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KMID : 1040120170030020111
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Evidence and Values in Healthcare
2017 Volume.3 No. 2 p.111 ~ p.122
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Clinical Effectiveness of Telemonitoring Intervention for Chronic Obstructive Pulmonary Disease: A Systematic Review
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Sul Ah-Ram
Lyu Da-Hyun
Park Dong-Ah
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Abstract
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Objectives: The aim of this research was to investigate the clinical effectiveness of telemonitoring intervention for Chronic Obstructive Pulmonary Disease (COPD).
Methods: To conduct systematic review, we comprehensively searched 4 international databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL) and 5 domestic databases (KoreaMed, KMbase, KISS, RISS, KISTI) up to March 2016. Additional searches included a manual search of study reference lists. We did not limit publication year or language. We selected randomized controlled trials (RCT) comparing telemonitoring group and control group for COPD. The Cochrane tool was applied for assessing the risk of bias. Critical outcomes were exacerbation rate, quality of life and all-cause mortality. Important outcomes were healthcare utilization (hospitalization and emergency room visits) and Chronic Respiratory disease Questionnaire (CRQ)-Dyspnea score. We analyzed dichotomous data as risk ratio (RR), and continuous data as mean difference (MD).
Results: Twenty four RCTs of telemonitoring were included. Overall, as a result of meta-analysis, there were no variables showing statistically significant results between telemonitoring group and control group. Exacerbation rate (6 studies) was not different between two groups (RR 0.67, 95% CI 0.31~1.42). Due to the moderate degree of the heterogeneity among studies (I2=67%), subgroup analysis was performed. Intervention duration could be one of the factors describing the heterogeneity. No differences between groups were found for St George’s Respiratory Questionnaire (SGRQ) total scores (8 studies) (MD 0.53, 95% CI ?5.01~6.07) and allcause mortality (6 studies) (RR 0.80, 95% CI 0.48~1.35). Similarly, no differences in the healthcare utilization outcomes were observed: total length of study in hospitals (5 studies; MD 0.54, 95% CI -0.49~2.58), total number of admissions in hospitals (5 studies; MD -0.13, 95% CI -0.58~0.32) and total number of emergency room visits (2 studies; MD -0.16, 95% CI -0.38~0.05). Finally, CRQ-Dyspnea score (4 studies) was not different between two groups (MD 0.60, 95% CI ?2.75~3.96).
Conclusion: The use of telemonitoring for COPD was unlikely to result in statistically significant improvements in health outcomes. However, in the subgroup analysis, telemonitoring longer than 6 months reduced the exacerbation rates. To clarify the effectiveness of telemonitoring for COPD, further researches are needed with the well-defined intervention and outcome variables.
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KEYWORD
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Telehomitoring, U-health, Telehealth, Homecare, Chronic obstructive pulmonary disease, Effectiveness
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Listed journal information
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