Table 2.

Studies on virtual coaching applied to clinical or medical contexts included in the analysis as randomized controlled trials.

Paper reference	Study aim	Outcome measurement	Conclusion
Allen et al 2008 [17]	Engage and empower patients to collaborate with their primary care physician in managing their health conditions	Access to Web site; access to personal online worksheets; number of emails sent to the electronic coach	Nurses can play an important role, joining efforts to develop new territory to promote patients as partners in managing their health conditions.
Gabriele et al 2011 [18]	The effects of electronic coach support on weight loss, dietary behavior, physical activity, and engagement	Waist and hip circumstances; questionnaire for intervention engagement; Social Support Inventory; dietary behavior	Nutrition education apps are feasible and acceptable solutions to support health promotion interventions.
Martorella et al 2012 [19]	Investigate the preliminary effects of a virtual nursing intervention to improve pain relief in patients undergoing cardiac surgery	Questionnaires; pain intensity score (at the time of admission and after surgery)	Web-tailored approach can increase accessibility to health education and promote pain relief without generating more costs.
Watson et al 2012 [20]	Increase activity levels, via step count, in overweight or obese individuals	Step count	The virtual coach was beneficial in maintaining activity level.
Bickmore et al 2013 [21]	Promote both physical activity and fruit and vegetable consumption through a series of simulated conversations with users on their home computers	IPAQa; step count; National Institutes of Health - National Cancer Institute (NIH-NCI) fruit and vegetable scan; weight	Automated health intervention software designed for efficient re-use is effective at changing health behavior.
Bickmore et al 2013 [22]	Compare the efficacy of a computer-based physical activity program with that of a pedometer control condition in sedentary older adults	Daily step count	An automated exercise promotion system deployed from outpatient clinics increased walking among elderly over the short-term.
Wijsman et al 2013 [23]	Assess whether a Web-based intervention increases physical activity and improves metabolic health in inactive older adults.	Wrist activity monitor; anthropometric measures; blood samples analysis	In inactive older adults, a 3-month Web-based physical activity intervention was effective in increasing objectively measured daily physical activity and improving metabolic health.
Friederichs et al 2014 [24]	Determine whether a Web-based physical activity intervention based on motivational interviewing with an avatar results in more positive appreciation and higher effectiveness of the intervention, when compared to an intervention that is purely text-based	Web-based questionnaires; IPAQ	Avatars that do not strengthen the social relationship with the user do not enhance the intervention impact.
Vroege et al 2014 [25]	Assess how many participants successfully reached the physical activity level as targeted and the effects of the intervention on body composition and metabolic health	Wrist activity monitor; body mass index; blood samples analysis	Of the intervention group, 42.0% reached their daily physical activity end goal, which was associated with a markedly better effect on body composition and metabolic health compared to the effect in the entire intervention group.
Broekhuizen et al 2016 [26]	Assess if an internet-based intervention aimed to increase physical activity was effective in improving quality of life of inactive older adults	Wrist activity monitor; Dutch paper version of the Research and Development 36-item health survey	Internet-based physical activity program was effective in improving quality of life in 60-70-year-olds after 3 months.
Leahey et al 2016 [27]	Efficacy of a novel approach to weight loss maintenance based on modifying the cost–benefit ratio	Weight	Internet delivered cost–benefit approach to weight loss maintenance may be effective for long-term weight control.
Ritchie et al 2016 [28]	Evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality	Number of rehospitalizations, death, days in the hospital, and out of the community	Clinically meaningful reduction in 30-day rehospitalization rates in chronic obstructive pulmonary disease patients when using an interactive voice response–enhanced care transition intervention.
Gardiner et al 2017 [29]	Evaluate the feasibility of using an ECA to teach lifestyle modifications to urban women	Patient Health Questionnaire; Household Food Insecurity Access Scale; Self-Efficacy for Exercise Scale; Perceived Stress Scale	It is feasible to use an ECA to promote health behaviors on stress management and healthy eating among diverse urban women.
King et al 2017 [30]	Compare the effectiveness of 2 linguistically and culturally adapted, community-based physical activity interventions with the potential for broad reach and translation	Changes in walking and other forms of physical activity measured via self-reporting and accelerometers.	The intervention has substantial potential to reduce the health disparities gap by influencing a key health behavior in underserved populations.
Cotè et al 2018 [31]	Evaluate the acceptability, feasibility, and preliminary efficacy of virtual nurse intended to support medication adherence among kidney transplant recipients	Web-Based Nursing Intervention Acceptability Scale; number of completed sessions; medication adherence measures	The results support the feasibility and acceptability of proposed virtual nurse. It could constitute an accessible adjunct in support of existing specialized services.
Hui et al 2018 [32]	Evaluate the effectiveness of an information technology-based lifestyle intervention program on improving physical activity level and health status in a sample of middle-aged Hong Kong adults	Physical Activity measured by accelerometer; IPAQ	The information technology–based lifestyle intervention is fast, inexpensive, flexible, and convenient for adults, especially those with a busy work life.

^aIPAQ: International Physical Activity Questionnaire.