Gooch, Helen Jane 
, Jarvis, Kathryn and Stockley, Rachel
(2023)
Are Behaviour Change Approaches Incorporated Within Digital
Technology-Based Physical Rehabilitation Interventions Following Stroke?
A Scoping Review.
Journal of Medical Internet Research
.
Official URL: https://www.jmir.org/
Abstract
Background:
Digital health technologies (DHTs) are increasingly used in physical
stroke rehabilitation to support individuals to successfully engage with
the frequent, intensive, and lengthy activities required to optimise
recovery. Despite this, little is known about behaviour change within
these interventions.
Objective:
This scoping review aimed to
identify if, and how behaviour change approaches (i.e., theories, models
and frameworks, and techniques to influence behaviour) are incorporated
within physical stroke rehabilitation interventions that include a DHT.
Methods:
Databases (Embase, Medline, PyscINFO, CINAHL, Cochrane
Library and AMED) were searched using keywords relating to behaviour
change, DHT, physical rehabilitation and stroke. Results were
independently screened by 2 reviewers. Sources were included if they
reported a completed primary research study in which a behaviour change
approach could be identified within a physical stroke rehabilitation
intervention that included a DHT. Data including the study design, DHT
utilised, and behaviour change approaches were charted. Specific
behaviour change techniques were coded to the behaviour change technique
taxonomy version 1 (BCTTv1).
Results:
From a total of 1973
identified sources, 103 studies (5%) were included for data charting.
The most common reason for exclusion at full text screening, was the
absence of an explicit approach to behaviour change (165/245, 67%).
Almost half of the included studies (45/103, 44%) were described as
pilot or feasibility studies. Virtual reality (VR) was the most
frequently identified DHT type (58/103, 56%) and almost two-thirds of
studies focused on upper limb rehabilitation (65/103, 63%). Only a
limited number of studies (18/103, 17%) included a theory, model, or
framework for behaviour change. The most frequently used BCTTv1 clusters
were feedback and monitoring (88/103, 85%), reward and threat (56,
54%), goals and planning (33, 32%), and shaping knowledge (33, 32%).
Relationships between feedback and monitoring, and reward and threat
were identified using a relationship map with prominent use of both
these clusters in interventions which included VR.
Conclusions:
Despite an assumption that DHTs can promote engagement in
rehabilitation, this scoping review demonstrates that very few studies
of physical stroke rehabilitation which include a DHT, overtly utilised
any form of behaviour change approach. From those studies that did
consider behaviour change, most did not report robust underpinning
theory. Future development and research need to explicitly articulate
how including DHTs within an intervention may support the behaviour
change required for optimal engagement in physical rehabilitation
following stroke, as well as establish their effectiveness. This
understanding is likely to support the realisation of the transformative
potential of DHTs in stroke rehabilitation.
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