joseph’s Healthcare Hamilton/McMaster University) for peer review of the Medline search strategy.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
