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Meta-Analysis
. 2022 Nov 3;24(11):e35508.
doi: 10.2196/35508.

Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis

Donato Giuseppe Leo  1   2 , Benjamin J R Buckley  1   2 , Mahin Chowdhury  3 , Stephanie L Harrison  1   2 , Masoud Isanejad  4 , Gregory Y H Lip  1   2 , David J Wright  2 , Deirdre A Lane  1   2 ; TAILOR investigators  5
Collaborators, Affiliations
Meta-Analysis

Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis

Donato Giuseppe Leo et al. J Med Internet Res. .

Abstract

Background: Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients' acceptability of this technology and their rate of uptake.

Objective: The aim of this study was to systematically review the current evidence on telemonitoring in the management of patients with long-term conditions and evaluate the patients' uptake and acceptability of this technology.

Methods: MEDLINE, Scopus, and CENTRAL (the Cochrane Central Register of Controlled Trials) were searched from the date of inception to February 5, 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: intervention uptake and adherence; study retention; patient acceptability, satisfaction, and experience using the intervention; changes in physiological values; all-cause and cardiovascular-related hospitalization; all-cause and disease-specific mortality; patient-reported outcome measures; and quality of life. In total, 2 reviewers independently assessed the articles for eligibility.

Results: A total of 96 studies were included, and 58 (60%) were pooled for the meta-analyses. Meta-analyses showed a reduction in mortality (risk ratio=0.71, 95% CI 0.56-0.89; P=.003; I2=0%) and improvements in blood pressure (mean difference [MD]=-3.85 mm Hg, 95% CI -7.03 to -0.68; P=.02; I2=100%) and glycated hemoglobin (MD=-0.33, 95% CI -0.57 to -0.09; P=.008; I2=99%) but no significant improvements in quality of life (MD=1.45, 95% CI -0.10 to 3; P=.07; I2=80%) and an increased risk of hospitalization (risk ratio=1.02, 95% CI 0.85-1.23; P=.81; I2=79%) with telemonitoring compared with usual care. A total of 12% (12/96) of the studies reported adherence outcomes, and 9% (9/96) reported on satisfaction and acceptance outcomes; however, heterogeneity in the assessment methods meant that a meta-analysis could not be performed.

Conclusions: Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalization rates and a lack of positive impact on patients' quality of life.

Trial registration: PROSPERO CRD42021236291; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236291.

Keywords: chronic condition; eHealth; meta-analysis; self-monitoring; systematic review; telemedicine; telemonitoring.

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Conflict of interest statement

Conflicts of Interest: BJRB has received research funding from the Bristol Myers Squibb (BMS)-Pfizer Alliance. SLH has received an investigator-initiated grant from BMS. GYHL has been a consultant and speaker for the BMS-Pfizer Alliance, Boehringer Ingelheim, and Daiichi-Sankyo. No fees were received personally. DJW has been a consultant and speaker for Medtronic and Boston Scientific. DAL has received investigator-initiated educational grants from BMS; been a speaker for Boehringer Ingelheim, Bayer, and the BMS-Pfizer Alliance; and consulted for Boehringer Ingelheim, Bayer, and the BMS-Pfizer Alliance, all outside the submitted work.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram depicting the screening and study selection process.
Figure 2
Figure 2
Impact of telemonitoring versus comparator on quality of life (QoL). 1.9.1: EQ-5D; 1.9.2: Minnesota Living with Heart Failure Questionnaire (MLHFQ); 1.9.3: SF-36 mental score; and 1.9.4: SF-36 physical component [15,31,35,47,96,101,104,136].
Figure 3
Figure 3
Impact of telemonitoring versus comparator on the mortality rate at 6 and 12 months. The study by Mortara et al [80] was not included in the mortality meta-analyses because of the use of a composite outcome of mortality and hospitalization where absolute mortality results were not available. The study by Seto et al [92] was not included in the mortality meta-analyses because of 0 events in the control group [15,39,40,50,60,64,84,96,101,105,107].
Figure 4
Figure 4
Impact of telemonitoring versus comparator on hospitalization at 6 and 12 months [23,25,34,52,80,83].
Figure 5
Figure 5
Impact of telemonitoring versus usual care on changes in systolic blood pressure (mean difference) at the longest study time point and at 6 months [15,17,24,38,45,62,72,75,77,90].
See this image and copyright information in PMC

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