JMIR Publications

ABSTRACT

Background:

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.

Objective:

This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS).

Methods:

We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure (CNKI) and Wanfang, a Chinese medical database and searched papers published from Jan 1st, 2015, to July 1st, 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% confidence interval 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.

Results:

Twenty RCTs with 4153 patients was included in the qualitative review. 17 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 were 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 = 0.002), whereas no significant effects were found on depression (SMD = -0.25, 95%CI= [-0.72, 0.23], p = 0.30), anxiety (SMD = -0.10, 95%CI= [-0.27, 0.07], p = 0.71), fatigue (SMD = -0.36, 95%CI= [-1.06, 0.34], p = 0.0007) and self-care (SMD = 0.77, 95%CI= [-0.28, 1.81], p < 0.00001). In the subdomains of quality of life, telehealth statistically significant improved physical functioning (SMD = 0.15, 95%CI= [0.02, 0.29], p = 0.03), mental functioning (SMD = 0.37, 95%CI= [0.13, 0.60], p = 0.002) and social functioning (SMD = 0.64, 95%CI= [0.00, 1.29], p = 0.05), while there was no difference on cognitive functioning (MD = 8.31, 95%CI= [-7.33, 23.95], p = 0.30) and role functioning (MD = 5.30, 95%CI= [-7.80, 18.39], p = 0.43).

Conclusions:

Telehealth chronic disease management system 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 tested among different chronically ill groups.