Telerehabilitation intervention for type 2 diabetes

The comorbidity burden of diabetes and stroke: a retrospective study in Beijing, China

BACKGROUND

The high costs associated with diabetes management, coupled with the increasing prevalence of comorbidities, present a significant challenge to China's healthcare system, with cardiovascular complications being particularly prominent. The purpose of this study was to evaluate the comorbidities of diabetic patients with stroke in Beijing from 2016 to 2018 and the impact on treatment options and associated costs.

METHODS

This retrospective cohort study included diabetic patients enrolled in Beijing's medical insurance with outpatient medical records. We compared comorbidities, medications, and related treatment costs between stroke and non-stroke patients.

RESULTS

A representative sample of 2,853,036 patients with diabetes was identified from the data collected from 2016 to 2018, of which an average of 21.18% of patients reported stroke. A higher percentage of diabetic patients with stroke reported other comorbidities including hypertension, coronary artery disease, dyslipidemia, chronic respiratory disease, and osteoporosis as compared to those without stroke(all p's < 0.0001). The costs increased dramatically if diabetic patients developed comorbidities, including hypertension, CAD, dyslipidemia, CRD, and osteoporosis. Annual costs of medications were higher for diabetic patients with stroke and any types of comorbidity compared to diabetic patients without stroke (p <.0001, respectively). More types of drugs were used for diabetic patients with stroke and any types of comorbidity.

CONCLUSIONS

The needs of individuals with diabetes and stroke, including their comorbidity patterns and medical burdens, must be carefully taken into account. Health systems will need to address the increasing demand for diagnosing and managing comorbidities in individuals with diabetes and stroke.

The effects of tele-based interventions for depression and anxiety symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD): A systematic review and meta-analysis

BACKGROUND

Depression and anxiety are common psychiatric symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD). While face-to-face psychotherapy is a common option, tele-based interventions provide a more accessible alternative. However, a comprehensive synthesis of evidence from clinical trials for COPD patients has yet to be conducted.

OBJECTIVE

This study aims to evaluate the effects of tele-based interventions in reducing depressive and anxiety symptoms in patients with COPD.

METHODS

A systematic search of PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE databases was conducted from inception to May 5, 2024. Eligible studies included Randomized Controlled Trials (RCTs) of people with COPD patients receiving tele-based interventions reporting on the outcomes of depression or anxiety. Data extraction and quality assessment were performed independently by two researchers. The quality of the included studies was assessed using the Cochrane risk-of-bias tool. Meta-analysis was performed using RevMan (version 5.4) and Stata (version 18.0) software.

RESULTS

Following the search, 9 RCTs with a total of 2064 patients with COPD were included. The meta-analysis revealed that tele-based interventions reduced depressive symptoms in patients with COPD (Standardized Mean Difference [SMD] = -0.15, 95 % CI -0.24 to -0.06; P = 0.001). The subgroup analysis indicated that the PHQ-9 (SMD = -0.24, 95 % CI -0.37 to -0.10; P = 0.001) was better at detecting changes in depressive symptoms compared to other scales; the first 3 months of intervention (SMD = -0.36, 95 % CI -0.52 to -0.19; P < 0.001) was the most pronounced improvement; and telehealth interventions were more effective (SMD = -0.30, 95 % CI -0.46 to -0.15; P < 0.001) than telemonitoring interventions. Tele-based interventions also reduced anxiety symptoms in patients with COPD (SMD = -0.12, 95 % CI -0.22 to -0.02; P = 0.02).

CONCLUSIONS

The evidence supports the efficacy of tele-based interventions in alleviating depression and anxiety symptoms in COPD patients. However, further large-scale and rigorously designed studies are warranted to strengthen the evidence.

Effects of home-based telemedicine and mHealth interventions on blood pressure in stroke patients: a systematic evaluation and meta-analysis of randomized controlled trials

BACKGROUND

Stroke is a common cerebrovascular disease. Elevated blood pressure is the most significant manageable factor for both initial and recurrent strokes. Despite the potential benefits of telemedicine and mobile health technology (mHealth) in managing blood pressure among stroke patients, there remains skepticism.

OBJECTIVES

This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to assess the effectiveness of telemedicine and mHealth interventions in managing blood pressure in stroke patients.

METHODS

We identified randomized controlled trials (RCTs) evaluating telemedicine and mHealth technology interventions for blood pressure in patients with stroke or transient ischemic attack (TIA) from the inception date of each database up to January 2, 2024 by systematic searches of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. The Cochrane Risk of Bias tool (ROB 2.0) was used to evaluate study quality. Sources of heterogeneity were explored through Meta-regression, subgroup analyses, sensitivity analyses and publication bias assessment. Meta-analysis was performed using R 4.2.2 statistical software.

RESULTS

A total of 13 randomized controlled trials with 3803 participants were included. The meta-analysis found that telemedicine and mHealth improved control of both systolic [MD = -4.37, 95 % CI (-5.50, -3.24), I2 = 43 %, P<0.00001] and diastolic blood pressures [MD = -1.72, 95 % CI (-2.45, -0.98), I2 = 0 %, P<0.00001] in stroke patients compared to the conventional care group. Stroke patients who received telemedicine and mHealth interventions showed improved medication adherence than usual care [SMD=0.52, 95 % CI (0.03, 1.00), I2 = 90 %, P<0.00001]. Meta-regression and subgroup analyses identified several key factors influencing systolic and diastolic blood pressure control in stroke patients, including whether stroke patients have hypertension, the specific forms of telemedicine and mHealth interventions employed, the duration of these interventions, and the frequency of intervention intervals.

CONCLUSIONS

Overall, telemedicine and mHealth reduced stroke patients' systolic blood pressure by an average of 4.37 mm Hg and diastolic blood pressure by an average of 1.72 mm Hg and improved medication adherence compared with usual care. As an emerging medical model, telemedicine and mHealth intervention create a good prospect for the management of blood pressure in stroke patients in the future.

Cardiometabolic, functional, and psychosocial effects of a remotely supervised home-based exercise program in individuals with type 2 diabetes (RED study): study protocol for a randomized clinical trial

BACKGROUND

Type 2 diabetes mellitus (T2D) is a serious global health problem, and exercise is considered an essential non-pharmacological tool in T2D prevention and treatment. During periods of social isolation experienced by the COVID-19 pandemic, home-based exercise programs were strongly recommended as a strategy to facilitate exercise practice and reduce the negative impacts of social isolation. Remotely supervised exercise stands out as an easily accessible strategy after the pandemic, as it is a tool that aims to facilitate access to exercise by this population. The purpose of the RED study is to verify the effects of a remotely supervised home-based exercise program compared to a control group on cardiometabolic, functional, and psychosocial outcomes in patients with T2D.

METHODS

Participants are randomized into the control group (CG) and the intervention group (IG). Participants allocated to the CG receive recommendations for the practice of physical activity based on information from chapters of the Physical Activity Guide for the Brazilian Population, while the IG will perform a 12-week home-based exercise program supervised remotely by video call. The intervention has a weekly frequency of two sessions per week on non-consecutive days during the first 6 weeks and three sessions per week on non-consecutive days for the remaining 6 weeks. The RED study has HbA1c as the primary outcome, and the participants' cardiometabolic, functional, and psychosocial parameters are assessed at baseline (week 0) and post-intervention (week 13).

DISCUSSION

Expected results of the proposed study will provide the knowledge base of health professionals and deliver more evidence for a growing area, i.e., home-based exercise and T2D. Additionally, this protocol aims to verify and demonstrate whether this program can be accessible and effective for different health outcomes in patients with T2D.

TRIAL REGISTRATION

The RED study protocol was prospectively registered at ClinicalTrials.gov (NCT05362071). Date registered April 6, 2022. https://clinicaltrials.gov/ct2/show/NCT05362071 .

The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Fibromyalgia is a chronic pain syndrome characterized by persistent and widespread musculoskeletal pain. Telerehabilitation is a promising treatment for patients with fibromyalgia through long-term monitoring, intervention, supervision, consultation, and education.

OBJECTIVE

This study aimed to perform a comprehensive systematic review and meta-analysis of the efficacy and safety of telerehabilitation in patients with fibromyalgia.

METHODS

Randomized controlled trials (RCTs) related to fibromyalgia and telerehabilitation were systematically searched in the PubMed, PEDro, Cochrane Library, ScienceDirect, Ovid MEDLINE, Embase, and Web of Science databases from inception to November 13, 2022. Two independent researchers screened the literatures and evaluated the methodological quality using the Cochrane Risk of Bias Tool. The outcome measures included the Fibromyalgia Impact Questionnaire scale, pain intensity, depression, pain catastrophizing, quality of life (QoL), and adverse events. Pooled effect sizes were calculated by Stata SE 15.1; a fixed effects model was used when I²<50%, whereas a random effects model was used when I²≥50%.

RESULTS

A total of 14 RCTs with 1242 participants were included in this meta-analysis. The pooled results indicated that the telerehabilitation improved the Fibromyalgia Impact Questionnaire score (weighted mean difference -8.32, 95% CI -11.72 to -4.91; P<.001), pain intensity (standardized mean difference [SMD] -0.62, 95% CI -0.76 to -0.47; P<.001), depression levels (SMD -0.42, 95% CI -0.62 to -0.22; P<.001), pain catastrophizing (weighted mean difference -5.81, 95% CI -9.40 to -2.23; P=.001), and QoL (SMD 0.32, 95% CI 0.18 to 0.47; P<.001) in patients with fibromyalgia compared to control interventions. Only 1 RCT reported a mild adverse event of telerehabilitation; the other 13 RCTs did not mention this.

CONCLUSIONS

Telerehabilitation can improve the symptoms and QoL of fibromyalgia. However, the safety of telerehabilitation remains uncertain due to the lack of sufficient evidence for the management of fibromyalgia. More rigorously designed trials are needed in the future to verify the safety and efficacy of telerehabilitation in fibromyalgia.

TRIAL REGISTRATION

PROSPERO CRD42022338200; https://tinyurl.com/322keukv.

Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis

BACKGROUND

Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode.

OBJECTIVE

This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases.

METHODS

A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots.

RESULTS

A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate.

CONCLUSIONS

This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.

Technology-based and supervised exercise interventions for individuals with type 2 diabetes: Randomized controlled trial

AIMS

The purpose of this study was to estimate, for people with type 2 diabetes (T2D), the extent to which glycemic control was affected by a 12-week program using mobile app and wearable smartwatch in comparison to supervised exercise training.

METHODS

This study was a stratified, randomized, assessor-blind, controlled, pragmatic trial with three parallel groups which were supervised, mobile app and wearable smartwatch. Individually tailored exercise regimens delivered through a supervisor, mobile app and wearable smartwatch. Programs consisted of aerobic, resistance exercises, calisthenic, flexibility, balance, and coordination exercises. Primary outcome was change in glycemic control (HbA1c); secondary outcome was Six Minute Walk Test; and explanatory outcomes were exercise behaviour, muscle function, and physical capacity. The groups were contrasted for change in HbA1c and absolute reduction of ≥0.5% (Minimal Important Change). Linear and logistic regressions were used to compare the groups and generalized estimated equations were used to analyze the explanatory outcomes.

RESULTS

In total, 90 people were randomized, 6 were lost over 12 weeks, leaving 84 with outcome data. The difference in HbA1c did not differ between the supervised and the technology groups combined and between the mobile app and smartwatch group. Proportions of people achieving a clinically meaningful difference on HbA1c between the supervised and technology groups were similar (46% vs 43%) and the associated OR was 0.87 (95%CI:0.34-2.28). Within the two technology groups, proportions of people achieving a clinically meaningful difference in HbA1c were 48% in the mobile app and 38% in the smartwatch groups and the associated OR was 0.65 (95%CI:0.21-2.03). The groups did not differ on secondary and explanatory outcomes.

CONCLUSIONS

The results of our trial provide evidence that all outcomes have improved in all groups regardless of the exercise delivery method. Considering the supervised programs are not available for everybody, technological options are crucial to implement to help individuals self-manage most aspects of their diabetes.

Feasibility and acceptance of a virtual multidisciplinary care programme for patients with type 2 diabetes during the COVID-19 pandemic

BACKGROUND AND AIMS

Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients' acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors.

METHODS

The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019.

RESULTS

During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively.

CONCLUSION

The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.