Adherence to Actigraphic Devices in Elementary School-Aged Children: Systematic Review and Meta-Analysis

Anna C Morris ^1,2, Asilay Seker ^1,2, Laurence Telesia ^1,2

⁰CAMHS Digital Lab, King's Maudsley Partnership, IOPPN, King's College London and South London and Maudsley NHS Foundation Trust, 16 De Crespigny Park, London, SE5 8AB, United Kingdom.

Journal of Medical Internet Research +

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November 3, 2025

View abstract on PubMed

Summary

Actigraphy adherence in primary school children is generally high, especially for those with health conditions. However, significant variability exists, meaning high adherence cannot be assumed in all studies.

Area Of Science

Sleep science
Pediatric research
Biomedical engineering

Background

Consistent wear is crucial for reliable actigraphy data.
Actigraphy adherence in primary school children presents unique challenges.
No prior quantitative synthesis of adherence in this age group existed.

Purpose Of The Study

To establish the first pooled estimate of actigraphy adherence in primary school-aged children.
To investigate factors influencing actigraphy adherence in this population.
To provide a comprehensive overview of adherence data for future research.

Main Methods

Systematic literature search across seven databases (Embase, MEDLINE, PsycINFO, etc.) and gray literature.
Inclusion of empirical studies with quantitative adherence data for children aged 5-11 years.
Proportional meta-analysis of adherence data and meta-regression to explore influencing factors.

Main Results

Pooled adherence across 135 studies (n=64,541) was 81.6% (95% CI 78.7%-84.4%).
Significant heterogeneity was observed (I2=98.8%), with prediction intervals ranging from 42.8% to 100%.
Children with physical, neurodevelopmental, or mental health diagnoses showed higher adherence; no effects found for age, protocol length, or incentives.

Conclusions

Actigraphy adherence is generally high in primary school children, particularly those with health conditions.
Substantial variability in adherence necessitates careful consideration for future actigraphy applications.
Standardized reporting and planning for adherence variability are recommended for future research.

Keywords:

actigraphy adherence ambulatory monitoring children fitness trackers motor activity sleep telemedicine