TITLE: Maintaining physical activity through the use of digital tools for people with a long-term condition/s (LTCs): A scoping review.
AUTHORS: Paul Clarkson, Jo Adams, Paul Muckelt, Chloe Grimmett, Hazel Everitt, Carol Clark, Zoe Saynor, Katherine Cook, Aoife Stephenson, Suzanne McDonough

[DESCRIPTION]
<div class = "text-blocks"><div class = "text-block"><span style = "font-weight:bold;">Background</span></div><div class = "text-block">Physical activity (PA) is important for both the prevention and management of long-term conditions (1). Previous research has identified a beneficial impact of PA on pain, function and overall health (2, 3, 4). However, levels of PA are often lower in people with a long-term condition (LTC) and decline further for those with multiple conditions (5, 6). Digital tools, such as websites, apps or wearables, show some potential for supporting engagement with PA in the short term (7, 8), but lack data on maintaining PA behaviours longer term. A search of existing reviews in this area identified only a small number of systematic reviews that included digital interventions with a focus on maintaining PA for people with a LTC (9, 10, 11). Of these, only Grimmett et al (2019) reported effective maintenance at >3 months post-intervention (9). Consequently, a scoping review methodology has been chosen to explore digital PA maintenance for people with a LTC more widely.</div><div class = "text-block">The aims of this review are to:</div><div class = "text-block"><ul style = "list-style-type:disc;"><li style = "counter-reset:ol0;list-style-type:disc;">Identify the range and variety of digital tools and their associated theoretical foundations for supporting people with a LTC/s to maintain physical activity.</li><li style = "counter-reset:ol0;list-style-type:disc;">Uncover the components considered to be necessary for engagement with digital tools to support maintenance of physical activity</li></ul></div><div class = "text-block">Review objectives:</div><div class = "text-block"><ol style = "list-style-type: decimal;"><li style = "counter-reset:ol0;">What is the “extent (size), range (variety) and nature (characteristics) of the evidence” (12) on digital tools to support the maintenance of physical activity for people with a LTC/s?</li><li style = "counter-reset:ol0;">What theoretical underpinnings are used in digital tools to promote the maintenance of physical activity?</li><li style = "counter-reset:ol0;">What are the experiences of people using digital tools to maintain physical activity?</li><li style = "counter-reset:ol0;">What are the barriers and facilitators to maintaining physical activity for people with a LTC/s using digital tools?</li></ol></div><div class = "text-block"><span style = "font-weight:bold;">Design</span></div><div class = "text-block">This scoping review will be undertaken in accordance with PRISMA-ScR guidelines (12) and the frameworks developed by Arksey and O’Malley (13) and Levac et al., (14). Preliminary searches will be undertaken in consultation with an academic librarian to create a comprehensive search strategy. Screening of titles and abstracts will be undertaken by two independent reviewers, with conflicts resolved by an independent verifier, using Covidence software (15). Full-text screening will subsequently be undertaken following this same approach. A charting form will be developed based on the objectives of the review and refined by the research team. Data will be collated and summarised, with quantitative sources described descriptively and qualitative data analysed thematically (16). Results will be presented using summary tables and/or using pictorial/flow charts, if appropriate.</div></div>

[STEPS]
?. Protocol and registrationThe protocol for this scoping review is publicly available from protocols.io.
?. Eligibility criteriaAll studies types will be included, from 2009 - 2019Long-term conditions include; cardiovascular disease, myocardial infarction, stroke/TIA, Asthma, COPD, chronic kidney disease, diabetes mellitus, dementia, mental health, depression, osteoporosis, rheumatoid arthritis, osteoarthritis and obesity. Studies that use the terms ‘long-term condition’, chronic or multimorbidity will also be included as long as one or more of the above conditions is included. Cancer and low back pain will be excluded due to recently published reviews in this area.Physical activity – Studies with adults who are not maintaining 150 minutes of moderate to vigorous physical activity per week will be included.Maintenance – Follow-up at least 3-months post the end of the intervention.Digital tools – Defined in accordance with the World Health Organisation classification of digital health interventions v1.0 (17).Information sourcesDatabases for searching includeCINAHL, Medline, OVID EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and trial registries - PROSPERO, ISRCTN, ICTRP (WHO), EU clinical trials register, Clinicaltrials.gov for all relevant studies between 2009 – 2019.
?. Search strategyPreliminary searches and consultation with an academic librarian will be undertaken to establish a comprehensive list of search terms and search strategy. Reference lists of eligible studies will also be searched to identify additional studies to identify additional studies that may have been missed in the original searches.
?. Selection of sources of evidenceFive percent of titles and abstracts will be assessed by two independent reviewers to confirm the eligibility criteria. Screening of titles/abstracts will be divided amongst the review team using the Covidence software (15), with each title/abstract reviewed by two independent reviewers. Conflicts will be decided by an independent verifier.Full-text screening will follow, using the same procedure.
?. Data charting processData will be charted into a Microsoft Excel form, based on the objectives of the review. The charting form will be available on an online portal allowing the team to see each other’s contribution and discuss any concerns.
?. Data itemsExtracted data will be based on the objectives of the review, including the type and contents of the digital tool, theoretical underpinning, experience of users and barriers/facilitators to use.Effectiveness data will also be extracted from the studies, which alongside theoretical underpinnings, may support a more focused future review.
?. Synthesis of resultsQuantitative data will be collated and synthesised descriptively. Thematic analysis will be used to synthesis qualitative data, using the staged approach by Braun and Clarke (16). Collation and synthesis of findings will be undertaken by members of the research team based on experience with quantitative and qualitative analysis.
?. [References]
(1)Public Health England (2016) Health Matters: getting every adult active every day. London: The Stationary Office Available from:https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day[Accessed 18th November 2019](2)Marley J, Tully MA, Porter-Armstrong A, Bunting B, O’Hanlon J, Atkins L, Howes S and McDonough SM (2017) The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis.BMC Musculoskeletal Disorders18(1): 482(3)O’Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM and McDonough SM (2015) Walking Exercise for Chronic Musculoskeletal Pain: Systematic Review and Meta-AnalysisArchives of Physical Medicine and Rehabilitation96(4): 724-734(4)Holm I, Tveter A.T., Moseng T, Dagfinrud H (2015) Does outpatient physical therapy with the aim of improving health-related physical fitness influence the level of physical activity in patients with long-term musculoskeletal conditions? Physiotherapy 101 (3): 273-278(5)SaundersDH, SandersonM, HayesS, JohnsonL, KramerS, CarterDD, JarvisH, BrazzelliM, MeadGE (2020) Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub7.(6)Moseng T, Tveter AT, Holm I and Dagfinrud H (2014) Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study Physiotherapy, 100, pp. 319-324(7)Berry A, McCabe CS, Muir S and Walsh N (2018) Digital behaviour change interventions to facilitate physical activity in osteoarthritis: a systematic reviewPhysical Therapy Reviews23(3): 197-206(8)Connelly J, Kirk A, Masthoff J and MacRury S (2013) The use of technology to promote physical activity in Type 2 diabetes management: a systematic reviewDiabetic Medicine30(12):(9)Grimmett, C, Corbett, T, Brunet, J, Shepherd, J, Pinto, B.M., May, CR. and Foster, C (2019) Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors. International Journal of Behavioral Nutrition and Physical Activity, 16 (1), 1-20(10)Samdal GB, Eide GE, Barth T, Williams G and Meland E (2017) Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analysesThe International Journal of Behavioral Nutrition and Physical Activity14(1): 42(11)Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, Sriram PS and Zagora J (2013) Web 2.0 chronic disease self-management for older adults: a systematic reviewJournal of Medical Internet Research15(2): e35(12)Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. (2018b) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169 (7):467-473. doi:10.7326/M18-0850.(13)Arksey H and O’Malley L (2005) Scoping studies: towards a methodological frameworkInternational Journal of Social Research Methodology8(1): 19-32(14)Levac D, Colquhoun H and O’Brien K (2010) Scoping studies: advancing the methodologyImplementation Science5: 69(15)Covidence Software, Veritas Health Innovation, Melbourne, Australia(16)Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi:10.1191/1478088706qp063oa(17)World Health Organization (2018) Classification of Digital Health Interventions v1.0 [Available from:https://apps.who.int/iris/bitstream/handle/10665/260480/WHO-RHR-18.06-eng.pdf[Accessed 12th March 2020]