Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda
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
References (53)
- et al.
Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials
Diabetes Res Clin Pract
(2016) - et al.
Telemedicine and remote management of patients with heart failure
Lancet
(2011) - et al.
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
J Clin Epidemiol
(2009) - et al.
Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: a randomized control trial
J Psychiatr Res
(2015) - et al.
Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients
Patient Educ Couns
(2013) - et al.
Internet-enhanced management of fibromyalgia: a randomized controlled trial
Pain
(2010) - et al.
Randomized trial of the effectiveness of a non-pharmacological multidisciplinary face-to-face treatment program on daily function compared to a telephone-based treatment program in patients with generalized osteoarthritis
Osteoarthritis Cartilage
(2015) - et al.
A new form of communication between rheumatology and primary care: The virtual consultation
Reumatol Clin
(2016) - et al.
Can pain be managed through the Internet? A systematic review of randomized controlled trials
Pain
(2011) - WHO | Publications. WHO. 〈http://www.who.int/goe/publications/en/〉; n.d. [accessed...
A comparative study on the utility of telehealth in the provision of rheumatology services to rural and northern communities
Int J Circumpolar Health
An evaluation of telehealth in the provision of rheumatologic consults to a remote area
J Rheumatol
Telemedicine in rheumatology
J Rheumatol
How critical is tele-medicine to the rheumatology workforce?
Arthritis Care Res
Telerheumatology: an idea whose time has come
Intern Med J
Telerheumatology: not ready for prime time
Intern Med J
Author reply
Intern Med J
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
The BMJ
CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials
Br Med J
Non-invasive continuous respiratory monitoring on general hospital wards: a systematic review
PLOS ONE
Handgrip strength measured by a dynamometer connected to a smartphone: a new applied health technology solution for the self-assessment of rheumatoid arthritis disease activity
Rheumatology
Self-assessment tool of disease activity of rheumatoid arthritis by using a smartphone application
Telemed E-Health
Patients’ own ability to assess activity of their rheumatoid arthritis
Rheumatology
Effectiveness of a telemonitoring intensive strategy in early rheumatoid arthritis: comparison with the conventional management approach
BMC Musculoskelet Disord
RAHelp: an online intervention for individuals with rheumatoid arthritis
Arthritis Care Res
Cited by (122)
Strategies for organizing rheumatology consultations
2024, Revista Colombiana de ReumatologiaRecommendations on the intervention of patients with rheumatological diseases by telemedicine in Colombia
2024, Revista Colombiana de ReumatologiaTeleconsultation in rheumatology: A literature review and opinion paper
2023, Seminars in Arthritis and RheumatismSatisfaction with a telemedicine service among patients with rheumatoid arthritis
2023, Revista Colombiana de ReumatologiaThe concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions
2023, Journal of Pediatric NursingCitation Excerpt :Another study revealed concerns regarding the accuracy of virtual visits as only 40% of the diagnosis was made correctly through video-teleconferencing visits (Graham et al., 2000). However, the reliability of this data was hampered due to the small size and the old means of telecommunication used in the study (Piga et al., 2017). In another study conducted on parents' children, desire to see a physician in person was cited by 63% as a reason against TM, although 35% of them reported concern about a physician's competence as a reason against surgical telemonitoring (Abdulhai et al., 2018).
- 1
M.P. and I.C. equally contributed to this work.