Effectiveness of telemonitoring versus usual care for chronic obstructive pulmonary disease: A systematic review and meta-analysis

Abstract

Aims The purpose of this research was to investigate the effectiveness of telemonitoring for chronic obstructive pulmonary disease. Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and CINAHL up to September 2018. We selected randomised controlled trials comparing telemonitoring and control groups for chronic obstructive pulmonary disease management. Two reviewers independently examined articles based on eligibility, extracted data and evaluated the risk of bias. The Cochrane tool was applied for assessing the risk of bias. The 95% confidence interval was calculated. Results A total of 28 randomised controlled trials were included. Meta-analysis revealed that there were no variables showing a statistically significant difference between telemonitoring and control groups. Chronic obstructive pulmonary disease exacerbation rate (six studies) was not different between two groups (risk ratio 0.67, 95% confidence interval 0.31–1.42). Subgroup analysis showed that telemonitoring reduced exacerbation rates when the intervention continued for longer than six months or pulmonary function was monitored. No differences between groups were noticed for mortality (seven studies, risk ratio 0.89, 95% confidence interval 0.60–1.34). Similarly, no differences between groups were observed in the patient-reported outcomes (St George’s Respiratory Questionnaire, Chronic Respiratory Disease Questionnaire-Dyspnea score) and for health service utilization (length of hospital stay, number of hospital admissions, number of emergency room visits). Conclusions Telemonitoring for chronic obstructive pulmonary disease was unlikely to result in statistically significant improvements in health outcomes. However, our novel finding was that at least six months of intervention duration and monitoring of pulmonary function play roles in activating the effects of telemonitoring.

Telemonitoring Interventions in COPD Patients: Overview of Systematic Reviews

“…e list of excluded literature studies and reasons of exclusion are displayed in Appendix 2 in Supplementary materials. us, a total of 8 SRs and MAs [16][17][18][19][20][21][22][23] were finally included in this overview. e study selection process is shown in Figure 1.…”

“…We included six systematic review and meta-analysis [16-18, 20, 22, 23], one meta-analysis [19], and one systematic review, which were published between 2011 and 2019, with four from Asian countries [16][17][18][19] and four from European countries [20][21][22][23], and all databases reviews retrieved ranged from one to six, with PubMed, Embase, and Cochrane Library as the most widely searched databases. e number of RCTs included in each review ranged from 3 to 28, and the total participants ranged from 391 to 3645.…”

“…Reviews. According to AMSTAR-2 classification, two reviews were regarded as high quality [20,23], two as low quality [19,22], and four as critically low quality [16][17][18]21]. e result of AMSTAR-2 score showed that the key factors affecting the quality of the reviews were item 3 (only 1 review [22] explained the selection of the study designs for inclusion), and item 7 (only 2 reviews [20,23] provided a list of excluded studies and justified the exclusions).…”

“…e detail of GRADE evaluation is shown in Table 3. [16,18,21,23] reported the effects of TIs on mortality, three of them [16,18,23] combined the data into meta-analysis, and one [21] Records identi ed through database searching (n = 468)…”

“…e results of the four reviews showed that there was no statistically significant difference in the reduction of mortality between the TIs and the control group. According to the GRADE system, the quality of evidence for mortality reported in three MAs [16,18,23] was low, and the main reason for the downgrade was risk of bias.…”