The effectiveness of physical activity interventions using activity trackers during or after inpatient care: a systematic review and meta-analysis of randomized controlled trials
Authors: de Leeuwerk Marijke E. , Bor Petra , van der Ploeg Hidde P. , de Groot Vincent , van der Schaaf Marike , van der Leeden Marike ,   on behalf of the OPRAH consortium, Geleijn Edwin , van Vliet Vincent , Geelen Sven J. G. , Huijsmans Rosalie J. , Kruizenga Hinke M. , Weijs Peter J. M. , ten Dam Suzanne , Besselink Marc G. , Dickhoff Chris , Tuynman Jurriaan B. , van Berge Henegouwen Mark I. , Eskes Anne M. , Pijnappels Mirjam A. G. M. , Ket Johannes C. F. , Heijmans Martijn W. 
Published: May 2022

Abstract
Background
Promoting physical activity (PA) in patients during and/or after an inpatient stay appears important but challenging. Interventions using activity trackers seem promising to increase PA and enhance recovery of physical functioning.

Objective
To review the effectiveness of physical activity interventions using activity trackers on improving PA and physical functioning, compared to usual care in patients during and/or after inpatient care. In addition, it was determined whether the following intervention characteristics increase the effectiveness of these interventions: the number of behaviour change techniques (BCTs) used, the use of a theoretical model or the addition of coaching by a health professional.

Design
Systematic review and meta-analysis.

Data Sources
PubMed, EMBASE, Cinahl, SportDiscus and Web of Science databases were searched in March 2020 and updated in March 2021.

Eligibility criteria for selecting studies
Randomized controlled trials (RCTs) including interventions using activity trackers and feedback on PA in adult patients during, or less than 3 months after, hospitalization or inpatient rehabilitation.

Methods
Following database search and title and abstract screening, articles were screened on full text for eligibility and then assessed for risk of bias by using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses, including subgroup analysis on intervention characteristics, were conducted for the outcomes PA and physical functioning.

Results
Overall, 21 RCTs totalling 2355 patients were included. The trials covered a variety of clinical areas. There was considerable heterogeneity between studies. For the 13 studies that measured PA as an outcome variable(N = 1435), a significant small positive effect in favour of the intervention was found (standardized mean difference (SMD) = 0.34; 95%CI 0.12–0.56). For the 13 studies that measured physical functioning as an outcome variable (N = 1415) no significant effect was found (SMD = 0.09; 95%CI -0.02 - 0.19). Effectiveness on PA seems to improve by providing the intervention both during and after the inpatient period and by using a theoretical model, multiple BCTs and coaching by a health professional.

Conclusion
Interventions using activity trackers during and/or after inpatient care can be effective in increasing the level of PA. However, these improvements did not necessarily translate into improvements in physical functioning. Several intervention characteristics were found to increase the effectiveness of PA interventions.

Trial registration
Registered in PROSPERO (CRD42020175977) on March 23th, 2020.