The last 2 decades witnessed a significant development in information technology to the point that it has become widely available in almost all aspects of modern life [1]. This has been greatly influenced by the innovative development of devices, the widespread implementation of various performing networks (eg, Microsoft Teams), and more recently, the rising need for remote delivery associated with the COVID-19 pandemic [2,3]. This has strongly contributed to driving improvements in the use of technology in health care and introducing new concepts in health care delivery through the use of digital health (DH) [1,4,5].

DH plays a significant role in health care, and it can be seen in many medical specialties [6,7]. Several definitions exist for DH [5], often with different terms used interchangeably, including DH care [1,4], telehealth [1,5,8], telemedicine [6,8-10], or telecare [11]. However, DH is the umbrella term that encompasses all other terms [12-14].

DH tools can be delivered anywhere. They can be delivered in different health care settings, with both the health care professional (HCP) and patient present in these settings, or at the patient’s own residence, where the patient can use a digital tool to track, document, and monitor their health and can have an opportunity to communicate with the HCP [6]. Thus, DH provides a wider scope of care and interventions that aim to reduce associated pressures on health care systems [8].

Traumatic injuries represent a significant cause of early death and morbidity, especially among the working population [15,16]. Globally, traumatic injuries are reported to cause around 5 to 6 million deaths each year [16,17], with around 40 million people left with permanent impairments and 100 million left with transient impairments [18-21], and there is a rising need for prolonged rehabilitation care to adjust to postinjury life. Rehabilitation is described as “a process of assessment, treatment, and management with ongoing evaluation by which the individual (and their family/carers) are supported to achieve their maximum potential for physical, cognitive, social, and psychological function, participation in society and quality of living” [22]. While there has been a recognition that more lives are being saved, rehabilitation following trauma is greatly behind, with global estimates of at least one in every 3 people needing rehabilitation services at some point throughout their injury [23]. Many people who have had major trauma are left with disability, medical dependency, family disruption, and ongoing psychosocial issues [16,24]. There is additionally a financial burden associated with supporting the rehabilitation needs of patients after major trauma [25,26].

A traumatic injury is defined as any injury that requires admission to a hospital at the time of injury [15]. According to the National Institute for Health and Care Excellence (NICE), a major trauma or injury is also defined as an injury or a combination of injuries that are life-threatening or life-changing and that could result in long-term disability [27,28]. This includes musculoskeletal injuries, traumatic brain injuries (TBIs), spinal cord injuries (SCIs), multiple fractures, and traumatic amputation [29].

Traumatic injuries have negative consequences, both physically and mentally [15]. SCIs, for example, hinder the patient’s ability to access health care, affecting their mobility and transportation [30,31] and thus disrupting the patient’s quality of life [32,33]. On the other hand, TBIs affect memory, executive functions, and cognitive skills associated with planning and decision making [34,35], leading to long-lasting activity-limiting impairment [36], disability [37,38], and changed health care needs [39]. These injuries are usually associated with psychological consequences that require equal attention [29].

Mild injuries are usually treated at home with minimal time spent in the hospital when needed [29]. However, major injuries usually require more intensive or specialized care to properly manage the patient’s condition [29]. Following traumatic injuries, patients still need rehabilitation support to help them regain their optimum function and independence [15]. However, several challenges are encountered with providing continuous services in the health care setting, including a lack of available beds in rehabilitation facilities, a dwindling number of workers in these facilities, the location of rehabilitation facilities far from a person’s home and from family members (eg, people living in rural areas), and the difficulty for people with different injuries to travel to rehabilitation facilities to receive rehabilitation support [40-43]. There is therefore a need to continue delivering services using alternative and remote pathways to keep patients connected to rehabilitation and health care services [41]. DH is a cost-effective solution that is increasingly being used to support people with different traumatic injuries [44-47].

Similar results were reported for services delivered face-to-face and those delivered in a virtual remote environment [48]. Over the past decade, the advancement and wide availability of information and communication technologies have been associated with an increase and expansion of the use of remote approaches to deliver medical and rehabilitation services [35,49,50]. Several DH interventions have been designed in the past decades to support people with different types of traumatic injuries.

This review aims to (1) identify DH interventions that support the physical, functional, or psychological rehabilitation of adult patients who have experienced major high-impact physical traumatic injuries and (2) assess the impact of these interventions on health-related outcomes.

The review attempts to answer the following questions:

The study inclusion criteria are as follows: (1) research that is focused on a DH intervention to support the physical, functional, or psychological rehabilitation of patients with major physical trauma; (2) primary end user of the DH intervention is an adult patient (aged 18 years or older); (3) DH intervention with potential for direct interaction with a HCP; (4) any form of digital-based intervention or treatment delivered by any digital means (eg, website or app) over any time frame; (5) intervention delivered remotely at the patient’s own residence (no need to be in an office, clinic, or health care setting); (6) research that reports patient health-related outcomes (any reported health care outcome); (7) RCT with a comparison or control group; and (8) original research (article or journal article).

Studies that do not meet one or more of the above criteria or that meet any of the following exclusion criteria will be excluded from the review: (1) DH intervention that is not focused on the physical, functional, or psychological rehabilitation of patients; (2) research that includes patients with minor or low-impact trauma or injury; (3) research focused on healthy people or public members; (4) DH intervention that is only delivered at a hospital or health care setting; (5) study where the researcher or HCP needs to perform home visits to deliver the intervention; (6) DH intervention end user is a patient carer or caregiver, family member, HCP, or student (eg, medical or nursing student); (7) research that includes caregivers or family members with reported outcomes that cannot be distinguished from patient-reported outcomes; (8) research with no reported outcomes or that only reports outcomes that are not related to health (eg, feasibility, acceptability, satisfaction, or economic evaluation); (9) research that includes mixed patient cohorts with several underlying conditions having no specific links to reported outcomes; (10) research where the underlying cause of injury is mixed (eg, traumatic and nontraumatic SCIs); (11) research that focuses on stroke or poststroke, burns, concussion, or stress after intensive care unit discharge; (12) research that focuses on psychological health rehabilitation that is not secondary to physical traumatic injury; (13) research that predicts the occurrence of an outcome or where the digital intervention is used as a screening tool; (14) digital intervention validation research; and (15) study design that is not considered an RCT (eg, quasiexperimental design, pretest/posttest cohort study, qualitative research, observational study, cross-sectional study, and review).

No ethical approval is deemed necessary for this review, as the review will be conducted by searching available evidence that does not report any personal information about individual participants.

This review is designed to identify published RCTs that investigate the use of remotely delivered DH interventions and their impact on supporting the physical, functional, or psychological rehabilitation of adult patients with major physical high-impact traumatic injuries. Identifying this would add more information to current knowledge on the use of DH interventions in rehabilitation care and would establish the extent of the use of these interventions and their potential impact for improving patient outcomes.

Major traumatic injuries can drive problems with the patient’s mobility and access to health care services, and depending on the type of injury, other associated symptoms may include changes in breathing, swallowing, drinking, and cognitive functioning, and may cause depression and anxiety [15]. Major trauma thus puts patients at risk for chronic health conditions that can become life-threatening if not adequately managed [64]. Major trauma is a common cause of death in adults younger than 40 years. Various traumatic injuries demand different rehabilitation support [15]. Therefore, it is important to address the rehabilitation care needs of individual patients. Patients discharged home following acute inpatient care for their major traumatic injuries are usually still in need of continuous long-term rehabilitation support. Effective DH interventions that will be identified in this review are expected to benefit these patients by supporting their needs and improving their health-related outcomes and overall independence.

DH has undergone great development in terms of its application, growth, and reach. The number of DH interventions is increasing worldwide, as evidenced by the growing number of scientific publications, which has been greatly influenced by the COVID-19 pandemic [1]. There is additionally growing development of DH interventions for managing patients with traumatic injuries [65-68]. A wide range of DH tools have been described by previous studies in rehabilitation services, including the use of remote communication pathways such as emails, text messages, and video conferencing [69,70]. Positive outcomes were also reported by previous studies on the impact of telerehabilitation in improving patient outcomes [71,72]. Therefore, there are promising expectations for the use and impact of DH interventions in patients with major trauma.

This review has several strengths. To the best of the authors’ knowledge, this is the first review to investigate the use of DH interventions in supporting people with major traumatic injuries. The findings of the review are expected to address, inform, and minimize gaps in DH rehabilitation specific to this patient population. The review will adhere to the PRISMA guidelines related to conducting systematic reviews [73] and will use a rigorous strategy, including searching related databases and checking the bibliography of the included studies and relevant reviews to identify additional relevant studies. Furthermore, no language restriction will be used in the search strategy to reduce the risk of missing studies that might be relevant to this review. Moreover, to reduce the risk of selection bias, the screening of retrieved studies and the quality assessment of included studies will be conducted by 2 reviewers, and data extraction will be checked by another reviewer, with disagreements resolved via discussion or by consulting a third reviewer, where appropriate.

The review has some limitations. The review will only focus on studies that include patients with major traumatic injuries; thus, studies with a mixed cohort of patients with various degrees of injury severity will be rejected. This may lead to missing the identification of useful interventions. However, if a distinction is made regarding the impact of the DH intervention on the various injury levels in the included cohort sample, the study will be included. Another limitation is that the review does not investigate a specific DH intervention or outcome measure. This approach might identify studies with a wide range of different DH interventions and outcomes, reducing the possibility of conducting a meta-analysis of the included studies. Upon completion of this review, further strengths and limitations might be identified and summarized.

DH interventions provide an avenue to support the rehabilitation needs of patients, especially using remote pathways, when challenges exist in providing face-to-face support. The findings of this review will help identify the interventions currently available to support patients with major traumatic injuries, the types of major injuries being targeted by DH interventions, the impacts these interventions have on patient health-related outcomes, and the prioritization of resources toward rehabilitation interventions that are most effective or have the largest evidence base. Additionally, by identifying existing evidence, this review could support drawing conclusions to inform policy makers and guide HCPs to implement effective interventions in practice to better support patient outcomes.

The findings of this systematic review will be disseminated through various channels to share the results with the wider academic, professional, and research communities. The findings will be published in a peer-reviewed journal, and the work will be presented at relevant scientific conferences. Additionally, links to conference presentations or posters and published peer-reviewed work will be shared on professional social media platforms such as LinkedIn.

The findings of this review will highlight the available evidence on DH interventions to support physical, functional, or psychological rehabilitation in patients with major trauma, and the associated impact on patient health-related outcomes. The review results will provide directions on the available interventions that could be implemented in practice. The findings will also help identify existing gaps that warrant further research and investigation.