Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis

Youjin Jung; Jimin Kim; Dong Ah Park

doi:10.4040/jkan.2018.48.4.389

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Jung, Kim, and Park: Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis

Review Article

J Korean Acad Nurs 2018;48(4):389-406.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.4.389

Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis

Youjin Jung^1,², Jimin Kim¹, Dong Ah Park^1,

¹National Evidence-Based Healthcare Collaborating Agency, Seoul

²College of Nursing, Korea University, Seoul, Korea

Address reprint requests to : Park, Dong Ah National Evidence-Based Healthcare Collaborating Agency, Namsan Square 7F, 173 Toegye-ro, Jung-gu, Seoul 04554, Korea Tel: +82-2-2174-2771 Fax: +82-2-747-4918 E-mail: pda124@neca.re.kr

Received 9 May 2018 Revised 26 July 2018 Accepted 1 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma.

Methods

We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies.

Results

Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence.

Conclusion

The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.

Keywords: Asthma, Telemedicine, Review, Meta-analysis

References

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Figure 1.

Flow diagram of the study selection process.

Figure 2.

Assessment risk of bias in included studies.

Figure 3.

Forest plot of meta-analysis on effects of telemonitoring and usual care.

Table 1.

Characteristics of Included Studies

Study	Country	No. of patients (I/C)	Age (mean)		Female (%)	Intervention	Control	Asthma severity	FEV₁ (%pred)		Study duration
Study	Country	No. of patients (I/C)	I	C	Female (%)	Intervention	Control	Asthma severity	I	C	Study duration
Voorend-van Bergen 2015	Netherlands	180_† (91/89)	10.3	10.2	32.8	Web-based monthly monitoring	Usual care	NR	98.1	93.9	12 months
Wiecha 2015	USA	58 (37/21)	11.9	12.9	41.4	Web-based interactive asthma education, monitoring	Usual care	NR	NR	NR	6 months
Deschildre 2012	France	50 (25/25)	11.0	11.2	26.0	Home telemonitoring	Conventional treatment	Severe	87.4	83.3	12 months
Rikkers-Mutsaerts 2012	Netherlands	90 (46/44)	13.4	13.8	50.0	Internet-based self-management	Usual care	Mild-severe	88	92	12 months
Jacobson 2009	USA	59 (29/30)	NR	NR	50.8	Electronic monitoring	Paper asthma diary	NR	NR	NR	2 months
Chan 2007	USA	120 (60/60)	10.2	9.0	37.5	Internet-based home monitoring and education	Office-based care, traditional in-person education and case management	Mild-severe	104.1	96.8	12 months
Jan 2007	Taiwan	164 (88/76)	10.9	9.9	61.6	Internet-based interactiv telemonitoring	Traditional asthma care (written asthma diary supplemented with instructions for self-management)	Mild-severe	NR	NR	3 months
Guendelman 2002 Guendelman 2004	USA	134 (66/68)	12.0	12.2	42.5	Healthy Buddy & asthma diary	Paper asthma diary	Mild-severe	NR	NR	3 months

C=Control; I=Intervention; NR=Not Reported.

†272 participants were randomized to a telemonitoring group using ACT (Asthma Control Test) scores (n=91), to a control group (usual care) based on ACT without web feedback (n=89) and to a group for which FeNO (Fractional exhaled nitric oxide) and the ACT were used to monitor asthma (n=92). We chose not to include the FeNo group, as the comparison between telemonitoring and control groups was a purer comparison of the effect of telemonitoring than of use of FeNO.

2

Intervention Characteristics of Included Studies

Study	Transmitted Data	TM Equipment	Transmission Frequency	TM Type (Data review/ Response or Action)	Intervention Tpe
Study	Transmitted Data	TM Equipment	Transmission Frequency	TM Type (Data review/ Response or Action)	Self-monitoring	Asthma information, self-care education	Asthma action plan	Interactive/ immediate feedback from device	Messages/alerts to patients from device
Voorend-van Bergen 2015	ACT or C-ACT	Web	monthly	Asynchronous - Data review: the researcher or asthma nurse - Response: treatment advice by email (within three working days)	√	x	√	x	x
Wiecha 2015	PEF, symptoms, medication use	Web	NR	Asynchronous - Data review: every two months (project’s participating pediatric asthma specialist, asthma nurse specialist) - Response: A summary of their conclusions and treatment recommendations was posted to the private discussion board.	√	√	√	√	x
Deschildre 2012	FEV¹	Spirometer, web	daily	Asynchronous - Data review: spirometry data (once a day) by a physician - Response: physician contact the parents of the child (treatment adjustment, referral)	√	x	x	x	x
Rikkers- Mutsaerts 2012	ACQ, FEV¹	Web, phone (text message, reminder)	weekly	Asynchronous - Data review: weekly assessment - Response: instant feedback on their level of asthma control, advice, contact the asthma nurse through the web or by phone	√	√	√	x	x
Jacobson 2009	Asthma symptoms use of medications	s, Hand-sized electronic device (electronic asthma monitoring system), web	daily	Asynchronous - Data review: the data are uploaded to a central site, then clinician or case manager review the data - Response: telephone the home to assess the child’s status, adjust the child’s medications if necessary, or have the child come in to see the physician	√	x	x	√	√
Chan 2007	Peak flow meter readings, inhaler use, symptom scores (in electronic diary)	A home computer system, camera, web	daily	Asynchronous - Data review: 2 times per week for 6 weeks and then once-weekly thereafter by the case managers - Response: e-mail contact between patients and case managers (unclear how the case manager intervened)	√	√	√	x	x
Jan 2007	^PEF, FEV¹, symptoms (in electronic diary)	Web (Internet-based paediatric asthma monitoring programme)	daily	Asynchronous - Data review: the data can be shared with the patient’s physician - Response: patient’s physician give feedback via telephone or e-mail	√	√	√	x	x
Guendelman 2002 Guendelman 2004	Peak flow readings, symptoms, medication use, functional status	Home based interactive device (Health Buddy), telephone line, web	daily	Asynchronous - Data review: nurse coordinator sends a set of queries each day according patients’ questions and information - Response: immediate feedback from device	√	√	x	√	√

ACT=Asthma Control Test; ACQ=Asthma Control Questionnaire; C-ACT=Childhood Asthma Control Test; FEV₁=Forced Expiratory Volume in 1 second; NR=Not Reported; PEF=Peak Expiratory Flow; TM=Telemonitoring.

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