Jung Youjin, Kim Jimin, Park Dong Ah
National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
College of Nursing, Korea University, Seoul, Korea.
J Korean Acad Nurs. 2018 Aug;48(4):389-406. doi: 10.4040/jkan.2018.48.4.389.
This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma.
We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies.
Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.200.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.432.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence.
The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.
本综述旨在评估远程监测(TM)在儿童和青少年哮喘管理中的有效性。
我们检索了Ovid-MEDLINE、Ovid-EMBASE、CENTRAL(Cochrane对照试验中央注册库)、CINAHL(护理学与健康相关文献累积索引)以及5个国内数据库,以识别截至2017年12月发表的随机对照试验(RCT)。两名评审员独立选择相关研究,评估方法学质量并提取数据。我们对TM与常规护理进行了荟萃分析,并总结了纳入研究的干预特征。
在识别出的3095篇文章中,本综述纳入了8项RCT(9篇文章)。纳入研究的TM干预类型在各研究中有所不同(传输数据、传输频率、数据审查等)。TM组和常规护理组的合并哮喘控制评分无显著差异(标准化均数差0.04,95%置信区间(CI)-0.20至0.28)。另一项汇总分析表明,TM组和常规护理组在哮喘急性加重方面无统计学显著差异(比值比0.95,95%CI 0.43至2.09)。总体而言,这些研究的汇总结果显示,TM并未导致健康结局出现临床上的显著改善,但我们分析中的一些研究表明,TM提高了患者的药物依从性和干预依从性。
目前的证据基础并未表明TM干预与常规护理之间存在任何差异,但TM干预可能被视为为儿童和青少年哮喘患者提供自我管理支持的一种有前景的策略。需要进一步设计良好的研究来评估对临床结局的影响。