Impact of remote vital sign monitoring on health outcomes in acute respiratory infection and exacerbation of chronic respiratory conditions: systematic review and meta-analysis

Background Our aim was to investigate the effectiveness of virtual wards on health outcomes in patients with acute respiratory infection. Methods We searched four electronic databases from January 2000 to March 2021 for randomised controlled trials (RCTs). We included studies in people with acute respiratory illness or an acute exacerbation of a chronic respiratory illness, where a patient or carer measured vital signs (oximetry, blood pressure, pulse) for initial diagnosis and/or asynchronous monitoring, in a person living in private housing or a care home. We performed random-effects meta-analysis for mortality. Results We reviewed 5834 abstracts and 107 full texts. Nine RCTs were judged to be relevant for inclusion, in which sample sizes ranged from 37 to 389 (total n=1627) and mean ages ranged between 61 and 77 years. Five were judged to be at low risk of bias. Five RCTs had fewer hospital admissions in the intervention (monitoring) group, out of which two studies reported a significant difference. Two studies reported more admissions in the intervention group, with one reporting a significant difference. We were unable to perform a meta-analysis on healthcare utilisation and hospitalisation data due to lack of outcome definition in the primary studies and variable outcome measurements. We judged two studies to be at low risk of bias. The pooled summary risk ratio for mortality was 0.90 (95% CI 0.55–1.48). Conclusion The limited literature for remote monitoring of vital signs in acute respiratory illness provides weak evidence that these interventions have a variable impact on hospitalisations and healthcare utilisation, and may reduce mortality.

A total of 511 participants were enrolled in the study, including 352 in the Proactive iCare treatment group and 159 in the Usual Care control group. A total of 122 participants did not complete the study.
Used intention-to-treat analysis. COPD education was given to each participant in intervention group, during weekday sessions with the Health Buddy and informally during phone calls with study coordinators. Participants in usual care group did not receive COPD education or advice but were advised to inform their health care provider if they had SpO2 ≤88%.

Kessler 2018
Patients were allocated to groups in a 1:1 fashion according to a pre-specified randomisation list generated before the study by a partialminimisation computer algorithm under supervision of For practical reasons, the study was open; neither the patients nor the investigators were blinded to the COPD management strategy.
A total of 345 patients were randomised to the DM group (172) or the UM group (173). In the DM and UM groups, respectively, 15 and 11 patients did not complete the initial 5-week run-in period.
Used intention-to-treat analysis. The control group received the usual or routine COPD care and patient follow-up practices used at each investigational centre. Site-specific usual management practices (e.g. centre-specific COPD This trial was registered at www.clinicaltrials.gov (NCT01241526) the study sponsor. Patients were assigned a randomisation number by study staff at each centre in sequential numerical order through a telephone-based interactive voice response system. Randomisation was stratified by smoking status (current or former), need for respiratory assistance (none, or on LTOT and/or HMV), and centre. No differences were found between groups for baseline parameters. educational booklets or programme information, if any) were collected at the beginning and end of the patient inclusion period.

Vianello 2016
Randomisation was performed using a dedicated algorithm provided by PASS 2008 software that took into account patient's age and gender. Patients were randomised to the intervention or control groups using a 2:1 Using the TM equipment, patients transmitted their monitored Heart Rate and SpO2 values to the operator. If the measurement was outside of the patient's normal range, the operator. alerted the clinical staff.
The 334 eligible participants were randomly assigned: 230 were assigned to the TM group and 104 to the control one. Out of the 230 patients allocated to the study group, 19 did not actually participate in the Used per-protocol analysis. This trial was registered at www.clinicaltrials.gov (NCT01513980) allocation. Each participating center implemented randomization locally using the same methodology.
No differences were found between groups for baseline parameters.
study. At the end of the study, the data of 181 patients who had been randomized to the TM group and 81 control group, respectively, were available for analysis.

Chatwin 2016
Patients were randomised to telemonitoring or delayed telemonitoring (control group), stratified for COPD or non-COPD diagnosis in blocks of five with results generated and made available from our statistics unit. No differences were found between groups for baseline parameters.
Telemonitoring was carried out in the patient's home. It was not possible to blind patients or health professionals.
2 patients in the intervention group discontinued the intervention. 1 patient in the intervention group never received the allocated intervention. All patients in the control group received the allocated treatment.
One patient in the control group was discontinued owing to suspicion of malignancy.
Used intention-to-treat analysis. Statistician analyzing the data was blinded to allocation.
This trial was registered at www.clinicaltrials.gov (NCT01155856) for baseline parameters.
Randomisation was performed centrally by a telephone voice response service from a computer-generated allocation sequence with a varying block size of 10 and 14.
Participants were allocated to the two groups in a 1:1 ratio, and the randomisation was stratified by smoking status (current or ex-smoker versus never-smoker) and by trial site hospital 1 or hospital 2). No differences were found between groups for baseline parameters.
Teleconsultations were conducted with patients in their homes and nurses at the hospital. The patient could take readings of the measurements on the telemedicine equipment, while the nurse collected the patient measurements electronically on a screen at the hospital.
266 patients were included in the present trial. Readmission could be determined in 261 patients at 4 weeks, in 257 patients at 8 weeks, in 253 at 12 weeks, and in 242 patients at 26 weeks.
Used intention-to-treat analysis.
The study was approved by the appropriate ethics committees.

Chau 2012
Patients were randomized to receive telecare or usual care following a simple randomization procedure (drawing a slip of paper with the group assignment Participants in the intervention group were asked to monitor their SpO2 and pulse rate using the device and transmit the data to the online network platform.

Kamei 2011
Language barrier Research assistant randomly assigned the consented persons to the intervention group or the control group by the envelope method. No differences were found between groups for baseline parameters.

Language barrier
The daily mental and physical condition of the patient was monitored at a remote location, and health / nursing guidance and mentoring were continuously provided.
Data of all patients randomised to study arms were analysed.
No patient was lost during study period or follow up.
Used intention-to-treat analysis.

Language barrier
This study was carried out with the approval of the research ethics review committee of the affiliated and Cooperating institutions. However, the trial protocol was not registered.

Vitacca 2009
Using a set of computer-generated random numbers in 1:1 ratio patients were assigned to the treatment or control group. No differences were found between groups for baseline parameters.
Patients recorded SpO2 using a finger pulse oximeter at home and the data was transferred to a TA nurse at the hospital, via a home telephone line.
All data reported in CONSORT flow diagram.
Used intention-to-treat analysis.