Journal of Telemedicine and Telecare最新文献

IntroductionThe aim of this study was to compare the effectiveness of two methods of telerehabilitation (TR) delivery: mobile health TR (mHealth-TR) and video conference TR (VC-TR) in improving outcomes for patients with RC tendinopathy.MethodsEighty-five participants diagnosed with RC tendinopathy were randomized into synchronous (VC-TR) and asynchronous (mHealth-TR) groups. Both groups received an identical 8-week exercise programme delivered through their assigned platform. The programme included scapular mobilization, range-of-motion, strengthening, and stretching exercises. The primary outcomes were pain level (Visual Analogue Scale [VAS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH] score), quality of life (Short Form-36 Health Survey [SF-36] score), and shoulder mobility (universal goniometer). The assessments were carried out at baseline, after the treatment (week 8) and at a follow-up of 16 weeks.ResultsThe mean participant age was 51.8 years (SD 9.24), with 27% (n = 23) male. No significant between-group differences were observed for pain (VAS) or shoulder mobility (P > .05 for both). However, a significant group-by-time interaction effect was found for disability, measured by the DASH score (F(1,83) = 10.56, P = .001), and quality of life, measured by the SF-36 overall score (excluding physical role functioning, emotional role functioning, and social function) (Vitality/Energy: F(1,83) = 7.34, P = .006; Pain: F(1,83) = 4.78, P = .034; General Health: F(1,83) = 4.82, P = .032). Post-hoc analysis indicated significant improvements in disability and quality of life scores in the synchronous VC-TR group compared to the asynchronous mHealth-TR group. Specifically, DASH scores in the synchronous group decreased by 9.41 points (95% CI: 3.46 to 15.36, P = .002) from baseline to after treatment, and by 9.34 points (95% CI: 3.48 to 15.20, P = .002) by the 16th week. For quality of life, the VC-TR group showed significant improvements in the Vitality/Energy, Pain, and General Health domains from baseline to follow-up, with mean differences of 6.41, 11.68, and 10.83, respectively (all P < .05).DiscussionThis study suggests that patients with RC tendinopathy may experience greater improvements in pain management, disability, and overall quality of life through synchronous VC-TR compared to asynchronous mHealth-TR.

BackgroundEvolving stroke care demands careful screening of stroke patients to ensure the right care is administered to the right patients in a timely manner. Telestroke has been increasingly utilized to improve access to stroke specialists to make these assessments. Here we explore the care processes at these telestroke site to determine if an optimal care process can be determined.MethodsThis is a post-hoc analysis of data collected as part a larger quality improvement program, the IMPROVE stroke care program. We rank ordered and normalized the DTN times from encounters that used telestroke services to range between 0 and 1. We used linear mixed models to assess the acute stroke care process steps most associated with improvement in thrombolytic administration times.ResultsThe dataset consisted of 21,456 acute stroke code assessments, of which 8356 (80.6%) were conducted via telestroke (TS) services. Of these TS events, 7088 (84.8%) were conducted at sites that used TS for >85% of all events. Compared to private vehicle, EMS arrival is associated with 4% improvement in DTN ranks, though when paired with prehospital notification, DTN ranks significantly improve by 25%. Key process steps associated with shorter DTN times included calling a code stroke quickly upon arrival and notifying the telestroke consultant prior to obtaining the initial CT scan.DiscussionWorking with local EMS to provide prehospital notification along with rapid code stroke activation and consultant notification prior to CT were identified as best practices for providing timely acute stroke care using telestroke providers.

BackgroundHeart failure (HF) patients are frequently rehospitalized shortly after discharge. Telemonitoring and clinical decision support systems (CDSS) health alert follow-up may reduce the mortality and hospitalization in HF patients following discharge.MethodologyWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trial until May 2024. Dichotomous data were pooled using risk ratio (RR) and continuous data using mean difference. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024555577.ResultsWe included eight RCTs with a total of 7661 patients. Patients managed by CDSS were at lower risk of all-cause mortality than those who received usual care [RR: 0.64 with 95% confidence interval [CI] (0.45, 0.92), p = 0.01]. However, there was no difference in all-cause hospitalization [RR: 0.99 with 95% CI (0.88, 1.11), p = 0.84] between both groups. Additionally, CDSS led to a significant increase in mineralocorticoid antagonist (MRA) prescription compared to usual care [RR: 1.77 with 95% CI (1.48, 2.11), p < 0.00001], but there was no difference in addition of all-class guideline-directed medical therapy (GDMT) [RR: 1.23 with 95% CI (1.00, 1.52), p = 0.05] between the both groups.ConclusionClinical decision support systems significantly reduced all-cause mortality and increased MRA prescription. Still, there was no difference in all-cause hospitalization and the addition of all-class GDMT. More robust studies with longer follow-ups are therefore required to thoroughly examine the efficacy of CDSS in optimizing HF management.

IntroductionHeart failure (HF) is associated with high incidence and mortality rates, limited physical activity, decreased quality of life, and increased healthcare expenses. Implementing a Telehealth Care (TC) HF program might address these challenges while improving patient outcomes.MethodWe conducted a retrospective observational study using electronic medical record data. The study recruited 916 participants screened with ICD-10 code I50 from 2016 to 2020. After data screening, 210 participants were divided into a remote care group and a control group using propensity score matching. Patients in the remote care group received TC visits for HF management via Bluetooth-enabled equipment, while those in the control group received typical care.ResultsAmong the 587 participants, those who received TC experienced reduced rates of all-cause mortality and readmission within one year, as well as lower rates of cardiovascular disease and HF-related readmission. However, there was no significant difference in cardiovascular disease mortality compared to the control group within one year. Kaplan-Meier time-event curves showed that there were significant differences in survival analysis.DiscussionTC significantly reduced all-cause mortality and rehospitalization rates in HF patients, highlighting its role in enhancing patient outcomes through remote monitoring. Although cardiovascular-specific mortality within one year did not exhibit significant differences, the TC group had fewer HF-related readmissions. This suggests improved disease management and self-care in this group. The findings demonstrate the potential of TC as a valuable tool in standard HF care, particularly for patients with comorbidities, such as diabetes and coronary heart disease.

IntroductionTelemedicine (TM) has potential to address the global opioid use disorder treatment gap, yet its uptake, priorities, and barriers have not been mapped internationally.MethodsWe conducted a cross-sectional, web-based survey (July to November 2024) of clinicians and clinical leaders via the International Society of Addiction Medicine, World Psychiatric Association, and allied contacts. The questionnaire captured telemedicine facilitated medication for opioid use disorder (TMOUD) practices, priorities, and barriers. Responses were summarised overall and stratified by World Bank country-income group and by current TMOUD availability.ResultsSixty-eight experts from 37 countries, 32% from low/middle-income countries (LMICs), participated. General TM use rose from 57% before COVID-19 to 94% in 2024. TMOUD was available in 26 jurisdictions (38%), more often in high-income than LMIC settings (58% vs 11%). Barriers to prescribing were identified, and few settings reimbursed video and telephone consultations equally. Improving treatment retention (69%), reducing missed appointments (62%), and expanding medications to underserved (60%) or remote (57%) populations as top priorities, yet fewer than 40% reported that TMOUD was currently used to meet those goals. Key barriers were inadequate policy support (60%), lack of professional guidance (63%), restrictive regulation (48%), poor digital infrastructure (broadband 29%; e-prescribing 56%), and limited clinician training (54%); almost every barrier was more common in LMICs.DiscussionTMOUD remains uneven and concentrated in high-income countries. Updated clinical guidance, digital connectivity investment and interoperable e-health systems, and targeted workforce development, particularly in LMICs, are needed to realise TM's potential for equitable and effective treatment of opioid use disorder. This global survey fills a critical knowledge gap by documenting expert perspectives across income settings, offering cross-national evidence to inform equitable expansion of TMOUD worldwide.

ObjectivesRemote patient monitoring (RPM), combining home blood pressure measurements with telehealth services, effectively manages hypertension. Successful implementation of RPM programs at scale requires understanding program costs and financial sustainability. We evaluated the financial performance of an RPM program.MethodsConducted from March to June 2024 in the Cardiology Division at New York University Langone Health, the study used field observation, surveys, and micro-costing methods. A costing tool was developed to quantify program costs in 2024 US dollars, including personnel, equipment, and supplies. RPM-related services reimbursement rates were estimated using Medicare billing information. The return-on-investment (ROI) ratio was calculated by dividing net return (profit) by the RPM program costs. Sensitivity analyses assessed the impact of varying parameters on the ROI of RPM.ResultsThe average RPM program cost was estimated at $330 per patient (range: $208-$452). Major expenses included data review by staff ($172 per patient), blood pressure devices ($48 per patient), and phone communications ($36 per patient). ROI varied based on patient compliance with home blood pressure monitoring (≥16 days per month), with an average estimate of 22.2% (range: -11.1%-93.3%) per patient at a 55% compliance rate. The ROI was most sensitive to changes in data-review costs, insurance reimbursement rates, patient compliance, device setup, and communication costs.ConclusionsThe RPM program achieved a positive ROI from the perspective of a clinical division in a large healthcare system. Successful implementation and financial sustainability of RPM require efforts to reduce human resource costs and enhance patient engagement.

ObjectiveTo quantify the impact of technology-enabled rehabilitation nursing on patient-reported function after lower-limb arthroplasty and to explore effect modification by surgical procedure and by technological modality.MethodsTen databases were searched from inception to 2 May 2025. Randomised controlled trials (RCTs) comparing an innovative digital or electromechanical rehabilitation intervention with usual postoperative care and reporting WOMAC, KOOS or HOOS outcomes were eligible. Risk of bias was assessed with Cochrane RoB 2.0. Standardised mean differences (Hedges g) were pooled using a Hartung-Knapp REML random-effects model; heterogeneity was quantified with I². Sub-group analyses were prespecified for surgery type (TKA vs THA) and technology class (virtual reality VR, web/app telerehabilitation WB, robot/sensor RB). Publication bias was evaluated with funnel-plot inspection and Egger's regression. The certainty of evidence was assessed with the GRADE framework.ResultsFifteen RCTs (1012 experimental, 954 control participants; 11 TKA, 3 THA, 1 mixed) met the criteria and were all rated overall "low risk" by RoB 2.0. Across trials, technology-enabled care conferred a small but significant improvement in patient-reported function (g = 0.28; 95% CI 0.00 to 0.56; p = 0.049; I² = 86%). VR produced the largest point estimate (g = 0.62; 95% CI -0.18 to 1.41; 4 trials); WB yielded a modest, non-significant benefit (g = 0.18; 95% CI -0.24 to 0.59; 8 trials); RB showed a comparable, non-significant effect (g = 0.14; 95% CI -0.23 to 0.50; 3 trials). The χ² test for subgroup differences was not significant (p = 0.16). Egger's test revealed no evidence of small-study effects (p = 0.73). Leave-one-out and influence analyses confirmed robustness of the pooled estimate. The certainty of evidence was rated as moderate (GRADE).ConclusionsNext-generation digital and electromechanical rehabilitation programmes achieve at least non-inferior- and potentially clinically relevant-improvements in self-reported function after lower-limb arthroplasty while reducing in-person therapist time. Virtual-reality platforms appear most promising, but heterogeneity suggests that dose, feedback fidelity and sensor precision are key effect drivers. Large, standardised multicentre trials with cost-utility endpoints are needed to clarify which technological components add value for which patients.

ObjectiveInability to attend in-person care is a common barrier to accessing exercise therapy and education programs for knee osteoarthritis. The primary aim of this randomised clinical trial (RCT) was to determine if telehealth was non-inferior to 'in-person' delivery of a group-based exercise therapy and education program (GLA:D^®) for knee-related burden at 3 (primary timepoint), 12 and 24 months in people with knee osteoarthritis.DesignThis pre-registered (ACTRN12619000235101) two-arm (in-person v telehealth) non-inferiority limited-disclosure RCT commenced in April 2019, with a planned sample of 110. Knee-related burden was evaluated at baseline, 3- (primary timepoint), 12- and 24-month following intervention commencement by summating four Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄: pain, symptoms, activities of daily living, quality of life [QoL]). Secondary outcomes included health-related QoL, pain severity, physical activity, functional performance, patient satisfaction and global rating of change.ResultsRecruitment ceased in March 2020 due to COVID-19 restrictions. Forty-four participants enrolled at baseline (22 per group). Forty-three (98%), 40 (91%) and 29 (66%) participants provided 3-, 12- and 24-month follow-up data, respectively. The lower limit of the 95% confidence interval (CI) was above the non-inferiority threshold (i.e. -10 points) for KOOS₄ at 3 (mean difference, 95%CI = 6, -2 to 15) and 12 months (0, -9 to 9). Compared to in-person, mean reduction in worst pain was greater for telehealth delivery at 3 months (16.5, 95%CI 0.8 to 32.2). No other secondary outcomes were different between groups.ConclusionKnee-related burden outcomes following telehealth-delivered group-based exercise therapy and education in people with knee osteoarthritis might not be different to in-person delivery.

BackgroundFew studies have explored the cost and clinical impacts of enhanced telehealth interventions for stroke in contemporaneous practice. As such, we sought to compare the cost-effectiveness of a clinical service supported by a purpose built platform for stroke telehealth in South Australia.MethodsMarkov decision analytic models were constructed to model the implementation of an enhanced telehealth programme versus historical controls with limited referral support. The models were profiled on a minimum dataset of 470 patients with stroke symptoms presenting across eight regional/rural hospitals in South Australia. Clinical outcomes and costs were derived from published sources. Incremental cost-effectiveness ratios were used to estimate the cost-effectiveness of the telehealth platform over a lifetime time horizon, from the perspective of the Australian healthcare system compared with a historical control.ResultsImplementation of the South Australia Telestroke programme was associated with a gain of 0.10 quality-adjusted life years and a cost saving of $3873 per patient. That is, over a 5-year period, the introduction of technology-enabled telehealth resulted in a total projected cost saving of $8.7 million (M). This was driven by a reduction in the costs attributed to management (per patient -$2676; total projected: -$6.0 M), nursing home care (per patient: -$3268; total projected: -$7.3 M), non-medical costs (per patient: -$510; total projected: -$1.1 M) and futile transfers (per patient: -$111; total projected: -$250,248), which offset higher intervention costs (per patient: $2674; total projected: $6.0 M) and hospital costs (per patient: $18; total projected: $41,092). Sensitivity analyses confirmed the robustness of these findings.ConclusionThe implementation of an enhanced telehealth programme improves patient outcomes and is cost-saving relative to a telestroke programme with limited referral support. Our findings support ongoing implementation of the enhanced telehealth programme across South Australian hospitals.

ObjectivesTo compare the effects of physical therapy via telerehabilitation on the improvement in cardiopulmonary function, physical factors and psychological factors in patients with coronavirus disease 2019 (COVID-19).MethodsThirty-two patients with COVID-19 were randomly assigned to intervention and control groups. Both groups received online guidance and a leaflet on cardiopulmonary rehabilitation. Additionally, participants in the intervention group received physical therapy training via video call, which included pulmonary training and various exercises. Cardiopulmonary exercise testing, quality of life, functional capacity, cognitive function, lower body strength and endurance and psychological aspects (anxiety, depression and insomnia) were assessed.ResultsThe physical therapy programme delivered via telerehabilitation significantly improved cardiopulmonary function in patients with COVID-19 at the 3-month follow-up compared with the control group. Additionally, the physical therapy programme had beneficial effects on functional capacity, depression symptoms and quality of life.ConclusionA physical therapy programme via telerehabilitation can be delivered to patients with COVID-19 in their own homes to improve cardiopulmonary function after 3 months of follow-up.