Interactive Digital Self-management Interventions for Chronic Respiratory Disease: Systematic Review and Meta-analysis (Preprint)

BACKGROUND Interactive, digital self-management (IDSM) interventions may help individuals with chronic respiratory disease manage their condition. OBJECTIVE The aim of this review was to summarize the characteristics and effectiveness of IDSM interventions for individuals with chronic respiratory diseases. METHODS Reviewers screened titles, abstracts, and full texts of studies featuring: 1) applications or wearable devices for IDSM, 2) randomized controlled trials, and 3) adults with chronic respiratory disease. Articles were excluded if they were not available in English, French, or Portuguese. Study and intervention characteristics and outcomes were extracted. A meta-analysis was conducted for outcomes with combinable data. RESULTS The search generated 93,419 studies. Twenty-four trials were included in the qualitative synthesis and 17 in the quantitative synthesis. Studies evaluated 1726 individuals with asthma and 1265 individuals with chronic obstructive pulmonary disease (COPD; FEV1 %predicted 36 to 69). In asthma, median (range) intervention length was 12 (8-52) weeks. In COPD, median (range) intervention length was 24 (2-48) weeks. Meta-analysis for COPD studies showed IDSM interventions had a greater effect than control for health status (COPD Assessment Test score mean difference [95%CI]: -2.7 [-4.3, -1.2], P < .01) and physical activity (steps per day: 627.65 [95%CI 104.23, 1151.06], P = .02). Meta-analysis for asthma studies examined asthma control. No effect greater was found for asthma control test (0.55 [95% CI -1.90, 3.00], P = .66) or asthma control questionnaire (2.80 [95% CI -0.08, 0.64], P = .12). Evidence quality ranged from very low to moderate. CONCLUSIONS This review outlined the effectiveness and characteristics of IDSM interventions for chronic respiratory disease. Interventions were heterogeneous and studies yielded very low to moderate quality evidence. For COPD, IDSM benefitted health status and physical activity. Improvements in design of IDSM interventions will assist clinicians to identify those best suited to improve health in individuals with respiratory conditions.