Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

Background: Chronic obstructive pulmonary disease is a major burden on healthcare systems worldwide. Tele-monitoring has recently been used for management of chronic obstructive pulmonary disease patients. Objectives: We analyzed the effect of tele-monitoring on chronic obstructive pulmonary disease patients and performed subgroup analysis by patient severity and intervention type. Design: Systematic review. Data source: Electronic databases including Ovid-Medline, Ovid-Embase, and the Cochrane Library. Review methods: We conducted a meta-analysis of randomized controlled trials published up to April 2017. Three databases were searched, two investigators independently extracted data and assessed study quality using risk of bias. Results: Out of 1,185 studies, 27articles were identified to be relevant for this study. The included studies were divided by intervention: 15studies used tele-monitoring only, 4studies used integrated telemonitoring (pure control), and 8studies used integrated tele-monitoring (not pure control). We also divided the studies by patient severity: 16studies included severely ill patients, 8studies included moderately ill patients, and 3studies did not discuss the severity of the patients' illness. Meta-analysis showed that tele-monitoring reduced the emergency room visits (risk ratio 0.63, 95% confidence interval 0.55-0.72) and hospitalizations (risk ratio 0.88, 95% confidence interval 0.80-0.97). The subgroup analysis of patient severity showed that tele-monitoring more effectively reduced emergency room visits in patients with severe vs. moderate disease (risk ratio 0.48, 95% confidence interval 0.31-0.74; risk ratio 1.28, 95% confidence interval 0.61-2.69, retrospectively) and hospitalizations (risk ratio 0.92, 95% confidence interval 0.82-1.02; risk ratio 1.24, 95% confidence interval 0.57-2.70, retrospectively). The mental health quality of life score (mean difference 3.06, 95% confidence interval 2.15-3.98) showed more improved quality of life than the physical health quality of life score (mean difference-0.11, 95% confidence interval-0.83-0.61). Conclusions: Tele-monitoring reduced rates of emergency room visits and hospitalizations and improved the mental health quality of life score. Integrated tele-monitoring including the delivery of coping skills or education by online methods including pulmonary rehabilitation is recommended to produce significant improvement. This application of integrated tele-monitoring (the delivery of education, exercise etc. in addition to tele-monitoring) is more useful for patients with (very) severe chronic obstructive pulmonary disease than those with moderate disease. Tele-monitoring might be a useful application of information and communication technologies, if the intervention includes the appropriate intervention components for eligible patients. Further studies such as large size randomized controlled trials with sub-group by patient severity and intervention type is needed to confirm these finding. (C) 2018 Published by Elsevier Ltd.