Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 4, 2020
Date Accepted: Mar 11, 2021
Effects of telemedicine and mobile health on systolic blood pressure management in stroke patients: a systematic review and meta-analysis of randomized controlled trials
ABSTRACT
Background:
Stroke is a common harmful disease with high recurrence and mortality rates. It not only affects patients’ quality of life, but also imposes a heavy economic burden on the family, medical system, and society. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Mobile health (mhealth) interventions may have the potential to facilitate the control of blood pressure among stroke patients, but its effectiveness has not been established.
Objective:
This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of mhealth interventions on the control of systolic blood pressure among stroke patients, in order to provide a reference for clinical applications.
Methods:
The Cochrane evaluation method was adopted to conduct the systematic review. The research literature published up to June 2020 and consisting of RCTs related to mhealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane Collaboration Risk of Bias Tool was used to evaluate the quality of the studies selected for the meta-analysis. A randomized or fixed-effects model was used to analyze changes in systolic blood pressure between the mhealth intervention group and the usual care group in the RCTs. The I2 statistic was used to assess heterogeneity.
Results:
Ten RCTs with a total sample size of 12974 stroke patients met the inclusion criteria. Compared with the usual care group, the mhealth intervention group had a significantly greater impact on the control of systolic blood pressure (mean difference (MD) -4.26 mmHg, 95% confidence interval (CI) -7.39 to -1.12; P=0.008). A subgroup analysis showed the intervention mode of telephone calls plus short message service (SMS) (MD -9.09 mmHg, 95% CI 12.71 to -5.46, P<0.001) or SMS reminder (MD -4.34 mmHg, 95% CI -6.55 to -2.13, P=0.0001), had a greater impact on the control of systolic blood pressure in the mhealth intervention group than the usual care group. Among the stroke patients with a baseline systolic blood pressure ≥140 mmHg (MD -6.15 mmHg, 95% CI -9.44 to -2.86: P=0.0002), or an intervention interval ≤1 week (MD -6.51, 95% CI -9.36 to -3.66: P<0.0001), the control of systolic blood pressure of the mhealth intervention group was better than that of the usual care group.
Conclusions:
In general, the mhealth interventions reduced the systolic blood pressure of the stroke patients by an average of 4.26 mmHg compared with usual care. Mhealth interventions are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke patients, especially those with hypertensive stroke.
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