title: Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea.
abstract: BACKGROUND
  Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used.
  
  
  METHODS
  Randomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.
  
  
  RESULTS
  Nine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95% CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education.
  
  
  CONCLUSIONS
  The use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.
  
  
  BACKGROUND
  In PROSPERO 2012: CRD42012003294.
  
  
  METHODS
  http://www.crd.york.ac.uk/PROSPEROFILES/3294_PROTOCOL_20121016.pdf.
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-90187 Umeå, Sweden. Electronic address: sara.lundell@umu.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Lundell
authors.affiliation: Department of Radiation Sciences, Umeå University, S-90187 Umeå, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Holmner
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-90187 Umeå, Sweden.
authors.forename: Börje
authors.initials: B
authors.lastname: Rehn
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-90187 Umeå, Sweden.
authors.forename: Andre
authors.initials: A
authors.lastname: Nyberg
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, S-90187 Umeå, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Wadell
mesh_terms: D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D000069350:Telerehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: 6-min walk test; Physical activity level; Physical capacity; Symptoms; Telemedicine