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Table 2 Characteristics of included studies

From: Effectiveness of remote home monitoring for patients with Chronic Obstructive Pulmonary Disease (COPD): systematic review

Study
(country)
Study period
(Design)
Study objective Eligibility criteria Number of centres Number of participants Follow-up Outcomes
RHM (smartphones, apps, tablets) vs no RHM
  Park 2020
(South Korea) [19]
Mar 2016- Jun 2018
(RCT)
To examine the effect of a smartphone app-based, self-management program on self-care behavior Inclusion criteria:
• Age ≥ 45 years old
• Mild, moderate or severe COPD
• Had a smartphone and could text messages
• Able to communicate
Exclusion criteria:
• Psychiatric disorder
• COPD-related hospitalization in the last 2 months
• Exacerbation
• Oxygen saturation < 93% in a stable state or < 85% after a six minute walk test
• Severe respiratory symptoms in a stable state
• Attended PR in the previous year
• Other diseases that made physical activity and/or exercise difficult
• Use of assistive devices to walk or problems with balance
Multiple centres RHM: 23
no RHM: 21
6 months • Adherence
• ER visits
• Exacerbations
• Exercise capacity and activity levels
• Health-related quality of life
• Hospital admissions
• Lung function and other symptoms
• Mental health
• Patient experience
• Safety
• Self-efficacy
• Visits to physician
  Boer 2019
(Netherlands) [20]
Jun 2015- Jul 2016
(RCT)
To examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations Inclusion criteria:
• Age ≥ 40 years old
• Spirometry-confirmed diagnosis of COPD (FEV1/FEVC < 70%)
• 2 or more exacerbations in the last year
• Had experienced 2 or more symptom-based exacerbations
Exclusion criteria:
• Severe comorbid conditions that prohibited safe participation
• Insufficient knowledge of the Dutch language
• Persisting difficulties in using the mHealth system after a 2-week practice period and additional assistance
Multiple centres RHM: 43
no RHM: 44
12 months • Adherence
• Exacerbations
• Health-related quality of life
• Hospital admissions
• Lung function and other symptoms
• Mortality
• Patient experience
• Self-efficacy
• Visits to physician
  Walker 2018
(Spain, UK, Slovenia, Estonia, Sweden) [21]
Oct 2013- Apr 2016
(RCT)
To evaluate the effectiveness of remote monitoring in reducing healthcare utilization Inclusion criteria:
• Age ≥ 60 years old
• Moderate to very severe diagnosis of COPD
• Acute exacerbation with or without hospitalization in the previous year
• Smoking history of ≥ 10 pack-years
• One or more chronic conditions (congestive heart failure, ischemic heart disease, hypertension, hyperlipidemia and clinically significant sleep-disordered breathing)
• Clinically stable, with at least 4 weeks since the last exacerbation
Exclusion criteria:
• Significant visual disturbance or mental health disorders
• Planned prolonged absence from home
• Living in areas not covered by a mobile data network
• Unable to use the study equipment
Multiple centres RHM: 154
no RHM: 158
9 months • Adherence
• Cost
• Exacerbations
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Mental health
• Mortality
  Tabak 2014a
(Netherlands) [22]
Dec 2011- Jul 2013
(RCT)
To investigate the satisfaction and use of telehealth in patients with COPD Inclusion criteria:
• Age > 40 years old
• Diagnosis of COPD based on the GOLD criteria
• Internet access at home
• Able to understand Dutch
Exclusion criteria:
• Age < 75 years old
• Exacerbation in the previous month
• Three or more exacerbations in the previous two years
• One hospitalization for respiratory problems in the previous two years
• Serious disease with low survival rates
• Other diseases influencing bronchial symptoms and/or lung function (e.g., cardiac insufficiency, sarcoidosis)
• Severe psychiatric illness
• Uncontrolled diabetes mellitus
Multiple centres RHM: 15
no RHM: 14
9 months • Adherence
• ER visits
• Exacerbations
• Exercise capacity and activity levels
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Lung function and other symptoms
• Patient experience
  Tabak 2014b
(Netherlands) [23]
Oct 2010- Apr 2011
(RCT)
To assess the effectiveness of telerehabilitation in patients with COPD Inclusion criteria:
• Current or former smoker
• Able to read and speak Dutch
• Internet access at home
Exclusion criteria:
• Infection or exacerbation in the previous month
• Impaired hand function causing inability to use the intervention
• Disorders or progressive disease seriously influencing daily activities (e.g. amputation)
• Other diseases influencing bronchial symptoms and/or lung function (e.g. sarcoidosis)
• Regular oxygen therapy (> 16 h per day or pO2 < 7.2 kPa)
• Asthma
• Attended physiotherapy in the last six weeks
NR RHM: 18
no RHM: 16
1 month • Adherence
• Exercise capacity and activity levels
• Health-related quality of life
• Lung function and other symptoms
RHM (dedicated monitoring devices) vs no RHM
  Shany 2017
(Australia) [24]
Mar 2009- Oct 2010
(RCT)
To investigate the effects of home tele monitoring in patients with severe COPD Inclusion criteria:
• At least one hospital admission for an exacerbation in the last year
Exclusion criteria:
• Insufficient English fluency
• Motor deficits that might prevent the use of the telehealth
• Cognitive impairment
• Participation in another trial
• No landline phone connection at home
Single centre RHM: 21
no RHM: 21
12 months • Adherence
• Cost
• ER visits
• Hospital admissions
• Length of hospitalization
• Mental health
• Mortality
• Patient experience
• Provider experience
  Vianello 2016
(Italy) [25]
Nov 2011- May 2014
(RCT)
To investigate the benefits of a telemonitoring system in managing acute exacerbation advanced-stage COPD patients Inclusion criteria:
• Age ≥ 18 years old
• Severe to very severe diagnosis of COPD
• Life expectancy > 12 months
• Capability of using, alone or assisted, the intervention
Exclusion criteria:
• Concomitant significant lung disease
• Negative advice of the GP
• Serious social problems, including lack of adequate family support and/or other social support networks
Multiple centres RHM: 230
no RHM: 104
12 months • Adherence
• ER visits
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Mental health
• Mortality
• Visits to physician
  Segrelles 2014
(Spain) [26]
Jan 2010- Jul 2011
(RCT)
To assess the efficacy and effectiveness of a home telehealth program for COPD patients with severe airflow obstruction Inclusion criteria:
• Age ≥ 50 years old
• Severe to very severe diagnosis of COPD (FEV1 < 50% predicted, FEV1/FVC ratio < 70%)
• Long-term home oxygen therapy
Exclusion criteria:
• Current smoker
• Enrolled in a palliative care program
• Institutionalized or at risk of social exclusion
• Unable to understand all procedures
Multiple centres RHM: 30
no RHM: 30
7 months • Adherence
• ER visits
• Hospital admissions
• Length of hospitalization
• Mortality
  De San Miguel 2013
(Australia) [27]
NR
(RCT)
To understand the impact of telehealth monitoring for COPD patients on health service utilization and cost-effectiveness Inclusion criteria:
• Diagnosis of COPD
• Use of home oxygen therapy
• Able to speak English
Exclusion criteria:
• Dementia
• Palliative care
• No telephone landline
• Unable to use telehealth equipment due to cognitive impairment or physical disability
Single centre RHM: 40
no RHM: 40
6 months • Cost
• ER visits
• Health-related quality of life
• Hospital admission
• Length of hospitalization
• Patient experience
• Visits to physician
  Jehn 2013
(Germany) [28]
Jan 2012- Jan 2013
(RCT)
To determine if the use of home monitoring reduces risk of exacerbations due to changes in the weather Inclusion criteria:
• Age ≥ 40 years old
• Moderate to very severe diagnosis of COPD (FEV1 < 80% predicted and FEV1/FVC ratio < 70%)
• At least one exacerbation in the previous year
• Clinically stable for the last month
Exclusion criteria:
• Asthma
• Long-term oxygen therapy
• Severe heart, liver or kidney disease
• Any end stage malignant disease with life expectancy of less than six months
• Listed for a lung transplant
• Severe depression
• Residents in nursing home
• Physical disabilities limiting them from performing six minute walk tests
• Mentally disabled
Single centre RHM: 32
no RHM: 30
9 months • Adherence
• Exacerbations
• Exercise capacity and activity levels
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Lung function and other symptoms
• Visits to physician
  Jodar-Sanchez 2013
(Spain) [29]
Sep 2010- May 2011
(RCT)
To analyze the effectiveness of a telehealth programme in patients with advanced COPD Inclusion criteria:
• Adult
• Diagnosis of COPD
• Long-term oxygen therapy
• At least one hospitalisation for respiratory illness in the previous year
• Clinically stable during the previous three months
Exclusion criteria:
• No home telephone line
Single centre RHM: 24
no RHM: 21
4 months • Adherence
• ER visits
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Mortality
• Patient experience
• Provider experience
• Visits to physician
  Pare 2013
(Canada) [30]
Sep 2010- Oct 2011
(RCT)
To assess the effectiveness of home monitoring in reducing costs associated with managing COPD Inclusion criteria:
• Very serious COPD requiring frequent home visits (FEV1 < 45% predicted)
• At least one hospitalization in the previous year
• Willingness to manage their health status (with or without an informal caregiver)
• Able to communicate in English or French
• An operational telephone line at the home
Exclusion criteria:
• Suffered from psychological or psychiatric problems
• Cognitive deficit
• Visual or motor deficit that would unable the use of the intervention unless an informal caregiver agreed to assist
Multiple centres RHM: 60
no RHM: 60
Pre-phase: 12 months
Post phase: 12 months
• Cost
• ER visits
• Hospital admissions
• Length of hospitalization
• Patient experience
  Chau 2012
(Hong Kong) [31]
2010- NR
(RCT)
To examine user satisfaction and effectiveness of telecare services in patients with COPD Inclusion criteria:
• Age ≥ 60 years old
• Moderate or severe COPD
• At least one hospital admission due to exacerbation in the previous year
Exclusion criteria:
• Impaired cognitive function
• Illiterate
• Hearing problems
• Unable to operate the telecare device
Single centre RHM: 30
no RHM: 23
Mean
RHM: 65.18 days
no RHM: 68.44 days
• Adherence
• ER visits
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Lung function and other symptoms
• Patient experience
  Dinesen 2012
(Denmark) [32]
NR
(RCT)
To test whether preventive home monitoring in COPD reduced the admission rate to hospital and the cost of hospitalization Inclusion criteria:
• Age > 18 years old
• Diagnosis of severe or very severe COPD
• Able to understand oral and written information
Exclusion criteria:
• Heart disease that could limit physical activity
• Mental illness
• Terminal malignancy disease
• Severe rheumatoid arthritis
• Pregnancy
Multiple centres RHM: 60
no RHM: 51
10 months • Adherence
• Cost
• Hospital admissions
  Lewis 2010
(UK) [33]
Nov 2007 – Mar 2009
(RCT)
To determine if telemonitoring in stable, and optimized COPD patients affects their health care utilization Inclusion criteria:
• Diagnosis of moderate to severe COPD
• Completed at least 12 out of 18 sessions of outpatient PR
• Have a GP
• Have a standard telephone line
Exclusion criteria:
• Chronic asthma and interstitial lung disease
• Unstable cardiac disease
• Cognitive impairments
• Other medical conditions that would unable the use of the intervention
• Living in nursing or residential institution
• Participation in any investigational drug trial in the last month
• Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study
Single centre RHM: 20
no RHM: 20
12 months • Adherence
• ER visits
• Health-related quality of life
• Hospital admissions
• Length of hospitalization
• Mental health
• Mortality
• Patient experience
• Visit to physician
  Au 2015
(USA) [34]
2006- 2007
(Observational)
To examine the effects of telemonitoring on resource use among Medicare patients with COPD Inclusion criteria:
• At least a diagnosis of COPD, congestive heart failure, or diabetes mellitus
Exclusion criteria:
• Comorbidities such as dementia or blindness that would limit interaction with the program
Multiple centre RHM: 619
no RHM: 619
3 years • Adherence
• ER visits
• Exacerbations
• Hospital admissions
• Length of hospitalization
  Davis 2015
(USA) [35]
Oct 2010- Aug 2012
(Retrospective study)
To determine feasibility of a transitional care program that integrated mobile health technology and home visits for underserved COPD and HF patients Inclusion criteria:
• Diagnosis of COPD or HF
• Underserved
• Able to speak English or Spanish
• US residence
• Independent in their own care or with reliable caregiver
Exclusion criteria:
• End-stage COPD or HF
• Hospice candidate
• Cancer
• Pulmonary fibrosis
• On dialysis
• Discharged to a setting other than home
Multiple centres RHM: 58
no RHM: 174
3 months • Adherence
• ER visits
• Health-related quality of life
• Mortality
• Patient experience
RHM with feedback (phone calls, text messages) vs RHM with no feedback
  Sink 2018 [39]
(USA)
Jan 2016- Dec 2016
(RCT)
To study the effect of an automated telemedicine intervention on patients’ time-to-hospitalization Inclusion criteria:
• Diagnosis of COPD
• Age > 18 years old
• Willingness to provide a telephone number at which they can receive text messages or voice phone messages
Exclusion criteria:
• Intention to transfer care away from the clinic
Single centre RHM: 83
no RHM: 85
8 months • Adherence
• Hospital admissions
  Franke 2016
(Germany) [37]
Sep 2012- Mar 2015
(RCT)
The primary aim was to compare daily exercise times in patients with stable COPD, either with or without supporting phone calls Inclusion criteria:
• Moderate to very severe diagnosis of COPD
Exclusion criteria:
• Malignancy
• Symptomatic cardiac disease
Single centre Total: 53a 6 months • Adherence
• Exercise capacity and activity levels
• Health-related quality of life
  1. Notes: Tabak 2014a [22] and Tabak 2014b [23] used the same exercise monitoring device and smartphone technology. De San Miguel 2013  [27] and Lewis 2010 [33] used the same telemonitoring device. Segrelles 2014 [26] and Jodar-Sanchez 2013 [29] used the same devices to collect vital signs measures and modem technology to transmit collected measurements
  2. a Cross-over randomized trial
  3. COPD Chronic obstructive pulmonary disease, FEV1 Forced expiratory volume in one second, FVC Forced vital capacity, GP General practitioner, HF Heart failure, PR Pulmonary rehabilitation, RCT Randomized controlled trial, RHM Remote home monitoring