Studies on the value of remote care in inflammatory RMDs (PICO 1)
| Study | Study design | Disease | N° | Demographics* | Intervention | Control | Outcomes | Results† | RoB‡ |
| Berdal et al 11 | RCT | RA, SpA, PsA, SLE, OA | 389 | Age: 58 y Female: 71% FU duration: 12 mo | Self-management booklet, goal setting interviews, telephone FU, additionally to traditional rehabilitation programme | Traditional rehabilitation programme | Efficacy (HRQoL/PGI) | Better HRQoL values at discharge; no differences in other outcomes at any timepoints | RoB 2: low |
| Gossec et al24 | RCT | RA | 320 | Age: 57 y Female: 79% FU duration: 12 mo | E-health platform for health self-assessment and storing questions, additionally to rheumatology visits | Rheumatology visits | User perception | Better patient-physician interactions and patient perceived care | RoB 2: some concern |
| Khan et al13 | RCT | SLE | 50 | Age: 43 y Female: 95% FU duration: 16 w | Smartphone/Web application for tracking lifestyle activities and disease triggers, telephone calls to discuss lifestyle modifications, additionally to usual care | Usual care as recommended by treating physician | Efficacy (FACIT-F; BPI-SF; QoL) | Less fatigue, pain and QoL outcomes | RoB 2: high |
| Pers et al14 | RCT | RA in moderate/high disease activity | 94 | Age: 18–75 y§ Female: 75% FU duration: 6 mo | Smartphone app notifying rheumatologist for the necessity of a visit | Standard care | Efficacy (N° of visits, DAS28; HAQ; RAPID-3; SF-12) Safety (adverse events) User perception | Lower n° of total visits, no differences in other outcomes | RoB 2: high |
| Salaffi et al16 | RCT | Early RA | 41 | Age: 50 y Female: 75% FU duration: 12 mo | Web application for disease activity assessment and user perception, telephone calls in case of active disease | Conventional strategy | Efficacy (RAID; CDAI) User perception | Better according to the number of patients reaching remission and time to remission. Better for function radiological progression. Patient satisfaction was high with the application, but no comparisions were made | RoB 2: high |
| Song et al15 | RCT | RA | 92 | Age: 55 y Female: 71% FU duration: 24 w | Telephone education (medication, side effects, exercise, psychological approaches), additionally to standard care | Standard care | Efficacy (DAS28) Adherence | Better for compliance and medication adherence, no difference in disease activity | RoB 2: high |
| Taylor-Gjevre et al17 | RCT | Inflammatory arthritis | 85 | Age: 56 y Female: 20% FU duration: 9 mo | Remote diagnostic videoconference including physical exam by an on-site physical therapist | In person (F2F) rheumatology FU | Efficacy (DAS28; EQ-5D; RADAI) User perception | No differences | RoB 2: high |
| de Thurah et al12 | RCT | RA in low disease activity | 294 | Age: 61 y Female 69% FU duration: 52 w | Telehealth FU every 3–4 mo | Outpatient department every 3–4 mo | Efficacy (DAS28; HAQ; EQ-5D) Adherence | Non-inferiority between intervention and control | RoB 2: low |
| Ammerlaan et al23 | Cohort study | Patients with RMDs | 19 | Age: 22 y Female: 84% FU duration: 6 w | Six-week long interactive online programme (chatting with peers and peer leaders, home exercises, discussion board) | Three-day F2F programme with similar content | User perception | No differences | ROBINS-I: serious |
| Kennedy et al18 | Cohort study | Patients with RMDs (RA, PsA, SLE, IBD, arthritis, gout) | 123 | Age: 58 y Female: 90% FU duration: 6 mo | Teleconference for patient education (learning best practices, integration of self-management strategies) | F2F meeting with identical programme | Efficacy (self-efficacy) | No differences | ROBINS-I: serious |
| Leggett et al19 | Cohort study | New rheumatology referrals | 100 | Age: 48 y Female: 75% FU duration: two visits (no info) | Diagnostic telephone and subsequent teleconference consultation between patients and rheumatologists in a general practitioner office | F2F meeting | Efficacy (diagnostic accuracy) User perception | Numerically better diagnostic accuracy, patient and general practitioner satisfaction in the teleconference group compared with telephone consultations alone, no difference between teleconference and F2F | ROBINS-I: moderate |
| Nguyen-Oghalai et al20 | Cohort study | Veterans with suspected RMDs | 38 | Age: 57 y Female: 8% FU duration: 2–3 mo | Diagnostic videoconference between patient, nurse practitioner (same place) and rheumatologist | F2F visit with the same patients, 2–3 mo after videoconference | Efficacy (diagnostic accuracy) User perception | No statistical comparisions performed | ROBINS-I: moderate |
| Wood et al22 | Cohort study | Veterans with inflammatory arthritis | 85 | Age: 64 y Female: 15% FU duration: not given | Telemedicine care (videoconference) | Usual care (F2F) | Efficacy (travel distance) User perception Cost-effectiveness | Costs and distance of driving decreased when switching from usual to telemedicine care. No difference in satisfaction with medical care | ROBINS-I: serious |
| Kessler et al21 | Cross-sectional study | Paediatric patients with RMDs | 338 | No information reported | Telemedicine clinic for routine FU visits | In person visits in a rheumatology clinic | Efficacy (time schedule) Cost-effectiveness | Less distance travelled, less hours missed for work/school, less expenses for food/lodging, higher interest in telehealth | NA |
*Age/Female ratio was calculated by the sum of age (mean or median) or female ratio (%) of intervention and control groups, respectively and divided by the number of groups, unless reported otherwise.
†Results are reported in respect to the comparison of the intervention with the control.
‡Overall RoB is reported according to the RoB 2 tool (low, some concern, high RoB) and the ROBINS-I tool (low, moderate, serious RoB). Cross-sectional and qualitative studies were assessed using the Joanna Briggs Institute Critical Appraisal checklists which do not determine an overall RoB (therefore reported as ‘NA’).
§Age was reported as the number of patients (%) in age categories: 18–39 years: 8 (9); 40–59 years 41 (46); 60–75 years: 40 (45).
BPI-SF, Brief Pain Inventory Short Form; CDAI, Clinical Disease Activity Index; DAS28, Disease Activity Score based on 28 joints; EQ-5D, European Quality of Life 5 Dimensions; FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue; F2F, face-to-face; FU, follow-up; HAQ, Health Assessment Questionnaire; HRQoL, Health-Related Quality of Life; IBD, inflammatory bowel disease; mo, months; NA, not available; PGI, patient generated index; PsA, psoriatic arthritis; QoL, quality of life; RA, rheumatoid arthritis; RADAI, Rheumatoid Arthritis Disease Activity Index; RAID, Rheumatoid Arthritis Impact of Disease; RAPID-3, Routine Assessment of Patient Index Data 3; RCT, randomised controlled trial; RMDs, rheumatic musculoskeletal disease; RoB, risk of bias; ROBINS-I, risk-of-bias tool for non-randomised studies of interventions; SF-12, Short Form 12; SLE, systematic lupus erythematosus; SpA, spondyloarthritis; w, weeks; y, years.