Do telemedical interventions improve quality of life in patients with COPD? A systematic review

Figures & data

Figure 1 Selection process.

Abbreviation: QoL, quality of life.

Table 1 Characteristics of studies (100+ patients for evaluation) investigating the effect of telehealth care interventions on quality of life in patients with COPD

Study	Type of study	No of patients	Types of telehealth intervention	Type of control	Mode of outcome measurement	Statistically significant group differences regarding QoL
McDowell et al^Citation9	Two-center, randomized controlled trial	110	Standardized home-based program + telemonitoring via home telehealth device Telemonitoring: daily clinical observations (blood pressure, heart rate, and oxygen saturation) and questions related to symptoms (difficulty in breathing, cough, sputum, and tiredness). Daily data reviewed within 10 minutes for signs of deterioration; if alert, contact to the patient. Also contact to the patient every week if no alerts.	Standardized home-based program Standard care: at least two home visits by physiotherapist and nurse for disease-specific education, including signs of exacerbation. Contact to respiratory team in case of exacerbation, and, if managed at home, close monitoring by the respiratory team. All patients offered rehabilitation or access to weekly maintenance exercise class.	SGRQ EuroQol-5D HADS	SGRQ (total and subscores), in favor of telehealth HADS (anxiety score), in favor of telehealth
Blumenthal et al^Citation3	Dual-site, randomized clinical trial	298	Cognitive-behavioral coping skills training Coping skills training: instruction in cognitive-behavioral coping skills to patients and partners over the telephone (14 sessions over 16 weeks). The program included four components: 1) education about stress and pulmonary health, 2) training in a variety of coping skills, 3) promotion of physical activity, and 4) maintenance and generalization.	Usual care and COPD education Usual care and COPD education: usual care through their local physician together with COPD education over the telephone (14 sessions).	Beck Depression Inventory-II State-Trait Anxiety Inventory-State SF-36 Pulmonary Quality of Life Scale UCSD Shortness of Breath Questionnaire Brief Fatigue Inventory SGRQ	“Psychological” QoL (anxiety, overall mental health, emotional role functioning, and social functioning), in favor of Telehealth “Somatic” QoL (fatigue and shortness of breath), in favor of telehealth
Pinnock et al^Citation10	Researcher-blinded, multicenter, randomized controlled trial	205	Usual clinical care + telemonitoring (touch screen) Telemonitoring: daily questionnaire about symptoms and use of treatment, self-assessment if symptoms had increased, symptoms of upper respiratory tract infection, or fever. Online data monitored daily and contact to patient if alert occurred.	Usual clinical care Usual clinical care: provided according to local service model, including education on self-management.	SGRQ HADS SECD6	None
Walters et al^Citation11	Cluster randomized controlled trial	154	Health mentoring Health mentoring: health mentor telephone calls (16 sessions of 30 minutes over 12 months) based on the following core components: 1) psychoeducation, 2) self-management skills training, 3) cognitive coping skills training, 4) communication skills, and 5) promotion of self-efficacy to manage chronic illness. Individualized action plans to reach goals were specified by participants in negotiation with the health mentor during phone calls.	Usual care Usual care: usual care provided by a GP plus regular monthly phone calls from a research nurse.	SF-36 SGRQ HADS	None
Stickland et al^Citation12	Parallel-group, noninferiority trial	135	Telehealth pulmonary rehabilitation via video link Telehealth pulmonary rehabilitation: video conference from their local hospital with a pulmonologist for assessment. Patients attended the telehealth pulmonary rehabilitation twice a week for 8 weeks within their local community. Program identical to standard pulmonary rehabilitation, although in smaller groups.	Standard pulmonary rehabilitation Standard pulmonary rehabilitation: two sessions per week for 8 weeks of group exercise for 2 hours and group education for 1 hour, supervised by a respiratory therapist.	–SGRQ	None
Trappenburg et al^Citation13	Multicenter, nonrandomized controlled study	115	Telemonitoring via home telehealth device + standard care Telemonitoring: daily personalized questionnaire that monitored their disease symptoms, medication compliance, and knowledge of their disease. Daily responses sent by patients were automatically categorized and prioritized (color coding). Telemonitoring was provided by respiratory nurses who reviewed patient answers Monday to Friday. In case of alarming values, the patients were contacted by the respiratory nurse.	Standard care Standard care: patients had usual access to their pulmonary physician, GP, and respiratory nurse.	CCQ	None

Abbreviations: QoL, quality of life; SGRQ, St George’s Respiratory Questionnaire; EuroQol-5D, EuroQol 5 Dimensions Questionnaire; HADS, Hospital Anxiety and Depression Scale; SF-36, Short Form 36; SECD6, Self-Efficacy for Managing Chronic Disease 6-Item Scale; GP, general practitioner; CCQ, Clinical COPD Questionnaire; UCSD, University of California, San Diego.

Table 2 Characteristics of studies (>100 patients for evaluation) investigating the effect of telehealth care interventions on quality of life in patients with COPD

Study	Type of study	No of patients	Type of telehealth intervention	Type of control	Mode of outcome measurement	Statistically significant group differences regarding QoL
Jakobsen et al^Citation14	Two-center, noninferiority, randomized controlled trial	57	Home-based telehealth hospitalization for exacerbation of COPD Home-based telehealth hospitalization: patients transported home within the first 24 hours with a touch screen with a webcam, pulse oximeter, spirometer, thermometer, nebulizer for bronchodilators, oxygen compressor, and a medicine box (antibiotics, prednisone, sedative, beta2-agonist, and anticholinergics); equipment kept until discharge. Daily ward rounds via touch screen with webcam and vital signs measuring functions. Unscheduled and acute contacts could always be effectuated 24/7 by the patient pressing the “call hospital” button on the touch screen.	Standard hospital care Standard care: standard hospital treatment for exacerbation of COPD.	SGRQ CCQ EuroQol-5D	None
Berkhof et al^Citation15	Single-center prospective randomized controlled trial	95	Telemedicine by phone Telemedicine: regular outpatient visit by pulmonologist at baseline and after 6 months. Patients contacted (by a nurse from the medical center) every 2 weeks by phone. The structured phone call included a short validated health status questionnaire (CCQ). The scores were recorded in a database, and if change from previous scores exceeded the minimal clinical important difference, pulmonologists were notified immediately to contact the patient. The pulmonologist then inquired about signs and symptoms of exacerbation.	Standard care Standard care: regular outpatient visit by pulmonologist at baseline and after 6 months; and interim outpatient visits planned at 2 months and 4 months with a pulmonary nurse.	CCQ SGRQ SF-36	None
Paneroni et al^Citation16	Multicenter, prospective, controlled, nonrandomized pilot study	36	Home-based telerehabilitation Telerehabilitation: telerehabilitation platform with activity list, telemonitoring (physiological parameters), and video assistance. Setup as for standardized outpatient rehabilitation according to guidelines. Twenty-eight sessions (100 minutes) over 40 days. Exercises performed once daily, with information on symptoms and oxygen saturation before and after exercise. Rehabilitation tutor contacted patients by phone or videoconference for collection of data and supervision. In case of severe complications, patients had access to a pulmonologist or emergency department.	Standard outpatient rehabilitation Control group: retrospectively identified from the database of patients (also nonnaïve to rehabilitation) referred for rehabilitation.	SGRQ	None
de San Miguel et al^Citation17	Randomized controlled trial	71	Telemonitoring via telehealth device Telehealth remote monitoring group: the telehealth nurse installed the telehealth equipment and trained the participants in its use and also provided them with an educational book about COPD. Participants performed daily measurements of vital signs (blood pressure, weight, temperature, pulse, and oxygen saturation) and answered questions related to their general state of health. Data transmitted automatically via telephone and monitored daily by the telehealth nurse. Any deviation outside the participant’s predefined normal parameters triggered an alert, and a phone call from the telehealth nurse for further evaluation.	Standard care Standard care: visited by the telehealth nurse, provided with the educational book about COPD. No further contact apart from data collection.	CRQ-SAS	None
Schou et al^Citation18	Randomized clinical trial	40/38	Telemonitoring and ward rounds via video call Home-based telehealth hospitalization: patients admitted for exacerbation provided with a touch screen with a webcam, pulse oximeter, spirometer, thermometer, nebulizer for bronchodilators, oxygen compressor, and a medicine box (antibiotics, prednisone, sedative, beta2-agonist, and anticholinergics); equipment kept until discharge. Daily ward rounds via touch screen with webcam and vital signs measuring functions.	Standard hospital care Usual care: standard hospital treatment for exacerbation of COPD.	SGRQ HADS	None
Jódar-Sánchez et al^Citation19	Randomized controlled trial	45	Telemonitoring via telehealth device Telemedicine: vital signs (oxygen saturation, heart rate, blood pressure, and lung function) measured on weekdays and uploaded to clinical call center and managed by nurses using a triage application. Red alerts triggered contact to the patient (for verification and further information) and escalation of information to the case manager for evaluation and clinical response (actions to be taken).	Standard care Usual care: conventional medical care.	SGRQ EuroQol-5D	None
Antoniades et al^Citation20	Randomized pilot study	36	Telemonitoring via telehealth device Telemonitoring: laptop computer with digitally integrated blood pressure cuff, pulse oximeter, pneumotachograph (for spirometry), electrocardiograph touch plate, thermometer, and scale. Measurements of vital signs, including spirometry and questionnaires about symptoms and medication usage uploaded daily and reviewed 5 days weekly by a study nurse; if an alert occurred, further action was taken by the study nurse. Throughout the study, access to a nurse outreach via telephone if they felt unwell.	Control group Standard best practice care: clinical management according to guidelines, written action plan and availability of pulmonary rehabilitation. Throughout the study, access to a nurse outreach via telephone if they felt unwell.	SF-36 CRDQ	None
Chau et al^Citation21	Single-center, randomized, nonblinded, parallel-group study	40	Home education + telemonitoring via telehealth device Telecare service: home visit with education in self-care and symptom management techniques by community nurse. Patients measured oxygen saturation, pulse rate, and respiration rate 3 times daily from Monday to Friday. Data sent to patients’ personal health database for recording and monitoring by a community nurse.	Control group Home education: home visit by community nurse offering education on self-care and symptom management techniques.	CRQ	None
Sicotte et al^Citation22	Quasiexperimental retrospective and prospective study	44	Telemonitoring via telehealth device Telemonitoring: daily use of web phone with a touch screen monitor for entering data on symptoms, health status, and treatment compliance. In case of alerts, based on predetermined parameters, patients were provided with advice tailored to changes in their condition; warning messages also sent to surveillance center (operating 24/7), and patient contacted by the nursing staff by telephone for further evaluation.	Control group Standard care: care according to guidelines (matched controls).	MOS-SF12	None
Halpin et al^Citation23	Prospective randomized controlled trial	77	Phone calls Health forecasting system: alert calls (every Tuesday) from the automated system in case of elevated risk of exacerbation; call act as a reminder for patients to follow previous advice related to exacerbation and ensure they have sufficient medication. The response to a subset of diary items on symptoms was used as a trigger to contact the patient to determine if an exacerbation was starting.	Standard care Standard care: usual care and information of the forecasting system.	SGRQ	None
Lewis et al^Citation24	Randomized controlled trial	40	Telemonitoring via telehealth device Telemonitoring: standard care and handheld telemonitor. Patients answered questions about their condition twice daily and recorded temperature and oxygen saturation. Alerts managed by the Chronic Disease Management Team and observations copied to the hospital respiratory nurses.	Standard care Standard care: usual acre and contact to the Chronic Disease Management Team.	SGRQ HADS EuroQol-5D	None
Koff et al^Citation25	Single-center, randomized, controlled clinic trial	38	COPD education and telemonitoring via telehealth device Proactive integrated care: a 3-month period with the following interventions: 1) disease-specific education, 2) teaching of self-management techniques, 3) enhanced communication with study coordinators, and 4) remote home monitoring (Monday to Friday for change in symptoms, oxygen saturation, FEV1 and steps in 6-minute walk distance). Every weekday, 20-minute morning session with COPD education, questions about symptoms and enter data. Alerts managed by coordinator, if necessary referral to GP.	Standard care Usual care: managed as usual by their GP.	SGRQ	SGRQ (total score), in favor of telehealth

Abbreviations: QoL, quality of life; SGRQ, St George’s Respiratory Questionnaire; CCQ, Clinical COPD Questionnaire; EuroQol-5D, EuroQol 5 Dimensions Questionnaire; SF-36, Short Form 36; CRQ-SAS, Chronic Respiratory Disease Questionnaire, Self-Administered Standardized; HADS, Hospital Anxiety and Depression Scale; MOS-SF12, Medical Outcome Study, Short Form 12 Items Scale; GP, general practitioner.

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