Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Ministry of Health Office for Healthcare Transformation, Ministry of Health, Singapore, Singapore.
J Med Internet Res. 2023 Feb 16;25:e33185. doi: 10.2196/33185.
Chronic obstructive pulmonary disease (COPD) is a growing epidemic, with a heavy associated economic burden. Education, physical activity, and pulmonary rehabilitation programs are important aspects of the management of COPD. These interventions are commonly delivered remotely as part of telemedicine interventions. Several systematic reviews and meta-analyses have been conducted to assess the effectiveness of these interventions. However, these reviews often have conflicting conclusions.
We aim to conduct an umbrella review to critically appraise and summarize the available evidence on telemedicine interventions for the management of COPD.
In this umbrella review, the MEDLINE, Embase, PsycINFO, and Cochrane databases were searched from inception to May 2022 for systematic reviews and meta-analyses relating to telemedicine interventions for the management of COPD. We compared odds ratios, measures of quality, and heterogeneity across different outcomes.
We identified 7 systematic reviews that met the inclusion criteria. Telemedicine interventions used in these reviews were teletreatment, telemonitoring, and telesupport. Telesupport interventions significantly reduced the number of inpatient days and quality of life. Telemonitoring interventions were associated with significant reductions in respiratory exacerbations and hospitalization rates. Teletreatment showed significant effectiveness in reducing respiratory exacerbations, hospitalization rate, compliance (acceptance and dropout rate), and physical activity. Among studies that used integrated telemedicine interventions, there was a significant improvement in physical activity.
Telemedicine interventions showed noninferiority or superiority over the standard of care for the management of COPD. Telemedicine interventions should be considered as a supplement to usual methods of care for the outpatient management of COPD, with the aim of reducing the burden on health care systems.
慢性阻塞性肺疾病（COPD）是一种日益严重的流行疾病，其经济负担沉重。教育、体育活动和肺康复计划是 COPD 管理的重要方面。这些干预措施通常作为远程医疗干预的一部分远程提供。已经进行了几项系统评价和荟萃分析，以评估这些干预措施的有效性。然而，这些综述的结论往往存在冲突。
我们旨在进行伞式评价，批判性地评估和总结关于远程医疗干预 COPD 管理的现有证据。
在本次伞式评价中，从建库到 2022 年 5 月，我们检索了 MEDLINE、Embase、PsycINFO 和 Cochrane 数据库，以获取与远程医疗干预 COPD 管理相关的系统评价和荟萃分析。我们比较了不同结局的优势比、质量指标和异质性。
我们确定了 7 项符合纳入标准的系统评价。这些综述中使用的远程医疗干预措施包括远程治疗、远程监测和远程支持。远程支持干预显著减少了住院天数和生活质量。远程监测干预与呼吸恶化和住院率的显著降低相关。远程治疗在减少呼吸恶化、住院率、依从性（接受率和脱落率）和身体活动方面显示出显著的有效性。在使用综合远程医疗干预的研究中，身体活动显著改善。
远程医疗干预在 COPD 管理方面显示出非劣效性或优于标准护理。远程医疗干预应被视为 COPD 门诊管理中常规护理方法的补充，旨在减轻医疗保健系统的负担。
