eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability

Abstract

Background eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.

Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study

“…This may be an important fact for other researchers developing apps for multi-morbid older adults in rehabilitation facilities, who have rarely been involved in app development to this extent. Although studies on eHealth interventions are already being conducted in the context of geriatric rehabilitation, apps have only been considered as a form of intervention in a few studies to date, and many applications relate to specific clinical conditions, particularly in the neurological field [ 14 ]. In older adults with limited mobility and after hip fractures, positive effects on mobility, functional outcomes, and hospitalization could be achieved through telerehabilitation interventions with an app [ 16 ] or via web sites [ 15 , 51 ].…”

“…In addition, only 8% of all identified studies assessed the use of health apps as an eHealth intervention. However, the results on the applicability of eHealth with the target group indicated that interventions are feasible if adequate training takes place, and if the eHealth intervention is simple and has good usability [ 14 ]. For example, a study on telerehabilitation via a website compared with conventional rehabilitation after a hip fracture showed that patients in the telerehabilitation group achieved better functional scores than those in the control group [ 15 ].…”

Reshaping the Management of Allergic Rhinitis in Primary Care: Lessons from the COVID-19 Pandemic

“…However, older adults may have minimal experience and familiarity with technology, and their chronic condition may also affect the usability of digital technology for self-care. It has emerged that the main difficulties of the elderly to use digital technology were due to vision and hearing issues [ 50 ].…”

A bibliometric analysis on global eHealth

“…The combination of subjective symptoms and other objective findings may contribute to personalized patient care and can be used in the preventive setting, at diagnosis, during treatment, rehabilitation, follow-up or in the palliative setting, 8 so as to realize activity monitoring and self-management, health care education, home care or symptom monitoring. At the same time, in the field of Gerontology, 9 it allowed rehabilitation in virtual space or serious games or the development of intelligent framework. 10 , 11 The current coronavirus disease 2019 (COVID-19) pandemic highlighted some potential of eHealth, which could not only help overcome COVID-19, but also improve many aspects of health care, 12 including cancer care.…”