Synchronous video telemedicine in lower extremities ulcers treatment: A real-world data study

Gamus, Alexander; Keren, Elad; Kaufman, Hanna; Chodick, Gabriel

doi:10.1016/j.ijmedinf.2019.01.009

Cited by 11 publications

(28 citation statements)

References 23 publications

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“…Ultimately, 12 trials met the inclusion criteria, comprising a total of 3913 patients. Of these 5 were cluster RCTs [ 19 - 21 , 29 , 30 ], 1 was an RCT [ 22 ], and 6 were cohort studies [ 17 , 18 , 27 , 31 - 33 ]. The results of the study selection are shown in Multimedia Appendix 2 .…”

Section: Resultsmentioning

confidence: 99%

“…The selected studies [ 17 - 22 , 27 , 29 - 33 ] were published within 15 years. All studies included outpatients or patients in nursing homes.…”

Section: Resultsmentioning

confidence: 99%

“…All studies included outpatients or patients in nursing homes. A total of 8 trials [ 17 - 19 , 27 , 29 - 32 ] treated patients with chronic wounds due to different etiologies (mixed wounds), 3 trials [ 20 , 22 , 33 ] treated patients with diabetic foot ulcers, and 1 study [ 21 ] enrolled patients with pressure ulcers. Whereas most studies included any severity of ulcers, one study [ 20 ] excluded patients with prior ulcers, which lead to a low proportion of severe ulcers.…”

Section: Resultsmentioning

confidence: 99%

“…The TM consultation specialists included specialized wound care nurses [ 20 , 21 , 32 ], wound care physicians [ 17 , 19 , 22 , 27 , 30 , 33 ], podiatrists [ 20 ], dermatologists [ 18 , 31 ], and a multidisciplinary team [ 21 ]. Wound care varied, particularly in the control group, because of the clinical heterogeneity of TM organization between studies, with 8 of these being community-based models [ 17 - 19 , 21 , 29 - 32 ], and the other 4 wound center-based models [ 20 , 22 , 27 , 33 ]. The treatment method and efficacy might have some differences between the two kinds of treatment models.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, we tested the hypothesis of noninferiority of TM follow-up for the primary efficacy outcomes. We adopted a Δ=–0.15 as margin of minimum clinically important differences [ 27 , 28 ]. For the primary efficacy outcomes, noninferiority of TM was demonstrated when the lower boundary of the 95% CI was greater than 0.85, which meant that TM could retain at least 85% of the effect of the conventional standard care.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

Cao¹,

Gao²,

Chen³

et al. 2020

JMIR Mhealth Uhealth

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Background Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. Objective The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. Methods We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. Results A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. Conclusions Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

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