Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis

Abstract

Background Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. Objective This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. Methods We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. Results A total of 8988 studies were screened, of which 30 (0.33%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. Conclusions Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases.

A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study

“…Musculoskeletal conditions are the second greatest contributor to disability worldwide and is a significant burden to the individual and society [ 3 ]. It is expected that the impact of musculoskeletal conditions on the health service and on society will continue to rise as life expectancy increases [ 4 ]. Many different approaches have been explored to reduce this burden, including medical interventions, work-related approaches (reducing stress at work as well as improving health and safety regulations), social education (improving awareness of exercise and healthy eating), and the use of technology.…”

“…Back and neck pain, osteoarthritis, rheumatoid arthritis, and fractures are among the most disabling conditions and can be a significant barrier to healthy aging [ 5 ]. Musculoskeletal conditions can be classified by the body part affected (eg, knee pain and shoulder pain), whether the condition is noninflammatory (such as osteoarthritis) or inflammatory (such as rheumatoid arthritis), and whether the condition is restricted to the musculoskeletal system or more widespread (such as systemic lupus erythematosus) [ 4 ]. To compound matters, musculoskeletal issues tend to be associated with other diseases, such as heart or respiratory disease and stroke, and lead to an increase in disabilities and deaths [ 6 - 8 ].…”

“…Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction [ 4 , 19 - 21 ] as well as prevent further deconditioning [ 22 ]. The aim of this study was to evaluate the usability of a re-enablement platform called Active and Independent Management System (AIMS) that was developed to address the de-enablement that occurs in hospitalized inpatients for one of the groups considered to be most at risk, that is, older adults.…”