{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:00:54Z","timestamp":1793361654600,"version":"4.5.0"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2018,1,15]],"date-time":"2018-01-15T00:00:00Z","timestamp":1515974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2018,1,15]],"date-time":"2018-01-15T00:00:00Z","timestamp":1515974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digital Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (\u22120.73; 95% CI: \u22121.84, 0.38), weight (\u22121.29; \u22123.06, 0.48), waist circumference (\u22122.41; \u22125.16, 0.34), body fat percentage (0.11; \u22121.56, 1.34), systolic blood pressure (\u22122.62; \u22125.31, 0.06), and diastolic blood pressure (\u22120.99; \u22122.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.<\/jats:p>","DOI":"10.1038\/s41746-017-0002-4","type":"journal-article","created":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T15:46:36Z","timestamp":1513007196000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":221,"title":["Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials"],"prefix":"10.1038","volume":"1","author":[{"given":"Benjamin","family":"Noah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle S.","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasan","family":"Mosadeghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libby","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Johl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Delshad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vartan C.","family":"Tashjian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Kwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma","family":"Jusufagic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brennan M. R.","family":"Spiegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2018,1,15]]},"reference":[{"key":"2_CR1","doi-asserted-by":"publisher","first-page":"2750","DOI":"10.1109\/TBME.2015.2422751","volume":"62","author":"J Andreu-Perez","year":"2015","unstructured":"Andreu-Perez, J., Leff, D. R., Ip, H. M. & Yang, G. Z. From wearable sensors to smart implants\u2014toward pervasive and personalized healthcare. IEEE Trans. Biomed. Eng. 62, 2750\u20132762 (2015).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"2_CR2","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.4103\/1735-1995.172991","volume":"20","author":"S Ajami","year":"2015","unstructured":"Ajami, S. & Teimouri, F. Features and application of wearable biosensors in medical care. J. Res. Med. Sci. 20, 1208\u20131215 (2015).","journal-title":"J. Res. Med. Sci."},{"key":"2_CR3","doi-asserted-by":"publisher","first-page":"283rv283","DOI":"10.1126\/scitranslmed.aaa3487","volume":"7","author":"SR Steinhubl","year":"2015","unstructured":"Steinhubl, S. R., Muse, E. D. & Topol, E. J. The emerging field of mobile health. Sci. Transl. Med. 7, 283rv283 (2015).","journal-title":"Sci. Transl. Med."},{"key":"2_CR4","doi-asserted-by":"publisher","first-page":"e0165908","DOI":"10.1371\/journal.pone.0165908","volume":"11","author":"JM Pevnick","year":"2016","unstructured":"Pevnick, J. M., Fuller, G., Duncan, R. & Spiegel, B. M. R. A large-scale initiative inviting patients to share personal fitness tracker data with their providers: initial results. PLoS ONE 11, e0165908 (2016).","journal-title":"PLoS ONE"},{"key":"2_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jegh.2011.11.005","volume":"2","author":"L Atallah","year":"2012","unstructured":"Atallah, L., Lo, B. & Yang, G. Z. Can pervasive sensing address current challenges in global healthcare? J. Epidemiol. Glob. Health 2, 1\u201313 (2012).","journal-title":"J. Epidemiol. Glob. Health"},{"key":"2_CR6","doi-asserted-by":"publisher","first-page":"17472","DOI":"10.3390\/s131217472","volume":"13","author":"H Banaee","year":"2013","unstructured":"Banaee, H., Ahmed, M. U. & Loutfi, A. Data mining for wearable sensors in health monitoring systems: a review of recent trends and challenges. Sens. 13, 17472\u201317500 (2013).","journal-title":"Sens."},{"key":"2_CR7","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1177\/1545968311425908","volume":"25","author":"BH Dobkin","year":"2011","unstructured":"Dobkin, B. H. & Dorsch, A. The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors. Neurorehabil. Neural Repair. 25, 788\u2013798 (2011).","journal-title":"Neurorehabil. Neural Repair."},{"key":"2_CR8","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.2196\/jmir.7.1.e1","volume":"7","author":"H Oh","year":"2005","unstructured":"Oh, H., Rizo, C., Enkin, M. & Jadad, A. What is eHealth (3): a systematic review of published definitions. J. Med. Internet Res. 7, e1 (2005).","journal-title":"J. Med. Internet Res."},{"key":"2_CR9","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1089\/tmj.2006.0073","volume":"13","author":"S Sood","year":"2007","unstructured":"Sood, S. et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemed. J. E. Health 13, 573\u2013590 (2007).","journal-title":"Telemed. J. E. Health"},{"key":"2_CR10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1089\/tmj.2016.0051","volume":"23","author":"A Vegesna","year":"2017","unstructured":"Vegesna, A., Tran, M., Angelaccio, M. & Arcona, S. Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemed. J. E. Health 23, 3\u201317 (2017).","journal-title":"Telemed. J. E. Health"},{"key":"2_CR11","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1016\/j.ijmedinf.2012.06.003","volume":"81","author":"JP Chau","year":"2012","unstructured":"Chau, J. P. et al. A feasibility study to investigate the acceptability and potential effectiveness of a telecare service for older people with chronic obstructive pulmonary disease. Int. J. Med. Inform. 81, 674\u2013682 (2012).","journal-title":"Int. J. Med. Inform."},{"key":"2_CR12","doi-asserted-by":"publisher","first-page":"e1554","DOI":"10.7717\/peerj.1554","volume":"4","author":"CS Bloss","year":"2016","unstructured":"Bloss, C. S. et al. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors. PeerJ. 4, e1554 (2016).","journal-title":"PeerJ"},{"key":"2_CR13","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1258\/1357633054461930","volume":"11","author":"S Scalvini","year":"2005","unstructured":"Scalvini, S. et al. Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations. J. Telemed. Telecare. 11, 14\u201316 (2005).","journal-title":"J. Telemed. Telecare."},{"key":"2_CR14","doi-asserted-by":"publisher","first-page":"e1756","DOI":"10.1136\/bmj.e1756","volume":"344","author":"D Ryan","year":"2012","unstructured":"Ryan, D. et al. Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ 344, e1756 (2012).","journal-title":"BMJ"},{"key":"2_CR15","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1161\/HYPERTENSIONAHA.111.188409","volume":"60","author":"AG Logan","year":"2012","unstructured":"Logan, A. G. et al. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 60, 51\u201357 (2012).","journal-title":"Hypertension"},{"key":"2_CR16","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1001\/jamainternmed.2015.7712","volume":"176","author":"MK Ong","year":"2016","unstructured":"Ong, M. K. et al. Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial. JAMA Intern. Med. 176, 310\u2013318 (2016).","journal-title":"JAMA Intern. Med."},{"key":"2_CR17","doi-asserted-by":"publisher","first-page":"e233","DOI":"10.2196\/jmir.2843","volume":"15","author":"CA Wijsman","year":"2013","unstructured":"Wijsman, C. A. et al. Effects of a web-based intervention on physical activity and metabolism in older adults: randomized controlled trial. J. Med. Internet Res. 15, e233 (2013).","journal-title":"J. Med. Internet Res."},{"key":"2_CR18","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1111\/jgs.13432","volume":"63","author":"C Pedone","year":"2015","unstructured":"Pedone, C., Rossi, F. F., Cecere, A., Costanzo, L. & Antonelli Incalzi, R. Efficacy of a physician-led multiparametric telemonitoring system in very old adults with heart failure. J. Am. Geriatr. Soc. 63, 1175\u20131180 (2015).","journal-title":"J. Am. Geriatr. Soc."},{"key":"2_CR19","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-8-41","volume":"8","author":"SL Shuger","year":"2011","unstructured":"Shuger, S. L. et al. Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial. Int. J. Behav. Nutr. Phys. Act. 8, 41 (2011).","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"2_CR20","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.parkreldis.2015.11.004","volume":"22","author":"P Ginis","year":"2016","unstructured":"Ginis, P. et al. Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson\u2019s disease: a pilot randomized controlled trial. Park. Relat. Disord. 22, 28\u201334 (2016).","journal-title":"Park. Relat. Disord."},{"key":"2_CR21","doi-asserted-by":"publisher","first-page":"564","DOI":"10.3346\/jkms.2013.28.4.564","volume":"28","author":"YH Lee","year":"2013","unstructured":"Lee, Y. H. et al. Impact of home-based exercise training with wireless monitoring on patients with acute coronary syndrome undergoing percutaneous coronary intervention. J. Korean Med. Sci. 28, 564\u2013568 (2013).","journal-title":"J. Korean Med. Sci."},{"key":"2_CR22","first-page":"565","volume":"51","author":"BY Tan","year":"2010","unstructured":"Tan, B. Y., Ho, K. L., Ching, C. K. & Teo, W. S. Novel electrogram device with web-based service centre for ambulatory ECG monitoring. Singap. Med. J. 51, 565\u2013569 (2010).","journal-title":"Singap. Med. J."},{"key":"2_CR23","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1038\/hr.2015.32","volume":"38","author":"YN Kim","year":"2015","unstructured":"Kim, Y. N., Shin, D. G., Park, S. & Lee, C. H. Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure. Hypertens. Res. 38, 491\u2013497 (2015).","journal-title":"Hypertens. Res."},{"key":"2_CR24","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1177\/1545968314550369","volume":"29","author":"AK Dorsch","year":"2015","unstructured":"Dorsch, A. K., Thomas, S., Xu, X., Kaiser, W. & Dobkin, B. H. SIRRACT: an international randomized clinical trial of activity feedback during inpatient stroke rehabilitation enabled by wireless sensing. Neurorehabil. Neural Repair. 29, 407\u2013415 (2015).","journal-title":"Neurorehabil. Neural Repair."},{"key":"2_CR25","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1089\/tmj.2012.0244","volume":"19","author":"K De San Miguel","year":"2013","unstructured":"De San Miguel, K., Smith, J. & Lewin, G. Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease. Telemed. J. E. Health 19, 652\u2013657 (2013).","journal-title":"Telemed. J. E. Health"},{"key":"2_CR26","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.hrtlng.2007.04.004","volume":"37","author":"AK Woodend","year":"2008","unstructured":"Woodend, A. K. et al. Telehome monitoring in patients with cardiac disease who are at high risk of readmission. Heart Lung. 37, 36\u201345 (2008).","journal-title":"Heart Lung."},{"key":"2_CR27","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.3899\/jrheum.130912","volume":"41","author":"M Piga","year":"2014","unstructured":"Piga, M. et al. Telemedicine applied to kinesiotherapy for hand dysfunction in patients with systemic sclerosis and rheumatoid arthritis: recovery of movement and telemonitoring technology. J. Rheumatol. 41, 1324\u20131333 (2014).","journal-title":"J. Rheumatol."},{"key":"2_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-015-0591-5","volume":"16","author":"P Kent","year":"2015","unstructured":"Kent, P., Laird, R. & Haines, T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskelet. Disord. 16, 131 (2015).","journal-title":"BMC Musculoskelet. Disord."},{"key":"2_CR29","doi-asserted-by":"publisher","first-page":"477","DOI":"10.5665\/sleep.1728","volume":"35","author":"N Fox","year":"2012","unstructured":"Fox, N. et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 35, 477\u2013481 (2012).","journal-title":"Sleep"},{"key":"2_CR30","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1177\/2150131912469546","volume":"4","author":"J Greene","year":"2013","unstructured":"Greene, J., Sacks, R., Piniewski, B., Kil, D. & Hahn, J. S. The impact of an online social network with wireless monitoring devices on physical activity and weight loss. J. Prim. Care Community Health 4, 189\u2013194 (2013).","journal-title":"J. Prim. Care Community Health"},{"key":"2_CR31","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1258\/jtt.2012.110704","volume":"18","author":"B Dinesen","year":"2012","unstructured":"Dinesen, B. et al. Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients. J. Telemed. Telecare. 18, 221\u2013225 (2012).","journal-title":"J. Telemed. Telecare."},{"key":"2_CR32","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1089\/tmj.2014.0176","volume":"21","author":"JB Wang","year":"2015","unstructured":"Wang, J. B. et al. Wearable sensor\/device (Fitbit One) and SMS text-messaging prompts to increase physical activity in overweight and obese adults: a randomized controlled trial. Telemed. J. E. Health 21, 782\u2013792 (2015).","journal-title":"Telemed. J. E. Health"},{"key":"2_CR33","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1080\/07315724.2013.875437","volume":"33","author":"C Luley","year":"2014","unstructured":"Luley, C. et al. Weight loss by telemonitoring of nutrition and physical activity in patients with metabolic syndrome for 1 year. J. Am. Coll. Nutr. 33, 363\u2013374 (2014).","journal-title":"J. Am. Coll. Nutr."},{"key":"2_CR34","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1177\/1054773808320837","volume":"17","author":"KH Dansky","year":"2008","unstructured":"Dansky, K. H., Vasey, J. & Bowles, K. Impact of telehealth on clinical outcomes in patients with heart failure. Clin. Nurs. Res. 17, 182\u2013199 (2008).","journal-title":"Clin. Nurs. Res."},{"key":"2_CR35","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-82","volume":"13","author":"C Pedone","year":"2013","unstructured":"Pedone, C., Chiurco, D., Scarlata, S. & Incalzi, R. A. Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial. BMC Health Serv. Res. 13, 82 (2013).","journal-title":"BMC Health Serv. Res."},{"key":"2_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30284-4","author":"EA Finkelstein","year":"2016","unstructured":"Finkelstein, E. A. et al. Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Lancet Diabetes Endocrinol. https:\/\/doi.org\/10.1016\/S2213-8587(16)30284-4 (2016).","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2_CR37","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1111\/j.1475-6773.2004.00269.x","volume":"39","author":"JH Hibbard","year":"2004","unstructured":"Hibbard, J. H., Stockard, J., Mahoney, E. R. & Tusler, M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv. Res. 39, 1005\u20131026 (2004).","journal-title":"Health Serv. Res."},{"key":"2_CR38","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1001\/jama.2016.12858","volume":"316","author":"JM Jakicic","year":"2016","unstructured":"Jakicic, J. M. et al. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: the IDEA randomized clinical trial. JAMA 316, 1161\u20131171 (2016).","journal-title":"JAMA"},{"key":"2_CR39","doi-asserted-by":"crossref","unstructured":"Klasnja, P., Consolvo, S. & Pratt, W. In Proc. SIGCHI Conference on Human Factors Computing Systems. 3063\u20133072 (ACM, Vancouver, BC, Canada, 2011).","DOI":"10.1145\/1978942.1979396"},{"key":"2_CR40","unstructured":"Shih, P. C., Han, K., Poole, E. S., Rosson, M. B. & Carroll, J. M. Use and adoption challenges of wearable activity trackers. In iConf. Proc. (iSchools, Newport Beach, California, 2015)."},{"key":"2_CR41","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.jclinepi.2013.08.015","volume":"67","author":"J McCambridge","year":"2014","unstructured":"McCambridge, J., Witton, J. & Elbourne, D. R. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J. Clin. Epidemiol. 67, 267\u2013277 (2014).","journal-title":"J. Clin. Epidemiol."},{"key":"2_CR42","doi-asserted-by":"publisher","first-page":"e76","DOI":"10.2196\/resprot.3957","volume":"3","author":"S Agboola","year":"2014","unstructured":"Agboola, S. et al. Pain management in cancer patients using a mobile app: study design of a randomized controlled trial. JMIR Res. Protoc. 3, e76 (2014).","journal-title":"JMIR Res. Protoc."},{"key":"2_CR43","doi-asserted-by":"publisher","first-page":"e79","DOI":"10.2196\/resprot.4041","volume":"3","author":"S Agboola","year":"2014","unstructured":"Agboola, S. et al. Improving outcomes in cancer patients on oral anti-cancer medications using a novel mobile phone-based intervention: study design of a randomized controlled trial. JMIR Res. Protoc. 3, e79 (2014).","journal-title":"JMIR Res. Protoc."},{"key":"2_CR44","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1377\/hlthaff.2013.0992","volume":"33","author":"J Kvedar","year":"2014","unstructured":"Kvedar, J., Coye, M. J. & Everett, W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Aff. 33, 194\u2013199 (2014).","journal-title":"Health Aff."},{"key":"2_CR45","doi-asserted-by":"crossref","unstructured":"Agboola, S., Palacholla, R. S., Centi, A., Kvedar, J. & Jethwani, K. A multimodal mHealth intervention (FeatForward) to improve physical activity behavior in patients with high cardiometabolic risk factors: rationale and protocol for a randomized controlled trial. JMIR Res. Protoc. 5 (2016).","DOI":"10.2196\/resprot.5489"},{"key":"2_CR46","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1177\/109019817400200405","volume":"2","author":"IM Rosenstock","year":"1974","unstructured":"Rosenstock, I. M. The health belief model and preventive health behavior. Health Educ. Monogr. 2, 354\u2013386 (1974).","journal-title":"Health Educ. Monogr."},{"key":"2_CR47","first-page":"1102","volume":"47","author":"JO Prochaska","year":"1992","unstructured":"Prochaska, J. O., DiClemente, C. C. & Norcross, J. C. In search of how people change. Appl. Addict. Behav. Am. Psychol. 47, 1102\u20131114 (1992).","journal-title":"Appl. Addict. Behav. Am. Psychol."},{"key":"2_CR48","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","volume":"50","author":"I Ajzen","year":"1991","unstructured":"Ajzen, I. The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 50, 179\u2013211 (1991).","journal-title":"Organ. Behav. Hum. Decis. Process."},{"key":"2_CR49","doi-asserted-by":"publisher","first-page":"276","DOI":"10.11613\/BM.2012.031","volume":"22","author":"ML McHugh","year":"2012","unstructured":"McHugh, M. L. Interrater reliability: the kappa statistic. Biochem. Med. 22, 276\u2013282 (2012).","journal-title":"Biochem. Med."},{"key":"2_CR50","unstructured":"Higgins, J. P. & Green, S. Cochrane Handbook for Systematic Reviews of Interventions. (The Cochrane Collaboration, 2011)."},{"key":"2_CR51","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JP Higgins","year":"2002","unstructured":"Higgins, J. P. & Thompson, S. G. Quantifying heterogeneity in a meta-analysis. Stat. Med. 21, 1539\u20131558 (2002).","journal-title":"Stat. Med."},{"key":"2_CR52","doi-asserted-by":"crossref","unstructured":"Sterne, J. A. C. et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 343 (2011).","DOI":"10.1136\/bmj.d4002"},{"key":"2_CR53","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","volume":"17","author":"AR Jadad","year":"1996","unstructured":"Jadad, A. R. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control. Clin. Trials 17, 1\u201312 (1996).","journal-title":"Control. Clin. Trials"}],"updated-by":[{"DOI":"10.1038\/s41746-018-0027-3","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2018,4,9]],"date-time":"2018-04-09T00:00:00Z","timestamp":1523232000000}}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-017-0002-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-017-0002-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-017-0002-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T13:43:41Z","timestamp":1751118221000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-017-0002-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,15]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["2"],"URL":"https:\/\/doi.org\/10.1038\/s41746-017-0002-4","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,15]]},"assertion":[{"value":"11 May 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2017","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2017","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2018","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2018","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A correction to this article has been published and is linked from the HTML version of this article.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20172"}}