"Remote care interventions have become more widespread over the past 20 years, with presumed benefits for diagnosis, treatment, rehabilitation and follow-up monitoring of patients.”
Remote care was shown to have similar, and sometimes better, results when compared with face-to-face (F2F) care regarding safety, efficacy, medication adherence, and user perception outcomes. However, heterogeneity and the risk of bias (RoB) in the available literature were the most common limitations, according to a systematic literature review published in RMD Open.1
“Due to the growing number of patients but an inadequate increment of human resources, there is an increasing pressure on the healthcare system, and new forms of care are needed, for example, telehealth-based follow-ups, or self-management interventions in the form of patient education,” investigators stated. “Thanks to the sophistication of communication systems and technologies, remote care interventions have become more widespread over the past 20 years, with presumed benefits for diagnosis, treatment, rehabilitation and follow-up monitoring of patients.”
Investigators developed a search strategy including publications in PubMed, Embase, and Cochrane Library. Eligible studies were published in English, French, German, Portuguese, and Spanish, and were full research articles, qualitative studies, and short reports or research letters of both prospective and retrospective studies. Additionally, unpublished studies from both the American College of Rheumatology (ACR) 2020 and European Alliance of Associations for Rheumatology (EULAR) 2020 conferences were screened for relevancy. Afterwards, 2 independent reviewers performed a standardized data extraction, synthesis, and RoB assessment according to study type.
Of the 2240 references that were initially identified, 129 had a full-text review and 47 fulfilled the inclusion criteria for the analysis (26 randomized controlled trails [RCTs], 8 prospective cohort studies, 8 cross-sectional studies, and 5 qualitative studies). The most frequently studied aspect was remote monitoring (n=35), with telephone or video calls cited as the most common mode of delivery (n=30).
Of the 34 studies that analyzed the outcomes of telemedicine, the majority evaluated efficacy and user perception, with 34% and 21%, respectively, reporting that remote care was superior to F2F care. Major benefits were time and cost savings. However, 13 studies stated technical aspects as a major drawback and barrier of remote care. No studies observed the implementation of remote care. The main limitation was heterogeneity of outcomes and methods, and 50% of studies had significantly high RoB.
A limitation of the study was the lack of blinding of patients and investigators to remote care interventions, which may have led to an overestimation of effect sizes. Additionally, none of the studies had follow-up periods longer than 1 year. In the cross-sectional and qualitative studies, RoB was evaluated exclusively in a descriptive manner because the Joanna Briggs Institute (JBI) Critical Appraisal Checklists do not have cut-offs for low, moderate, and high RoB. Publication bias may also be a factor, as results are more likely to be published if they are positive. Future trials should either compare telehealth with conventional care or use a sham intervention, such as online material only, in a control group.
“The need for new healthcare solutions is imminent due to the COVID-19 pandemic, leading to a recent increase in remote care research in rheumatic and musculoskeletal diseases (RMDs),” investigators concluded. “Currently available studies comparing remote with F2F care reported similar results for various efficacy, safety, adherence and user perception outcomes.”
Marques A, Bosch P, de Thurah A, et al. Effectiveness of remote care interventions: a systematic review informing the 2022 EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases. RMD Open. 2022;8(1):e002290. doi:10.1136/rmdopen-2022-002290