Background: The population is aging on a global scale, triggering vulnerability for chronic multimorbidity, balance disorders, and falls. Falls with injuries are the main cause of accidental death in the elderly population, representing a relevant public health problem. Balance disorder is a major risk factor for falling and represents one of the most frequent reasons for health care demand. The use of information and communication technologies to support distance healthcare (eHealth) represents an opportunity to improve the access and quality of health care services for the elderly. In recent years, several studies have addressed the potential of eHealth devices to assess the balance and risk of falling of elderly people. Remote rehabilitation has also been explored. However, the clinical applicability of these digital solutions for elderly people with balance disorders remains to be studied. Objective: The aim of this review was to guide the clinical applicability of eHealth devices in providing the screening, assessment, and treatment of elderly people with balance disorders, but without neurological disease. Methods: A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Data were obtained through searching the PubMed, Google Scholar, Embase, and SciELO databases. Only randomized controlled trials (RCTs) or quasiexperimental studies (QESs) published between January 2015 and December 2019 were included. The quality of the evidence to respond to the research question was assessed using Joanna Briggs Institute (JBI) Critical Appraisal for RCTs and the JBI Critical Appraisal Checklist for QESs. RCTs were assessed using the Cochrane risk of bias tool. We provide a narrative synthesis of the main outcomes from the included studies. Results: Among 1030 unduplicated articles retrieved, 21 articles were included in this review. Twelve studies explored different technology devices to obtain data about balance and risk of falling. Nine studies focused on different types of balance exercise training. A wide range of clinical tests, functional scales, classifications of faller participants, sensor-based tasks, intervention protocols, and follow-up times were used. Only one study described the clinical conditions of the participants. Instrumental tests of the inner ear were neither used as the gold-standard test nor performed in pre and postrehabilitation assessments. Conclusions: eHealth has potential for providing additional health care to elderly people with balance disorder and risk of falling. In the included literature, the heterogeneity of populations under study, methodologies, eHealth devices, and time of follow-up did not allow for clear comparison to guide proper clinical applicability. This suggests that more rigorous studies are needed.

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中文翻译：

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用于解决老年人平衡障碍的电子健康：系统评价

背景：人口正在全球范围内老龄化，引发慢性多发病、平衡障碍和跌倒的脆弱性。跌倒受伤是老年人意外死亡的主要原因，是一个相关的公共卫生问题。平衡障碍是跌倒的主要风险因素，也是医疗保健需求最常见的原因之一。使用信息和通信技术支持远程医疗保健 (eHealth) 是改善老年人医疗保健服务的可及性和质量的机会。近年来，多项研究探讨了电子健康设备在评估老年人跌倒平衡和风险方面的潜力。还探索了远程康复。然而，这些数字解决方案对患有平衡障碍的老年人的临床适用性仍有待研究。目的：本综述的目的是指导电子健康设备的临床适用性，为患有平衡障碍但没有神经系统疾病的老年人提供筛查、评估和治疗。方法：根据 PRISMA（系统评价和元分析的首选报告项目）声明进行系统评价。数据是通过搜索 PubMed、Google Scholar、Embase 和 SciELO 数据库获得的。仅纳入了 2015 年 1 月至 2019 年 12 月期间发表的随机对照试验 (RCT) 或准实验研究 (QES)。使用 Joanna Briggs Institute (JBI) 的 RCT 关键评估和 QES 的 JBI 关键评估清单对回答研究问题的证据质量进行了评估。使用 Cochrane 偏倚风险工具评估 RCT。我们对纳入研究的主要结果进行了叙述性综合。结果：在检索到的 1030 篇非重复文章中，21 篇被纳入本综述。十二项研究探索了不同的技术设备，以获取有关平衡和跌倒风险的数据。九项研究侧重于不同类型的平衡运动训练。使用了广泛的临床测试、功能量表、摔倒参与者的分类、基于传感器的任务、干预方案和随访时间。只有一项研究描述了参与者的临床状况。内耳的仪器测试既不用作金标准测试，也不用于康复前后的评估。结论：电子健康有潜力为平衡障碍和跌倒风险的老年人提供额外的医疗保健。在纳入的文献中，研究人群、方法、电子健康设备和随访时间的异质性无法明确比较以指导适当的临床适用性。这表明需要更严格的研究。电子健康设备和随访时间不允许进行明确比较以指导适当的临床适用性。这表明需要更严格的研究。电子健康设备和随访时间不允许进行明确比较以指导适当的临床适用性。这表明需要更严格的研究。

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