Implementation of digital health in rural populations with chronic musculoskeletal conditions: a scoping review.

This scoping review aimed to comprehensively map the evidence regarding the implementation of digital health interventions in rural populations with chronic musculoskeletal conditions. Chronic musculoskeletal conditions are a significant global health concern, associated with high levels of disability and substantial impacts on health care systems. Rural populations, due to social determinants such as low education and limited health care access, bear an even greater burden of these conditions. Digital health technologies offer the potential to improve clinical outcomes for chronic musculoskeletal conditions and may help mitigate these determinants. Rural populations face unique barriers that can hinder the successful implementation of digital health technologies; therefore, it is crucial to explore the use of these technologies within the specific context of rural populations, focusing not only on clinical effectiveness but also on sustainable implementation and scalability in real-world settings. Studies from 2000 onward, in any language, reporting the use of digital health interventions in rural areas for adults with chronic musculoskeletal conditions were considered for inclusion. This review followed the Arksey and O'Malley framework and JBI guidance for scoping reviews. Searches were conducted across PubMed, Embase.com, Web of Science Core Collection, Scopus, and gray literature sources. Two reviewers independently performed the screening process and data charting. Expert Recommendations for Implementing Change (ERIC) and Proctor's framework guided the charting and synthesis of implementation strategies and implementation outcomes, respectively. Content analysis was applied to interpret the qualitative data and align the findings with these frameworks. Seventeen studies met the eligibility criteria, showcasing diverse digital programs and mapping a wide range of clinical outcomes. Concerning the implementation processes, 5 studies evaluated barriers and facilitators, but only 1 conducted the assessment before the implementation. A total of 22 discrete implementation strategies were described, and 8 studies evaluated implementation outcomes. This scoping review highlights that digital health interventions for individuals with chronic musculoskeletal conditions in rural settings are increasingly being implemented and clinically evaluated; however, theory-informed implementation is lacking. Despite increasing importance in ensuring sustainable adoption and deployment of evidence-based interventions in real-world settings, implementation science principles are still poorly represented in the field of rural digital health for chronic musculoskeletal conditions. OSF https://osf.io/cwsqj. A Portuguese-language version of the abstract of this review is available at: http://links.lww.com/SRX/A111.