Nursing Department, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 03080, Korea.
Red Cross College of Nursing, Chung-Ang University, 84, Heuseok-ro, Dongjak-gu, Seoul 06974, Korea.
Int J Environ Res Public Health. 2021 Jun 23;18(13):6757. doi: 10.3390/ijerph18136757.
This systematic review and meta-analysis aimed to provide current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits. We systematically searched for randomised controlled trials using nine databases from August to September 2020 following the Cochrane Collaboration Guidelines. Of 2159 records identified, 22 studies involving 2906 participants met the inclusion criteria. The participants in 55% and 59% of studies had severe airflow limitations and severe exacerbation histories in the preceding year, respectively. The most commonly telemonitored data were oxygen saturation (91%) and symptoms (73%). A meta-analysis showed that telemonitoring did not reduce the number of admissions (12 studies) but decreased the number of ER visits due to severe exacerbations [7 studies combined, standardised mean difference (SMD) = -0.14; 95% confidence interval (CI): -0.28, -0.01]. Most studies reported no benefit in mortality, quality of life, or cost-effectiveness. All eight studies that surveyed participant satisfaction reported high satisfaction levels. Our review suggested that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations and that telemonitoring was well-accepted by patients with COPD and could be easily integrated into their existing care.
本系统评价和荟萃分析旨在提供有关远程监测预防 COPD 恶化的有效性的最新证据，重点关注需要住院或急诊（ER）就诊的严重恶化。我们按照 Cochrane 协作组的指南，从 2020 年 8 月至 9 月使用九个数据库系统地搜索了随机对照试验。在 2159 条记录中，有 22 项研究符合纳入标准，涉及 2906 名参与者。55%和 59%的研究参与者分别在前一年有严重气流受限和严重恶化史。最常远程监测的数据是血氧饱和度（91%）和症状（73%）。荟萃分析显示，远程监测并没有减少住院人数（12 项研究），但减少了因严重恶化而导致的急诊就诊次数[7 项研究合并，标准化均数差（SMD）=-0.14；95%置信区间（CI）：-0.28，-0.01]。大多数研究报告称死亡率、生活质量或成本效益没有改善。调查参与者满意度的八项研究均报告了高满意度。我们的综述表明，将远程监测添加到常规护理中可以减少不必要的急诊就诊次数，但不太可能预防因 COPD 恶化导致的住院治疗，而且 COPD 患者对远程监测的接受程度较高，并且可以很容易地整合到他们现有的护理中。
