Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults

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BACKGROUND: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults' increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. OBJECTIVE: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). METHODS: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. RESULTS: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials' digital systems including SMS text message interventions and surveys (≥62% satisfied) and the use of wearable devices such as Fitbits (≥81% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. CONCLUSIONS: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics.

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