Systematic review of telemonitoring in COPD: an update.
Systematic review of telemonitoring in COPD: an update.
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DOI：
10.5603/piap.2015.0077
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发表时间：
2015-01-01
影响因子：
--
通讯作者：
Lelli, Diana
中科院分区：
文献类型：
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作者：
Pedone, Claudio;Lelli, Diana
远程医疗可以支持慢性阻塞性肺疾病（COPD）患者的个人护理计划，从而有可能改善临床结果。迄今为止，没有明确的证据表明远程医疗对此类患者有益。本研究的目的是提供远程医疗在减少不良临床结果方面的有效性的最新信息。我们在 Pubmed 数据库中检索了 2005 年 1 月至 2014 年 12 月期间发表的文章。我们仅纳入专门针对 COPD 患者并采用远程医疗干预措施的随机对照试验。评估的结果包括病情加重次数、急诊室就诊次数、慢性阻塞性肺病住院次数、住院时间和死亡次数。我们最终纳入了 12 项随机对照试验。其中大多数样本量较小，质量较差，所使用的参数和技术存在很大的异质性。大多数研究报告称，远程监护对任何原因的住院治疗都有积极影响，风险降低 10% 至 63%；然而，只有三项研究达到了统计学意义。与慢性阻塞性肺病相关的入院和急诊就诊也观察到相同的趋势。远程医疗在缩短住院时间、改善生活质量和减少死亡方面没有显着效果。总之，我们的研究证实，关于远程医疗对慢性阻塞性肺病（COPD）有效性的现有证据并不能得出明确的结论；大多数证据表明远程监控对入院和急诊就诊有积极影响。需要进行更多具有足够样本量并充分考虑背景临床服务的试验才能明确确定其有效性。
Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles published between January 2005 and December 2014. We included only randomized controlled trials exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death. We eventually included 12 randomized controlled trials. Most of them had a small sample size and was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions between 10% and 63%; however only three studies reached statistical significance. The same trend was observed for COPD-related hospital admission and ER visits. No significative effects of telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing deaths. In conclusion, our study confirms that the available evidence on the effectiveness of telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size and with adequate consideration of background clinical services are needed to definitively establish its effectiveness.