Digital health interventions to improve recovery for intensive care unit survivors: A systematic review

Objective: Recovery models of care for intensive care unit (ICU) survivors are limited by availability, accessibility, and efficacy. Digital health interventions represent an alternative mode of service delivery. The primary aim of this systematic review was to describe implementation factors (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for digital health interventions for ICU survivors. The secondary aim was to describe any effect on patient-reported health outcomes. Data sources: A systematic search of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excertpa Medica Database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Systematic Reviews (CENTRAL) databases was undertaken in March 2023. Study selection: Two independent reviewers screened abstracts and full texts against eligibility criteria. Studies of adult survivors with any post-ICU discharge care, delivered via a digital mode, were included. Studies were excluded if published before 1990 or not in English. Data extraction: Quantitative data were extracted using predefined data fields. Risk of bias was assessed using the NewcastleeOttawa Scale and Cochrane Risk of Bias Tool 2.0. Implementation factors were reported according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Data synthesis: A total of 6482 studies were screened. Ten studies, with 686 participants, were included. Implementation factors were reported in all studies. Acceptability (reported in six studies) was high, with high satisfaction and usability scores, defined a priori by investigators. Eight studies reported intervention adherence rates between 46% and 100%. Nine studies report final outcome measurement retention rates up to 12 months, between 52% and 100%. Five studies included the primary outcome as the difference in a patient-reported health outcome. Appraisal of efficacy and digital health literacy was limited due to substantial methodological variation and a lack of reporting in included studies. There was some risk of bias in 50% of studies. Conclusions: Digital health interventions can be successfully implemented for critical care survivors and have varying intervention adherence and retention rate success. To broaden reach, future research should include cultural diversity and investigate digital health access, literacy, and cost-effectiveness. International Prospective Register of Systematic Reviews Registration: CRD42022348252. (c) 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).