Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda

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Abstract

Objective

To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction.

Methods

PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration’s tool for assessing risk of bias and a modified version of CONSORT 2010 Statement.

Results

A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools.

Conclusion

Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are needed.

Introduction

Telemedicine is the remote delivery of healthcare services and clinical practices through medical data transmission via Information and Communication Technologies (ICT). Undeniable benefits are associated with the spreading of telemedicine, which can represent an additional and potentially suitable tool for diagnosis, treatment, rehabilitation and follow-up monitoring of patients [1]. Growing prevalence of chronic diseases, shortages in economic resources, increased patients’ demands for greater availability and better quality of healthcare services make telemedicine an interesting challenge for present and future. It was firstly employed to ensure access to healthcare in rural areas enabling patients to easily obtain specialty services while remaining within their local community [2], [3], [4]. More recently, telemedicine has found wider application in chronic diseases for increasing the number of follow-up consultations and encouraging tight home-monitoring in order to improve patients outcome [5], [6]. Furthermore, limiting the number of hospital visits, telemedicine reduces travel time and related stress. It also promises financial advantages reducing costs for both patients and healthcare payers [3], [4], [7].

Telemedicine has different possible applications in rheumatology and an increasing number of articles was published on specialized journal in last years. A heated debate was engaged on the potential utility and efficacy of telemedicine service in rheumatology, but emerging studies in this field were so encouraging that led some Authors to coin the term “tele-rheumatology” [8], [9], [10]. Although the number of studies on tele-rheumatology seems booming, it lacks a systematic review of the scientific literature focusing on unmet needs in this field and outlining a research agenda for future studies. The objective of our study was to systematically review the scientific literature regarding telemedicine applications in rheumatology and to draw conclusions about feasibility, effectiveness, and patient satisfaction for tele-rheumatology interventions proposed so far.

Section snippets

Materials and methods

A panel of 3 rheumatologists (A.M., M.P., and I.C.) developed the review protocol according to PRISMA guidelines [11] and outlining search strategy, eligibility criteria for study inclusion, methods of study selection, and quality assessment.

Search results

The electronic databases search yielded 177 publications for screening and 59 articles retrieved for further evaluation. After exclusion of 36 articles, 23 were selected for present review (Fig. 1).

Characteristics of controlled and uncontrolled studies are shown in Tables 1 and 2, respectively. Worthy of note is the heterogeneity of published studies in terms of intervention. Therefore, we opted for clustering studies according to disease: 7 studies (30.4%) included patients with Rheumatoid

Discussion

This systematic literature review of telemedicine applications to rheumatology provided evidence of a roused interest in tele-rheumatology leading to a remarkable increase in number of published studies mostly over the last 5 years.

Synchronous tele-rheumatology application [41], requiring a live interaction between health professionals and patients, is meant to offer a virtual alternative to the in-person Rheumatologist’s visit. This ICT use probably represents what most people first think of

Conclusions

In conclusion, improvement in ICT and the need for new healthcare solutions have pushed tele-rheumatology research, leading to a remarkable increase in published RCTs and, consequently, to an improved quality of available data. Although proved having a high feasibility and patient satisfaction rates, the evidence for a superior or equal effectiveness of tele-rheumatology compared to the standard face-to-face approach was weakened by some methodological biases and wide heterogeneity of

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    1

    M.P. and I.C. equally contributed to this work.

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