Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: Systematic Review and Meta-analysis

• Published in: Journal of medical Internet research Vol. 25; no. 1; p. e44256
• Main Authors: Xiao, Ziyan, Han, Xiuping
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 27.04.2023; JMIR Publications
• Subjects: Anxiety; Bias; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Clinical trials; Cognitive functioning; COVID-19; Depression - therapy; Diabetes; Disease Management; Fatigue; Fatigue - therapy; Functional impairment; Hospitals; Humans; Infrastructure; Internet; Intervention; Keywords; Long term; Medical research; Mental depression; Mental health; Meta-analysis; Multiple Chronic Conditions; Pandemics; Patients; Physical ability; Psychological well being; Quality of Life; Questionnaires; Review; Self care; Self-efficacy; Selfmanagement; Social functioning; Statistical analysis; Systematic review; Telemedicine; literature search; telemedicine; medical adherence; chronic condition; meta analysis; mental health; management system; meta analyses; telehealth chronic management system; systematic; self-management; disease management; effectiveness evaluation; anxiety; fatigue; chronic disease; self-efficacy; review method; depression; quality of life; search strategy
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/44256

Long-term daily health monitoring and management play a more significant role in telehealth management systems nowadays, which require evaluation indicators to present patients' general health conditions and become applicable to multiple chronic diseases. This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS). We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure and Wanfang, a Chinese medical database, and searched papers published from January 1, 2015, to July 1, 2022, regarding randomized controlled trials on the effectiveness of the telehealth system on patients with chronic diseases. The narrative review summarized the questionnaire indicators presented in the selected studies. In the meta-analysis, Mean Difference (MD) and Standardized Mean Difference (SMD) with a 95% CI were pooled depending on whether the measurements were the same. Subgroup analysis was conducted if the heterogeneity was significant, and the number of studies was sufficient. Twenty RCTs with 4153 patients were included in the qualitative review. Seventeen different questionnaire-based outcomes were found, within which quality of life, psychological well-being (including depression, anxiety, and fatigue), self-management, self-efficacy, and medical adherence were most frequently used. Ten RCTs with 2095 patients remained in meta-analysis. Compared to usual care, telehealth system can significantly improve the quality of life (SMD 0.44; 95% CI 0.16-0.73; P=.002), whereas no significant effects were found on depression (SMD -0.25; 95% CI -0.72 to 0.23; P=.30), anxiety (SMD -0.10; 95% CI -0.27 to 0.07; P=.71), fatigue (SMD -0.36; 95% CI -1.06 to 0.34; P<.001), and self-care (SMD 0.77; 95% CI -0.28-1.81; P<.001). In the subdomains of quality of life, telehealth statistically significantly improved physical functioning (SMD 0.15; 95% CI 0.02 to 0.29; P=.03), mental functioning (SMD 0.37; 95% CI 0.13-0.60; P=.002), and social functioning (SMD 0.64; 95% CI 0.00-1.29; P=.05), while there was no difference on cognitive functioning (MD 8.31; 95% CI -7.33 to 23.95; P=.30) and role functioning (MD 5.30; 95% CI -7.80 to 18.39; P=.43). TCDMS positively affected patients' physical, mental, and social quality of life across multiple chronic diseases. However, no significant difference was found in depression, anxiety, fatigue, and self-care. Subjective questionnaires had the potential ability to evaluate the effectiveness of long-term telehealth monitoring and management. However, further well-designed experiments are warranted to validate TCDMS's effects on subjective outcomes, especially when tested among different chronically ill groups.