The Feasibility and Efficacy of Telespirometry for Pulmonary Monitoring of Cystic Fibrosis: A Systematic Review

Abstract

Background: Spirometry via telehealth (telespirometry) involves remote monitoring of lung function, which is useful to detect pulmonary changes and increase continuity of care for patients with cystic fibrosis (CF). Purpose: This systematic review aims to evaluate the feasibility and efficacy of telespirometry assessments for paediatric and adult CF patients. Method: A comprehensive search of health-related databases (CINAHL, Emcare (Ovid), Medline (Ovid), PEDRo and Scopus) was conducted. For inclusion, patients had to be clinically diagnosed with CF and studies could be of any study design or level according to the National Health and Medical Research Council (NHMRC) evidence hierarchy, had to use telespirometry devices for lung function tests, and be written or translated into English. The Crowe Critical Appraisal Tool (CCAT) was used to assess study quality, while also accounting for potential sources of bias encountered during the review process. Data was exported and summarised using the population, intervention, comparators, and outcomes (PICO) framework in Microsoft excel, to provide clinical recommendations. Results: Fourteen studies were included, with participants ranging from 5 to 44-years-old. Thirteen trials were performed domestically, while sample sizes and baseline patient characteristics varied. Nine studies analysed a control and intervention group. All studies varied in the intervention regime and clinical support provided. Collectively, the literature indicated poor patient adherence to telespirometry, which acted as a barrier to gauging its efficacy. Although appearing to be effective in detecting pulmonary deterioration, inconsistencies in pulmonary exacerbation (PEx) criteria were identified and lack of significant improvements in pulmonary outcomes were observed. Conclusion: Poor quality literature and small sample sizes increased risk of bias and restricted the application of the results to clinical practice. The current evidence base is limited by minimal experimental studies, lack of standardised telespirometry protocols, and criteria for PExs and poor patient compliance. Recommendations: At this stage, telespirometry for CF monitoring should be used by motivated and rurally/remotely located patients to complement in-person consults until its uptake is improved and accuracy and clinically efficacy can be ascertained.