Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 22, 2019
Date Accepted: May 14, 2020
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Telemedicine in chronic wound management: a systematic review and meta-analysis
ABSTRACT
Background:
Chronic wounds have been a great burden to patients and the health care system. The popularity of internet has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have provided contradictory results on the effect of telemedicine in chronic wound management.
Objective:
To evaluate the efficacy and safety of TM in chronic wound management.
Methods:
We systematically searched the electronic database (Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis was conducted to estimate endpoints.
Results:
Six RCTs and 6 cohort studies including 3913 patients were included. Efficacy outcomes in RCTs showed no significant differences in wound healing (HR 1.16; 95% CI 0.96 - 1.39; P = .13), and wound healing around 1 year (RR, 1.05; 95% CI, 0.89 – 1.23; P = .15). Non-inferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR, 0.45; 95% CI, 0.29 – 0.71; P = .00). The result of cohort studies showed that TM was more effective than standard care (HR 1.74; 95% CI 1.43-2.12; P = .00), while the outcome efficacy RR of wound healing around 1 year (RR, 1.21; 95% CI, 0.96 – 1.53; P = .56) and 3 months (RR, 1.24; 95% CI, 0.47-3.3; P = .67) was not significantly different between TM and standard care. Non-inferiority criteria of TM was met for wound healing around 1 year in cohort studies.
Conclusions:
Currently available evidence suggests telemedicine has similar efficacy and safety, and met non-inferiority with conventional standard care of chronic wounds. Large-scale, well-designed randomized controlled trials are warranted.
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