Evaluating the effectiveness and implementation of digital health interventions for patients with spinal cord injury:...

To evaluate the effectiveness and implementation of digital health interventions (DHIs) for patients with spinal cord injury (SCI) compared with control groups.

We conducted a systematic review of relevant randomized controlled trials (RCTs). Five electronic databases were searched from inception to January 1, 2026. The analysis examined the effects of DHIs on patients' clinical symptoms, quality of life, psychological status, and other outcomes. Quantitative analyses were performed using Review Manager software (version 5.4), and the results were presented using forest plots. The Cochrane Risk of Bias (RoB 1.0) tool was used to assess risk of bias, and the GRADE approach was applied to evaluate the overall certainty of evidence.

A total of 26 RCTs were included. The meta-analysis showed that DHIs significantly reduced pain in patients with spinal cord injury (SMD = -0.19, 95% CI -0.38 to -0.00, P = 0.05) and improved independent living ability as measured by the Functional Independence Measure (FIM) (MD = 10.69, 95% CI 9.33-12.04, P < 0.00001). DHIs also significantly improved depressive symptoms (SMD = -0.25, 95% CI -0.51 to -0.00, P = 0.05) and anxiety symptoms (MD = -1.11, 95% CI -1.99 to -0.23, P = 0.01). In addition, DHIs significantly improved lower limb function, as reflected by improvements in the Timed Up and Go test (TUG) (MD = -0.92, 95% CI -1.60 to -0.23, P = 0.009) and the 10-Meter Walk Test (10MWT) (MD = -1.61, 95% CI -2.93 to -0.28, P = 0.02), and also enhanced balance ability (MD = 30.61, 95% CI 6.97-54.26, P = 0.010). However, no significant improvement was observed in upper limb function. DHIs also improved quality of life in the psychological domain (MD = 2.66, 95% CI -0.03-5.36, P = 0.05), social domain (MD = 1.52, 95% CI 0.75-2.30, P = 0.0001), and environmental domain (MD = 1.10, 95% CI 0.19-2.01, P = 0.02). Among the included studies, the reach of digital health technologies ranged from 14.05% to 100%, feasibility ranged from 58.33% to 100%, and adherence ranged from 51.05% to 100%. Only two studies reported mild adverse events. In this review, seven studies were assessed as having a low risk of bias, while 19 studies were rated overall as having a high risk of bias. The certainty of evidence in this review ranged from very low to moderate.

Current evidence suggests that digital health technologies, as a supplement to conventional rehabilitation, may help improve certain functional outcomes, psychological health, and quality of life in patients with spinal cord injury, while also alleviating pain to some extent. However, the certainty of these findings is limited by multiple factors. Future high-quality studies are needed to further strengthen the evidence in these areas.