Effectiveness and Implementation of Digital Health Interventions on Physiological, Psychological, and Functional Outcomes in Adults With Multimorbidity: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

内容摘要

Multimorbidity involves heterogeneous disease combinations, treatment burden, competing priorities, and complex care pathways. Digital health interventions (DHIs) may support monitoring, self-management, and care coordination, but their effects on health-related outcomes remain uncertain. This systematic review and meta-analysis evaluated the effectiveness of DHIs on physiological, psychological, and functional outcomes in adults with multimorbidity, summarized implementation outcomes, and explored intervention-multimorbidity matching patterns. PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL with Full Text, Scopus, gray literature sources, trial registries, reference lists, and forward citations were searched through April 7, 2026. English-language randomized or cluster-randomized trials enrolled adults with 2 or more chronic conditions and compared a DHI with a comparator lacking the same digital component. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses used restricted maximum likelihood estimation, Hartung-Knapp adjustment, and Nagashima-Noma-Furukawa prediction intervals. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. In total, 36 reports (37 trials) were included. A total of 7 were rated as high risk of bias and 29 as having some concerns; none was rated as low risk overall. No statistically significant pooled effects were observed for glycated hemoglobin, blood pressure, mortality, hospitalization, or readmission, depression response, health-related quality of life, or pain-related functional impact or disability. For glycated hemoglobin, 6 studies (3992 participants) yielded a mean difference of -0.12 percentage points (95% CI -0.36 to 0.11; 95% prediction interval -0.70 to 0.43). For systolic blood pressure, 6 studies including 5596 participants yielded a mean difference of -3.40 mm Hg (95% CI -8.94 to 2.14; 95% prediction interval -19.15 to 13.03). Depression severity was the only outcome whose pooled 95% CI favored the intervention (8 studies; 1861 participants; standardized mean difference -0.49, 95% CI -0.82 to -0.16), but its prediction interval spanned benefit to harm (-1.53 to 0.51). Certainty was low or very low for all 7 GRADE-assessed outcomes. Implementation findings suggested feasibility, especially with monitoring, coaching, or clinician contact, but reporting was heterogeneous. Current evidence does not support consistent, transferable benefits of DHIs across most outcomes in adults with multimorbidity. Their real-world value may depend less on technology type than on alignment among intervention mechanisms, patient complexity, outcomes, and delivery context. Future DHIs should be adaptive, burden-sensitive, and workflow-integrated, linking digital data to patient priorities, clinician responses, and care coordination.