Telehealth interventions for mobility after lower limb loss: A systematic review and meta-analysis of randomized controlled trials

Background: Mobility is a crucial component for healthy aging after lower limb loss (LLL). Telehealth technologies, for example, smart devices, are novel approaches for health programs delivery regardless of geographical boundaries. Objectives: To assess the effect of telehealth interventions on mobility, quality of life, and antecedents of health behavior compared with a control condition (usual care or simpler telehealth interventions with fewer number of behavior change techniques [BCTs]) for community-dwelling adults (.50 years) with an LLL and the effect of mode of delivery and BCTs used in telehealth interventions on health outcomes. Study design: Systematic review and meta-analysis. Methods: We systematically searched MEDLINE, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PsycINFO, and SPORTDiscus on January 28, 2021, to identify relevant randomized controlled trials. Two authors independently screened records and assessed risk of bias. We conducted a narrative synthesis of evidence and, when appropriate, used the standardized mean difference (SMD) and mean difference for meta-analyses and the Grading Recommendations Assessment, Development, and Evaluation approach for practice recommendations. Results: We identified six randomized controlled trials. Telephone was the most common delivery mode (n53), and "instructions for performing behaviors" was the most common BCT (n 5 5). Very low certainty evidence showed no changes in mobility (six studies: SMD 5 0.33 [95% confidence interval [CI] 520.08, 0.75]), quality of life (two studies: mean difference520.08 [95% CI520.30, 0.15]), and antecedents of behavior (five studies: SMD 5 0.04 [95% CI520.28, 0.36]). Conclusions: Our review highlights a knowledge gap for the effect of telehealth interventions for people with LLL. Although no promising effect was shown for telehealth interventions, very low certainty evidence precludes making a definitive clinical recommendation.