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Glynn L, Mc Cann M, Mc Cabe C. Smartphone applications supporting self-management programme for adults with Chronic Obstructive Pulmonary Disease: A Scoping Review. PLOS DIGITAL HEALTH 2024; 3:e0000532. [PMID: 38870123 PMCID: PMC11175531 DOI: 10.1371/journal.pdig.0000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) significantly impacts on both the quality and quantity of life for patients due to frequent exacerbations requiring hospital admissions resulting in increased morbidity and mortality. A self-management programme purpose is to increase one's knowledge, confidence, and skills to self-manage their chronic illness such as COPD. OBJECTIVE The objective of this review will therefore answer the following research question: What is the current literature pertaining to the use of a smartphone app in supporting a comprehensive self-management programme among COPD patients? A preliminary search was conducted in, Medline, Embase and CINAHL databases to ascertain index terms and keywords. Following this a rigorous search was carried out on Medline, Embase, CINAHL, Web of Science and ASSIA. The findings from this search are presented in tabular form using the PRSIMA flow diagram. RESULTS In this review, fifteen studies met the inclusion criteria. Across all studies participants engaged with the app and developed self-management skills and knowledge to manage their chronic illness. However, engagement with the app without third party involvement declined over time. Technical issues did not cause harm to participants but in some cases contributed to reduced engagement. Smartphone self-management apps empowered a cohort of COPD participants to engage in managing their chronic illness which proved useful in detecting exacerbations earlier resulting in reducing the need for hospitalisations over a three-to-six-month period. By reducing hospitalisations incurred a cost savings for health care and an improved quality and quantity of life for these participants. CONCLUSION It is evident from the literature that smartphone self-management apps may positively influence participants self-management decisions in terms of knowledge, increase physical activity, self-efficacy that may result in reduced hospitalisation and improved quality of life. It is clear that technical issues and sustained engagement over longer periods of time remains a challenge.
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Affiliation(s)
- Lisa Glynn
- School of Nursing and Midwifery, University of Galway, Ireland
| | - Margaret Mc Cann
- School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland
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Lai CY, Lin CH, Chao TC, Lin CH, Chang CC, Huang CY, Chiang SL. Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101853. [PMID: 38824899 DOI: 10.1016/j.rehab.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Telerehabilitation has been developed and applied for years for cardiac and pulmonary diseases with good clinical outcomes. However, its application to participants with long COVID remains limited. OBJECTIVES To investigate the effectiveness of a 12-week telerehabilitation training program in participants with long COVID. The primary outcome was cardiorespiratory fitness (CRF), and secondary outcomes were physical activity (PA) amounts, exercise self-efficacy, sleep quality, and health-related quality of life (HRQOL). METHODS A parallel-group, randomized controlled trial was conducted. Eligible participants with long COVID (n = 182) were randomly assigned in a 1:1 ratio to either the experimental group (EG) or the control group (CG). The EG received 12 weeks of telerehabilitation training with weekly remote monitoring for exercise maintenance and support. The CG received PA counseling only. CRF, PA amounts, exercise self-efficacy, sleep quality, and HRQOL were assessed at baseline and 12 weeks. Generalized estimating equations were used to analyze the intervention effects by examining the interaction between time and group. RESULTS One hundred twenty-two participants (67 %) completed the study, and 182 were included in the intention-to-treat analysis. The EG had greater walking behavior (β = -763.3, p < 0.001), total amount of PA (β= -711, p = 0.003), exercise self-efficacy (β = -1.19, p < 0.001), and better sleep quality (β = 1.69, p = 0.012) after the 12-weeks of telerehabilitation training than the CG. However, there were no significant differences in any CRF parameters or HRQOL at 12 weeks between the EG and CG. CONCLUSION Telerehabilitation training offers a personalized and convenient approach that can increase exercise willingness and PA amounts and improve sleep quality. These findings underscore the potential benefits of telerehabilitation training for promoting healthier lifestyles and improving overall health outcomes. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT05205460) on January 25, 2022.
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Affiliation(s)
- Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Huei Lin
- School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chueh-Ho Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
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Sedhed J, Johansson H, Andersson N, Åkesson E, Kalbe E, Franzén E, Leavy B. Feasibility of a novel eHealth intervention for Parkinson's disease targeting motor-cognitive function in the home. BMC Neurol 2024; 24:114. [PMID: 38580913 PMCID: PMC10996106 DOI: 10.1186/s12883-024-03614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) drastically affects motor and cognitive function, but evidence shows that motor-cognitive training improves disease symptoms. Motor-cognitive training in the home is scarcely investigated and eHealth methods can provide continual support for PD self-management. Feasibility testing is however required. OBJECTIVE To assess the feasibility (i) Recruitment capability (ii) Acceptability and Suitability (iii) Demand and Safety of a home-based motor-cognitive eHealth exercise intervention in PD. METHODS The 10-week intervention was delivered using the ExorLive® application and exercises were individually adapted and systematically progressed and targeted functional strength, cardiovascular fitness, flexibility, and motor-cognitive function. People with mild-to moderate PD were assessed before and after the intervention regarding; gait performance in single and dual-task conditions; functional mobility; dual-task performance; balance performance; physical activity level; health related quality of life and perceived balance confidence and walking ability; global cognition and executive function. Feasibility outcomes were continuously measured using a home-exercise diary and contact with a physiotherapist. Changes from pre- and post-intervention are reported descriptively. RESULTS Fifteen participants (mean age 68.5 years) commenced and 14 completed the 10-week intervention. In relation to intervention Acceptability, 64% of the motor sessions and 52% of motor-cognitive sessions were rated as "enjoyable". Concerning Suitability, the average level of exertion (Borg RPE scale) was light (11-12). Adherence was high, with 86% of all (420) sessions reported as completed. No falls or other adverse events occurred in conjunction with the intervention. CONCLUSIONS This motor-cognitive eHealth home exercise intervention for PD was safe and feasible in terms of Recruitment capability, Acceptability, Safety and Demand. The intensity of physical challenge needs to be increased before testing in an efficacy trial. TRIAL REGISTRATION This trial is registered at Clinicaltrials.gov (NCT05027620).
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Affiliation(s)
- Jenny Sedhed
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden.
| | - Hanna Johansson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Andersson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
| | - Elisabet Åkesson
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erika Franzén
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Breiffni Leavy
- Stockholm Sjukhem Foundation, R&D unit, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 141 83, Sweden
- Theme Women's Health and Allied Health Professionals, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Zhang X, Jia G, Zhang L, Liu Y, Wang S, Cheng L. Effect of internet-based pulmonary rehabilitation on physical capacity and health-related life quality in patients with chronic obstructive pulmonary disease-a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1450-1458. [PMID: 37036029 DOI: 10.1080/09638288.2023.2196095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Pulmonary rehabilitation (PR) is now recognized as the most effective treatments for individuals with chronic obstructive pulmonary disease (COPD), internet-based PR arises a promising method. The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based PR programs on physical capacity and health-related quality of life in patients with COPD. MATERIALS AND METHODS Randomized controlled trials were identified through systematically searches in PubMed, EMBASE, web of science, CENTRAL, Cochrane Library, and Google Scholar databases. RESULTS Twelve studies (1433 patients) were included. For physical capacity, there was no significant difference between groups was found according to the 6-min walk test (6MWT) (MD10.42, 95% CI -2.92 to 23.77, p = 0.13, I2 = 0%). For the health-related quality of life, no significant difference between groups was found regarding the St George's Respiratory Questionnaire (SGRQ) (MD -0.64, 95% CI -3.52 to 2.23, p = 0.66), COPD assessment test (CAT)(MD -0.34, 95% CI -1.62 to 0.94, p = 0.60), modified Medical Research Council scale (mMRC)(MD 0.17, 95% CI -0.06 to 0.39, p = 0.15) and Chronic Respiratory Questionnaire (CRQ)(MD 1.32 95% CI -5.88 to 8.53, p = 0.72). CONCLUSIONS This study has established the potential for delivery of PR via the internet in demonstrating non-inferiority of physical capacity and health-related quality of life (HRQoL) compared with conventional PR.IMPLICATIONS FOR REHABILITATIONLong-term rehabilitation training for patients with chronic obstructive pulmonary disease needs a more convenient and feasible way.In this study, internet-based rehabilitation showed similar effects as conventional rehabilitation on physical activity and health-related quality of life.Internet-based rehabilitation strategies would be helpful for this population.All internet-based rehabilitation strategies should be simple and sustainable.
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Affiliation(s)
- Xin Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Gongwei Jia
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liping Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Yilin Liu
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Sanrong Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Cheng
- Department of Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Robinson SA, Moy ML, Ney JP. Value of Information Analysis of a Web-Based Self-Management Intervention for Chronic Obstructive Pulmonary Disease. Telemed J E Health 2024; 30:518-526. [PMID: 37615601 PMCID: PMC10877383 DOI: 10.1089/tmj.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023] Open
Abstract
Objective: Technology-based programs can be cost-effective in the management of chronic obstructive pulmonary disease (COPD). However, cost-effectiveness estimates always contain some uncertainty, and decisions based upon them carry some risk. We conducted a value of information (VOI) analysis to estimate the value of additional research of a web-based self-management intervention for COPD to reduce the costs associated with uncertainty. Methods: We used a 10,000-iteration cost-effectiveness model from the health care payer perspective to calculate the expected value of perfect information (EVPI) at the patient- and population-level. An opportunity loss was incurred when the web-based intervention did not produce a greater net monetary benefit than usual care in an iteration. We calculated the probability of opportunity loss and magnitude of opportunity costs as a function of baseline health utility. We aggregated opportunity costs over the projected incident population of inpatient COPD patients over 10 years and estimated it as a function of the willingness-to-pay (WTP) threshold. Costs are in 2022 U.S. Dollars. Results: Opportunity losses were found in 22.7% of the iterations. The EVPIpatient was $78 per patient (95% confidence interval: $75-$82). The probability that the intervention was the optimal strategy varied across baseline health utilities. The EVPIpopulation was $506,666,882 over 10 years for a WTP of $50,000. Conclusions: Research estimated to cost up to $500 million would be warranted to reduce uncertainty. Future research could focus on identifying the impact of baseline health utilities to maximize the cost savings of the intervention. Other considerations for future research priorities include implementation efforts for technology-based interventions.
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Affiliation(s)
- Stephanie A. Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Marilyn L. Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John P. Ney
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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Matthias K, Honekamp I, Heinrich M, De Santis KK. Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews. J Med Internet Res 2023; 25:e49639. [PMID: 38019578 PMCID: PMC10719824 DOI: 10.2196/49639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD). OBJECTIVE This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity. METHODS MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics. RESULTS Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83%) and acceptance, satisfaction, or adherence (3/30, 10%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps. CONCLUSIONS This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results. TRIAL REGISTRATION PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/40538.
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Affiliation(s)
- Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Ivonne Honekamp
- Faculty of Business, University of Applied Science Stralsund, Stralsund, Germany
| | - Monique Heinrich
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Shah AJ, Althobiani MA, Saigal A, Ogbonnaya CE, Hurst JR, Mandal S. Wearable technology interventions in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:222. [PMID: 38012218 PMCID: PMC10682416 DOI: 10.1038/s41746-023-00962-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and is associated with multiple medical and psychological comorbidities. Therefore, future strategies to improve COPD management and outcomes are needed for the betterment of patient care. Wearable technology interventions offer considerable promise in improving outcomes, but prior reviews fall short of assessing their role in the COPD population. In this systematic review and meta-analysis we searched ovid-MEDLINE, ovid-EMBASE, CINAHL, CENTRAL, and IEEE databases from inception to April 2023 to identify studies investigating wearable technology interventions in an adult COPD population with prespecified outcomes of interest including physical activity promotion, increasing exercise capacity, exacerbation detection, and quality-of-life. We identified 7396 studies, of which 37 were included in our review. Meta-analysis showed wearable technology interventions significantly increased: the mean daily step count (mean difference (MD) 850 (494-1205) steps/day) and the six-minute walk distance (MD 5.81 m (1.02-10.61 m). However, the impact was short-lived. Furthermore, wearable technology coupled with another facet (such as health coaching or pulmonary rehabilitation) had a greater impact that wearable technology alone. Wearable technology had little impact on quality-of-life measures and had mixed results for exacerbation avoidance and prediction. It is clear that wearable technology interventions may have the potential to form a core part of future COPD management plans, but further work is required to translate this into meaningful clinical benefit.
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Affiliation(s)
- Amar J Shah
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | - Malik A Althobiani
- UCL Respiratory, University College London, London, UK
- King Abdulaziz University, Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, Jeddah, Makkah, Saudi Arabia
| | - Anita Saigal
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | | | - John R Hurst
- Royal Free London NHS Foundation Trust, London, UK
- UCL Respiratory, University College London, London, UK
| | - Swapna Mandal
- Royal Free London NHS Foundation Trust, London, UK.
- UCL Respiratory, University College London, London, UK.
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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Nyberg A, Sondell A, Lundell S, Marklund S, Tistad M, Wadell K. Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis. JMIR Hum Factors 2023; 10:e43269. [PMID: 36995743 PMCID: PMC10131608 DOI: 10.2196/43269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. OBJECTIVE The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. METHODS This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. RESULTS The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. CONCLUSIONS This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.
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Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Sondell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sara Lundell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Bowman M, Jalink M, Sharpe I, Srivastava S, Wijeratne DT. Videoconferencing interventions and COPD patient outcomes: A systematic review. J Telemed Telecare 2023:1357633X231158140. [PMID: 36883234 DOI: 10.1177/1357633x231158140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Videoconferencing circumvents various physical and financial barriers associated with in-person care. Given this technology's potential benefits and timely nature, we conducted a systematic review to understand how videoconferencing for chronic obstructive pulmonary disease (COPD) follow-up care affects patient-related outcomes. METHODS We included primary research evaluating the use of bidirectional videoconferencing for COPD patient follow-up. The outcomes of interest were resource utilization, mortality, lifestyle factors, patient satisfaction, barriers, and feasibility. We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases for articles published from January 1, 2010, to August 2, 2021. Relevant information was extracted and presented descriptively and common themes and patterns were identified. The risk of bias for each study was assessed using design-specific validated tools. RESULTS We included 39 studies of 18,194 patients (22 quantitative, 12 qualitative, and 5 mixed methods). The included studies were grouped by type of intervention; 18 studies explored videoconferencing for exercise, 19 explored videoconferencing for clinical assessment/monitoring, and 2 examined videoconferencing for education. Generally, videoconferencing was associated with high levels of patient satisfaction. There were mixed results in terms of its effects on resource utilization and lifestyle-related factors. Additionally, 12 studies were at high risk of bias, indicating that these results should be interpreted with caution. CONCLUSIONS The videoconferencing interventions resulted in high levels of patient satisfaction, despite facing technological issues. Overall, more research is needed to better understand the effects of videoconferencing interventions on resource utilization and other patient outcomes, quantifying their advantages over in-person care.
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Affiliation(s)
- Meghan Bowman
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
| | - Matthew Jalink
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
- Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Isobel Sharpe
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
| | | | - Don Thiwanka Wijeratne
- Department of Public Health Sciences, 4257Queen's University, Kingston, Ontario, Canada
- Department of Medicine, 4257Queen's University, Kingston, Ontario, Canada
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11
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Ma R, Su H, Jiao K, Liu J. Role of Th17 cells, Treg cells, and Th17/Treg imbalance in immune homeostasis disorders in patients with chronic obstructive pulmonary disease. Immun Inflamm Dis 2023; 11:e784. [PMID: 36840492 PMCID: PMC9950879 DOI: 10.1002/iid3.784] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, following strokes and cardiovascular diseases. Chronic lung inflammation is believed to play a role in the development of COPD. In addition, accumulating evidence shows that the immune system plays a crucial role in the pathogenesis of COPD. Significant advancements have been made in research on the pathogenesis of immune diseases and chronic inflammation in recent years, and T helper 17 (Th17) cells and regulatory T (Treg) cells have been found to play a crucial role in the autoimmune response. Th17 cells are a proinflammatory subpopulation that causes autoimmune disease and tissue damage. Treg cells, on the other hand, have a negative effect but can contribute to the occurrence of the same disease when their antagonism fails. This review mainly summarizes the biological characteristics of Th17 cells and Treg cells, their roles in chronic inflammatory diseases of COPD, and the role of the Th17/Treg ratio in the onset, development, and outcome of inflammatory disorders, as well as recent advancements in immunomodulatory treatment targeting Th17/Treg cells in COPD.
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Affiliation(s)
- Ru Ma
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Hongling Su
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Keping Jiao
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina,Department of Gansu Provincial People's HospitalLanzhouChina
| | - Jian Liu
- Department of The First Clinical School of MedicineLanzhou UniversityLanzhouChina
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12
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Del Hoyo J, Millán M, Garrido-Marín A, Aguas M. Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers. World J Gastroenterol 2023; 29:1139-1156. [PMID: 36926667 PMCID: PMC10011957 DOI: 10.3748/wjg.v29.i7.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 02/09/2023] [Indexed: 02/21/2023] Open
Abstract
This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients’ acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.
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Affiliation(s)
- Javier Del Hoyo
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mónica Millán
- Department of Surgery, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Alejandro Garrido-Marín
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mariam Aguas
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
- Health Research Institute La Fe, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
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13
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Ramachandran HJ, Oh JL, Cheong YK, Jiang Y, Teo JYC, Seah CWA, Yu M, Wang W. Barriers and facilitators to the adoption of digital health interventions for COPD management: A scoping review. Heart Lung 2023; 59:117-127. [PMID: 36801546 DOI: 10.1016/j.hrtlng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Knowledge of the barriers and facilitators in the adoption of digital health interventions (DHI) is sparse yet crucial to facilitate chronic obstructive pulmonary disease (COPD) management. OBJECTIVES This scoping review aimed to summarize patient- and healthcare provider-level barriers and facilitators in the adoption of DHIs for COPD management. METHODS Nine electronic databases were searched from inception up till October 2022 for English language evidence. Inductive content analysis was used. RESULTS This review included 27 papers. Frequent patient-level barriers were poor digital literacy (n = 6), impersonal care delivery (n = 4), and fear of being controlled by telemonitoring data (n = 4). Frequent patient-level facilitators were improved disease understanding and management (n = 17), bi-directional communication and contact with healthcare providers (n = 15), and remote monitoring and feedback (n = 14). Frequent healthcare provider-level barriers were increased workload (n = 5), lack of technology interoperability with existing health systems (n = 4), lack of funding (n = 4), and lack of dedicated and trained manpower (n = 4). Frequent healthcare provider-level facilitators were improved efficiency of care delivery (n = 6) and DHI training programmes (n = 5). CONCLUSION DHIs have the potential to facilitate COPD self-management and improve efficiency of care delivery. However, several barriers challenge its successful adoption. Attaining organizational support in developing user centric DHIs that can be integrated and are interoperable with existing health systems is crucial if we are to witness tangible return on investments at the patient-, healthcare provider- and healthcare system-level.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore.
| | - Joo Lin Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Yue Krystal Cheong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
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Sönnerfors P, Skavberg Roaldsen K, Lundell S, Toots A, Wadell K, Halvarsson A. Preferences for an eHealth tool to support physical activity and exercise training in COPD: a qualitative study from the viewpoint of prospective users. BMC Pulm Med 2023; 23:65. [PMID: 36782155 PMCID: PMC9925217 DOI: 10.1186/s12890-023-02353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Despite well-known positive effects of pulmonary rehabilitation, access is limited. New strategies to improve access are advocated, including the use of eHealth tools. OBJECTIVES The aim of this study was to explore prospective users' preferences for an eHealth tool to support the self-management of physical activity and exercise training in COPD. METHODS A qualitative research design was applied. Data was collected in six, audio recorded, digital co-creation workshops, which were guided by a participatory and appreciative action and reflection approach. A total of 17 prospective users took part in the process, including people with COPD (n = 10), relatives (n = 2), health care givers (n = 4) and a patient organization representative (n = 1). During the workshops, pre-selected relevant topics to exploring end-users' preferences for eHealth support in self-management in COPD were discussed. The workshops were recorded and transcribed. Data was analysed using inductive qualitative content analysis. RESULTS The overarching theme "fusing with, rather than replacing existing support structures" was uncovered when the two-sided relationship between positive expectations towards digital solutions and the fear of losing access to established rehabilitation systems, emerged in the discussions. Three categories were identified, focused on wishes for an evidence-based support platform of information about COPD, a well-designed eHealth tool including functionalities to motivate in the self-management of physical activity and exercise training, and requirements of various forms of support. Co-creators believed that there were clear benefits in combining the best of digital and existing support systems. CONCLUSIONS Co-creators viewed an eHealth tool including support for physical activity and exercise training as a valuable digital complement to the now existing rehabilitation services. A future eHealth tool needs to focus on user-friendliness and prospective users's requests.
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Affiliation(s)
- Pernilla Sönnerfors
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Kirsti Skavberg Roaldsen
- grid.4714.60000 0004 1937 0626Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden ,grid.416731.60000 0004 0612 1014Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway ,grid.10919.300000000122595234Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sara Lundell
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Annika Toots
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Karin Wadell
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Alexandra Halvarsson
- grid.4714.60000 0004 1937 0626Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden ,grid.24381.3c0000 0000 9241 5705Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
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Uche-Okoye D, Ajemba MN, Amy B, Arene EC, Ugo CH, Eze NP, Anyadike IK, Onuorah UM, Chiwenite CM. Is telerehabilitation an effective maintenance strategy for patients with chronic obstructive pulmonary diseases: a systematic review. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2023; 47:13. [PMID: 36743313 PMCID: PMC9890431 DOI: 10.1186/s42269-023-00980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has proven to improve the physical and psychosocial function in patients with chronic obstructive pulmonary disease (COPD). However, the gains achieved during pulmonary rehabilitation diminish over time without an effective maintenance strategy. With several factors affecting access to pulmonary rehabilitation, calls for innovative models were made, which saw the emergence of studies exploring telerehabilitation (TR) as an alternative to traditional pulmonary rehabilitation models. Although there are current reviews exploring the effectiveness of telerehabilitation as an alternative for conventional PR, no review has considered telerehabilitation effectiveness in the long term. Hence, this review aims at examining the effectiveness of telerehabilitation following to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. MAIN BODY A systematic review of the literature using CINAHL, MEDLINE, SCOPUS, Web of science PEDRO, AMED and EMBASE databases was conducted to assess the effectiveness of telerehabilitation following PR in patients with COPD. Health-related quality of life (HRQoL) and exercise capacity was maintained within 6-12 months of a TR maintenance programme. However, there was no significant increase in HRQoL and exercise capacity between the intervention and control groups in 6-12 months. CONCLUSIONS This review suggests that a TR maintenance strategy effectively maintains benefits gained and may improve HRQoL and exercise capacity within 6-12 months for patients with COPD. Nonetheless, it is impossible to extrapolate the findings to the general population due to the paucity of included studies. Further high quality randomised controlled trials examining TR in the long-term is required in the future. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s42269-023-00980-8.
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Núñez-Cortés R, Flor-Rufino C, Martínez-Arnau FM, Arnal-Gómez A, Espinoza-Bravo C, Hernández-Guillén D, Cortés-Amador S. Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID. Diagnostics (Basel) 2022; 13:24. [PMID: 36611316 PMCID: PMC9818883 DOI: 10.3390/diagnostics13010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8240000, Chile
| | - Cristina Flor-Rufino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Affordable, portable and self-administrable electrical impedance tomography enables global and regional lung function assessment. Sci Rep 2022; 12:20613. [PMID: 36450830 PMCID: PMC9712422 DOI: 10.1038/s41598-022-24330-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Accessibility of diagnostic screening and treatment monitoring devices for respiratory diseases is critical in promoting healthcare and reducing sudden complications and mortality. Spirometry is the standard for diagnosing and monitoring several lung diseases. However, it lacks regional assessment capabilities necessary for detecting subtle regional changes in certain diseases. It also requires challenging breathing maneuvers difficult for elderlies, children, and diseased patients. Here, we actualized an affordable, portable, and self-administrable electrical impedance tomography (EIT) system for home-based lung function assessment and telemedicine. Through simultaneous EIT-spirometry trials on healthy subjects, we demonstrated that our device can predict spirometry indicators over a wide range and can provide regional mapping of these indicators. We further developed a close-to-effortless breathing paradigm and tested it by longitudinally monitoring a COVID-19 discharged subject and two healthy controls with results suggesting the paradigm can detect initial deterioration followed by recovery. Overall, the EIT system can be widely applicable for lung function screening and monitoring both at homes and clinics.
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Jirasakulsuk N, Saengpromma P, Khruakhorn S. Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis. JMIR Rehabil Assist Technol 2022; 9:e36028. [PMID: 36048520 PMCID: PMC9478822 DOI: 10.2196/36028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Real-time telerehabilitation (TR) is a new strategy for delivering rehabilitation interventions to older adults with musculoskeletal conditions, to provide continuity to conventional services and mitigate travel-related barriers. Objective We aimed to examine the effectiveness of treatment delivered via real-time TR services compared to conventional services among older adults with musculoskeletal conditions, in terms of physical performance, treatment adherence, and cost-effectiveness. Methods A literature search of randomized controlled trials (RCTs) published from January 2000 to April 2022 was conducted in six online databases: Cochrane Library, PubMed (ie, MEDLINE), PEDro, ClinicalKey, EBSCO, and ProQuest. The main eligibility criterion for articles was the use of real-time TR among older adults with musculoskeletal conditions to improve physical performance. Two reviewers screened 2108 abstracts and found 10 studies (n=851) that met the eligibility criteria. Quality assessment was based on version 2 of Cochrane’s risk-of-bias tool for RCTs, in order to assess the methodological quality of the selected articles. Results were pooled for meta-analyses, based on the primary outcome measures, and were reported as standardized mean differences (SMDs) with 95% CIs. A fixed model was used, and subgroup analysis was performed to check for possible factors influencing TR’s effectiveness based on different treatments, controls, and outcome measures. Results The search and screening process identified 10 papers that collectively reported on three musculoskeletal conditions in older adults and three types of TR programs. Aggregate results suggested that real-time TR, compared to conventional treatment, was more effective at improving physical performance regarding balance (SMD 0.63, 95% CI 0.36-0.9; I2=58.5%). TR was slightly better than usual care at improving range of motion (SMD 0.28, 95% CI 0.1-0.46; I2=0%) and muscle strength (SMD 0.76, 95% CI 0.32-1.2; I2=59.60%), with moderate to large effects. Subgroup analyses suggested that real-time TR had medium to large effects favoring the use of smartphones or tablets (SMD 0.92, 95% CI 0.56-1.29; I2=45.8%), whereas the use of personal computers (SMD 0.25, 95% CI –0.16 to 0.66; I2=0%) had no effect on improving balance and was comparable to conventional treatment. Conclusions We found that real-time TR improved physical performance in older adults with musculoskeletal conditions, with an effectiveness level equal to that of conventional face-to-face treatment. Therefore, real-time TR services may constitute an alternative strategy for the delivery of rehabilitation services to older adults with musculoskeletal conditions to improve their physical performance. We also observed that the ideal device for delivering TR is the smartphone. Results suggested that the use of smartphones for TR is driven by ease of use among older adults. We encourage future studies in areas related to rehabilitation in older adults, in addition to examination of physical performance outcomes, to gain additional knowledge about comprehensive care. Trial Registration PROSPERO CRD42021287289; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287289
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Affiliation(s)
- Nathaphon Jirasakulsuk
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Pattaridaporn Saengpromma
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
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Chapel B, Alexandre F, Heraud N, Ologeanu-Taddei R, Cases AS, Bughin F, Hayot M. Standardization of the assessment process within telerehabilitation in chronic diseases: a scoping meta-review. BMC Health Serv Res 2022; 22:984. [PMID: 35918690 PMCID: PMC9344755 DOI: 10.1186/s12913-022-08370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. Aims and objectives The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. Results Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. Conclusions Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08370-y.
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Affiliation(s)
- Blandine Chapel
- University of Montpellier, Montpellier Research of Management, Montpellier, France.
| | - François Alexandre
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | - Nelly Heraud
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | | | - Anne-Sophie Cases
- University of Montpellier, Montpellier Research of Management, Montpellier, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
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Brown RC, Coombes JS, Jungbluth Rodriguez K, Hickman IJ, Keating SE. Effectiveness of exercise via telehealth for chronic disease: a systematic review and meta-analysis of exercise interventions delivered via videoconferencing. Br J Sports Med 2022; 56:bjsports-2021-105118. [PMID: 35715175 DOI: 10.1136/bjsports-2021-105118] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases. DESIGN Systematic review incorporating meta-analysis. DATA SOURCES PubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus. ELIGIBILITY CRITERIA The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Trials analysing participants with chronic disease undergoing aerobic and/or resistance exercise training over videoconferencing, with exercise capacity and/or quality of life outcomes were included. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life. Risk of bias was analysed using the Downs and Black quality checklist and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS Thirty-two trials were included in this review, of which 12 were comparator trials. Small-moderate between-group (videoconferencing vs comparator) effects favouring videoconferencing were seen for studies using a non-exercising comparator for exercise capacity (standardised mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=<0.001) and quality of life (SMD=0.400, 95% CI 0.099 to 0.701; p=0.009). Small effects favouring videoconferencing were observed for studies using an exercising comparator for quality of life (SMD=0.271, 95% CI 0.028 to 0.515; p=0.029) and exercise capacity (SMD=0.242, 95% CI 0.059 to 0.426; p=0.009). Moderate risk of bias was identified for included studies (16.3±3.6/28), with GRADE certainty ratings of 'low' (quality of life) and 'moderate' (exercise capacity). Session attendance was 70% and was reported in 23 trials. No serious adverse events relating to videoconferencing were found. Nine trials documented the total number of technical issues that occurred in 17% of the sessions. Positive satisfaction outcomes were associated with ease of access and usefulness of technology. CONCLUSION In patients with chronic disease, videoconferencing exercise interventions appear to be feasible and effective for improving exercise capacity and quality of life. More robust methodology is needed in future studies to improve the certainty of the evidence. PROSPERO REGISTRATION NUMBER CRD42020191243.
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Affiliation(s)
- Riley Cc Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Klaus Jungbluth Rodriguez
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Mater Research Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
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21
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Song CY, Liu X, Wang YQ, Cao HP, Yang Z, Ma RC, Yin YY, Xie J. Effects of home-based telehealth on the physical condition and psychological status of patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Int J Nurs Pract 2022:e13062. [PMID: 35545098 DOI: 10.1111/ijn.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/15/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
AIMS This systematic review and meta-analysis aimed to evaluate the effects of home-based telehealth compared with usual care on six-minute walking distance (6MWD), health-related quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease. METHODS We identified randomized controlled trials through a systematic multidatabase search. Titles and abstracts were assessed for relevance. Two authors independently extracted data and assessed the risk of bias and quality of evidence. Meta-analyses were conducted using Review Manager and Stata. RESULTS We included 32 randomized controlled trials (n = 5232). Devices used for home-based telehealth interventions included telephones, videos, and combined devices. The quality of the evidence was downgraded due to high risk of bias, imprecision, and inconsistency. Home-based telehealth significantly increased 6MWD by 35 m (SD = 30.42) and reduced symptom burden by 3 points (SD = -2.30) on the COPD assessment test compared with usual care. However, no significant differences in anxiety and depression were noted between the home-based telehealth group and the standard care group. In subgroup analysis, home-based telehealth significantly improved 6MWD and health status after 6-12 months and >12 months. CONCLUSION Low quality evidence showed that home-based telehealth interventions reduce symptom burden and increase walking distance to a clinically meaningful extent in patients with COPD. However, no effects on depression and anxiety were observed.
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Affiliation(s)
- Chun-Yu Song
- School of Nursing, Jilin University, Changchun, China
| | - Xin Liu
- School of Nursing, Jilin University, Changchun, China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, Changchun, China
| | - Hui-Ping Cao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhuo Yang
- Department of Emergency, The First Hospital of Jilin University, Changchun, China
| | - Rui-Chen Ma
- School of Nursing, Jilin University, Changchun, China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, Changchun, China
| | - Jiao Xie
- School of Nursing, Jilin University, Changchun, China
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22
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Li Y, Qian H, Yu K, Huang Y. The Long-Term Maintenance Effect of Remote Pulmonary Rehabilitation via Social Media in COPD: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2022; 17:1131-1142. [PMID: 35586118 PMCID: PMC9109805 DOI: 10.2147/copd.s360125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background Although the benefits of conventional pulmonary rehabilitation (PR) maintenance are well documented, it is challenged by many difficulties. We investigated whether remote home-based PR maintenance strategy via social media (WeChat) is effective on clinical improvements and reducing the risk for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods The eligible stable COPD patients completing an initial 8-week PR were allocated into three groups randomly. Group A: PR maintenance via social media supervision at home. Group B: PR maintenance at hospital. Group C: Usual care. During a 12-month follow-up, the frequency of acute exacerbation of COPD (AECOPD), 6 minutes walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) were evaluated every 3 months. Results At the end of the follow-up, compared to the decline in the usual care group (n = 49), the clinical improvements of 6MWD, CAT, and mMRC were sustained in both the home-based group (n = 47) and the hospital-based maintenance group (n = 44) (p < 0.001), no difference was observed between these two groups (p > 0.05). In multivariate analysis, the home-based PR maintenance and hospital-based PR maintenance were independent predictors of lower risk for AECOPD (incidence rate ratio (IRR) 0.712, 95% CI 0.595–0.841, p < 0.001 and IRR 0.799, 95% CI 0.683–0.927, p = 0.002), respectively. Conclusion Remote PR maintenance via social media is effective in reducing the risk for AECOPD and keeping the clinical improvement from decline. Remote PR maintenance via social media might be used to deliver alternatives to conventional PR.
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Affiliation(s)
- Yi Li
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People’s Republic of China
- Correspondence: Yi Li, Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People’s Republic of China, Email
| | - Hongyu Qian
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People’s Republic of China
| | - Kewei Yu
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People’s Republic of China
| | - Ying Huang
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People’s Republic of China
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23
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Richter B, Wattenberg I, Vollmer AL, Hornberg C, Wrede B, Lätzsch R. [The COVID-19 Pandemic as an Opportunity for Teletherapy? - A Survey of non-medical therapy professionals in the health sector]. DAS GESUNDHEITSWESEN 2022; 84:319-325. [PMID: 34344047 PMCID: PMC11248726 DOI: 10.1055/a-1537-8933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the use of teletherapy during the corona pandemic by three non-medical therapy professionals in the health sector. METHOD As part of a questionnaire-based online survey, 282 participants from the field of ergotherapy, physiotherapy and speech therapy were asked about usage behavior, challenges, potentials, and general conditions of teletherapy. RESULTS Especially ergo and speech therapists used teletherapy during the corona pandemic. From their point of view, teletherapy also had a potential to be used as an alternative form of therapy, regardless of the coronavirus pandemic, adding that there was a great need for further assistance and training in the field of teletherapy. CONCLUSION To implement this form of therapy on a long-term basis, in addition to technical requirements and training opportunities, accounting formalities need to be clarified.
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Affiliation(s)
- Birte Richter
- Medizinische Assistenzsysteme, Universität Bielefeld Medizinische Fakultät OWL, Bielefeld, Deutschland
| | - Ivonne Wattenberg
- AG Sustainable Environmental Health Sciences, Universität Bielefeld Medizinische Fakultät OWL ,Bielefeld, Deutschland
| | - Anna-Lisa Vollmer
- Medizinische Assistenzsysteme, Universität Bielefeld Medizinische Fakultät OWL, Bielefeld, Deutschland
| | - Claudia Hornberg
- Gründungsdekanin, AG Sustainable Environmental Health Sciences, Universität Bielefeld Medizinische Fakultät OWL, Bielefeld, Deutschland
| | - Britta Wrede
- Medizinische Assistenzsysteme, Universität Bielefeld Medizinische Fakultät OWL, Bielefeld, Deutschland
| | - Rebecca Lätzsch
- AG Sustainable Environmental Health Sciences, Universität Bielefeld Medizinische Fakultät OWL ,Bielefeld, Deutschland
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24
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Pang L, Liu H, Liu Z, Tan J, Zhou LY, Qiu Y, Lin X, He J, Li X, Lin S, Ghosh S, Mao R, Chen M. Role of Telemedicine in Inflammatory Bowel Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e28978. [PMID: 35323120 PMCID: PMC8990345 DOI: 10.2196/28978] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 10/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear. OBJECTIVE This systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis. RESULTS A total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference -0.71, 95% CI -1.07 to -0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine.
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Affiliation(s)
- Lanlan Pang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hengyu Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhidong Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinyu Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Yuan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinshen He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sinan Lin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Subrata Ghosh
- NIHR Biomedical Research Centre, Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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25
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Lundell S, Toots A, Sönnerfors P, Halvarsson A, Wadell K. Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease. BMC Med Inform Decis Mak 2022; 22:68. [PMID: 35303895 PMCID: PMC8932463 DOI: 10.1186/s12911-022-01806-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background Using participatory methods to engage end-users in the development and design of eHealth is important to understand and incorporate their needs and context. Within participatory research, recent social distancing practice has forced a transition to digital communication platforms, a setting that warrants deeper understanding. The aim of this study was to describe the experiences of, and evaluate a digital co-creation process for developing an eHealth tool for people with chronic obstructive pulmonary disease (COPD). Methods The co-creation was guided by Participatory appreciative action and reflection, where a convenience sample (n = 17), including persons with COPD, health care professionals, relatives and a patient organization representative participated in six digital workshops. User instructions, technical equipment, and skilled support were provided if necessary. Workshops centred around different topics, with pre-recorded films, digital lectures and home assignments to up-skill participants. Process validity, experiences and ownership in the co-creation process were evaluated by repeated respondent validation, member checking, questionnaires and by assessing attendance. Data was analysed quantitatively or qualitatively as appropriate. Results The co-creators were in general satisfied with the digital format of the workshops. Mean attendance and perceived engagement in workshops was high and the experience described as enjoyable. Engagement was facilitated by up-skilling activities and discussions in small groups. Few had used digital communication previously, and feelings ranging from excitement to concern were expressed initially. Technical issues, mainly audio related, were resolved with support. At completion, skills using equipment and digital platform surpassed expectations. Few disadvantages with the digital format were identified, and advantages included reduced travel, time efficiency and reduced infection risk. Conclusions Experiences of digital co-creation were overwhelmingly positive, despite initial barriers related to computer naivety and use of digital equipment and platforms. The high level of satisfaction, engagement, attendance rates, and agreement between individual and group views suggests that a digital co-creation process is a feasible method. Several important success factors were identified, such as the provision of information and education on discussion topics in advance of workshops, as well as the smaller group discussions during workshops. The knowledge gained herein will be useful for future digital co-creation processes.
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Affiliation(s)
- Sara Lundell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
| | - Annika Toots
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
| | - Pernilla Sönnerfors
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Halvarsson
- Division of Physiotherapy, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden
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26
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Rochester CL. Does Telemedicine Promote Physical Activity? Life (Basel) 2022; 12:life12030425. [PMID: 35330176 PMCID: PMC8948765 DOI: 10.3390/life12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Exercise capacity and physical activity are different concepts: the former refers to what an individual is capable of performing, while the latter refers to what the individual does in daily life. Low levels of physical activity (PA), which are very common in individuals with COPD, are associated with poor health outcomes, including increased symptoms, a more rapid decline in lung function, increased health care utilization and increased mortality risk. Because of these pervasive negative outcomes, attempts have been made to increase physical activity in individuals with COPD, hoping that success in this area will mitigate the negative effects of inactivity. Based on its ability to increase exercise capacity and reduce dyspnea in COPD and other chronic respiratory diseases, pulmonary rehabilitation (PR) would be expected also increase physical activity in these patients. However, accessibility to pulmonary rehabilitation programs is problematic in some areas, and studies testing its effectiveness in this outcome area have had inconsistent results. Using telehealth interventions using technology to provide medical care conveniently over a distance would have the benefit of reaching a larger proportion of individuals with COPD. A systematic review of clinical trials testing telehealth to promote physical activity had mixed results and low-certainty evidence, resulting in the inability to recommend any single type of intervention. Thus, using telehealth interventions to promote physical activity for individuals with chronic respiratory diseases, while promising, remains an area where future investigations are needed to identify its optimal modalities and clarify its benefits.
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Affiliation(s)
- Carolyn L. Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; ; Tel.: +1-203-785-4163; Fax: +1-203-785-3627
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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27
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Chacornac M, Faoro A, Texereau J, Billoet C, Hominal S. Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study. JMIR Form Res 2022; 6:e32205. [PMID: 35275068 PMCID: PMC8956987 DOI: 10.2196/32205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background Management of patients with multiple chronic diseases is a growing public health challenge, especially in rural sectors where access to physicians may be limited. Connected medical devices monitoring vital signs, associated with eHealth program and structured telephone support, may improve complex patient management through early detection of disease complications, positive impact on patients’ health, and health resources consumption optimization. Objective The aim of this study was to evaluate the technical performance and user experience of the NOMHAD eHealth system in patients with multimorbidity. Methods This was a pilot, single-arm, interventional study. Patients with multimorbidity with any combination of chronic heart failure (CHF), chronic obstructive pulmonary disease, and diabetes were followed for 80-100 days using the NOMHAD eHealth system. This system used connected devices telemonitoring symptoms and vital signs (eg, body weight, oxygen saturation, pulse rate, blood pressure, and blood glucose), associated with structured telecoaching and educational support by call center nurses. An overall risk indicator (ORI) was automatically computed after each data teletransmission. The ORI was color coded; green indicated no action required; yellow, orange, and red (low to high priority, respectively) generated telenotifications and indicated to the nurses the need for a telecoaching action. Each ORI was calculated by combining 7 clinical stability system indicators based on symptom questionnaires and vital signs. Technical accuracy of the system was assessed by comparing system-generated ORIs with ORIs recalculated from raw data. Ease of use, usefulness, satisfaction, and acceptability of the system were assessed through patient adherence to self-assessments, and through self-administered questionnaires to patients, call center nurses, and physicians. Results A total of 23 patients were enrolled in this study and participated between April 2016 and March 2017 at 5 study centers in France. All patients were successfully equipped and evaluable for analysis. Mean age was 68.5 (SD 10.4) years and most patients were men (n=20). The most common multimorbidity was CHF + diabetes (n=15), followed by patients with all 3 diseases (n=5). Mean effective follow-up was 78.7 (SD 24.2) days. The system generated 6263 ORIs, as several ORIs could be generated on a single day for any patient. Overall system sensitivity was 99.2% (95% CI 98.9-99.4) and overall specificity was 91.3% (95% CI 87.7-94.1). Most patients (20/23, 87%) were satisfied with the system and agreed that it helped them to better understand and manage their diseases, and 19/23 (83%) valued the nurse regular contacts. Nurses and physicians were generally satisfied with the system and considered it useful. All users indicated they would agree to long-term use of the system. Conclusions This study provides evidence that the NOMHAD eHealth system is accurate, acceptable, informative, and feasible for patients with multimorbidity, supporting further investigation of its clinical benefits. Trial Registration Agence Nationale de Sécurité du Médicament et des Produits de Santé 2015-A01106-43; https://ictaxercb.ansm.sante.fr/Public/index.php
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Affiliation(s)
- Mathieu Chacornac
- Department of Cardiology, Centre Hospitalier Annecy-Genevois, Pringy, France
| | | | - Joëlle Texereau
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,VitalAire, Air Liquide Health Care, Gentilly, France
| | | | - Stéphane Hominal
- Department of Pneumology, Centre Hospitalier Annecy-Genevois, Pringy, France
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Downie S, Shnaigat M, Hosseinzadeh H. Effectiveness of health literacy- and patient activation-targeted interventions on chronic disease self-management outcomes in outpatient settings: a systematic review. Aust J Prim Health 2022; 28:83-96. [PMID: 35131029 DOI: 10.1071/py21176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022]
Abstract
Chronic diseases are the leading causes of morbidity and mortality and account for approximately 60% of all deaths worldwide. Self-management is a key strategy to manage chronic diseases, and there is emerging evidence recommending targeting both health literacy (HL) and patient activation (PA) to improve chronic disease self-management outcomes. The aim of this systematic review is to summarise the current evidence on the impact of HL- and PA-led interventions on self-management outcomes using randomised control trials (RCTs). Six well known databases (MEDLINE, Web of Science, Scopus, Science Citation Index, EMBASE and Academic Search Complete) were searched for RCTs of chronic disease self-management interventions targeting both HL and PA and published between 2004 and June 2021. The search terms included chronic disease, self-management, patient activation/engagement and health literacy/education. Ten studies were eligible for inclusion. We found that patients with low HL and PA levels are most likely to benefit from the interventions. The moderate improvements in PA and HL in the reviewed studies were translated into some improvements in physical activity and mental health outcomes but failed to improve patients' quality of life and healthcare utilisation outcomes. Patients with low HL were more likely to have higher PA levels after the interventions. This review suggests that both HL and PA are essential pillars for improving chronic disease self-management outcomes. However, more studies are needed to explore the long-term impacts of a combination of HL and PA on chronic disease self-management outcomes.
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Affiliation(s)
- S Downie
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - M Shnaigat
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia; and Corresponding author
| | - H Hosseinzadeh
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
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29
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Paelet L, Raskin J, ZuWallack R. Potential downside issues with telemedicine for individuals with chronic respiratory diseases. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Telemedicine refers to the use of communications technologies to provide or enhance medical care through mitigating the negative effects of patient-caregiver distance on medical evaluation and treatment. The general concept, telemedicine, can refer to a number of interventions, such as telemonitoring, tele-consultations, tele-education, tele-communication, and tele-rehabilitation. While telemedicine has seen steady growth its trajectory has increased during the COVID-19 pandemic. As a tool in health care delivery, telemedicine is often met with patient satisfaction often resulting from ease of use and accessibility. Additionally, outcomes may improve, although the medical literature is not consistent in this regard. However, enthusiasm over its beneficial effects should be tempered by negative aspects, including the decrease in direct patient-clinician interaction (such as loss of information from the physical examination) and potentially serious privacy risks. Finding a happy median between positive and negative features of telemedicine remains a work in progress.
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30
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The Role of Digital Tools in the Timely Diagnosis and Prevention of Acute Exacerbations of COPD: A Comprehensive Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12020269. [PMID: 35204359 PMCID: PMC8870887 DOI: 10.3390/diagnostics12020269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the airways and lung parenchyma with multiple systemic manifestations. Exacerbations of COPD are important events during the course of the disease, as they are associated with increased mortality, severe impairment of health-related quality of life, accelerated decline in lung function, significant reduction in physical activity, and substantial economic burden. Telemedicine is the use of communication technologies to transmit medical data over short or long distances and to deliver healthcare services. The need to limit in-person appointments during the COVID-19 pandemic has caused a rapid increase in telemedicine services. In the present review of the literature covering published randomized controlled trials reporting results regarding the use of digital tools in acute exacerbations of COPD, we attempt to clarify the effectiveness of telemedicine for identifying, preventing, and reducing COPD exacerbations and improving other clinically relevant outcomes, while describing in detail the specific telemedicine interventions used.
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Hayot M, Saey D, Costes F, Bughin F, Chambellan A. [Respiratory telerehabilitation in cases of COPD]. Rev Mal Respir 2022; 39:140-151. [PMID: 35000811 DOI: 10.1016/j.rmr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
Telerehabilitation brings together a set of rehabilitation practices applied remotely by means of information and communication technologies. Even though it has been taking on increasing importance in many health fields over 10 years, telerehabilitation had yet to find its place in pulmonary rehabilitation before 2020, when the pandemic situation impelled numerous teams to put it to work. Pilot studies on respiratory diseases, primarily COPD, along with recent data from randomized or non-randomized studies, have enhanced our understanding of "remote" practice. In this review of the literature, we will show that pulmonary telerehabilitation is feasible, safe and likely to yield short-term (and possibly longer term) effects generally similar to those achieved in the pulmonary rehabilitation programs of specialized centers, especially as regards some indicators of exercise tolerance, dyspnea or patient quality of life. However, the number of studies and patients included in these programs remains too limited in terms of modalities, duration, long-term effects, or adaptations in case of exacerbation to be the subject of recommendations. The potential of respiratory telerehabilitation justifies continuing clinical trials and experiments, which need to be coordinated with the interventions characterizing a conventional program.
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Affiliation(s)
- M Hayot
- PhyMedExp, INSERM-CNRS - Université de Montpellier, CHRU Montpellier, Montpellier, France.
| | - D Saey
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada; Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, Canada
| | - F Costes
- Université Clermont Auvergne, INRAE, UNH, CHU de Clermont Ferrand, Groupe de travail Alvéole SPLF, Clermont Ferrand, France
| | - F Bughin
- PhyMedExp, INSERM-CNRS - Université de Montpellier, CHRU Montpellier, Montpellier, France
| | - A Chambellan
- Service de Pneumologie, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Faculté de Médecine & Maïeutique, Université Catholique de Lille, France
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Calvache-Mateo A, López-López L, Heredia-Ciuró A, Martín-Núñez J, Rodríguez-Torres J, Ortiz-Rubio A, Valenza MC. Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312692. [PMID: 34886418 PMCID: PMC8657261 DOI: 10.3390/ijerph182312692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 01/16/2023]
Abstract
Background: Adults living with Chronic Obstructive Pulmonary Disease (COPD) often have difficulties when trying to access health care services. Interactive communication technologies are a valuable tool to enable patients to access supportive interventions to cope with their disease. The aim of this revision and meta-analysis is to analyze the content and efficacy of web-based supportive interventions in quality of life in COPD. Methods: Medline (via PubMed), Web of Science, and Scopus were the databases used to select the studies for this systematic review. A screening, analysis, and assessment of the methodological quality was carried out by two independent researchers. A meta-analysis of the extracted data was performed. Results: A total of 9 of the 3089 studies reviewed met the inclusion criteria. Most repeated web content elements were educational and involved communication with healthcare professional content. Finally, seven of the nine studies were included in a quantitative analysis. Web-based supportive interventions significantly improved quality of life when added to usual care (SMD = −1.26, 95% CI = −1.65, −0.86; p < 0.001) but no significant differences were found when compared with an autonomous pedometer walking intervention (p = 0.64) or a face-to-face treatment (p = 0.82). Conclusion: This systematic review and meta-analysis suggests that web-based supportive interventions may complement or accompany treatments in COPD patients due to the advantages of online interventions. The results obtained should be treated with caution due to the limited number of studies in this area and methodological weaknesses.
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Will Remotely Based Pulmonary Rehabilitation Water Down Its Effectiveness? Life (Basel) 2021; 11:life11111270. [PMID: 34833145 PMCID: PMC8625237 DOI: 10.3390/life11111270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease. Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Emerging alternative models of PR delivery such as home-based PR, tele-rehabilitation, web-based PR, or hybrid models could help address these barriers. Numerous studies have tested the feasibility, safety, and efficacy of these methods, but there is wide variability across studies and methods. We conducted a literature review to help determine if these alternative delivery methods watered down the effectiveness of PR. To evaluate the effectiveness of remotely based PR, the authors performed a literature search for randomized controlled trials (RCTs), cohort studies, and case series using PubMed, CINAHL, and Medline to identify relevant articles through 1 May 2021. Twenty-six applicable studies were found in which 11 compared tele-rehabilitation to conventional clinic-based PR; 11 evaluated tele-rehabilitation using the patient’s baseline status as control; and four compared tele-rehabilitation to no rehabilitation. Despite the different technologies used across studies, tele-rehabilitation was found to be both a feasible and an efficacious option for select patients with lung disease. Outcomes across these studies demonstrated similar benefits to traditional PR programs. Thus the existing data does not show that remotely based PR waters down the effectiveness of conventional PR. Use of remotely based PR is a feasible and effective option to deliver PR, especially for patients with significant barriers to conventional clinic-based PR. Additional, well-conducted RCTs are needed to answer the questions regarding its efficacy, safety, cost-effectiveness and who, among patients with COPD and other lung diseases, will derive the maximum benefit.
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Irina BP, Steluta MM, Emanuela T, Diana M, Cristina OD, Mirela F, Cristian O. Respiratory muscle training program supplemented by a cell-phone application in COPD patients with severe airflow limitation. Respir Med 2021; 190:106679. [PMID: 34763175 DOI: 10.1016/j.rmed.2021.106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/13/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to implement a respiratory muscle training program through a mobile phone application for COPD patients with severe airflow limitation. METHODS We conducted an experimental study to determine the efficacy of a six-month mobile phone application. At least three times a week for six months the patients would participate in an online training session. We evaluated the lung volumes, maximal inspiratory and expiratory pressure (MIP/MEP) and diaphragm amplitude. The tests were performed at the beginning and at the end of the study. RESULTS Thirty-four patients with severe COPD, aged between 44 and 67 years (Mean ± SD, 59.29 ± 6.063), accepted to follow a rehabilitation program based on the use of the Pneumocontrol application. We observed on increased of MEP from the pre-rehabilitation state (83.41 cmH2O) to the post-rehabilitation state (95.03 cmH2O), z = 5.087, p < 0.001. Also, the median MIP significantly increased from the pre-rehabilitation state to the post-rehabilitation state, z = 5.052, p < 0.001. Diaphragmatic distance also increased from 2.81 cm to 3.44 cm, z = 5.069, p < 0.001. CONCLUSION Respiratory muscle training supplemented through a cell phone-based application can improve respiratory muscle strength and diaphragm mobility.
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Affiliation(s)
- Barata Paula Irina
- "Vasile Goldis" University of Arad, Faculty of Medicine, Department of Physiology, Arad, Romania
| | - Marc Monica Steluta
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Pulmonology, Timisoara, Romania.
| | - Tudorache Emanuela
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Pulmonology, Timisoara, Romania
| | - Manolescu Diana
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Radiology Department, Timisoara, Romania
| | - Olar Dana Cristina
- "Vasile Goldis" University of Arad, Faculty of Medicine, Department of Physiology, Arad, Romania
| | - Frandes Mirela
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Biostatistics and Medical Informatics, Timisoara, Romania
| | - Oancea Cristian
- University of Medicine and Pharmacy "Victor Babes" Timisoara, Department of Pulmonology, Timisoara, Romania
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Criner GJ, Cole T, Hahn KA, Kastango K, Eudicone JM, Gilbert I. Use of a Digital Chronic Obstructive Pulmonary Disease Respiratory Tracker in a Primary Care Setting: A Feasibility Study. Pulm Ther 2021; 7:533-547. [PMID: 34463947 PMCID: PMC8589940 DOI: 10.1007/s41030-021-00168-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Telemonitoring is a promising self-management strategy to improve health care outcomes. This study evaluated real-world adoption of the chronic obstructive pulmonary disease (COPD) Co-Pilot daily symptom monitoring tool by patients and primary care providers (PCPs). Methods An open-label, 6-month, single-arm, multicenter, noninterventional feasibility study enrolled 97 patients aged ≥ 40 years with symptomatic or poorly controlled COPD and ≥ 10 pack-year smoking history. Patients received smartphones and training to use the COPD Co-Pilot application. During the study, patients tracked symptoms daily; an increase in symptom score of ≥ 1.0 point from baseline (symptom alert) prompted patients to contact their PCP via toll-free number. The primary endpoint was time to clinical recommendation (TTCR) from a symptom alert; adherence to completing daily symptom reports through the COPD Co-Pilot application and patient satisfaction were also measured. Results Overall, 87 of 96 patients (90.6%) received 2142 symptom alerts; 42 alerts (equivalent to 2% of all symptom alerts) resulted in 23 patients contacting their PCP. Median TTCR was 7.1 h (interquartile range [IQR]: 4.0–29.9). Among 15 patients using the toll-free number, median TTCR was 2.1 h (IQR 0.0–7.2) versus 19.6 h (IQR 4.5–45.2) for eight patients using other contact methods. Average COPD Co-Pilot adherence overall was 75.2% (95% CI 74.6–75.9). Patients responded favorably regarding the application’s ease of use, functionality, and information provided. Conclusions The COPD Co-Pilot tool was associated with relatively high levels of adherence, suggesting patients’ willingness to monitor symptoms daily. Although a limited number of patients initiated PCP contact, patients who used the study-provided toll-free number had substantially shorter median TTCR, suggesting that this tool could help empower patients to better manage their COPD. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00168-3.
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Affiliation(s)
- Gerard J Criner
- Temple University Hospital, Philadelphia, PA, USA. .,Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine At Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Therese Cole
- IQVIA, Rockville, MD, USA.,Advanced Clinical, Deerfield, IL, USA
| | | | - Kari Kastango
- IQVIA, Cambridge, MA, USA.,Everest Clinical Research, Little Falls, NJ, USA
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Role of new digital technologies and telemedicine in pulmonary rehabilitation : Smart devices in the treatment of chronic respiratory diseases. Wien Klin Wochenschr 2021; 133:1201-1207. [PMID: 34460006 PMCID: PMC8599213 DOI: 10.1007/s00508-021-01930-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/23/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary diseases are conditions characterized by a variable progression. Some individuals experience longer asymptomatic periods while others acute worsening periods and/or exacerbations triggered by symptom multiplication factors. Medications are adjusted to the patients' respiratory function, self-assessment of health and emerging certain physical changes. A more effective treatment may be applied by real-time data registered during the patient's everyday life. AIM AND METHODS Introducing new modern digital technology in pulmonary rehabilitation (PR) to help tracking the patients' medication, thus we systematically reviewed the latest publications on telemedicine and pulmonary telerehabilitation. CONCLUSION The use of the latest digital technologies in PR is very exciting and offers great opportunities while treating patients affected by specific conditions. On the one hand, adherence to medication can be improved in patients with chronic respiratory diseases by using these new state of the art devices; on the other hand, digital devices will also be able to monitor various physiological parameters of patients during their usual everyday activities. Data can be stored on a smartphone and shared with the provider. Relying on this information, physicians will be able to tailor medications and dosage to the specific needs of individual patients. Telerehabilitation may be a sustainable solution to the growing burden of chronic respiratory disease worldwide. However, PR must keep its cornerstones, such as education and motivations, which are most successful when conducted in person. Many issues remain to be resolved in the future, e.g. cybersecurity while using smart devices since they offer unique opportunities for PR.
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Janjua S, Carter D, Threapleton CJ, Prigmore S, Disler RT. Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2021; 7:CD013196. [PMID: 34693988 PMCID: PMC8543678 DOI: 10.1002/14651858.cd013196.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD, including bronchitis and emphysema) is a chronic condition causing shortness of breath, cough, and exacerbations leading to poor health outcomes. Face-to-face visits with health professionals can be hindered by severity of COPD or frailty, and by people living at a distance from their healthcare provider and having limited access to services. Telehealth technologies aimed at providing health care remotely through monitoring and consultations could help to improve health outcomes of people with COPD. OBJECTIVES To assess the effectiveness of telehealth interventions that allow remote monitoring and consultation and multi-component interventions for reducing exacerbations and improving quality of life, while reducing dyspnoea symptoms, hospital service utilisation, and death among people with COPD. SEARCH METHODS We identified studies from the Cochrane Airways Trials Register. Additional sources searched included the US National Institutes of Health Ongoing Trials Register, the World Health Organization International Clinical Trials Registry Platform, and the IEEEX Xplore Digital Library. The latest search was conducted in April 2020. We used the GRADE approach to judge the certainty of evidence for outcomes. SELECTION CRITERIA Eligible randomised controlled trials (RCTs) included adults with diagnosed COPD. Asthma, cystic fibrosis, bronchiectasis, and other respiratory conditions were excluded. Interventions included remote monitoring or consultation plus usual care, remote monitoring or consultation alone, and mult-component interventions from all care settings. Quality of life scales included St George's Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). The dyspnoea symptom scale used was the Chronic Respiratory Disease Questionnaire Self-Administered Standardized Scale (CRQ-SAS). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We assessed confidence in the evidence for each primary outcome using the GRADE method. Primary outcomes were exacerbations, quality of life, dyspnoea symptoms, hospital service utilisation, and mortality; a secondary outcome consisted of adverse events. MAIN RESULTS We included 29 studies in the review (5654 participants; male proportion 36% to 96%; female proportion 4% to 61%). Most remote monitoring interventions required participants to transfer measurements using a remote device and later health professional review (asynchronous). Only five interventions transferred data and allowed review by health professionals in real time (synchronous). Studies were at high risk of bias due to lack of blinding, and certainty of evidence ranged from moderate to very low. We found no evidence on comparison of remote consultations with or without usual care. Remote monitoring plus usual care (8 studies, 1033 participants) Very uncertain evidence suggests that remote monitoring plus usual care may have little to no effect on the number of people experiencing exacerbations at 26 weeks or 52 weeks. There may be little to no difference in effect on quality of life (SGRQ) at 26 weeks (very low to low certainty) or on hospitalisation (all-cause or COPD-related; very low certainty). COPD-related hospital re-admissions are probably reduced at 26 weeks (hazard ratio 0.42, 95% confidence interval (CI) 0.19 to 0.93; 106 participants; moderate certainty). There may be little to no difference in deaths between intervention and usual care (very low certainty). We found no evidence for dyspnoea symptoms or adverse events. Remote monitoring alone (10 studies, 2456 participants) Very uncertain evidence suggests that remote monitoring may result in little to no effect on the number of people experiencing exacerbations at 41 weeks (odds ratio 1.02, 95% CI 0.67 to 1.55). There may be little to no effect on quality of life (SGRQ total at 17 weeks, or CAT at 38 and 52 weeks; very low certainty). There may be little to no effect on dyspnoea symptoms on the CRQ-SAS at 26 weeks (low certainty). There may be no difference in effects on the number of people admitted to hospital (very low certainty) or on deaths (very low certainty). We found no evidence for adverse events. Multi-component interventions with remote monitoring or consultation component (11 studies, 2165 participants) Very uncertain evidence suggests that multi-component interventions may have little to no effect on the number of people experiencing exacerbations at 52 weeks. Quality of life at 13 weeks may improve as seen in SGRQ total score (mean difference -9.70, 95% CI -18.32 to -1.08; 38 participants; low certainty) but not at 26 or 52 weeks (very low certainty). COPD assessment test (CAT) scores may improve at a mean of 38 weeks, but evidence is very uncertain and interventions are varied. There may be little to no effect on the number of people admitted to hospital at 33 weeks (low certainty). Multi-component interventions are likely to result in fewer people re-admitted to hospital at a mean of 39 weeks (OR 0.50, 95% CI 0.31 to 0.81; 344 participants, 3 studies; moderate certainty). There may be little to no difference in death at a mean of 40 weeks (very low certainty). There may be little to no effect on people experiencing adverse events (very low certainty). We found no evidence for dyspnoea symptoms. AUTHORS' CONCLUSIONS Remote monitoring plus usual care provided asynchronously may not be beneficial overall compared to usual care alone. Some benefit is seen in reduction of COPD-related hospital re-admissions, but moderate-certainty evidence is based on one study. We have not found any evidence for dyspnoea symptoms nor harms, and there is no difference in fatalities when remote monitoring is provided in addition to usual care. Remote monitoring interventions alone are no better than usual care overall for health outcomes. Multi-component interventions with asynchronous remote monitoring are no better than usual care but may provide short-term benefit for quality of life and may result in fewer re-admissions to hospital for any cause. We are uncertain whether remote monitoring is responsible for the positive impact on re-admissions, and we are unable to discern the long-term benefits of receiving remote monitoring as part of patient care. Owing to paucity of evidence, it is unclear which COPD severity subgroups would benefit from telehealth interventions. Given there is no evidence of harm, telehealth interventions may be beneficial as an additional health resource depending on individual needs based on professional assessment. Larger studies can determine long-term effects of these interventions.
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Affiliation(s)
- Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | | | | | - Samantha Prigmore
- Respiratory Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rebecca T Disler
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Donner CF, ZuWallack R, Nici L. The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2021; 57:medicina57070726. [PMID: 34357007 PMCID: PMC8307990 DOI: 10.3390/medicina57070726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023]
Abstract
Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.
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Affiliation(s)
- Claudio F. Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021 Borgomanero, Italy
- Correspondence:
| | - Richard ZuWallack
- Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT 06015, USA;
- University of CT, Farmington, CT 06030, USA
| | - Linda Nici
- Pulmonary and Critical Care Section, Providence Veterans Administration Medical Center, Brown University, Providence, RI 02908, USA;
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A Systematic Review and Meta-Analysis of Telemonitoring Interventions on Severe COPD Exacerbations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136757. [PMID: 34201762 PMCID: PMC8268154 DOI: 10.3390/ijerph18136757] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analysis aimed to provide current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits. We systematically searched for randomised controlled trials using nine databases from August to September 2020 following the Cochrane Collaboration Guidelines. Of 2159 records identified, 22 studies involving 2906 participants met the inclusion criteria. The participants in 55% and 59% of studies had severe airflow limitations and severe exacerbation histories in the preceding year, respectively. The most commonly telemonitored data were oxygen saturation (91%) and symptoms (73%). A meta-analysis showed that telemonitoring did not reduce the number of admissions (12 studies) but decreased the number of ER visits due to severe exacerbations [7 studies combined, standardised mean difference (SMD) = −0.14; 95% confidence interval (CI): −0.28, −0.01]. Most studies reported no benefit in mortality, quality of life, or cost-effectiveness. All eight studies that surveyed participant satisfaction reported high satisfaction levels. Our review suggested that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations and that telemonitoring was well-accepted by patients with COPD and could be easily integrated into their existing care.
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Seron P, Oliveros MJ, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro RC, Merino-Osorio C, Nahuelhual P, Inostroza J, Jalil Y, Solano R, Marzuca-Nassr GN, Aguilera-Eguía R, Lavados-Romo P, Soto-Rodríguez FJ, Sabelle C, Villarroel-Silva G, Gomolán P, Huaiquilaf S, Sanchez P. Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther 2021; 101:pzab053. [PMID: 33561280 PMCID: PMC7928601 DOI: 10.1093/ptj/pzab053] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy. METHODS We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts-where the intervention to be evaluated is telerehabilitation by physical therapy-were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures. RESULTS Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results. CONCLUSIONS Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews. IMPACT Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.
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Affiliation(s)
- Pamela Seron
- Internal Medicine Department and CIGES, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - María-Jose Oliveros
- Internal Medicine Department and CIGES, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Ruvistay Gutierrez-Arias
- Instituto Nacional del Tórax and Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andres Bello, Santiago, Chile
| | - Rocío Fuentes-Aspe
- Internal Medicine Department and CIGES, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | - Catalina Merino-Osorio
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana- Universidad del Desarrollo, Santiago, Chile
| | - Paula Nahuelhual
- Departamento de Evaluación de Tecnologías Sanitarias y Salud Basada en Evidencia, Ministerios de Salud, Santiago, Chile
- Facultad de Medicina, Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
| | - Jacqueline Inostroza
- Internal Medicine Department, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Yorschua Jalil
- Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andres Bello
- Programa de Doctorado Ciencias Medicas, Pontificia Universidad Católica de Chile, Escuela de Medicina, Santiago, Chile
| | - Ricardo Solano
- Medical Specialties Medicine Department, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Gabriel N Marzuca-Nassr
- Internal Medicine Department, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Raul Aguilera-Eguía
- Departamento de Salud Pública and Carrera de Kinesiología, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Pamela Lavados-Romo
- Departamento Ciencias Preclínicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Francisco J Soto-Rodríguez
- Internal Medicine Department, Faculty of Medicine, Universidad de La Frontera
- Facultad de Ciencias de la Salud, Carrera de Kinesiología, Universidad Autónoma de Chile, Temuco, Chile
| | - Cecilia Sabelle
- Universidad Santo Tomás, Temuco, Chile
- Servicio de Salud Araucanía Sur, Temuco, Chile
| | - Gregory Villarroel-Silva
- Departamento Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Hospital Josefina Martínez, Santiago, Chile
| | | | - Sayen Huaiquilaf
- Pediatrics and Child surgery Department, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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Shnaigat M, Downie S, Hosseinzadeh H. Effectiveness of Health Literacy Interventions on COPD Self-Management Outcomes in Outpatient Settings: A Systematic Review. COPD 2021; 18:367-373. [PMID: 33902367 DOI: 10.1080/15412555.2021.1872061] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease which imposes significant health and economic burdens on societies. Self-management is beneficial in controlling and managing COPD and health literacy (HL) is a major driver of COPD self-management. This review aims to summarize the most recent evidence on the effectiveness of HL driven COPD self-management interventions using randomized controlled trials (RCTs). Eight data bases including Science Citation Index, Academic Search Complete, Social Sciences Citation Index, CINAHL Plus, APA PsycInfo, MEDLINE, Scopus and ScienceDirect were searched to find eligible RCTs assessing the effectiveness of HL interventions on COPD self-management outcomes in outpatient settings between 2008 and February 2020. Ten RCTs met the eligibility criteria. The review found that HL interventions led to moderate improvements in physical activity levels (four out of seven trials) and COPD knowledge (three out of six trials). Surprisingly, none of the RCTs led to significant improvement in medication adherence, which warrants further studies. Furthermore, there were inconclusive findings regarding other COPD self-management outcomes such as smoking cessation, medication adherence, dyspnea, mental health, hospital admissions and health related quality of life.
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Affiliation(s)
- Mahmmoud Shnaigat
- School of Health & Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Sue Downie
- Discipline of Medical and Exercise Science, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Hassan Hosseinzadeh
- School of Health & Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
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42
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Song X, Hallensleben C, Zhang W, Jiang Z, Shen H, Gobbens RJJ, Kleij RMJJVD, Chavannes NH, Versluis A. Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24602. [PMID: 33788700 PMCID: PMC8047793 DOI: 10.2196/24602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Weihong Zhang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zongliang Jiang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Rutkowski S. Management Challenges in Chronic Obstructive Pulmonary Disease in the COVID-19 Pandemic: Telehealth and Virtual Reality. J Clin Med 2021; 10:1261. [PMID: 33803853 PMCID: PMC8003143 DOI: 10.3390/jcm10061261] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
For the treatment of chronic obstructive pulmonary disease (COPD), early diagnosis and unconditionally correct management at the initial stage of the disease are very important when the symptoms are not yet too worrying. In this way, the progress of the disease can be slowed down, as can the occurrence of late, life-threatening symptoms. Pulmonary rehabilitation is an essential component of the management of COPD. The selection of appropriate exercises, which are determined during the classification of patients into a suitable improvement program, is of key importance in the process of rehabilitation. The coronavirus disease 2019 (COVID-19) pandemic has resulted in major limitations to public health care. Health systems were largely unprepared for an outbreak of this magnitude. Searching for new, attractive technologies that help patients with chronic diseases seems to be justified. This may be driven by telehealth platforms, likewise with the use of virtual reality (VR). Analysis of the available literature indicates promising effectiveness, high patient acceptance, and high motivations to undertake physical activity with the use of such a solution. Thus, the management of patients with COPD during the COVID-19 pandemic should include options for remote delivery of pulmonary rehabilitation, including home-based, telerehabilitation, and computer-based virtual programs.
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Affiliation(s)
- Sebastian Rutkowski
- Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
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van Buul AR, Derksen C, Hoedemaker O, van Dijk O, Chavannes NH, Kasteleyn MJ. eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study. JMIR Form Res 2021; 5:e24726. [PMID: 33734091 PMCID: PMC8075071 DOI: 10.2196/24726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/23/2020] [Accepted: 01/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. OBJECTIVE This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. METHODS This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. RESULTS The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results. CONCLUSIONS The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD.
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Affiliation(s)
- Amanda R van Buul
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden, Netherlands
| | - Marise J Kasteleyn
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden, Netherlands
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45
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Core Outcome Measures for Trials in People With Coronavirus Disease 2019: Respiratory Failure, Multiorgan Failure, Shortness of Breath, and Recovery. Crit Care Med 2021; 49:503-516. [PMID: 33400475 PMCID: PMC7892260 DOI: 10.1097/ccm.0000000000004817] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Respiratory failure, multiple organ failure, shortness of breath, recovery, and mortality have been identified as critically important core outcomes by more than 9300 patients, health professionals, and the public from 111 countries in the global coronavirus disease 2019 core outcome set initiative. The aim of this project was to establish the core outcome measures for these domains for trials in coronavirus disease 2019. DESIGN: Three online consensus workshops were convened to establish outcome measures for the four core domains of respiratory failure, multiple organ failure, shortness of breath, and recovery. SETTING: International. PATIENTS: About 130 participants (patients, public, and health professionals) from 17 countries attended the three workshops. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Respiratory failure, assessed by the need for respiratory support based on the World Health Organization Clinical Progression Scale, was considered pragmatic, objective, and with broad applicability to various clinical scenarios. The Sequential Organ Failure Assessment was recommended for multiple organ failure, because it was routinely used in trials and clinical care, well validated, and feasible. The Modified Medical Research Council measure for shortness of breath, with minor adaptations (recall period of 24 hr to capture daily fluctuations and inclusion of activities to ensure relevance and to capture the extreme severity of shortness of breath in people with coronavirus disease 2019), was regarded as fit for purpose for this indication. The recovery measure was developed de novo and defined as the absence of symptoms, resumption of usual daily activities, and return to the previous state of health prior to the illness, using a 5-point Likert scale, and was endorsed. CONCLUSIONS: The coronavirus disease 2019 core outcome set recommended core outcome measures have content validity and are considered the most feasible and acceptable among existing measures. Implementation of the core outcome measures in trials in coronavirus disease 2019 will ensure consistency and relevance of the evidence to inform decision-making and care of patients with coronavirus disease 2019.
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46
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Galdiz JB, Gómez A, Rodriguez D, Guell R, Cebollero P, Hueto J, Cejudo P, Ortega F, Sayago I, Chic S, Iscar M, Amado C, Rodríguez Trigo G, Cosio BG, Bustamante V, Pijoan JI. Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.arbr.2020.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Affiliation(s)
- André Vinícius Santana
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Centro de Ciências da Saúde, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Andrea Daiane Fontana
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Centro de Ciências da Saúde, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Fabio Pitta
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Centro de Ciências da Saúde, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
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48
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Suso-Martí L, La Touche R, Herranz-Gómez A, Angulo-Díaz-Parreño S, Paris-Alemany A, Cuenca-Martínez F. Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta-Meta-Analysis. Phys Ther 2021; 101:6145901. [PMID: 33611598 PMCID: PMC7928612 DOI: 10.1093/ptj/pzab075] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. METHODS A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. RESULTS Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03-0.34). CONCLUSION The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. IMPACT The advantages of lower cost and less interference by the rehabilitation processes in patients' daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.
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Affiliation(s)
- Luis Suso-Martí
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,Department of Physiotherapy, University CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - Roy La Touche
- Address all correspondence tLa Touche, Address: Centro Superior de Estudios Universitarios La Salle, Calle La Salle, n° 10, 28023 Madrid, Spain. E-mail:
| | - Aida Herranz-Gómez
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | | | - Alba Paris-Alemany
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
| | - Ferran Cuenca-Martínez
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
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49
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e-Health and telemedicine implementation in facial paralysis: challenges and pitfalls. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:429-434. [PMID: 33612973 PMCID: PMC7881343 DOI: 10.1007/s00238-021-01802-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/02/2021] [Indexed: 11/02/2022]
Abstract
During the current Covid-19 pandemic, a lot of changes had to be made in the care of patients with facial nerve paralysis (FNP). FNP is a life-changing condition with effects on both physical (both esthetic and functional) and psychological aspects of the patient's life. Telemedicine could be a suitable alternative in the therapy for these patients, since it is often not possible to travel to outpatient clinics or to have normal face-to-face appointments with treating physicians because of pandemic restrictions. This review provides an overview of the current literature in the treatment of FNP during the pandemic and the role of telemedicine/e-Health. Secondly, we will discuss the challenges and pitfalls of implementing e-Health and telemedicine applications in clinical practice. Level of evidence: Not ratable.
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50
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Aragaki D, Luo J, Weiner E, Zhang G, Darvish B. Cardiopulmonary Telerehabilitation. Phys Med Rehabil Clin N Am 2021; 32:263-276. [PMID: 33814057 DOI: 10.1016/j.pmr.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cardiopulmonary telerehabilitation is a safe and effective alternative to traditional center-based rehabilitation. It offers a sustainable solution to more conveniently meet the needs of patients with acute or chronic, preexisting or newly acquired, cardiopulmonary diseases. To maximize success, programs should prioritize basic, safe, and timely care options over comprehensive or complex approaches. The future should incorporate new strategies learned during a global pandemic and harness the power of information and communication technology to provide evidence-based patient-centered care. This review highlights clinical considerations, current evidence, recommendations, and future directions of cardiopulmonary telerehabilitation.
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Affiliation(s)
- Dixie Aragaki
- Department of Medicine, Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine at UCLA, Los Angeles, CA USA; Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (117), Los Angeles, CA 90073, USA.
| | - Jerry Luo
- Physical Medicine and Rehabilitation Residency (PGY-2), Greater Los Angeles VA Healthcare System, West Los Angeles VA Medical Center, 11301 Wilshire Boulevard (117), Los Angeles, CA 90073, USA
| | - Elizabeth Weiner
- Physical Medicine and Rehabilitation Residency (PGY-2), Greater Los Angeles VA Healthcare System, West Los Angeles VA Medical Center, 11301 Wilshire Boulevard (117), Los Angeles, CA 90073, USA
| | - Grace Zhang
- Physical Medicine and Rehabilitation Residency (PGY-2), Greater Los Angeles VA Healthcare System, West Los Angeles VA Medical Center, 11301 Wilshire Boulevard (117), Los Angeles, CA 90073, USA
| | - Babak Darvish
- Cardiopulmonary Telehealth Service, Physical Medicine and Rehabilitation Service, Greater Los Angeles Healthcare System, West Los Angeles VA Medical Center, 11301 Wilshire Boulevard (117), Los Angeles, CA 90073, USA
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