Behaviorally Informed Interventions to Promote Activity in the Home and Community for Adults with Neurological Disorders: A Systematic Review and Meta-Analysis.

Abstract

Importance: Physical activity can improve clinical outcomes among people with neurological conditions; however, people with these conditions rarely engage in recommended levels of activity. Remote monitoring (RM) with the incorporation of behavior change strategies is purported to be an effective approach to promote increased physical activity in the home setting, however, its effectiveness in promoting activity for people with neurological conditions is unclear.

Objectives: The objectives of this review were to examine the effectiveness of behaviorally informed RM interventions on physical activity in the home and community and to identify usage and impact of specific behavior change techniques (BCTs) implemented with RM interventions.

Data sources: PubMed, PsycINFO, and CINAHL were searched in March 2024.

Study selection: This study included a selection of randomized controlled trials on behaviorally informed RM interventions that use wearable sensors or digital applications to target physical activity for patients with neurological diseases.

Data extraction and synthesis: Data extraction was performed by 2 independent reviewers and data synthesis was performed with random effects meta-analysis. Behavior change techniques were classified using Michie's Behavior Change Technique Taxonomy. Promising BCTs were identified by examining the proportion of statistically significant studies for each technique. Risk of bias was assessed with the Risk of Bias 2 tool.

Main outcomes and measures: The main outcomes and measures included physical activity measured by self-report and accelerometers.

Results: Fourteen studies were included with some concerns of bias, encompassing individuals with multiple sclerosis, stroke, Parkinson disease, and spinal cord injury. Behaviorally informed RM interventions resulted in statistically significant improvements in self-reported physical activity (SMD = 0.27, 95% CI = 0.06 to 49]), but not accelerometry outcomes (SMD = 0.52, 95% CI = -0.07 to 1.11). Promising BCTs included self-monitoring, problem solving, goal setting, graded tasks, social support, and adding objects to the environment.

Conclusions and relevance: Remote monitoring shows initial promise to increase physical activity of people living with neurological conditions when paired with behavior change consultation.