Patient experiences with digital health interventions in self-management of rheumatic and musculoskeletal diseases: a systematic review and qualitative meta-synthesis.

OBJECTIVES: Digital health interventions (DHIs) provide great potential for the implementation of self-management strategies in rheumatic and musculoskeletal diseases (RMDs). In order to promote adoption of such tools, it is important to understand patients' perspectives with those interventions. This study aimed to meta-synthesise qualitative data to explore patients' experiences with and perceptions of DHIs facilitating self-management strategies. DESIGN: A qualitative meta-synthesis and systematic review following the Enhancing Transparency of Reporting the Synthesis of Qualitative Research (ENTREQ) statement. DATA SOURCES: Medline (via Pubmed), EMBASE, CINAHL and PsycINFO were searched. ELIGIBILITY CRITERIA: Peer-reviewed qualitative or mixed-method studies reporting patients' experiences, perceptions, preferences, acceptances, satisfaction, benefits and workloads of asynchronous or hybrid digital health interventions, limited to patients over 18 years old and English articles. DATA EXTRACTION AND SYNTHESIS: A data extraction form in Excel was developed. The text in the findings or results section, the quotes and the supplementary materials underwent thematic synthesis to derive themes. Methodological quality was assessed with the Critical Appraisal Skills Programme checklist. RESULTS: A total of 5517 records were identified via an initial search on 24th July 2023 and an update search on 16th January 2026, covering literature from inception to January 2026. Of those, 168 articles underwent full-text review, resulting in 22 studies included. The results showed that patients with RMDs expressed a preference for digital interventions as a complement to conventional care, rather than a replacement. Six major themes were identified: 'dealing with engagement' (in 21 of 22 studies), 'handling personal issues' (16/22), 'means of empowerment' (18/22), 'program-related barriers' (19/22), 'promoting a sense of independence' (17/22) and 'user-oriented programmes' (18/22). The majority of primary studies (20 out of 22 studies) presented no or very minor methodological limitations with equall or over 8 out of 10 scores. CONCLUSIONS: RMD patients preferred digital health interventions as an adjunct to traditional care, not as a replacement. Subjective preferences of patients and their request for healthcare professionals (HCPs) involvement should be taken into account to improve the adoption and integration of DHI in RMD routine care. SYSTEMATIC REVIEW REGISTRATION: Pre-published protocol of this systematic review was uploaded on Zenodo with https://doi.org/10.5281/zenodo.8207717.