Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving personalised health care over a distance, is seen as having the potential to improve care for people with COPD.

Aim: To systematically review the effectiveness of telehealthcare interventions in COPD to improve clinical and process outcomes.

Design and setting: Cochrane Systematic Review of randomised controlled trials.

Methods: The study involved searching the Cochrane Airways Group Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE, embase, and CINAHL, as well as searching registers of ongoing and unpublished trials. Randomised controlled trials comparing a telehealthcare intervention with a control intervention in people with a clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk of emergency department visit, hospitalisation, and death. Two authors independently selected trials for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration's risk of bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling.

Results: Ten randomised controlled trials were included. Telehealthcare did not improve COPD quality of life: mean difference -6.57 (95% confidence interval [CI] = -13.62 to 0.48). However, there was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27; 95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75).

Conclusion: In COPD, telehealthcare interventions can significantly reduce the risk of emergency department attendance and hospitalisation, but has little effect on the risk of death.

Figures

Figure 1

PRISMA flow diagram showing selection of studies.

Figure 2

Mean difference between groups at end of 12 months according to St George’s Respiratory Questionnaire for COPD-related quality of life. Random effects analysis.

Figure 3

Numbers of patients with one or more visits each to the emergency dept over 12 month period of study. Random effects analysis. M-H = Mantel Haenszel odds ratio.

Figure 4

Number of patients with one or more hospitalisations over 12 months. Fixed effects analysis. M-H = Mantel Haenszel odds ratio.

Figure 5

Deaths over 12 months in the control group and telehealthcare group of the studies. Fixed effects analysis. M-H = Mantel Haenszel odds ratio.