The Effectiveness of Telehealth Self-Management Interventions to Improve the Health Outcomes of Adults Undergoing Haemodialysis: A Systematic Review and Meta-Analysis

IF 3.5 3区医学 Q1 NURSING Journal of Clinical Nursing Pub Date : 2025-02-14 DOI:10.1111/jocn.17686

Si Xian Ng, Lian Kwang Tang, Hannele Turunen, Minna Pikkarainen, Yanhong Dong, Hong-Gu He

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Abstract

Background

Haemodialysis is a life-sustaining treatment for patients suffering from advanced chronic kidney disease that persists without respite. Adherence to complex haemodialysis regimens demands rigorous self-management. Current literature has suggested the potential of novel telehealth technologies in supporting the self-management of haemodialysis patients, but this remains inconclusive.

Aim

To synthesise available evidence to determine the effectiveness of telehealth self-management interventions on the health outcomes of adults undergoing haemodialysis.

Design

A systematic review and meta-analysis (reported according to the PRISMA Guidelines).

Methods

Nine electronic databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses Global), trial registries and grey literature were searched from inception till 1 December 2023 for randomised controlled trials on the effectiveness of telehealth self-management interventions for haemodialysis patients. Two independent reviewers performed screening, data extraction and risk-of-bias appraisal using Cochrane RoB tool-1. Meta-analyses using Review Manager Web synthesised the interventional effects. Cochrane GRADE assessed the overall quality of evidence.

Results

Fifteen randomised controlled trials (involving 1003 participants) were included. Telehealth self-management interventions had a medium statistically significant effect on improving self-efficacy (SMD = 0.54, 95% CI [0.25, 0.83], Z = 3.69, p = 0.0002). Additional meta-analyses for the outcomes of knowledge, treatment adherence, health-related quality of life, inter-dialytic weight gain and serum electrolyte levels were non-statistically significant but appeared promising to be improved by telehealth self-management. The overall certainty of evidence for all outcomes was very low.

Conclusions

This review provided insights into the clinical importance of telehealth self-management interventions in self-efficacy enhancement among haemodialysis patients. Future researchers are encouraged to optimise telehealth components relevant to the worldwide needs and cultural diversity of adults undergoing haemodialysis.

Implication for Professional Care

Adoption of technological healthcare delivery is vital in establishing positive health outcomes and sustainability of routine patient care pathways.

Patient or Public Contribution

None.

Registration: PROSPERO CRD42024438860

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远程医疗自我管理干预对改善成人血液透析健康结果的有效性：系统回顾和荟萃分析。

背景：血液透析是晚期慢性肾脏疾病患者的一种维持生命的治疗方法。坚持复杂的血液透析方案需要严格的自我管理。目前的文献表明，在支持血液透析患者自我管理的新型远程医疗技术的潜力，但这仍然是不确定的。目的：综合现有证据，确定远程医疗自我管理干预对血液透析成人健康结果的有效性。设计：系统回顾和荟萃分析（根据PRISMA指南报告）。方法：检索9个电子数据库（PubMed、EMBASE、Cochrane Central Register of Controlled Trials、MEDLINE、CINAHL、PsycINFO、Scopus、Web of Science和ProQuest Dissertations & Theses Global）、试验注册库和灰色文献，从成立到2023年12月1日，检索关于血液透析患者远程医疗自我管理干预有效性的随机对照试验。两名独立审稿人使用Cochrane RoB工具1进行筛选、数据提取和偏倚风险评估。使用Review Manager Web进行meta分析，综合干预效果。Cochrane GRADE评估了证据的总体质量。结果：纳入15项随机对照试验（1003名受试者）。远程医疗自我管理干预对提高自我效能感有中等统计学意义（SMD = 0.54, 95% CI [0.25, 0.83], Z = 3.69, p = 0.0002）。对知识、治疗依从性、健康相关生活质量、透析期间体重增加和血清电解质水平的meta分析结果无统计学意义，但似乎有望通过远程医疗自我管理得到改善。所有结果的证据的总体确定性非常低。结论：本综述揭示了远程医疗自我管理干预在提高血液透析患者自我效能感中的临床重要性。鼓励未来的研究人员优化与接受血液透析的成人的全球需求和文化多样性相关的远程医疗组成部分。对专业护理的启示：采用技术保健服务对于建立积极的健康结果和常规患者护理途径的可持续性至关重要。患者或公众贡献：无。登记号码：PROSPERO CRD42024438860。

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来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.