Table 2 Characteristics of included studies
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 |