Completion rates of smart technology ecological momentary assessment (EMA) in populations with a higher likelihood of cognitive impairment: A systematic review and meta-analysis.

Background: Ecological Momentary Assessment using smartphone technology (smart EMA) has grown substantially over the last decade. However, little is known about the factors associated with completion rates in populations who have a higher likelihood of cognitive impairment.
Methods: A systematic review of Smart EMA studies in populations at risk of cognitive impairment was carried out (PROSPERO; ref no CRD42022375829). Smartphone EMA studies in neurological, neurodevelopmental and neurogenetic conditions were included. Six databases were searched, and bias was assessed using Egger’s test. A meta-analysis was conducted on the full cohort of studies and a subgroup of studies including participants with confirmed cognitive impairment. Completion rates and moderators were analysed using meta-regression.
Results: Fifty-five cohorts were included with 18 cohorts reporting cognitive impairment. The overall completion rate was 74.4% (95% CI 71.1-77.6%). In the overall cohort, lower burden (k=52), number of assessments (k=54) and the use of cognitive or motor testing (k=48/7) led to higher completion rates. There were no significant moderators in the cognitive impairment group. Participants with cognitive impairment had significantly lower completion rates compared to those without cognitive impairment (p=.021). Limitations included significant methodological issues in reporting of completion rates, sample characteristics, and associations with completion and dropout rates.
Conclusion: Smart EMA is feasible for people with cognitive impairment. Future research should focus on the efficacy of using smart EMA within populations with cognitive impairment to develop an appropriate methodological evidence base.