Attrition Within Digital Health Interventions for People With Multiple Sclerosis: Systematic Review and Meta-analysis

Abstract

Background Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. Objective This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). Methods We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. Results There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. Conclusions This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.

Study protocol for an online lifestyle modification education course for people living with multiple sclerosis: the multiple sclerosis online course (MSOC)

“…Before commencing online course development, a systematic review and meta-analysis of RCTs (n = 32) describing digital health self-management interventions for plwMS was conducted to inform likely participant attrition. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively [ 72 ], demonstrating no significant difference in attrition between groups. A second systematic review and meta-analysis of RCTs of lifestyle interventions in other chronic diseases found no evidence of differential attrition between intervention and control arms, increasing confidence in conducting such studies with minimal potential of attrition bias [ 73 ].…”

Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression

“…Previous systematic reviews, such as Bevens et al [ 54 ], focused on the analysis of attrition of digital strategies in people with multiple sclerosis and found no significant differences between dropout rates in participants allocated to digital or control interventions. Although our findings are in line with these previous findings, the target population and research conditions differed from ours, so comparison of findings are difficult.…”

Dropout rate in randomised controlled trials of balance and gait rehabilitation in multiple sclerosis: is it expected to be different for virtual reality-based interventions? A systematic review with meta-analysis and meta-regression

“…This idea is supported by the prediction intervals, which stated that our findings could change with future trials. The recent systematic review of Bevens et al ( 2021 ) analysed the dropout rate in people with multiple sclerosis who received digital health interventions, showing no significant differences between experimental and control comparators. Therefore, we can consider that the adherence to virtual reality or other technological approaches were at least similar to other interventions.…”