BHPR RESEARCH: QUANTITATIVE122. THE EFFECT OF INTERACTIVE DIGITAL INTERVENTIONS ON PHYSICAL ACTIVITY IN PEOPLE WITH INFLAMMATORY ARTHRITIS

Abstract

Background: Physical activity (PA) is a key management strategy for people with inflammatory arthritis (IA) but, despite improving health and disease status, uptake is frequently low. Interactive Digital Interventions (IDIs) are defined as interactive interventions delivered through digital platforms that require user's contribution to produce personally relevant health information and provide support to facilitate behaviour change. This systematic review synthesizes the evidence from randomized controlled trials (RCTs) evaluating the effectiveness of IDIs to increase PA in people with IA. Method(s): We searched 7 electronic databases for published or unpublished studies in any language from database inception to 6 June 2016 with cross-referencing from retrieved studies and expert review. We included RCTs involving people with IA [rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis, and psoriatic arthritis] exploring the use of IDIs (as defined above) compared with usual care, waiting list or other non-IDIs and reporting outcome data for objective or self-reported PA at the end of the intervention and longer term follow-up. Independent data extraction and quality assessment, using the Cochrane risk of bias tool, was conducted by two reviewers. Result(s): 7,157 records were retrieved. Five manuscripts, reporting four RCTs (one high, two moderate, one low-quality studies) and one followup, involving 492 (459 RA, 33 JIA) participants met the inclusion criteria. Due to heterogeneity of outcome measures, a narrative synthesis was conducted. Where possible, extracted data are reported, otherwise, the mean difference (MD), 95% confidence intervals (CI) and effect sizes (Hedges' g) were computed. At the end of the intervention, there were no significant between group differences in objectively measured PA (3-day activity monitoring) reported in one high-quality study including people with RA and there was a small effect, favouring the intervention group, for maximal endurance time [MD: 26seconds (95% CI-47.2, 89.2); ES: g=0.2] in a moderate-quality study including children with JIA. There were between group differences in self-reported vigorous [MD: 0.9 days/ week (95% CI 0.4, 1.4); P<0.05], but not moderate, PA reported in one high-quality study and a further moderate-quality study found a difference in the number of minutes of exercise/week (gaming and social support group versus comparison: +13%versus -13%; P<0.05) at the end of intervention, in people with RA. In children with JIA, there was a small effect on moderate-vigorous PA [MD: 0.4 hours/day (95%CI -0.3, 1.1); ES: g=0.4], favouring the intervention group, in one moderate-quality study. There were no significant, between group, differences in PA in adults with RA in one high-quality follow-up study and one low-quality study at 1 year. Conclusion(s): There is limited evidence from RCTs of variable quality on the effectiveness of IDIs to increase PA in people with IA.