Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis
Abstract
Background Chronic obstructive pulmonary disease is a major burden on healthcare systems worldwide. Tele-monitoring has recently been used for management of chronic obstructive pulmonary disease patients.Objectives We analyzed the effect of tele-monitoring on chronic obstructive pulmonary disease patients and performed subgroup analysis by patient severity and intervention type.Design Systematic review.Data source Electronic databases including Ovid-Medline, Ovid-Embase, and the Cochrane Library.Review methods We conducted a meta-analysis of randomized controlled trials published up to April 2017. Three databases were searched, two investigators independently extracted data and assessed study quality using risk of bias.Results Out of 1,185 studies, 27articles were identified to be relevant for this study. The included studies were divided by intervention: 15studies used tele-monitoring only, 4studies used integrated tele-monitoring (pure control), and 8studies used integrated tele-monitoring (not pure control). We also divided the studies by patient severity: 16studies included severely ill patients, 8studies included moderately ill patients, and 3studies did not discuss the severity of the patients' illness. Meta-analysis showed that tele-monitoring reduced the emergency room visits (risk ratio 0.63, 95% confidence interval 0.55-0.72) and hospitalizations (risk ratio 0.88, 95% confidence interval 0.80-0.97). The subgroup analysis of patient severity showed that tele-monitoring more effectively reduced emergency room visits in patients with severe vs. moderate disease (risk ratio 0.48, 95% confidence interval 0.31-0.74; risk ratio 1.28, 95% confidence interval 0.61-2.69, retrospectively) and hospitalizations (risk ratio 0.92, 95% confidence interval 0.82-1.02; risk ratio 1.24, 95% confidence interval 0.57-2.70, retrospectively). The mental health quality of life score (mean difference 3.06, 95% confidence interval 2.15-3.98) showed more improved quality of life than the physical health quality of life score (mean difference -0.11, 95% confidence interval -0.83-0.61).Conclusions Tele-monitoring reduced rates of emergency room visits and hospitalizations and improved the mental health quality of life score. Integrated tele-monitoring including the delivery of coping skills or education by online methods including pulmonary rehabilitation is recommended to produce significant improvement. This application of integrated tele-monitoring (the delivery of education, exercise etc. in addition to tele-monitoring) is more useful for patients with (very) severe chronic obstructive pulmonary disease than those with moderate disease. Tele-monitoring might be a useful application of information and communication technologies, if the intervention includes the appropriate intervention components for eligible patients. Further studies such as large size randomized controlled trials with sub-group by patient severity and intervention type is needed to confirm these finding.
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Almost all primary studies of video versus face-to-face appointments were underpowered and had highly-selected samples.
“almost all primary studies were underpowered and had highly-selected samples”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [111]
Dozens of randomized controlled trials have compared video with face-to-face appointments in low-risk patients with stable long-term conditions.
“there have been dozens of randomized controlled trials comparing video with face to face appointments in low-risk patients with stable long-term conditions (109–114)”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [111]
Patients randomized to video did no worse clinically and were no less satisfied than those randomized to usual care, and costs where measured were similar.
“Overall, patients randomized to video did no worse clinically and were no less satisfied than those randomized to usual care, and that costs (where measured) were similar”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [111]
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- Authors
- Hong, Y., & Lee, S. H.
- Affiliations
- National Evidenc- based healthcare Collaborating Agency (KR)
- Gachon University (KR)
- Corresponding author
- Lee, Seon Heui
- ORCID
- Lee, Seon Heui
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 92
- Pages
- 1-15
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W2907957934
- Cited by
- 73
- References
- 42
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 7 · 2023: 15 · 2022: 13 · 2021: 13 · 2020: 11
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gachon University research fund of 2017 (GCU-2017-0179)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- remote patient monitoring, patient severity, emergency department visits, hospitalization, quality of life, subgroup analysis, disease severity classification
- MeSH terms
- Humans, Monitoring, Physiologic, Quality of Life, Retrospective Studies, Severity of Illness Index, Telemedicine, Pulmonary Disease, Chronic Obstructive
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