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Effectiveness of digital technologies to support nursing care: results of a scoping review

Authors:

Abstract

Background The field of digital technologies being developed or applied to support nursing care is very extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available – and to appraise the reliability of these results. An additional focus is put on the question which care settings and target groups have been addressed by the research so far. Methods A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19.510 scientific publications from 9 databases. Results A total of 123 single studies and 31 reviews were subjected to the analysis. The range of technologies that is researched to support nursing care is wide. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies (including decision support systems, electronic health records, hospital and nursing home information systems), sensors and robotic technologies. The results show that there are many studies that demonstrate positive effects of the technologies, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for nearly all technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and and specific context into which the technologies are introduced. Most studies are situated in inpatient care settings. Conclusion Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient care settings, informal care arrangements and cross-sectoral care should be intensified to further exploit the potential of digital technologies to improve independence of care-recipients and unburden formal an informal carers.
1
Additional file 1 - Results of single studies
Abbreviations: i=intervention; c=control, t1=time point 1, t2=time point 2, +=positive effect, -=negative effect, o=neutral effect, +/- =ambivalent effects
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Angst, Devaraj et
al. 2012 [14]
HIS (hospital)
Cross-Sectional
(n=2.179 hospitals)
Hospital
Person in need of care
+/-
Complex outcomes: cardiology IT has positive effect on
mortality, administrative IT has negative effect on interpersonal
care, positive results if hospitals have very much or very few
cardiology IT, negative results if hospitals have very much or
very few administrative IT
4
Appari, Johnson
et al. 2014 [11]
Cross-Sectional
(n=3.002 hospitals)
Hospital
Person in need of care
+
Positive effect on patient safety indicators (moderate)
4
McKenna, Dwyer
et al. 2017 [13]
Cohort Study
(n= 1.248 hospitals)
Hospital
Person in need of care
+
Reduction in severity adjusted mortality rate (small)
3
Restuccia, Cohen
et al. 2012 [12]
Cross-Sectional
(n=401 hospitals)
Hospital
Person in need of care
Formal Caregiver
Organisation
+
Positive effects on patient mortality and patient satisfaction; not
statistically significant positive effect on adherence to the
composite Hospital Compare process of care; High HIS-level has
positive effect on care quality (perceived by carers)
4
Steurbaut,
Colpaert et al.
2012 [18]
HIS (ICU)
Case study
(n=2 institutions)
ICU
Formal Caregiver
Organisation
+
Positive effect on data extraction of medical procedures
4
Alexander,
Pasupathy et al.
2014 [15]
HIS (nursing home)
Mixed Methods
(Cross-Sectional (n=5
nursing homes),
qualitative, social
network analysis)
Inpatient long-
term care
Organisation
+/-
Less interaction (communication) intensity in institutions with
high HIS-levels
4
Alexander, Steege
et al. 2015 [16]
Case study
(n=2 nursing homes)
Inpatient long-
term care
Organisation
+
Positive effect on communication (more robust and integrated
communication strategies)
4
Munyisia, Yu et al.
2012 [17]
Case study
(n=2 institutions)
Inpatient long-
term care
Organisation
+/-
Percentage of time spent on documentation by cares decreased
at 3 months, increased at 6 months, decreased at 23 months
4
Patmon, Gee et
al. 2016 [19]
HIS (subsystem/
patient
engagement)
Qualitative (n=38)
Hospital
Person in need of care
Formal Caregiver
+
Positive effects on patient distraction and patient education
(perceived by nurses)
Positive effect on care delivery (perceived by nurses)
4
2
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Hitt and Tambe
2016 [37]
EMR in long-term
care
Cross-Sectional (n=304)
Inpatient long-
term care
Organisation
+
Neutral effect on quality of care indicators,
small increases in productivity
4
Meehan 2017 [38]
Qualitative (n=20)
Inpatient long-
term care
Organisation
+
Positive effect on quality of care (perceived by nurses),
better readability of records, improved accessibility of
information
4
Rantz, Alexander et
al. 2011 [39]
Qualitative (n=5 focus
groups with 120
participants in total)
Inpatient long-
term care
Organisation
+/-
Positive effects on communication between caregiver and
doctor, follow-up care, access to information, safety of
care delivery
Negative effects on time spent with patient (reduced) and
on documentation (increased), double documentation,
negative effect on accuracy of care information
4
Mitchell and
Yaylacicegi 2012
[22]
EMR in hospitals in
general
Cross-Sectional
(n=252 hospitals)
Hospital
Person in need of care
+
Positive effects on patient safety in medium sized
hospitals, positive effect on post-operative safety and
mortality in large hospitals
4
Bradley 2011 [23]
Qualitative (n=18)
Hospital
Person in need of care
Formal Caregiver
+
Positive effect on patient safety and patient trust
(perceived by nurses)
Positive effect on nurse-patient relationship
4
Takian, Sheikh et al.
2012 [24]
Case study (interviews
n=48, observations 26
hours, document analysis:
n=65
Hospital
Organisation
+
Positive effect on data and information sharing, faster
communication, reduced patient risk for poor treatment
(but implementation very challenging)
4
Yusof 2015 [25]
Case study (interviews
n=7, observations: n=33,
document analysis: n=34
ICU
Organisation
+
Reduced documentation and data access time, positive
effect on clinical workflow, positive effect on work
effectiveness
4
Lo, Lee et al. 2014
[151]
Decision
support/Data results
management
Quasi-Experiment
(i: n=120, c: n=120)
Hospital
Organisation
+
Reduced time spent on surveillance work
2
Seibert, Maddox et
al. 2014 [26]
Medication
Administration
Quasi-Experiment
(pre/post-design n=10
units in 1 hospital)
Hospital
Organisation
+
Increased medication administration accuracy, reduced
number of target errors
2
Appari, Carian et al.
2012 [27]
Cross-Sectional
(n=2.603 hospitals)
Hospital
Organisation
+
Positive effect on adherence to medication guidelines (no
effect of implementation of CPOE alone)
4
Chanyagorn,
Kungwannarongkun
et al. 2016 [28]
User study (n=50)
Hospital
Person in need of care
+
Errors down to almost zero
4
Ching, Williams et
al. 2014 [29]
Case study (n=1 hospital)
Hospital
Organisation
+
Reduced numbers of medication errors, safe practice
violations, unsafe administration practices
4
3
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Huang and Lee
2011 [30]
Medication
Administration
Case study (interviews:
n=6, observations: n=86
Hospital
Organisation
+
Positive effects on nursing workflow, medication safety,
encountering operational difficulties, reduced time spent
with indirect patient care and medication administration
(all perceived by nurses)
4
Clarke, Patel et al.
2017 [32]
Patient
handoff/health
information exchange
Quasi-Experiment
(i: n=271, c: n=203)
Cross sectoral
care
Formal Caregiver
Organisation
+
Positive effect on handoff compliance, reduced
communication errors, positive effect on trainee workflow
2
Oakley and Hunter
2017 [31]
Quasi-Experiment
(pre/post-design n=1
hospital)
Hospital
Formal Caregiver
Organisation
+
Reduced workload for caregivers, reduced handover-list
errors
2
Yeaman, Ko et al.
2015 [34]
Quasi-Experiment
(pre/post-design n=5
institutions)
Cross sectoral
care
Person in need of care
+
Positive effect on patient 30 days readmission rate,
reduced emergency department return visits
2
Meyer-Delpho and
Schubert 2014 [33]
Case study (n=1
institution, survey: n=26)
Cross sectoral
care
Organisation
+
Reduced number of incomplete documentations, reduced
treatment/handling time
4
Lear and Walters
2015 [35]
Patient information
administration/Nurse
reminding system
Quasi-Experiment
(pre/post-design n=32)
Hospital
Formal Caregiver
o
No statistically significant effect on documentation
compliance; nurses expressed discomfort with system
2
Paranilam 2013 [36]
Quasi-Experiment (pre:
n=95, post: n=103)
Hospital
Person in need of care
Organisation
o
No effect on pain intensity for patients
No effect on frequency of pain measurements
2
Lapane, Hughes et
al. 2011 [43]
Risk assessment
RCT (i: n=12 nursing
homes, c: n=13 nursing
homes)
Inpatient long-
term care
Person in need of care
+
Positive effect on delirium, other results not statistically
significant, but some positive trends
1b
Dykes, I-Ching et al.
2012 [44]
Case-control
(case: n=48, c: n=144)
Hospital
Person in need of care
+
Reduced number of falls
2
Lang 2012 [45]
Care Decisions
Quasi-Experiment
(pre/post-design n=331)
Hospital
Formal caregiver
+
Positive effect on guideline compliance
2
Salinas, Chung et al.
2011 [46]
Quasi-Experiment
(i: n=32, c: n=39)
ICU
Person in need of care
+
Positive effects on mortality, resuscitation volume, total
fluid volume, crystalloids post-ICU admission, urinary
output, ventilation free days, no effect on ICU free days
2
van der Heide,
Willems et al. 2012
[56]
Video-Telecare
Quasi-Experiment
(pre/post-design pre:
n=130, post: n=85)
Outpatient long-
term care
Person in need of care
+/-
Positive effect on social and emotional loneliness,
ambivalent effect on feeling of safety
2
Cady 2012 [59]
Mixed Methods:
Cognitive Ethnography &
quantitative time-motion
work-flow analysis (n=3
nurses; n=57
children/families)
Hospital/Home
Organisation
o/-
Negative effect on required time for tasks caused by
technical problems in triage office
Neutral effect in care coordination office
4
4
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Cady and
Finkelstein 2014
[53]
Video-Telecare
Mixed Methods : Cogni-
tive Ethnography & quan-
titative time-motion
work-flow analysis (n=1
nurse)
Hospital/Home
Organisation
o
No effect on workflow
Neutral effect on required time of video versus telephone
coordinated care
4
Bowles, Hanlon et
al. 2011 [50]
Video Telecare incl.
remote monitoring
RCT
(i: n=27, c: n=26)
Outpatient long-
term care
Person in need of care
+
Positive effect on hospital readmission (not statistically
significant)
secondary outcomes: positive effects on access to care
and patient satisfaction (significant)
1b
Steventon, Bardsley
et al. 2013 [54]
Remote health-
monitoring
RCT (i: n=1276,
c: n=1324)
Primary
Care/Home
Person in need of care
o
Not statistically significant positive effect on hospital
admissions (within 12 month)
No effect on mortality, social care use, contact with GPs,
admissions to residential or nursing care;
1b
Wakefield and
Vaughan-Sarrazin
2017 [55]
Cross-Sectional (n=123)
Primary
Care/Home
Person in need of care
Informal caregiver
o
No differences between home-telehealth users and non-
telehealth user identified
4
Paré, Poba-Nzaou
et al. 2013 [51]
Quasi-Experiment
(pre/post-design n=95)
Outpatient long-
term care
Person in need of care
+
Reduction in number of hospitalisations, reduced length of
hospital stays, fewer emergency room visits
2
Chiang and Wang
2016 [57]
Telecare per Instant-
Messaging
Qualitative (n=17)
Outpatient long-
term care
Formal caregiver
Organisation
+/-
Reduction in workload and stress/ disturbances in
personal life
Reduction in medical service consumption, facilitating
improvement in quality of care, positive effect on nurse-
patient relationship, problems in data protection, usability
in emergencies restricted
4
Göransson, Eriksson
et al. 2017 [52]
Telecare/ App
supported
Qualitative (n=29)
Outpatient long-
term care
Person in need of care
+
Positive effect on self-confidence, positive effect on self-
perceived “sense of security
4
Hicken, Daniel et al.
2017 [58]
Telecare/ Internet- vs.
telephone-based
support
RCT
(i1: n=77, c: n=78;
i2: N=30, c: n=44)
Primary
Care/Home
Informal caregiver
(dementia)
+/o
No differences in majority of comparative effectiveness
outcomes, but some positive effects for subgroup of
experienced internet users (positive effect on
grief/isolation)
1b
Chuang, Liu et al.
2015 [64]
Cloud based
smartphone nurse-
call system
Quasi-Experiment
(pre/post-design n=5)
Hospital
Organisation
+
Reduction of response time of nurses
2
Pemmassani, Paget
et al. 2014 [65]
Hands free
communication
Quasi-Experiment
(pre/post-design n=12)
Hospital
Formal caregiver
+
Reduced walking distance
2
Tielbur, Rice Cella
et al. 2015 [66]
Discharge huddle
with mobile
technology
Quasi-Experiment (pre-
post-design; pre: n=226,
post: n=188)
Hospital
Person in need of care
+
Reduced length of stay, reduced number of patients going
out without service, increased number of discharges to
affiliated partners (care institutions)
2
5
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
White, McIlfatrick
et al. 2015 [67]
Tele-conferencing for
remote training of
health care providers
Quasi-Experiment
(pre/post-design n=28)
Outpatient long-
term care
Formal caregiver
+
Positive effect on knowledge and skills; positive effect on
self-efficacy score (communication skills, assessment and
care planning, wellbeing, symptom management,
advanced care planning)
2
Blakey, Guy et al.
2012 [68]
Wireless call handling
and task
management system
(out of hours)
Case study (n= 1 hospital)
Hospital
Person in need of care
Formal caregiver
Organisation
+
Reduced length of stay, positive effect on cardiac arrest
calls, reduced number of untoward incidents related to
handover and medical response
Positive effect on user satisfaction (staff)
Coordination time for care-coordinator reduced
4
Melby, Brattheim et
al. 2015 [69]
Hospital-home care
collaboration by
electronic messaging
Qualitative (n=41)
Cross sectoral
care
Organisation
+
Positive effects on efficiency of communication,
information content, safer patient transitions (perceived
by nurses)
4
Wu, Rossos et al.
2011 [72]
Smartphone use in
clinical
communication
Mixed methods
(interviews (n=31),
ethnographic observa-
tions, frequency analysis
of e-mails and
smartphone calls)
Hospital
Organisation
+/-
Improvement in efficiency compared to pagers, increase of
mobility and multitasking abilities for residents; Increase
of interruptions, worsening of interprofessional
relationships (perceived by nurses), discordances between
nurses and doctors with respect to what is considered
urgent
4
Rodriguez 2016 [70]
Communication
between formal
caregiver and patient/
for suddenly
speechless patients
Quasi-Experiment
(i: n=52, c: n=63)
Hospital
Person in need of care
+
Reduced mean frustration, increased satisfaction with
communication method (perceived by patients)
2
Wieck, Blake et al.
2017 [71]
Communication
between
professionals and
relatives
/intraoperative
communication
Case study (n=50 families,
n=29 nurses, n=19
surgeons)
Hospital
Informal caregiver
Organisation
+
Positive effect on family satisfaction with intraoperative
communication
Positive effect on intraoperative communication,
increased ease in finding relatives post-op
4
Webster and
Hanson 2014 [88]
Provision of informa-
tion about residents
User study (n=44)
Inpatient long-
term care
Organisation
+
Positive effects on caregivers’ knowledge about patients
and engagement with patients
4
Yi-Sheng, Hsin-Ju et
al. 2014 [89]
Point of care
documentation
User study.
(i: n=11 measurements,
c: n=31 measurements)
Hospital
Organisation
+
Reduced time needed for measurement, positive effect on
process efficiency
4
Florczak, Scheurich
et al. 2012 [90]
Point of care wound
documentation
Case study (n=9)
Inpatient long-
term care
Organisation
+
Positive effect on wound management effectiveness scale
4
6
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Vowden and
Vowden 2013 [91]
Wound monitoring
and remote support
Case Study/Pilot RCT (i:
n=17, c: n=9)
Inpatient long-
term care
Person in need of care
+
Two case studies show improved patient outcomes, main
benefit: positive effect on ease of monitoring progress of
wounds
4
Mierlo, Meiland et
al. 2015 [86]
Dementia specific
digital social chart
RCT (i: n=41 caregiver,
n=13 case manager;
c: n=32 caregiver, n=14
case manager)
Home
Person in need of care
(dementia)
Informal caregiver
+/-
No significant differences for persons in need of care with
respect to needs assessment, QoL, Neuropsychiatric
Inventory at 6 months, more needs and unmet needs
reported for intervention group at 12 months;
Increase in sense of competence at 12 months
1b
1.6.3. Patient support for everyday life
Nijhof, van Gemert-
Pijnen et al. 2013
[87]
Personal assistant for
dementia
Qualitative (n=16)
Home
Person in need of care
(dementia)
Informal caregiver
+
Positive effects on well-being, structuring the day, doing
things independently for some patients (perceived by
others)
No effect on burden on the family, some positive effects
mentioned by single caregivers
4
Zaccarelli, Cirillo et
al. 2013 [80]
Cognitive stimulation
RCT
(i: n=174, c: n=174)
undefined
Person in need of care
(dementia)
+
Improved cognitive functions (mainly memory and
executive functions)
1b
Zhuang, Fang et al.
2013 [81]
RCT
(i: n=19, c: n=14)
Inpatient long-
term care
Person in need of care
(dementia)
o
Neutral effect on cognitive examination score, but
tendencies for improvements in intervention group (for
memory, language and visuospatial ability)
1b
Berenbaum, Lange
et al. 2011 [82]
Case study (n=80)
Inpatient long-
term / day care
Person in need of care
(dementia)
+
Positive comments on mood an QoL while using the
programme
4
Nordheim, Hamm
et al. 2015 [83]
Case study (n=14)
Inpatient long-
term care
Person in need of care
(dementia)
Organisation
+
Positive effects on cognitive abilities; small positive effects
on well-being; positive effect on neuropsychiatric
symptoms; also, some negative developments during
study period (small negative effect on Barthel-Index,
mental status, agitation)
Positive effect on communication with caregivers, easier
access to patients
4
Subramaniam and
Woods 2016 [152]
Digital life story books
Case study (n=6)
Inpatient long-
term care
Person in need of care
(dementia)
Informal Caregiver
+/-
Positive effect on QoL, negative effect on geriatric
depression score, positive effect on autobiographic
memory
Positive effect on quality of relationship between informal
caregiver and patient
4
Portela, Correia et
al. 2011 [85]
Serious Games (Wii)
Quasi-Experiment
(3-armed, i: n=20,
c1: n=23, c2: n=22
Inpatient long-
term care
Person in need of care
+/-
Positive effects on physical functioning and vitality,
negative effect on emotional performance
2
7
Authors/Year
Technology
subcategory / Specific
technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Chen, Huang et al.
2012 [84]
Serious Games (Xbox
Kinect)
Quasi-Experiment
(i: n=22, c: n=39)
Inpatient long-
term care
Person in need of care
+
Positive effects on general health, physical functioning,
role physical, body pain, social functioning
2
Pare, Sicotte et al.
2011 [78]
Software for planning
and optimizing
nursing processes
Mixed methods
(qualitative interviews:
n=57, survey: n=101,
document analysis: pre:
n=77, post: n=73, patient-
questionnaire: n=223
Outpatient long-
term care
Person in need of care
Organisation
+
Positive effect on patient education
Positive effects on completeness and quality of nursing
notes, quality of care, assessment of patient’s condition
(all perceived by caregivers), positive effect on
understanding the patient (perceived by caregivers and
patients)
4
Valerie, Choy et al.
2016 [79]
Intelligent
performance
assessment system
Case study (n=1 home
care service)
Outpatient long-
term care
Person in need of care
Organisation
+
Positive effect on patient satisfaction
Positive effects on quality of care and complaints per week
4
Olchanski, Dziadzko
et al. 2017 [92]
Electronic Medical
Record Interface for
ICU-use
Quasi-Experiment
(pre/post-design, pre:
n=983, post: n=856)
ICU
Person in need of care
+
Reduced overall and ICU mortality, reduced length of stay,
reduced costs of hospitalisation
2
Lazar, Demiris et al.
2016 [94]
Interface for people
with memory
impairment/dementia
Qualitative (n=16)
Inpatient long-
term care
Person in need of care
(dementia)
Informal Caregiver
+
Qualitatively described positive effects (i.e. enjoyment,
mental stimulation)
Facilitated interactions with informal caregiver
4
Schall, Cullen et al.
2017 [93]
Dashboard design
within an electronic
health record
User study. (n=7)
Hospital
Organisation
+
Positive effects on task completion time and task accuracy
4
Ranasinghe,
Dantanarayana et
al. 2014 [108]
Physical assistance
(robotic lifting device)
User study.
(n=60)
Inpatient long-
term care
Formal caregiver
+
Reduced force required to handle robotic device
compared to a standard hoist
4
Wang, Gorski et al.
2011 [109]
Physical assistance
(robotic wheelchair)
User study. (n=6)
Inpatient long-
term care
Person in need of care
(with cognitive
limitations)
-/+
Positive effect on mobility and independent distance
travelled, but technological reliability not sufficient for
safe usage
4
Summerfield,
Seagull et al. 2011
[107]
Physical assistance/
Transport (pharmacy
delivery robot)
Case study
(n=3 pharmacies)
Hospital/ICU
Organisation
+
Decreases in time from fax to label, time for order
preparation and idle time for medications to be delivered,
increased satisfaction of nurses with pharmacy
4
Broadbent, Orejana
et al. 2015 [104]
Social/service robot
(Cafero)
Quasi-Experiment
(i: n=85, c: n=48)
Hospital
Organisation
+
Reduced consultation length (robot measures vital signs
prior to consultation)
2
Bettinelli, Lei et al.
2015 [105]
Social/telepresence
robot
Quasi-Experiment
(20 nurses performing 68
robot rounds vs. 78
telephone rounds)
ICU
Formal Caregiver
o
Not statistically significant positive effect on Collaboration
and Satisfaction about Care Decision (CSACD) Scores of
Caregivers
2
8
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Broadbent, Kerse et
al. 2016 [106]
Socially interactive
robot (Guide robot,
Cafero)
Quasi-Experiment
(i: n=29 staff, n=27
residents; c: n=24 staff,
n=25 residents)
Inpatient long-
term care /
Hospital
Person in need of care
Formal caregiver
o
o
No significant effects on depression score, QoL, mobility,
activities of daily living, behavioural scores
No significant effects on QoL and Job morale (positive
effect on job satisfaction of control group)
2
Gustafsson,
Svanberg et al.
2015 [95]
Social/therapeutic
robot (JustoCat)
Case study
(n=4 patients); interviews
(n=14 relatives/prof.
caregiver)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on interaction, communication, relaxation
based on qualitative statements of caregivers
4
Baisch, Kolling et al.
2018 [98]
Social/therapeutic
robot (Paro, Pleo)
Qualitative
(n=73 interviews)
Inpatient long-
term care
Person in need of care
+
Positive short-term psycho-social effects based on
qualitative statements
4
Moyle, Jones et al.
2017 [103]
Social/therapeutic
robot (Paro)
RCT (i: n=138, c1: n=140,
c2: n=137)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects in Paro group on verbal and visual
engagement and agitation (based on observational data),
no effects on Cohens-Mansfield Agitation Inventory-Short
Form
1b
Petersen, Houston
et al. 2017 [101]
RCT
(i: n=35, c: n=26)
Inpatient long-
term care
Person in need of care
+
Positive effects on Rating of Anxiety in Dementia scale,
Cornell Scale for Depression in Dementia, Skin response,
pulse oximetry, pulse rate, reduced pain and psychoactive
medication
1b
Robinson,
MacDonald et al.
2013 [102]
RCT
(i: n=20, c: n=20)
Inpatient long-
term care
Person in need of care
+
Positive effect on loneliness, no effect on depression, no
effect on QoL
1b
Jøranson, Pedersen
et al. 2015 [100]
RCT
(i: n=27, c: n=26)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on Brief Agitation Rating Scale (BARS), brief
version of Cornell Scale for Symptoms of Depressions and
Dementia (CSDD) Scores
1b
Jøranson, Pedersen
et al. 2016 [99]
RCT
(i: n=27, c: n=26)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on Quality of Life in Late Dementia
(QUALID) scores and medication for subgroup with severe
dementia
1b
Bemelmans,
Gelderblom et al.
2015 [153]
Quasi-Experiment
(pre/post-design n=71)
Inpatient long-
term care
Person in need of care
(dementia)
Caregiver
+
o
Positive effect on Individually Prioritized Problems
Assessment (IPPA), mood
No significant effect on facilitation of care
2
Liang, Piroth et al.
2017 [154]
Pilot-RCT
(t1 i: n=14, c=13; t2: i:
n=13, c: n=11)
Day care/ home
Person in need of care
(dementia)
+
Positive effects on facial expressions (smiling),
communication with staff for day care group
2
Moyle, Cooke et al.
2013 [155]
Pilot-RCT
(i: n=9, c: n=9)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on QoL in Alzheimer’s Disease scale, Rating
Anxiety in Dementia Scale and some sub-dimensions of
Observed Emotion Rating Scale
2
Bennett, Grasso et
al. 2015 [156]
Case Study (n=8)
home
Person in need of care
+
Positive effect on depressive symptom scores (PHQ9)
4
9
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Birks, Bodak et al.
2016 [157]
Social/therapeutic
robot (Paro)
Qualitative (n=3)
Inpatient long-
term care
Person in need of care
Formal and informal
Caregiver
+
+
Positive effects on emotional state and challenging
behaviours (perceived by caregivers)
Facilitation of social interactions with patients
4
Šabanović, Bennett
et al. 2013 [158]
Qualitative (n=7)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on interaction with other people, attention
and activity
4
Wagemaker,
Dekkers et al. 2017
[159]
Case study (n=5)
Inpatient long-
term care
Person in need of care
(dementia)
o
No effects on alertness and mood (positive effects on
mood and alertness for 1 of 5 subjects)
4
Iacono and Marti
2016 [160]
User study.
(n=6)
Inpatient long-
term care
Person in need of care
(dementia)
+
Positive effects on narrative activity, quality of life in terms
of relaxing, socializing, smiling, participating (perceived by
caregivers after sessions)
4
Wada, Takasawa et
al. 2014 [161]
User study. (n=64)
Inpatient long-
term care
Person in need of care
+
Positive effects on 25 of the inhabitants (reduced anxiety
and irritation and depression, increase in speech); few
negative cases described (7 disliked Paro, 1 neg. reaction)
4
Valenti, Aguera-
Ortiz et al. 2015
[97]
Social/therapeutic
robot (Paro) /
humanoid socially
assistive robot (NAO)
Pilot RCT, Nursing home:
3-armed, Phase 1: i1:
n=22, i2: n=30, c: n=38;
Phase 2: i1: n=42, i2:
n=36, c: n=32,
Day Care Center:
pre/post design: n=37
Inpatient long-
term care / Day
care
Person in need of care
(dementia)
+/-
Selective outcomes: positive effects on apathy for Paro-
and NAO-group, positive effects on QoL-in-late stage-
dementia-Score, negative effects on irritability for both
groups, negative effects on delusions for NAO-group.
Decrease in quality of life for Paro-group compared to
conventional therapy,
In Day care: positive effects on irritability and neuro-psy-
chiatric symptoms of Nao-group compared to Paro-group
2
Shukla, Barreda-
Ángeles et al. 2017
[96]
Social/therapeutic
robot: humanoid
socially assistive
robot (NAO)
Case study (n=5)
undefined
Formal caregiver
+
Positive effect on subjective workload, no effect on time
spent on patient attention
4
van der Lende, Cox
et al. 2016 [118]
Behaviour Analysis /
Emergency detection
Quasi-Experiment
(pre/post-design n=41)
Inpatient long-
term care
Organisation
+
Positive effect on detecting seizures (but not considered
cost-effective)
2
Hardin, Dienemann
et al. 2013 [117]
Behaviour Analysis /
fall prevention
RCT
(i: n=5, c: n=5 medical
surgical units)
Hospital
Person in need of care
o
No significant difference in fall rate per 1.000 patient days
(primary outcome), but positive effect in fall rate per 1.000
admissions
1b
Sahota, Drummond
et al. 2014 [114]
RCT
(i: n=918, c: n=921)
Hospital
Person in need of care
o
No significant effect on fall incidence; no difference for
time to first bedside fall, positive trend to early bedside
falls risk (not significant)
1b
Shee, Phillips et al.
2014 [115]
Quasi-Experiment
(pre/post-design t1:
n=34, t2: n=34, t3: n=19)
Hospital
Person in need of care
(dementia)
+
Positive effect on fall rates (but maybe caused by other
reasons due to study limitations)
2
Tchalla, Lachal et al.
2013 [116]
Quasi-Experiment
(i: n=49, c: n=47)
Home
Person in need of care
(dementia)
+
Reduced number of falls in intervention group
2
10
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Pickham, Berte et
al. 2018 [112]
Behaviour Analysis /
pressure ulcer
prevention
RCT
(i: n=659, c: n=653)
ICU
Person in need of care
Formal caregiver
+
Reduced number of hospital-acquired pressure injuries,
secondary outcome: increase in total time with turning
compliance according to guidelines
1b
Marra, Sampaio
Camargo et al. 2014
[113]
Behaviour Analysis of
Carers/Hand hygiene
Quasi-Experiment
(i: n=1 unit, c: n=1 unit)
Hospital
Formal caregiver
+
Increase in dispensing episodes per patient day, increased
handrub consumption
2
Jousselme, Vialet et
al. 2011 [126]
External risk
detection /noise
sensor
Quasi-Experiment
(pre/post-design n=1 care
unit)
ICU
Formal caregiver
+
Reduction in noise level when device was present (no
difference if device turned on or off)
2
Lexis 2013 [119]
General Behaviour
Analysis/ Decision
support
Quasi-Experiment
(pre/post-design n=19
clients, n=16 informal
caregivers)
Outpatient long-
term care
Informal caregiver
Person in need of care
+
Informal caregiver: decrease of time spent on patient,
decreased subjective burden
Care recipient: no statistically significant changes
2
Rantz, Phillips et al.
2017 [120]
RCT
(i: n=86, c: n=85)
Inpatient long-
term care
Formal caregiver
+
Positive effect on walking speed, step distance and risk of
falling, no differences in health care costs
1b
Lazarou, Karakostas
et al. 2016 [121]
User study. (n=4)
Home
Person in need of care
(dementia)
+
Positive improvements in several test scales (20 different
scales were used), positive improvement in sleep patterns,
reduced anxiety
4
Pot, Willemse et al.
2012 [127]
Tracking /GPS-Device
Quasi-Experiment
(pre/post-design n=28)
Home
Informal caregiver
(dementia)
+
Positive effect on worrying (small), positive effect on
letting the patients go outside alone, no effect on Self-
Perceived Pressure from Informal Care scale
2
Osaimi, Kadi et al.
2017 [128]
Tracking/RFID-
Identification
Case study (n=190)
Hospital
Organisation
+/-
Positive effect on identifying infants, ambivalent effect on
workflow (both perceived by caregivers)
4a
Brown, Terrence et
al. 2014 [122]
Vital sign monitoring
(patient)
Quasi-Experiment
(i: n=2314, c: n=5329)
Hospital
Person in need of care
Organisation
+
o
Positive effect on average length of stay in ICU, positive
effect on total ICU days for transfers per 1.000 patients in
the medical-surgical unit,
No effect on number of transfers from surgical unit to ICU
2
Zhou, Liu et al. 2012
[123]
Case Studie (n=14)
Home
Informal caregiver
+
Time savings due to reduced number of hospital visits
4
Kuroda, Noma et al.
2013 [124]
User study. (n=24)
Hospital
Organisation
+/-
Reduction of time for input of vital sign measurements in
hospital information system, higher efficiency (perceived
by nurses), but technical error rate is too high for clinical
use
4
Pigini, Bovi et al.
2017 [125]
User study. (n1=15,
n2=17, n3=3)
Home
Person in need of care
+
Positive effects on health status monitoring (remembering
measurements), safety at home (self-perceived), reduced
stress compared to day hospital visit (self-perceived)
4
11
Authors/Year
Technology
subcategory /
Specific technology
Study type & size
Target Setting
Target group for effect
+,-,
o,
+/-
Effect
Level of
Evi-
dence
Miller, Rodger et al.
2011 [136]
Care support (multi-
modal distraction)
RCT
(i: n=20, c: n=20)
Hospital
Child in need of care
Organisation
+
+
Less pain reported by children, pain reduction reported by
parents, reduced stress levels reported by nurses, reduced
pulse rates, reduced healing time
Reduced treatment time
1b
Orto, Hendrix et al.
2015 [135]
Care support with
treatment focus
(smart pumps)
Quasi-Experiment
(pre/post-design
n=approx. 600 nurses)
Hospital
Person in need of care
+
Positive effect on adverse drug events
2
Vadiei, Shuman et
al. 2017 [134]
Cross-Sectional
(n=5 hospitals)
Hospital
Formal Caregiver
+
Positive effects on effective alerts, dosing errors and
proportional doses
4
Zimmermann,
Zeilfelder et al.
2017 [137]
Care support for Acti-
vities of Daily Living
(Drink monitoring)
User study. (n=15)
Inpatient long-
term care
Person in need of care
+
Increased drinking amount and frequency
4
Marek, Stetzer et
al. 2013 [131]
Reminder System
(medication
dispenser)
RCT (3-armed, i1: n=98,
i2: n=102, c: n=101)
Outpatient long-
term care
Person in need of care
o
No additional benefit by medication dispenser
1b
Akiyama and Sasaki
2013 [132]
Case study (n=17 people
in 10 homes)
Outpatient long-
term care
Person in need of care
Formal Caregiver
+/-
40% of care recipient says “frequency of forgetting
medicine is reduced”
increased workload in medication support
4
Suzuki, Yokoishi et
al. 2011 [133]
User study. (n=3)
Home
Person in need of care
+
Positive effect on missed medication rate
4
Hattink, Meiland et
al. 2016 [140]
AAL at home
Quasi-Experiment
(i: n=11, c: n=13)
Home
Person in need of care
(dementia)
Informal Caregiver
O
No significant differences (perceived autonomy, care
needs, QoL, performance of daily activities), no effect on
sense of competence for informal caregivers
2
Nijhof, van Gemert-
Pijnen et al. 2013
[141]
Qualitative (n=14)
Home
Person in need of care
(dementia)
Informal caregiver
+
+
Positive effect on sense of safety and security for care
(perceived by caregiver)
Positive effect on anxieties and concerns (self-perceived),
increased time for restorative activities
4
Trukeschitz B. 2018
[139]
AAL at home incl.
formal care
Quasi-Experiment
(i: n=59, c: n=59)
Outpatient long-
term care
Person in need of care
+
Positive effect on personal safety (small), no effect on QoL,
no effect on independency
2
Kipping, Rodger et
al. 2012 [142]
Virtual Reality for
distraction/pain
reduction
RCT
(i: n=20, c=21)
Hospital
Person in need of care
+
Positive effect on pain scale during dressing removal, less
medication needed, no differences in treatment times
1b
Mazzacano,
McSherry et al.
2016 [143]
Quasi-Experiment
(pre/post-design n=18)
Hospital
Person in need of care
+
Lower number of “breakthrough pain events during
dressing changes, less medication needed, no differences
in pain and anxiety
2
Patterson, Soltani
et al. 2012 [144]
RCT (3-armed, i1: n=23,
i2: n=15, c: n=17
Hospital
Person in need of care
o
No statistically differences in pain reduction
1b
Abbreviations: i=intervention; c=control, t1=time point 1, t2=time point 2, +=positive effect, -=negative effect, o=neutral effect, +/- =ambivalent effects
12
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