eHealth for Addressing Balance Disorders in the Elderly: Systematic Review

Abstract

Background The population is aging on a global scale, triggering vulnerability for chronic multimorbidity, balance disorders, and falls. Falls with injuries are the main cause of accidental death in the elderly population, representing a relevant public health problem. Balance disorder is a major risk factor for falling and represents one of the most frequent reasons for health care demand. The use of information and communication technologies to support distance healthcare (eHealth) represents an opportunity to improve the access and quality of health care services for the elderly. In recent years, several studies have addressed the potential of eHealth devices to assess the balance and risk of falling of elderly people. Remote rehabilitation has also been explored. However, the clinical applicability of these digital solutions for elderly people with balance disorders remains to be studied. Objective The aim of this review was to guide the clinical applicability of eHealth devices in providing the screening, assessment, and treatment of elderly people with balance disorders, but without neurological disease. Methods A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Data were obtained through searching the PubMed, Google Scholar, Embase, and SciELO databases. Only randomized controlled trials (RCTs) or quasiexperimental studies (QESs) published between January 2015 and December 2019 were included. The quality of the evidence to respond to the research question was assessed using Joanna Briggs Institute (JBI) Critical Appraisal for RCTs and the JBI Critical Appraisal Checklist for QESs. RCTs were assessed using the Cochrane risk of bias tool. We provide a narrative synthesis of the main outcomes from the included studies. Results Among 1030 unduplicated articles retrieved, 21 articles were included in this review. Twelve studies explored different technology devices to obtain data about balance and risk of falling. Nine studies focused on different types of balance exercise training. A wide range of clinical tests, functional scales, classifications of faller participants, sensor-based tasks, intervention protocols, and follow-up times were used. Only one study described the clinical conditions of the participants. Instrumental tests of the inner ear were neither used as the gold-standard test nor performed in pre and postrehabilitation assessments. Conclusions eHealth has potential for providing additional health care to elderly people with balance disorder and risk of falling. In the included literature, the heterogeneity of populations under study, methodologies, eHealth devices, and time of follow-up did not allow for clear comparison to guide proper clinical applicability. This suggests that more rigorous studies are needed.

How Can We Develop an Efficient eHealth Service for Provision of Care for Elderly People with Balance Disorders and Risk of Falling? A Mixed Methods Study

“…More recently, another digital service was made available on the NHS' digital platform to allow the sharing of clinical information between all levels of health care and to These healthcare solutions have revealed the potential to provide quality health services with complete, interoperable data in near real-time [17][18][19][20], and eHealth services with the engagement of patients and families for self and remote management of chronic conditions and prevention of risky behaviors [2,[20][21][22]. Indeed, many researchers have studied the potential of digital sensors to identify early balance deficit and identify fallers among elderly people, improving the data quality of clinical tests and functional scales as the Timed Up and Go Test (TUGT) and the Berg Balance Scale [23][24][25][26][27][28][29]. Other researchers have evaluated the benefits of eHealth devices in balance training, reducing the risk of falling [29][30][31].…”

“…Indeed, many researchers have studied the potential of digital sensors to identify early balance deficit and identify fallers among elderly people, improving the data quality of clinical tests and functional scales as the Timed Up and Go Test (TUGT) and the Berg Balance Scale [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Other researchers have evaluated the benefits of eHealth devices in balance training, reducing the risk of falling [ 29 , 30 , 31 ]. The eHealth services seem to have the potential to be a complementary method for preventive monitoring of falls, telerehabilitation, and monitoring of effective rehabilitation for elderly with balance disorder and risk of falling [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], aligned with the eHealth definition: “ an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies.…”

“…Other researchers have evaluated the benefits of eHealth devices in balance training, reducing the risk of falling [ 29 , 30 , 31 ]. The eHealth services seem to have the potential to be a complementary method for preventive monitoring of falls, telerehabilitation, and monitoring of effective rehabilitation for elderly with balance disorder and risk of falling [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], aligned with the eHealth definition: “ an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology ” [ 32 ].…”

“…However, in recent reviews [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], it was pointed out that the clinical applicability of eHealth devices and services in screening, assessing and treating elderly people with balance disorders and the risk of falling in Portugal is still unknown. Therefore, we aim at studying how to obtain an efficient eHealth service for the provision of care for elderly people with balance disorders and the risk of falling.…”

“…The increasing interest of elderly people in medical digital devices and the eHealth potential to enhance health promotion and physician–patient interaction to mitigate care access inequities and to allow remote management of balance disorders and risk of falling are opportunities that should be further explored for active and healthy aging [ 29 ]. This could be viewed as an opportunity to mitigate the aging pressure in the health systems.…”