Summary of findings 2. Remote monitoring compared to usual care.
| Remote monitoring compared to usual care | ||||||
| Patient or population: people with chronic obstructive pulmonary disease Setting: regional, international (university hospital; specialist respiratory outpatient clinics; community‐based primary care clinics and health services), single‐centre or multi‐centre Intervention: remote monitoring 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 | |||||
| Exacerbations | ||||||
| Number of people experiencing 1 or more exacerbations Follow‐up: 41 weeks** Asynchronous or synchronous remote monitoring |
370 per 1000 | 375 per 1000 (283 to 477) | OR 1.02 (0.67 to 1.55) | 424 (4 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b | |
| Quality of life | ||||||
| SGRQ total score Follow‐up: 17 weeks Scale: 0 to 100 Lower score is better Asychronous remote monitoring |
Mean SGRQ total score was ‐4.5 | MD 6.4 lower (18.56 lower to 5.76 higher) | ‐ | 45 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb,c | MID: 4 points (Jones 2005) Imprecision: does not meet OIS |
| CAT score Follow‐up: 38 weeks** Scale: 0 to 40 Lower score is better Asynchronous remote monitoring |
Mean CAT total score was 17.2 | MD 0.06 higher (1.34 lower to 1.45 higher) | ‐ | 405 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,d | MID: 2 points (Kon 2014) MD in control arm taken from the study of longer duration (Walker 2018) |
| CAT total score Follow‐up: 52 weeks Scale: 0 to 40 Lower score is better Asynchronous remote monitoring |
Mean CAT total score was 21.4 | MD 0.1 higher (1.42 lower to 1.62 higher) | ‐ | 229 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb,e | MID: 2 points (Kon 2014) |
| Symptoms of dyspnoea | ||||||
| CRQ‐SAS dyspnoea symptoms score Follow‐up: 26 weeks Scale: 0 to 100 Higher score is better Asychronous remote monitoring |
Mean dyspnoea symptoms score on the CRQ‐SAS was 4.16 | MD 0.44 lower (1.04 lower to 0.16 higher) | ‐ | 70 (1 RCT) | ⊕⊕⊝⊝ LOWb,f | MID: 0.5 reflects a small change. A change of 1.0 reflects a moderate change, and a difference of 1.5 reflects a large change (Schünemann 2003) Imprecision: does not meet OIS |
| Hospital service utilisation | ||||||
| Number of people admitted to hospital Follow‐up: 36 weeks** Asynchronous remote monitoring |
246 per 1000 | 283 per 1000 (196 to 387) | OR 1.21 (0.75 to 1.94) | 357 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,g | |
| Mortality | ||||||
| Mortality (all‐cause) Follow‐up: 38 weeks** Asynchronous remote monitoring |
73 per 1000 | 51 per 1000 (28 to 89) | OR 0.68 (0.37 to 1.25) | 798 (6 RCTs) | ⊕⊝⊝⊝ VERY LOWb,e | |
| *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. CAT: COPD assessment test; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CRQ‐SAS: chronic respiratory disease questionnaire self‐administered; 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 allocation concealment and performance, detection, attrition, and selective reporting bias.
bEvidence for this outcome was downgraded by 1 due to wide confidence intervals.
3Evidence was downgraded by 2 due to performance and detection bias. Selection bias (randomisation and allocation concealment) and selective reporting were unclear.
dEvidence for this outcome was downgraded by 2 due to performance and detection bias. One study was at high risk of selective reporting.
eEvidence for this outcome was downgraded by 2 due to allocation concealment and performance and detection bias.
fEvidence for this outcome was downgraded by 1 due to performance bias. Detection, attrition, and selective reporting were unclear.
gEvidence was downgraded by 2 due to performance and detection bias.