Telemedicine Intervention: Remote Monitoring and Consultation for People with Chronic Obstructive Pulmonary Disease (COPD)
Janjua S, Carter D, Threapleton CJD, Prigmore S, Disler RT Telemedicine interventions: remote monitoring and consultation for people with chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013196. doi: 10.1002 /14651858.CD013196.pub2. Accessed July 29, 2021.
Description.
This study was conducted to evaluate the effectiveness of telemedicine interventions that allow remote monitoring and consultation and multicomponent interventions to reduce dyspnea symptoms, use of hospital services, death and deterioration, and improve quality of life in patients with COPD.
Twenty-nine studies were included in the main results of the study. (5654 participants, 36% to 96% male, 4% to 61% female)
In the remote monitoring interventions, participants used a remote device to transfer measurements for later review by a health care professional; only five interventions transferred data and allowed for real-time (synchronous) review by a health care professional.
The study appeared to have a high risk of bias due to lack of blinding, and the certainty of evidence ranged from moderate to very low.
・Remote monitoring and usual care (8 studies, 1033 participants)
Very uncertain evidence suggests that remote monitoring and usual care may have no effect at all on the number of people experiencing exacerbations at 26 or 52 weeks; there may be no difference at all in quality of life (SGRQ) at 26 weeks, or in the effect on hospitalization. Also, COPD-related readmissions will probably decrease at 26 weeks.
・Remote monitoring only (10 studies, 2456 participants)
Very uncertain evidence is that remote monitoring may have no effect at all on the number of people experiencing exacerbations at 41 weeks. It also has no effect on quality of life and may have no effect at all on CRQ-SAS dyspnea symptoms at 26 weeks. There may be no difference in the number of people hospitalized or the impact on death.
No evidence of adverse events found.
・Multi-component intervention with remote monitoring or consultation component (11 studies, 2165 participants)
The very uncertain evidence is that the multicomponent intervention may not affect the number of people experiencing deterioration at 52 weeks at all.
Quality of life at 13 weeks showed signs of improvement in SGRQ total score, but not at 26 or 52 weeks; COPD Assessment Test (CAT) scores may improve at an average of 38 weeks, but the evidence is very uncertain and interventions vary.
It may have no effect at all on the number of people hospitalized at 33 weeks. The multicomponent intervention is likely to result in fewer people being readmitted at an average of 39 weeks. It is likely to make no difference at all in death at an average of 40 weeks. It is possible that there will be no effect at all on people experiencing adverse events. No evidence of symptoms of dyspnea was found.
Authors' conclusions.
Usual care delivered asynchronously with remote monitoring may not be overall more beneficial than usual care alone; some benefit in reducing COPD-related readmissions is seen, but evidence of moderate certainty is based on a single study. No evidence of dyspnea symptoms or harm has been found, and there is no difference in the number of deaths when telemonitoring is provided in addition to usual care.
Remote monitoring interventions alone are not superior to overall usual care for health outcomes.
Multicomponent interventions with asynchronous remote monitoring are not better than usual care, but they may provide short-term benefits in quality of life and may result in fewer readmissions to the hospital for any reason. It is unclear whether telemonitoring is responsible for the positive impact on readmissions, and it is not possible to identify any long-term benefits of having telemonitoring as part of patient care.
Due to the lack of evidence, it is unclear which COPD severity subgroups will benefit from telemedicine interventions.
