Just-in-Time Adaptive Interventions for Behavior Change in Physiological Health Outcomes and the Use Case for Knee Osteoarthritis: Systematic Review

Abstract

Background: Prevalence for knee osteoarthritis (KOA) is high and patients profit from individualized therapy approaches. Here, just-in-time adaptive interventions (JITAIs) are upcoming digital interventions for behavior change.Objective: This systematic summarizes the features and effectiveness of existing JITAIs regarding important parameters for KOA management and derives the most promising features to the use case of KOA. Methods:The electronic databases PubMed, Web of Science, Scopus, and EBSCO were searched using keywords related to JITAIs, physical activity, sedentary behavior, physical function, quality of life, pain, and stiffness. JITAIs for adults that focused on the effectiveness of at least one of the selected outcomes were included and synthesized qualitatively. Study quality was assessed with the Quality Assessment Tool Effective Public Health Practice Project (EPHPP).Results: A total of 31 studies with mainly weak overall quality were included in this review. The studies were mostly focused on physical activity and sedentary behavior and no study examined stiffness. The design of JITAIs varied with a frequency of decision points from a minute to a day, device-based measured and self-reported tailoring variables, intervention options including audible or vibration prompts and tailored feedback, and decision rules from simple if-then conditions based on one variable to more complex algorithms including contextual variables. Conclusions:The use of frequent decision points, device-based measured tailoring variables accompanied by user input, intervention options tailored to user-preferences, and simple decision rules showed the most promising results in previous studies. This can be set up using target variables for a KOA JITAI that include breaks in sedentary behavior, and an optimum of physical activity considering individual knee load for health benefits of patients.