Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials

Abstract

Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (−0.73; 95% CI: −1.84, 0.38), weight (−1.29; −3.06, 0.48), waist circumference (−2.41; −5.16, 0.34), body fat percentage (0.11; −1.56, 1.34), systolic blood pressure (−2.62; −5.31, 0.06), and diastolic blood pressure (−0.99; −2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.

The Use of Digital Health in the Detection and Management of COVID-19

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Harnessing the Potential of Emerging Digital Health and Biological Sampling Technologies for Clinical Drug Development: Promise to Reality

“…For balance, caution should be used in understanding the current state of digital biomarkers, as several studies reported in the literature are uncontrolled, underpowered studies. Recently, a meta‐analysis evaluating the impact of remote monitoring devices such as wearables for patient monitoring or improving clinical outcomes showed no impact of these devices on clinical outcomes such as BMI, blood pressure, or waist circumference . However, the authors noted that the studies were vastly heterogeneous in their design, device type, and outcomes.…”

“…Recently, a meta-analysis evaluating the impact of remote monitoring devices such as wearables for patient monitoring or improving clinical outcomes showed no impact of these devices on clinical outcomes such as BMI, blood pressure, or waist circumference. 40 However, the authors noted that the studies were vastly heterogeneous in their design, device type, and outcomes. This points overall to substantial gaps in the broader evidence base.…”

Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study (Preprint)

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