. 2023 Mar 23;35(5):953–968. doi: 10.1007/s40520-023-02381-3

Table 2.

Main characteristics of the studies included in the systematic review

References	Population	Device	Intervention	Comparator	Protocol duration	Outcomes	Main findings
Chau et al. [35]	N = 40 IG = 22 CG = 18	IG = 73.50 ± 6.05 CG = 72.22 ± 6.13	21.47 ± 4.00	IG: 21 M (95.5%) 1 F (4.5%) CG: 18 M (100%)	ASTRI telecare system (ATS): - Mobile phone - Respiratory rate sensor - Pulse oximeter	Tele-monitoring of oxygen saturation, pulse rate and respiration rate (three times a day from Monday to Friday)	Usual care	8 weeks	- Pulmonary function - HRQoL - Safety - User satisfaction - Feasibility	This study reports about 40 COPD patients monitored with the ASTRI telecare system They were monitored 3 times a day, and the study duration was 8 weeks The main finding is represented by no significant group differences between the FEV1 (% predicted), FEV1/FVC ratio (%), and dimension scores of CRQ (dyspnea, fatigue, emotion, and mastery) (all p > 0.05). No significant differences in the number of emergency department visits and hospital readmissions between the study groups were found (p > 0.05) Overall, the participants in the intervention group expressed satisfaction with the telecare service
Jiang et al. [36]	N = 106 IG = 53 CG = 53	IG = 70.92 ± 6.38 CG = 71.83 ± 7.60	IG = 22.21 ± 3.52 CG = 21.27 ± 2.36	IG: 44 M (83%) 9 F (17%) CG: 43 M (81%) 10 F (19%)	Mobile technology, social media WeChat	PeR = Pulmonary Internet Explorer Rehabilitation - Patients received PeR management based on clinical evaluation, including respiratory training, sports training, diet guidance, medication knowledge - Patients completed the home-based pulmonary rehabilitation training, completed the self-assessment report, and uploaded their training records	FtF = Face-to-Face group in the outpatient department received the same intervention as the PeR group, with the same pulmonary rehabilitation training equipment	6 months	- Quality of Life (chronic obstructive pulmonary disease assessment test [CAT]) - Functional outcomes (SGRQ and Ex-SRES) - modified Medical Research Council scale (mMRC) - Feasibility	This study reports about 106 COPD patients that followed a pulmonary rehabilitation program, supported by remote monitoring (social media WeChat) They were assessed at baseline, at 3 months, and at 6 months from the baseline. The study duration was 6 months The main finding is represented by no statistically significant differences in CAT (p = 0.53), Ex-SRES (p = 0.63), and mMRC scores (p > 0.05) between the two groups with the variation in time tendency. In the sixth month, no significant difference was found in terms of SGRQ in between groups analysis (p > 0.05)
Kawagoshi et al. [37]	N = 27 IG = 12 CG = 15	IG = 74 ± 8 CG = 75 ± 9	IG = 21.7 ± 3.1 CG = 22.0 ± 3.1	IG: 10 M 2 F CG: 14 M 1 F	Pedometer (Kens Lifecorder EX, Nagoya, Japan)	PR + P group (pulmonary rehabilitation and feedback from pedometer) PR + P group completed the monitoring using a pedometer and received monthly feedback for 1 year They attached the pedometer on the belt at the waist for 12 h a day for 1 year Moreover, they performed the same rehabilitation protocol of PR group	PR group (pulmonary rehabilitation only) Multidisciplinary home-based program: - Breathing retraining - Sitting calisthenics - Respiratory muscle stretching calisthenics - Level walking for at least 15 min - Inspiratory muscle exercises using an inspiratory muscle trainer intensity of 30–40% of the maximal inspiratory (PImax) - Monthly 45 min education program Practice this program daily at home and were supervised by a respiratory therapist every 2 weeks	1 year	- Quality of Life (CRQ) - Daily walking time - Submaximal exercise capacity (6MWD) - Quadriceps femoris muscle force (QF) - Feasibility	This study reports about 27 COPD patients monitored with a pedometer. They were monitored every day, and the study duration was 1 year The main finding is represented by the increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) which was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR The improvement rate of daily walking time after PR was significantly correlated with 6MWD and QF in all subjects
Pedone et al. [38]	N = 99 IG = 50 CG = 49	IG = 74.1 ± 6.4 CG = 75.4 ± 6.7	N/A	IG: 36 M (72%) 14 F (28%) CG: 31 M (63%) 18 F (37%)	“SweetAge” monitoring system: - Wristband (sensors for heart rate, physical activity, near-body temperature, and galvanic skin response) - Pulse oximeter (Nonin Medical Inc.) coupled with the wristband - Cellular telephone coupled with the wristband. The telephone was equipped with a software that allowed the reception of the data transmitted by the wristband and acted as a gateway to send the data to the monitoring system	The system was set up to perform 5 measurements of each parameter every three hours Oxygen saturation was measured over 1 min, for the other parameters five measurements of 1 min each were performed at a sampling rate of 60 Hz The data received were evaluated every day by an expert physician	N/A	9 months	- Number of exacerbations - Number of hospital admissions - Feasibility	This study reports about 99 COPD patients monitored with the “SweetAge” monitoring system. They were monitored every day, and the study duration was 9 months The main finding is represented by the incidence rate of respiratory events, which was 28/100 person/years in the intervention group vs. 42/100 person/years in the control group (IRR: 0.67, 95% CI 0.32–1.36). The corresponding figures for hospital admissions were 13/100 person/years and 20/100 person/years, respectively (IRR: 0.66, 95% CI 0.21–1.86) In this study, the main causes of drop-out were patients feeling uncomfortable with the wearable device or thinking that they disrupt the daily life rhythm
Walker et al. [39]	N = 312 IG = 154 CG = 158	IG = 71.0 (66.0–75.8 IQR) CG = 71.0 (65.3–76.0 IQR)	IG = 27.7 (24.5–30.8 IQR) CG = 26.9 (23.8–31.6 IQR)	IG: 101 M 53 F CG: 105 M 53 F	CHROMED monitoring platform: the platform comprised a device that measured within-breath respiratory mechanical impedance (RESMON PRO DIARY, Restech srl, Milan, Italy) using FOT, a touch-screen computer and a mobile modem	The intervention group used the CHROMED monitoring platform for nine months at approximately the same time each day Every two months, participants were telephoned and completed the CAT, PHQ-9 and MLHFQ questionnaires	Usual care	9 months	- Quality of life (EQ-5D, CAT, PHQ-9) - Hospitalization rate - TTFH - Costs - Feasibility	This study reports about 312 COPD patients monitored with the CHROMED monitoring platform. They were monitored every day, and the study duration was 9 months The main finding is that telemedicine was associated with fewer repeat hospitalizations (− 54%, p = 0.017). Previously hospitalized patients showed the greatest reduction in hospitalization rate (− 53%, p = 0.017) with large potential for cost savings (− 3736€/patient/year, p = 0.010). There were no significant between-group differences in the EQ-5D, CAT, or PHQ-9 scores (all p > 0.05) The largest differences in terms of costs were seen in patients with a previous hospitalization with COPD (€4147 vs. €6949, p = 0.008) Tele-monitoring did not significantly affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores

References

Population

Device

Intervention

Comparator

Protocol duration

Outcomes

Main findings

Sample size

Age (years)

BMI (kg/m²)

Male/Female

Chau et al. [35]

N = 40

IG = 22

CG = 18

IG = 73.50 ± 6.05

CG = 72.22 ± 6.13

21.47 ± 4.00

IG: 21 M (95.5%)

1 F (4.5%)

CG: 18 M (100%)

ASTRI telecare system (ATS):

- Mobile phone

- Respiratory rate sensor

- Pulse oximeter

Tele-monitoring of oxygen saturation, pulse rate and respiration rate (three times a day from Monday to Friday)

Usual care

8 weeks

- Pulmonary function

- HRQoL

- Safety

- User satisfaction

- Feasibility

This study reports about 40 COPD patients monitored with the ASTRI telecare system

They were monitored 3 times a day, and the study duration was 8 weeks

The main finding is represented by no significant group differences between the FEV1 (% predicted), FEV1/FVC ratio (%), and dimension scores of CRQ (dyspnea, fatigue, emotion, and mastery) (all p > 0.05). No significant differences in the number of emergency department visits and hospital readmissions between the study groups were found (p > 0.05)

Overall, the participants in the intervention group expressed satisfaction with the telecare service

Jiang et al. [36]

N = 106

IG = 53

CG = 53

IG = 70.92 ± 6.38

CG = 71.83 ± 7.60

IG = 22.21 ± 3.52

CG = 21.27 ± 2.36

IG: 44 M (83%)

9 F (17%)

CG: 43 M (81%)

10 F (19%)

Mobile technology, social media WeChat

PeR = Pulmonary

Internet Explorer Rehabilitation

- Patients received PeR management based on clinical evaluation, including respiratory training, sports training, diet guidance, medication knowledge

- Patients completed the home-based pulmonary rehabilitation training, completed the self-assessment report, and uploaded their training records

FtF = Face-to-Face group in the outpatient department received the same intervention as the PeR group, with the same pulmonary rehabilitation training equipment

6 months

- Quality of Life (chronic obstructive pulmonary disease assessment test [CAT])

- Functional outcomes (SGRQ and Ex-SRES)

- modified Medical Research Council scale (mMRC)

- Feasibility

This study reports about 106 COPD patients that followed a pulmonary rehabilitation program, supported by remote monitoring (social media WeChat)

They were assessed at baseline, at 3 months, and at 6 months from the baseline. The study duration was 6 months

The main finding is represented by no statistically significant differences in CAT (p = 0.53), Ex-SRES (p = 0.63), and mMRC scores (p > 0.05) between the two groups with the variation in time tendency. In the sixth month, no significant difference was found in terms of SGRQ in between groups analysis (p > 0.05)

Kawagoshi et al. [37]

N = 27

IG = 12

CG = 15

IG = 74 ± 8

CG = 75 ± 9

IG = 21.7 ± 3.1

CG = 22.0 ± 3.1

IG: 10 M

2 F

CG: 14 M

1 F

Pedometer (Kens Lifecorder EX, Nagoya, Japan)

PR + P group (pulmonary rehabilitation and feedback from pedometer)

PR + P group completed the monitoring

using a pedometer and received monthly feedback for 1 year

They attached the pedometer on the belt at the waist for 12 h a day for 1 year

Moreover, they performed the same rehabilitation protocol of PR group

PR group (pulmonary rehabilitation only)

Multidisciplinary home-based program:

- Breathing retraining

- Sitting calisthenics

- Respiratory muscle stretching calisthenics

- Level walking for at least 15 min

- Inspiratory muscle exercises using an inspiratory muscle trainer intensity of 30–40% of the maximal inspiratory

(PImax)

- Monthly 45 min education program

Practice this program daily at home and were supervised by a respiratory therapist every 2 weeks

1 year

- Quality of Life (CRQ)

- Daily walking time

- Submaximal exercise capacity (6MWD)

- Quadriceps femoris muscle force (QF)

- Feasibility

This study reports about 27 COPD patients monitored with a pedometer. They were monitored every day, and the study duration was 1 year

The main finding is represented by the increase in the time spent walking in the PR + P group (51.3 ± 63.7 min/day) which was significantly greater than that of PR group (12.3 ± 25.5 min/day) after the PR

The improvement rate of daily walking time after PR was significantly correlated with 6MWD and QF in all subjects

Pedone et al. [38]

N = 99

IG = 50

CG = 49

IG = 74.1 ± 6.4

CG = 75.4 ± 6.7

N/A

IG: 36 M (72%)

14 F (28%)

CG: 31 M (63%)

18 F (37%)

“SweetAge” monitoring system:

- Wristband (sensors for heart rate, physical activity, near-body temperature, and galvanic skin response)

- Pulse oximeter (Nonin Medical Inc.) coupled with the wristband

- Cellular telephone coupled with the wristband. The telephone was equipped with a software that allowed the reception of the data transmitted by the wristband and acted as a gateway to send the data to the monitoring system

The system was set up to perform 5 measurements of each parameter every three hours

Oxygen saturation was measured over 1 min, for the other parameters five measurements of 1 min each were performed at a sampling rate of 60 Hz

The data received were evaluated every day by an expert physician

N/A

9 months

- Number of exacerbations

- Number of hospital admissions

- Feasibility

This study reports about 99 COPD patients monitored with the “SweetAge” monitoring system. They were monitored every day, and the study duration was 9 months

The main finding is represented by the incidence rate of respiratory events, which was 28/100 person/years in the intervention group vs. 42/100 person/years in the control group (IRR: 0.67, 95% CI 0.32–1.36). The corresponding figures for hospital admissions were 13/100 person/years and 20/100 person/years, respectively (IRR: 0.66, 95% CI 0.21–1.86)

In this study, the main causes of drop-out were patients feeling uncomfortable with the wearable device or thinking that they disrupt the daily life rhythm

Walker et al. [39]

N = 312

IG = 154

CG = 158

IG = 71.0 (66.0–75.8 IQR)

CG = 71.0 (65.3–76.0 IQR)

IG = 27.7 (24.5–30.8 IQR)

CG = 26.9 (23.8–31.6 IQR)

IG: 101 M

53 F

CG: 105 M

53 F

CHROMED monitoring platform: the platform comprised a device that measured within-breath respiratory mechanical impedance (RESMON PRO DIARY, Restech srl, Milan, Italy) using FOT, a touch-screen computer and a mobile modem

The intervention group used the CHROMED monitoring platform for nine months at approximately the same time each day

Every two months, participants were telephoned and completed

the CAT, PHQ-9 and MLHFQ questionnaires

Usual care

9 months

- Quality of life (EQ-5D, CAT, PHQ-9)

- Hospitalization rate

- TTFH

- Costs

- Feasibility

This study reports about 312 COPD patients monitored with the CHROMED monitoring platform. They were monitored every day, and the study duration was 9 months

The main finding is that telemedicine was associated with fewer repeat hospitalizations (− 54%, p = 0.017). Previously hospitalized patients showed the greatest reduction in hospitalization rate (− 53%, p = 0.017) with large potential for cost savings (− 3736€/patient/year, p = 0.010). There were no significant between-group differences in the EQ-5D, CAT, or PHQ-9 scores (all p > 0.05)

The largest differences in terms of costs were seen in patients with a previous hospitalization with COPD (€4147 vs. €6949, p = 0.008)

Tele-monitoring did not significantly affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores

6MWD six-minute walk distance, ATS ASTRI telecare system, CAT chronic obstructive pulmonary disease assessment tool, CI confidence interval, COPD Chronic obstructive pulmonary disease, CG control group, CRQ Chronic Respiratory Questionnaire, EQ-5D EuroQoL EQ-5D questionnaire, Ex-SRES exercise self-regulatory efficacy scale, F_1,3 repeated measures analysis of variance, FEV₁ forced expiratory volume in 1 s, FtF Face-to-Face rehabilitation, FVC forced vital capacity, HRQoL Health-Related Quality of Life, IG intervention group, IQR interquartile range, IRR incidence rate ratio, mMRC modified Medical Research Council scale, N/A not available, PHQ-9 Patient Health Questionnaire, PR pulmonary rehabilitation, PR + P pulmonary rehabilitation + pedometer, PeR Pulmonary Internet Explorer Rehabilitation, QF quadriceps femoris muscle force, SGRQ St George’s Respiratory Questionnaire, TTFH time to first hospitalization;