Abstract
Objective The role of telemonitoring interventions (TIs) for chronic obstructive pulmonary disease (COPD) has been studied in many systematic reviews (SRs) and meta-analyses (MAs), but robust conclusions have not been reached due to wide variations in scopes, qualities, and outcomes. The aim of this overview was to determine the effectiveness of TIs on COPD patients. Methods PubMed, EMBASE, Web of Science, and Cochrane Library were searched for all reviews on the topic of TI in treating COPD from inception to July 8, 2019, without restrictions on language. According to the inclusion and exclusion criteria, the retrieved literature studies were screened to select SRs and MAs of randomized control trials (RCTs) that evaluated the effects of TIs in COPD patients. The methodological quality of SRs and MAs was assessed with the AMSTAR-2 tool, and the strength of evidence was assessed with the grades of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes in terms of mortality, quality of life (SGRQ total scores), exercise capacity (6MWD), and exacerbation-related outcomes (hospitalizations, exacerbation rate, and emergency room visits). Results Our overview included eight SRs and MAs published in 2011 to 2019, from 95 RCTs involving 10632 participants. After strict evaluation by the AMSTAR-2 tool, 75% of the SRs and MAs in this overview had either low or critically low methodological quality. The effects of TIs for COPD on mortality, quality of life, exercise capacity, and exacerbation-related outcomes are limited, and all of these outcomes scored either low or very low quality of evidence on the GRADE system. Conclusions There might be insufficient evidence to support the effectiveness of TIs for COPD currently, but the results of this overview should be interpreted dialectically and prudently, and the role of TIs in COPD needs further exploration.
Highlights
chronic obstructive pulmonary disease (COPD) is a complex chronic respiratory condition, usually caused by exposure to toxic gases or particles [1]
After screening the titles and abstracts, 323 literature studies were excluded because of irrelevant topic. erefore, 37 full-text review articles were selected for further evaluation. 29 articles were excluded for the following reasons: 7 incorporate nonrandomized trial; 6 do not evaluate clinical outcomes; 4 use telemonitoring as nonmajor intervention; 3 were protocols of review; 3 were meeting abstracts; 2 were synopsis or previous version of reviews; 4 were overview, narrative, or other type of review
Main Findings. is overview of 8 systematic reviews (SRs) and MAs published in 2011 to 2019 provided the clinical evidence on the effectiveness of telemonitoring interventions (TIs) in treating COPD from 95 randomized control trials (RCTs) that included 10632 participants. 75% of the included SRs and MAs were regarded as critically low to low quality according to the AMSTAR-2 evaluation, mainly due to failure to provide a list of excluded studies and justify the exclusion as well as the failure to explain the design of the selected studies. ese may lead to selection bias and reduce the reliability of the results to some extent
Summary
COPD is a complex chronic respiratory condition, usually caused by exposure to toxic gases or particles [1]. E reviews meeting all the following criteria were included: (1) performed in COPD patients with different grades of obstruction (GOLD I to IV) in stable periods; (2) assessing TIs (telemedicine, telehealthcare, telerehabilitation, teleconsultation, telecare, telehealth, etc.) compared with a control group (usual care, ordinary health care, blank control, face-to-face support, etc.); and (3) reporting at least one of the following outcomes: mortality, hospitalizations, exacerbation rate, emergency room visits, and quality of life (SGRQ total scores). Usual care (universal health program, advice face-to-face, education and home visits, standard home healthcare) quality of life (SGRQ), emergency room visits, hospitalization, lung function (FEV1, FVC), patient satisfaction, study withdrawal, cost, cost-effectiveness
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