Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a highly prevalent condition associated with a high health care resource consumption and health care expenditures, driven mainly by exacerbations-related hospitalizations. Telemedicine has been proposed as a mean for timely detection of exacerbation, but the available evidence is inadequate to provide conclusive information on its efficacy. The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD-related hospitalizations in an elderly population with COPD.MethodsThis is a parallel arms, randomized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility. Patients were randomly assigned to receive a non-invasive system able to telemonitor vital signs (oxygen saturation, heart rate, near-body temperature, overall physical activity) or standard care, and were followed up for 9 months. The outcome measures were the number of exacerbations and exacerbation-related hospitalization.ResultsFifty patients were included in the telemonitoring group and 49 in the control group. The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group (incidence rate ratio: 0.67, 95% CI: 0.32 – 1.36). The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years, respectively (IRR: 0.66, 95% CI: 0.21 – 1.86).ConclusionsIn our study, COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD-related hospitalizations compared to patients followed up using the standard model of care. These results need to be replicated in larger studies before they can be applied to the general COPD population. Trial registration number: NCT01481506 (clinicaltrials.gov). Funding: co-financed by Lazio Region and Intersistemi Inc.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…Another small RCT (n = 100) from Italy investigated the effects of telemonitoring on respiratory outcomes in an elderly population (65 years of age and older). 129 The intervention group received a wristband with sensors for heart rate, physical activity, near-body temperature, and galvanic skin response. The wristband was also connected to a pulse oximeter.…”

Feasibility of Using a Smartwatch to Intensively Monitor Patients With Chronic Obstructive Pulmonary Disease: Prospective Cohort Study (Preprint)

“…While most previous COPD telemonitoring studies collected data daily, [11] the one study with more frequent collection used a custom wristband that was designed to perform 5 measurements of their oxygen saturation, heart rate, body temperature, and physical activity every 3 hours. [18] However, they obtained on average only 4 recordings per patient day, and data was available for only 60% of patient days, seemingly due to lack of use of their system.…”

“…While telemonitoring studies have not consistently reported their recruitment rate [19;20], our recruitment rate was lower than the rate found in the custom COPD wristband study (16% vs 57%) and our dropout rate was higher (43% vs 22%). [18] This may have been due to privacy concerns of recording audio or may have been due to the differences in recruitment settings as one of our sources of patients were from hospitalized patients who were often too sick to participate. We heard from participants that to increase enrolment, we should provide patients with feedback about their activity, their heart rate, and how to better manage their COPD as they did not just want a passive monitoring device.…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Other authors used stand-alone spirometers [31,50] with modem transmission three times a week in COPD patients under long-term oxygen therapy (LTOT). PEDONE et al [37] used commercial cellular phones coupled with sensors allowing for five measurements of each parameter over 3 h. MAIOLO et al [42] monitored nocturnal SpO 2 twice a week. Different devices can be hooked-up to the ventilator-monitoring system in order to provide a more comprehensive care.…”