Telestroke, tele-oncology and teledialysis: a systematic review to analyse the outcomes of active therapies delivered with telemedicine support

We conducted a systematic review of studies involving telemedicine supervision of active treatment for rural patients in the fields of stroke, medical oncology and nephrology. Searches were performed on the MEDLINE, CINAHL and INFORMIT databases. A total of 521 articles were found, and an additional 42 articles were identified by searching the reference lists. After removing duplicates, screening the abstracts and assessing the full text of the articles, 14 articles remained. Nine concerned telestroke, two concerned tele-oncology and three concerned teledialysis. Most studies did not undertake randomisation, allocation concealment or selective outcome reporting making their risk of bias high. There were no randomised controlled trials and most sample sizes were small. Observational studies in telestroke showed favourable outcomes when comparing face-to-face and videoconferencing-assisted thrombolysis, with no significant differences between survival and intracerebral bleeds. Although tele-oncology has been used routinely for more than 20 years, there have been few formal studies. Home dialysis supervised through videoconferencing had similar patient outcomes compared to hospital dialysis. Telemedicine supervision of active treatment for rural patients appears promising, but more rigorous studies of effectiveness, feasibility and safety are required.