Summary of findings 1. Remote monitoring plus usual care compared to usual care.
| Remote monitoring plus usual care compared to usual care | ||||||
| Patient or population: people with chronic obstructive pulmonary disease Setting: primary, secondary, tertiary care; general hospital, specialist respiratory service, hospital‐based respiratory care; single‐centre or multi‐centre Intervention: remote monitoring plus usual care Comparison: usual care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | №. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with remote monitoring plus usual care | |||||
| Exacerbations | ||||||
| Number of people experiencing 1 or more exacerbations Follow‐up: 26 weeks Asynchronous remote monitoring |
469 per 1000 | 525 per 1000 (343 to 703) | OR 1.25 (0.59 to 2.67) | 108 (1 RCT) | ⊕⊝⊝⊝ VERY LOWa,b | Imprecision: does not meet OIS of 200 participants |
| Quality of life | ||||||
| SGRQ total score Follow‐up: 26 weeks Scale: 0 to 100 Lower score is better Asynchronous or synchronous remote monitoring |
Mean SGRQ total was 66.8 | MD 1.49 lower (9.43 lower to 6.44 higher) | ‐ | 204 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb, c, d | MID: 4 points (Jones 2005) Control arm MD was taken from McDowell 2015 |
| SGRQ total score Follow‐up: 52 weeks Scale: 0 to 100 Lower score is better |
Mean SGRQ total was 67.3 | MD 0.9 higher (3.71 lower to 5.51 higher) | ‐ | 205 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb, e | MID: 4 points (Jones 2005) |
| Dyspnoea symptoms | ||||||
| No evidence identified | ||||||
| Hospital service utilisation | ||||||
| Time to first hospitalisation after starting intervention Follow‐up: 52 weeks Asynchronous remote monitoring |
HR 1.08 (0.80 to 1.46) | 256 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb, e | |||
| Time to first COPD‐related re‐admission Follow‐up: 26 weeks Asynchronous remote monitoring |
HR 0.42 (0.19 to 0.93) | 106 (1 RCT) | ⊕⊕⊕⊝ MODERATE f | Imprecision: does not meet OIS of 200 participants | ||
| Mortality | ||||||
| Mortality (all‐cause) Follow‐up: 44 weeks** Asynchronous or synchronous remote monitoring |
93 per 1000 | 92 per 1000 (60 to 139) | OR 0.99 (0.62 to 1.58) | 927 (7 RCTs) | ⊕⊝⊝⊝ VERY LOWb, g | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). **Weighted mean duration. CI: confidence interval; COPD: chronic obstructive pulmonary disease; HR: hazard ratio; MD: mean difference; MID: minimally important difference; OIS: optimal information size; OR: odds ratio; RCT: randomised controlled trial; SGRQ: St George's Respiratory Questionnaire. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aEvidence for this outcome was downgraded by 2 due to performance, detection, and selective reporting bias. Allocation concealment was unclear.
bEvidence for this outcome was downgraded by 1 due to wide confidence intervals.
c Evidence for this outcome was downgraded by 2 due to performance and detection bias. One study was at high risk of selective reporting.
d Evidence for this outcome was downgraded by 2 due to very high heterogeneity.
e Evidence was downgraded by 2 due to performance and detection bias.
f Evidence for this outcome was downgraded by 1 due to performance bias. Allocation concealment was unclear.
g Evidence for this outcome was downgraded by 2 due to allocation concealment and performance, detection, and attrition bias in one or more studies.