Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial

Abstract

Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial AbstractObjective To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions.Design A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively.Correspondence to: S P Newman stanton.newman.1@city.ac.uk Extra material supplied by the author (see http://www.bmj.com/content/346/bmj.f653?tab=related#webextra)Web appendix 1: Whole Systems Demonstrator (WSD) terminology Web appendix 2: Description of the telehealth intervention Web appendix 3: Per protocol criteria Web figure 1: Provision of peripheral telehealth devices to intervention participants in the WSD Telehealth Questionnaire Study Web figure 2: Early removal of telehealth for reasons other than death across the 12 month trial period Web Main outcome measuresGeneric, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). ResultsIn the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696).Conclusions Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not e...

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa

“…Regarding year of publication, nine articles were dated 2012 (15)(16)18,(20)(21)(22)(29)(30)(31) , followed by years 2011 (n=6) (11)(12)(13)17,19,23,33) , 2010 (n=4) (24)(25)32,34) , 2013 (n=3) (14,(27)(28) and 2008 (n=1) (26) . The articles were published in General Cardiology journals (12)(13)(16)(17)(18)20,22,(24)(25)(28)(29)(30)(31)(32)34) , followed by General Clinical journals (14)(15)(26)(27)33) . Two articles were published in Nursing journals (19,23) and one was published in a Nutrition journal (21) (Chart 1).…”

“…The selected studies were performed in the following countries: USA (n=8) (12,15,17,19,(24)(25)(32)(33) , Sweden (n=2) (18,23) , Germany (n=2) (22,34) , Brazil (n=2) (21,26) , Australia (n=2) (28)(29) , United Kingdom (n=2) (14,31) , Italy (n=2) (16,30) , Spain (n=1) (13) , Taiwan (n=1) (19) and Iran (n=1) (27) . Nurses were the professionals performing the interventions in most studies (12,(14)(15)(19)(20)32) . Another study was performed by nurses in partnership with physical therapists (24) or physicians (22) , followed by nurses working with physical therapists, physicians and occupational therapists (18) .…”

“…Most studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(29)(30)(31)(33)(34) were randomized clinical trials (n=18), followed by two quasi-experimental studies (28,32) . Only one article (27) was a non-randomized clinical trial (4.3%) (Chart 1).…”

“…Nonpharmacological interventions proposed to improve the QoL of people with HF were: Remote health monitoring (12)(13)(14)(15)(16) , Instructions on health practices (17)(18)(19)(20)(21)(22) , Physical activity follow-up (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and Traditional Chinese Medicine practices (33)(34) . Chart 1 also presents characteristics of all studies, according to these categories.…”

Body-Worn, Ambient, and Consumer Sensing for Health Applications

“…Studies show inconsistent results in patient benefits, expected cost savings, and so forth. For example, some studies have shown measurable improvements in patient outcomes (Miguel et al, 2013); others have been neutral (Cox et al, 2012); while others reported no meaningful impact (Cartwright et al, 2013). The area of telehealth is still relatively immature and will continue to evolve over the next decade.…”