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      Telehealth for patients with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis protocol

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          Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease characterised by persistent respiratory symptoms. A focus of COPD interventional studies is directed towards prevention of exacerbations leading to hospital readmissions. Telehealth as a method of remote patient monitoring and care delivery may be implemented to reduce hospital readmissions and improve self-management of disease. Prior reviews have not systematically assessed the efficacies of various telehealth functionalities in patients with COPD at different stages of disease severity. We aim to evaluate which COPD telehealth interventions, classified by their functionalities, are most effective in improving patient with COPD management measured by both clinical and resource utilisation outcomes.

          Methods and analysis

          We will conduct a systematic review which will include randomised controlled trials comparing the efficacy of telehealth interventions versus standard care in patients with COPD with confirmed disease severity based on forced expiratory volume(%) levels. An electronic search strategy will be used to identify trials published since 2000 in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINHAL. Telehealth is described as remote monitoring and delivery of care where patient data/clinical information is routinely or continuously collected and/or processed, presented to the patient and transferred to a clinical care institution for feedback, triage and intervention by a clinical specialist. Two authors will independently screen articles for inclusion, assess risk of bias and extract data. We will merge studies into a meta-analysis if the interventions, technologies, participants and underlying clinical questions are homogeneous enough. We will use a random-effects model, as we expect some heterogeneity between interventions. In cases where a meta-analysis is not possible, we will synthesise findings narratively. We will assess the quality of the evidence for the main outcomes using GRADE.

          Ethics and Dissemination

          Research ethics approval is not required. The findings will be disseminated through publication in a peer-reviewed journal.

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          Most cited references 15

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          Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis.

          We conducted a systematic review of the literature about home telehealth for chronic obstructive pulmonary disease (COPD) compared with usual care. An electronic literature search identified 6241 citations. From these, nine original studies (10 references) relating to 858 patients were selected for inclusion in the review. Four studies compared home telemonitoring with usual care, and six randomized controlled trials compared telephone support with usual care. Clinical heterogeneity was present in many of the outcomes measured. Home telehealth (home telemonitoring and telephone support) was found to reduce rates of hospitalization and emergency department visits, while findings for hospital bed days of care varied between studies. However, the mortality rate was greater in the telephone-support group compared with usual care (risk ratio = 1.21; 95% CI: 0.84 to 1.75). Home telehealth interventions were similar or better than usual care for quality of life and patient satisfaction outcomes.
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            Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial?

            A crucial part in the development of any intervention is the preliminary work carried out prior to a large-scale definitive trial. However, the definitions of these terms are not clear cut and many authors redefine them. Because of this, the terms feasibility and pilot are often misused.
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              Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea.

              Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used.

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                19 September 2018
                : 8
                : 9
                [1 ] departmentLaboratory of Computing, Medical Informatics and Biomedical Imaging Technologies , Aristotle University of Thessaloniki , Thessaloniki, Greece
                [2 ] departmentResearch , Philips Electronics Nederland B.V. , Eindhoven, Netherlands
                [3 ] departmentDepartment of Health Economics, Centre for Public Health , Medical University of Vienna , Vienna, Austria
                [4 ] departmentTilburg Center for Communication and Cognition , Tilburg University , Tilburg, Netherlands
                [5 ] departmentDepartment of Biomedical and Health Information Sciences , University of Illinois at Chicago , Chicago, Illinois, USA
                [6 ] departmentDepartement of IEMS in McCormick School of Engineering , Northwestern university , Evanston, Illinois, USA
                [7 ] departmentServicio de Neumología , Hospital Clínic de Barcelona , Barcelona, Spain
                Author notes
                [Correspondence to ] Violeta Gaveikaite; violeta.gaveikaite@
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

                Funded by: This publication has received funding from the European Union’s Horizon 2020 research and innovation program - Marie Sklodowska-Curie Actions grant agreement - CHESS - Connected Health Early Stage Researcher Support System.;
                Respiratory Medicine
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