Ann Rehabil Med.  2023 Oct;47(5):348-357. 10.5535/arm.23090.

E-Health Interventions for Older Adults With Frailty: A Systematic Review

• Han HW
• Park SW
• Kim DY
• Lee BS
• Kim D
• Jeon N
• Yang YJ

• KMID: 2548394
• DOI: http://doi.org/10.5535/arm.23090

Abstract

Objective
To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.
Methods
A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected.
Results
Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07–0.94; p=0.80, I²=0%).
Conclusion
This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

Keyword

Telemedicine; Frailty; Exercise; Aged; Muscle strength

Figure

• 

  Fig. 1. PRISMA flow diagram. PEDro, Physiotherapy Evidence Database; RCT, randomized controlled trial.

• 

  Fig. 2. The Cochrane Collaboration’s tool for assessing the risk of bias in the included studies.

• 

  Fig. 3. Forest plot for upper extremity strength. SD, standard deviation; SMD, standardized mean difference; 95% CI, 95% confidence interval.

• 

  Fig. 4. Forest plot for frailty status 95% CI, 95% confidence interval.

• 

Reference

1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56:M146–56.

2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48:16–31. Erratum in: Age Ageing 2019;48:601.

3. Hutchison ED. A life course perspective. In : Hutchison ED, editor. Dimensions of human behavior: the changing life course. Sage Publications;2010. p. 1–38.

4. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016; 31:3–10.

5. Hudson JL, Bower P, Kontopantelis E, Bee P, Archer J, Clarke R, et al. Impact of telephone delivered case-management on the effectiveness of collaborative care for depression and anti-depressant use: a systematic review and meta-regression. PLoS One. 2019; 14:e0217948.

6. Peek ST, Wouters EJ, van Hoof J, Luijkx KG, Boeije HR, Vrijhoef HJ. Factors influencing acceptance of technology for aging in place: a systematic review. Int J Med Inform. 2014; 83:235–48.

7. Núñez de Arenas-Arroyo S, Cavero-Redondo I, Alvarez-Bueno C, Sequí-Domínguez I, Reina-Gutiérrez S, Martínez-Vizcaíno V. Effect of eHealth to increase physical activity in healthy adults over 55 years: a systematic review and meta-analysis. Scand J Med Sci Sports. 2021; 31:776–89.

8. Peterson MJ, Sloane R, Cohen HJ, Crowley GM, Pieper CF, Morey MC. Effect of telephone exercise counseling on frailty in older veterans: project LIFE. Am J Mens Health. 2007; 1:326–34.

9. Vestergaard S, Kronborg C, Puggaard L. Home-based video exercise intervention for community-dwelling frail older women: a randomized controlled trial. Aging Clin Exp Res. 2008; 20:479–86.

10. Upatising B, Hanson GJ, Kim YL, Cha SS, Yih Y, Takahashi PY. Effects of home telemonitoring on transitions between frailty states and death for older adults: a randomized controlled trial. Int J Gen Med. 2013; 6:145–51.

11. Kwan RY, Lee D, Lee PH, Tse M, Cheung DS, Thiamwong L, et al. Effects of an mHealth brisk walking intervention on increasing physical activity in older people with cognitive frailty: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2020; 8:e16596.

12. Esfandiari E, Miller WC, Ashe MC. The effect of telehealth interventions on function and quality of life for older adults with pre-frailty or frailty: a systematic review and meta-analysis. J Appl Gerontol. 2021; 40:1649–58.

13. Yerrakalva D, Yerrakalva D, Hajna S, Griffin S. Effects of mobile health app interventions on sedentary time, physical activity, and fitness in older adults: systematic review and meta-analysis. J Med Internet Res. 2019; 21:e14343.

14. Forman CR, Nielsen JB, Lorentzen J. Neuroplasticity at home: improving home-based motor learning through technological solutions. A review. Front Rehabil Sci. 2021; 2:789165.

15. Laver K, George S, Ratcliffe J, Quinn S, Whitehead C, Davies O, et al. Use of an interactive video gaming program compared with conventional physiotherapy for hospitalised older adults: a feasibility trial. Disabil Rehabil. 2012; 34:1802–8.

16. Varnfield M, Karunanithi M, Lee CK, Honeyman E, Arnold D, Ding H, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart. 2014; 100:1770–9.

17. Stork MJ, Bell EG, Jung ME. Examining the impact of a mobile health app on functional movement and physical fitness: pilot pragmatic randomized controlled trial. JMIR Mhealth Uhealth. 2021; 9:e24076.

18. Elavsky S, Knapova L, Klocek A, Smahel D. Mobile health interventions for physical activity, sedentary behavior, and sleep in adults aged 50 years and older: a systematic literature review. J Aging Phys Act. 2019; 27:565–93.

19. Peel NM, McClure RJ, Bartlett HP. Behavioral determinants of healthy aging. Am J Prev Med. 2005; 28:298–304.

20. Teichtahl AJ, Wang Y, Wluka AE, Szramka M, English DR, Giles GG, et al. The longitudinal relationship between body composition and patella cartilage in healthy adults. Obesity (Silver Spring). 2008; 16:421–7.

21. Arem H, Moore SC, Patel A, Hartge P, Berrington de Gonzalez A, Visvanathan K, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015; 175:959–67.

22. Moore SC, Patel AV, Matthews CE, Berrington de Gonzalez A, Park Y, Katki HA, et al. Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis. PLoS Med. 2012; 9:e1001335.

23. Drewnowski A, Evans WJ. Nutrition, physical activity, and quality of life in older adults: summary. J Gerontol A Biol Sci Med Sci. 2001; 56 Spec No 2:89–94.

24. Ceravolo MG, de Sire A, Andrenelli E, Negrini F, Negrini S. Systematic rapid "living" review on rehabilitation needs due to COVID-19: update to March 31st, 2020. Eur J Phys Rehabil Med. 2020; 56:347–53.

25. Carpallo-Porcar B, Romo-Calvo L, Pérez-Palomares S, Jiménez-Sánchez C, Herrero P, Brandín-de la Cruz N, et al. Efficacy of an asynchronous telerehabilitation program in post-COVID-19 patients: a protocol for a pilot randomized controlled trial. PLoS One. 2022; 17:e0270766.

26. Izquierdo M. [Multicomponent physical exercise program: Vivifrail]. Nutr Hosp. 2019; 36:50–6. Spanish.

27. Pérez-Zepeda MU, Martínez-Velilla N, Kehler DS, Izquierdo M, Rockwood K, Theou O. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age Ageing. 2022; 51:afac028.

28. Centers for Disease Control and Prevention (CDC). Telehealth interventions to improve chronic disease [Internet]. CDC; 2021 [cited 2023 May 24]. Available from: https://www.cdc.gov/dhdsp/pubs/telehealth.htm.

29. Cranen K, Groothuis-Oudshoorn CG, Vollenbroek-Hutten MM, IJzerman MJ. Toward patient-centered telerehabilitation design: understanding chronic pain patients’ preferences for web-based exercise telerehabilitation using a discrete choice experiment. J Med Internet Res. 2017; 19:e26.

30. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013; 381:752–62. Erratum in: Lancet 2013;382:1328.

31. Sun XH, Ma T, Yao S, Chen ZK, Xu WD, Jiang XY, et al. Associations of sleep quality and sleep duration with frailty and pre-frailty in an elderly population Rugao longevity and ageing study. BMC Geriatr. 2020; 20:9.

32. Kańtoch E, Kańtoch A. Cardiovascular and pre-frailty risk assessment during shelter-in-place measures based on multimodal biomarkers collected from smart telemedical wearables. J Clin Med. 2021; 10:1997.

33. Heydarian H, Adam M, Burrows T, Collins C, Rollo ME. Assessing eating behaviour using upper limb mounted motion sensors: a systematic review. Nutrients. 2019; 11:1168.

34. Mirtchouk M, Merck C, Kleinberg S. Automated estimation of food type and amount consumed from body-worn audio and motion sensors. In : . Paper presented at: 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing; 2016 Sep 12-16; Heidelberg, Germany. New York: Association for Computing Machinery;2016. p. 451–62.

35. Rollo ME, Ash S, Lyons-Wall P, Russell AW. Evaluation of a mobile phone image-based dietary assessment method in adults with type 2 diabetes. Nutrients. 2015; 7:4897–910.

36. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993; 342:1032–6.

37. Kumar P, Lee HJ. Security issues in healthcare applications using wireless medical sensor networks: a survey. Sensors (Basel). 2012; 12:55–91.

38. Hussein NH, Khalid A. A survey of cloud computing security challenges and solutions. Int J Comput Sci Inf Secur. 2016; 14:52–6.