Engagement and attrition with eHealth tools for remote monitoring in chronic arthritis: a systematic review and meta-analysis

Michaël Doumen, Diederik De Cock, Caroline Van Lierde, Albrecht Betrains, Sofia Pazmino, Delphine Bertrand, René Westhovens, Patrick Verschueren, Michaël Doumen, Diederik De Cock, Caroline Van Lierde, Albrecht Betrains, Sofia Pazmino, Delphine Bertrand, René Westhovens, Patrick Verschueren

Abstract

Objectives: Although eHealth tools are potentially useful for remote disease monitoring, barriers include concerns of low engagement and high attrition. We aimed to summarise evidence on patients' engagement and attrition with eHealth tools for remotely monitoring disease activity/impact in chronic arthritis.

Methods: A systematic literature search was conducted for original articles and abstracts published before September 2022. Eligible studies reported quantitative measures of patients' engagement with eHealth instruments used for remote monitoring in chronic arthritis. Engagement rates were pooled using random effects meta-analysis.

Results: Of 8246 references, 45 studies were included: 23 using smartphone applications, 13 evaluating wearable activity trackers, 7 using personal digital assistants, 6 including web-based platforms and 2 using short message service. Wearable-based studies mostly reported engagement as the proportion of days the tracker was worn (70% pooled across 6 studies). For other eHealth tools, engagement was mostly reported as completion rates for remote patient-reported outcomes (PROs). The pooled completion rate was 80%, although between-study heterogeneity was high (I2 93%) with significant differences between eHealth tools and frequency of PRO-collection. Engagement significantly decreased with longer study duration, but attrition varied across studies (0%-89%). Several predictors of higher engagement were reported. Data on the influence of PRO-reporting frequency were conflicting.

Conclusion: Generally high patient engagement was reported with eHealth tools for remote monitoring in chronic arthritis. However, we found considerable between-study heterogeneity and a relative lack of real-world data. Future studies should use standardised measures of engagement, preferably assessed in a daily practice setting.

Trial registeration number: The protocol was registered on PROSPERO (CRD42021267936).

Keywords: arthritis; epidemiology; health services research; patient reported outcome measures.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
PRISMA flow chart of systematic review. ICTRP, International Clinical Trials Registry Platform.
Figure 2
Figure 2
Forest plot of pooled completion rates for patient-reported outcomes collected with eHealth tools.
Figure 3
Figure 3
Forest plot of pooled completion rates according to eHealth tool. PDA, personal digital assistant; SMS, short message service; WAT, wearable activity tracker.
Figure 4
Figure 4
Forest plot of pooled completion rates according to patient-reported outcome collection frequency.
Figure 5
Figure 5
Forest plot of pooled proportion of study days a wearable activity tracker was actively worn.

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