Videoconferencing interventions and COPD patient outcomes: A systematic review

Abstract

Introduction

Videoconferencing circumvents various physical and financial barriers associated with in-person care. Given this technology's potential benefits and timely nature, we conducted a systematic review to understand how videoconferencing for chronic obstructive pulmonary disease (COPD) follow-up care affects patient-related outcomes.

Methods

We included primary research evaluating the use of bidirectional videoconferencing for COPD patient follow-up. The outcomes of interest were resource utilization, mortality, lifestyle factors, patient satisfaction, barriers, and feasibility. We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases for articles published from January 1, 2010, to August 2, 2021. Relevant information was extracted and presented descriptively and common themes and patterns were identified. The risk of bias for each study was assessed using design-specific validated tools.

Results

We included 39 studies of 18,194 patients (22 quantitative, 12 qualitative, and 5 mixed methods). The included studies were grouped by type of intervention; 18 studies explored videoconferencing for exercise, 19 explored videoconferencing for clinical assessment/monitoring, and 2 examined videoconferencing for education. Generally, videoconferencing was associated with high levels of patient satisfaction. There were mixed results in terms of its effects on resource utilization and lifestyle-related factors. Additionally, 12 studies were at high risk of bias, indicating that these results should be interpreted with caution.

Conclusions

The videoconferencing interventions resulted in high levels of patient satisfaction, despite facing technological issues. Overall, more research is needed to better understand the effects of videoconferencing interventions on resource utilization and other patient outcomes, quantifying their advantages over in-person care.

Keywords

ehealth remote consultation telecare telehealth teleconsulting systematic review COPD

Introduction

Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality, accounting for 3.2 million deaths worldwide in 2019.^1–3 Furthermore, the European COPD Audit found a 90-day all-cause readmission rate of 35.1%.⁴ In the United States, an analysis of Medicare claims data identified a 30-day all-cause readmission rate of 20.2%.⁵ Researchers and policymakers have recently begun using telehealth, technology-based medical services where distance is a factor,⁶ for COPD management.^7,8 Common applications of telehealth in COPD management include the monitoring of vital signs, patient education and self-management sessions, and pulmonary rehabilitation (PR) (i.e., supervised exercise and education sessions).⁸ These technologies have the potential to benefit patients who experience barriers in access to care,⁹ including rural,^10,11 elderly,^11,12 and Indigenous populations.¹³

Videoconferencing, a division of telehealth, provides bidirectional synchronous communication between providers and patients. It offers the benefits of face-to-face contact while circumventing various physical and financial barriers to accessing in-person care. Videoconferencing has also been associated with high levels of patient satisfaction.^14–16 Despite its advantages, this technology has not yet been widely implemented.

Several systematic reviews have summarized the effects of telehealth interventions on COPD management. However, few included videoconferencing-specific search terms or inclusion criteria.^7,8,17–21 To our knowledge, Almojaibel²² is the only systematic review to have focused specifically on videoconferencing. The review identified seven studies that evaluated the use of PR videoconferencing services for COPD patients. These interventions were well-accepted by patients, and no safety concerns were reported. This review specifically focused on PR-based interventions and only included literature published prior to 2015. To our knowledge, no reviews have assessed videoconferencing interventions focused on patient education, clinical assessment, or monitoring. Additionally, over recent years the context of the COVID-19 pandemic has further increased the popularity of telehealth for facilitating remote care,^23–25 highlighting the need to understand the effectiveness of these technologies.

We conducted a systematic review to investigate how providing videoconferencing for COPD patient follow-up affects patient-related outcomes including resource utilization, mortality, lifestyle factors, satisfaction, barriers, and feasibility. Understanding these relationships will help inform recommendations for future research and practice.

Methods

Study design and eligibility criteria

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist.²⁶ There is no published protocol associated with this review; all pertinent methodological details are available in the present manuscript and its supplement. This review included English-language primary research studies (clinical trials, quality improvement studies, and observational studies) with an available full text. The population of interest was adult patients (>18 years) with a confirmed COPD diagnosis. The target intervention was any form of videoconferencing, defined as a method of distance bidirectional face-to-face contact using telecommunication technologies.²⁷ Studies that did not include videoconferencing as the primary intervention were excluded. Our primary outcome was resource utilization, defined as all clinical-related visits following the intervention start date (hospital admissions and readmissions, emergency department visits, outpatient visits, exacerbations, and length of stay). Secondary outcomes included mortality, lifestyle factors, patient satisfaction, barriers, and feasibility. Table A1 contains the detailed eligibility criteria.

Search strategy

We systematically searched MEDLINE, EMBASE, EBM Reviews, and CINAHL electronic databases. The initial search was conducted on August 3, 2020, and it was subsequently updated on August 2, 2021 (Table A2). We only considered studies published after 2010 because prior studies would likely differ in terms of technology and clinical contexts.

Data extraction

Search results were aggregated and duplicates were removed using the Covidence platform.²⁸ Title/abstract screening was performed by two independent reviewers (MB and IS) to identify eligible articles, which were subsequently assessed for eligibility at the full-text level. Conflicts were resolved through consensus and, when needed, a third arbitrator (DTW).

Detailed information on the location, design, population, baseline characteristics, intervention, control, and outcomes was extracted by one reviewer and a random 10% sample was validated by a second reviewer for accuracy. We captured all qualitative and quantitative outcomes that aligned with our eligibility criteria and presented the findings descriptively using frequency counts and tables.

The included studies were grouped and presented by intervention domain based on how videoconferencing was used: exercise-based interventions, clinical assessment and monitoring interventions, and education interventions (Table 1). Within each domain, we presented outcomes in the following categories: quantitative, qualitative, and patient satisfaction and barriers (both qualitative and quantitative; combined due to the similar nature of these outcomes). All outcomes of interest were presented in the supplemental tables. In the main text, an abbreviated version of the tables was presented. To create the abbreviated tables, the overall themes for qualitative results were presented and a hierarchy was used for each quantitative outcome category, based on clinical relevance and frequency of outcome reporting (Table A3).

Table 1.

Videoconferencing domain definitions and examples

Domain	Definition	Example
Domain 1—Videoconferencing to facilitate exercise-based interventions	Exercise-specific homecare and guidance provided through videoconferencing technology.⁹¹	Telerehabilitation
Domain 2—Videoconferencing to facilitate clinical assessment and monitoring interventions	Direct communication between patient/family and staff/health operators to provide health advice or monitor patient outcomes through videoconferencing technology.⁹¹	Telemonitoring
Domain 3—Videoconferencing to facilitate education interventions	Direct reinforcement or distribution of education services through videoconferencing technology.^91,92	Tele coaching

Risk of bias assessment

Risk of bias assessments were preformed independently by two reviewers (MB and IS) and, when needed, a third arbitrator (MJ). Randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias Tool.²⁹ Non-randomized interventional studies were assessed using the Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) tool.³⁰ Observational studies were assessed using the Newcastle–Ottawa Scale.³¹ Qualitative studies were assessed using the Critical Appraisal Skills Programme (CASP).³² Based on the guidance of Long et al.,³³ we identified CASP items one (research aims), three (design), eight (data analysis), and nine (statement of findings) as most relevant to our research question.

Results

The literature search identified 1334 records. Thirty-nine studies were included in the final synthesis (22 quantitative, 12 qualitative, and 5 mixed methods; Figure 1). Although some studies, such as Hoaas et al.³⁴ and Kooij et al.,³⁵ appeared to meet our inclusion criteria, they were excluded because videoconferencing was not the main intervention component.

Figure 1.

Study PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Twelve of the included studies were RCTs, 9 were pre-post-intervention studies, 4 were non-randomized trials, 2 were retrospective cohort studies, and 12 were qualitative studies (Table 2, Table A4). The sample sizes ranged from n = 6³⁶ to n = 11,303,³⁷ and most (74%) had a sample size of 100 or less. Twenty-two studies were conducted in Denmark, six in Norway, five in the United States, two each in Australia and Canada, and one each in the Netherlands and South Korea. Length of study follow-up ranged from 7 days³⁸ to 5 years.³⁷

Table 2.

Summary of the study design characteristics and risk of bias for all included studies (n = 39).

Study ID	Study type/design	Sample size I/C	Intervention vs. control	Length of F/U	Risk of Bias
Domain 1- Exercise-based interventions with videoconferencing (n = 18 studies)
Bhatt 2019	Quantitative/Matched RC	80/160	12-wk PR (exercise, education) via videoconferencing vs. no PR	1 mo	LRB
Bødker 2015	Qualitative	11***	6-mo group exercise sessions via videoconferencing with PT or nurse	4 mo	LRB
Burkow 2015	Mixed methods/Pre-post	10*	9-wk web-based PR group (exercise, education) + weekly video consults with PT or nurse (assessed exercise progress, symptoms) vs. UC	9 wk	LRB
Donesky 2017	Quantitative/nRCT	7/8	8-wk group yoga via videoconferencing vs. paper educational materials + nurse phone calls	2 mo	HRB
Godtfredsen 2020	Quantitative/RCT (same as Hansen 2020)	67/67	10-wk PR group via videoconferencing (exercise, education) vs. 10-wk conventional PR	12 mo	LRB
Hansen 2020	Quantitative/RCT	67/67	10-wk PR group via videoconferencing (exercise, education) vs. 10-wk conventional PR	22 wk	LRB
Holland 2013	Quantitative/Pre-post	8*	8-wk telerehabilitation (exercise, education) + biweekly video consults with PT vs. UC	2 mo	LRB
Jansen-Kosterink 2015	Quantitative/nRCT	36/14**	12-wk mix of conventional PR and tele-PR (exercise) + optional video consults with PT vs. conventional PR	3 mo	HRB
Marquis 2015	Quantitative/Pre-post	26*	8-wk telerehabilitation program via videoconference (exercise, education; sessions transitioned from supervised to unsupervised) vs. UC	2 mo	LRB
Rayce 2020	Qualitative/Ethnographic	11***	Individual or group telerehabilitation sessions via videoconferencing	Not Reported	LRB
Rosenbek Minet 2015	Mixed methods/Pre-post	37*	3-wk training with PT and counseling with OT via videoconferencing vs. UC	3 wk	LRB
Selman 2015	Qualitative/nRCT	6/6	8-wk group yoga via videoconferencing vs. paper educational materials + nurse phone calls	8 wk	LRB
Simony 2020	Qualitative/ Phenomenological	15***	26-wk telerehabilitation program (exercise, education, consultations) via videoconferencing	26 wk	LRB
Sølling 2015	Qualitative/Explorative	9***	Videoconference-based respiratory training and nurse consultations	Not Reported	HRB
Stickland 2011	Quantitative/nRCT	147/262	8-wk PR program (exercise, education) via videoconference vs. standard PR program	6 mo	HRB
Tsai 2017	Quantitative/RCT	19/17	8-wk telerehabilitation group via videoconferencing (exercise) vs. UC	2 mo	LRB
Zanaboni 2017	Quantitative/Pre-post	10*	24-mo telerehabilitation (exercise) via videoconference + weekly video consults with PT vs. UC	24 mo	LRB
Zanaboni 2013	Mixed methods/Pre-post	10*	6-mo telerehabilitation (exercise) via videoconference + weekly video consults with PT vs. UC	6 mo	LRB
Domain 2- Clinical assessment and monitoring interventions with videoconferencing (n = 19 studies)
Barken 2018	Qualitative/Descriptive	10***	3-mo telemonitoring intervention with video consultations + transmission of health data	3 mo	LRB
Dyrvig 2015	Quantitative/RC	Pre-RCT 206/ 5485	Telemedicine intervention vs. no telemedicine intervention (intervention from Sorknaes, 2013)	42 d	LRB
		RCT 201/ 3931
		Post-RCT 689/ 4744
Emme 2014	Quantitative/RCT	25/25	Virtual hospital treatment with videoconferencing vs. standard care in hospital	3 mo	LRB
Emme 2014b	Qualitative/Descriptive	9***	Virtual hospital treatment with videoconferencing	18 mos	LRB
Jakobsen 2015	Quantitative/RCT	29/28	Virtual hospital treatment with videoconferencing vs. standard care in hospital	6 mo	LRB
Kim 2012	Mixed methods/Pre-post	78/36/30	Group 1: daily telemonitoring vs. Group 2: daily telemonitoring + telephone consultations vs. Group 3: daily telemonitoring + biweekly video consults (education)	6 mo	HRB
Mathar 2015	Qualitative	6***	2-wk PT and nurse video consultations (8 sessions)	2 wk	HRB
Nissen 2017	Qualitative/Descriptive	14***	Telemonitoring intervention with video consultations + transmission of health data	Not specified	LRB
Ringbaek 2015	Quantitative/RCT	141/140	Telemonitoring and video consults vs. UC	6 mo	LRB
Saleh 2014	Quantitative/Pre-post	99*	2-wk daily nurse video consultation vs. UC	12 mo	HRB
Schou 2014	Quantitative/RCT	22/22	Virtual hospital treatment with videoconferencing vs. standard care in hospital	6 wk	LRB
Schou 2013	Quantitative/RCT	22/22	Virtual hospital treatment with videoconferencing vs. standard care in hospital	3 mo	LRB
Sølling 2020	Qualitative/ Phenomenological	9***	Online video consultations run by primary care nurses	From 1.5-21 mos	LRB
Sorknaes 2016	Quantitative/RCT	132/134	1-wk daily nurse video consultation vs. UC	26 wk	HRB
Sorknaes 2016b	Qualitative/Post Phenomenological analysis	8***	1-wk daily nurse video consultation	7 d	LRB
Sorknaes 2013	Quantitative/RCT	132/134	1-wk daily nurse video consultation vs. UC	26 wk	LRB
Sorknaes 2011	Quantitative/nRCT	50/50	1-wk daily nurse video consultation + telephone follow-up thereafter vs. UC	28 d	LRB
Tupper 2018	Quantitative/RCT	141/140	Telemonitoring + video and non-video consultations vs. UC	6 mo	HRB
Vatnoy 2017	Qualitative	10***	Telemonitoring with video consultations + transmission of health data	10 d	HRB
Domain 3- Patient education interventions with videoconferencing (n = 2 studies)
Nield 2012	Mixed methods/RCT	11/11	Weekly pursed lips breathing education session via Skype vs. one-time hospital education session	3 mo	HRB
Thomas 2017	Quantitative/Pre-post	41*	Monthly inhaler training sessions via videoconferencing vs. UC	2 mo	LRB

*Compared same sample before/after intervention; **Results presented for COPD subgroup only, ***No control group.

Note: Outcome sample sizes are equal to sample sizes at baseline unless otherwise specified.

d: day; F/U: follow-up; HRB: high risk of bias; LRB: low risk of bias; mo: month; nRCT: non-randomized controlled trial; OT: occupational therapist; PC: prospective cohort; PR: pulmonary rehabilitation; PT: physiotherapist; RC: retrospective cohort; RCT: randomized controlled trial; UC: usual care; wk: week.

Risk of bias

Twelve RCTs were assessed for risk of bias using the Cochrane Risk of Bias tool; nine were deemed low risk (LRB) and three were deemed high risk (HRB) (Table 2, Table A5). Using the ROBINS-I scale, we evaluated the risk of bias for 13 non-randomized interventional/observational studies (Table 2, Table A6). One study was deemed low risk (LRB), six moderate risk (LRB), five serious risk (HRB), and one critical risk (HRB). Two cohort studies were assessed using the Newcastle–Ottawa scale, both of which were low risk (LRB; Table 2, Table A7). Twelve studies were appraised using the CASP qualitative checklist; nine were considered low risk (LRB) and three high risk (HRB; Table 2, Table A8).

Domain 1 – exercise-based interventions with videoconferencing

Quantitative outcomes

Thirteen studies (10 quantitative and 3 mixed methods) presented quantitative outcomes for exercise-based videoconferencing interventions (Table 3; Table A9).^39–51 All included some form of group-based or individually tailored exercise. Most also included educational^{40,41,43,44,46–48} and/or symptom telemonitoring^{39,42,44,46,50,51} components. The exercise programs ranged from 3 weeks⁴⁷ to 24 months,⁵⁰ with most lasting 8–10 weeks.^{39,41–44,46,48,49} Three studies were RCTs.^41,43,49

Table 3.

Summary of key outcomes for the n = 27 studies reporting quantitative outcomes.

Study ID	Primary outcomes	Secondary Outcomes
Study ID	Primary outcomes	Mortality	Feasibility	Lifestyle factors
Domain 1—Exercise-based interventions with videoconferencing
Bhatt 2019	30-d AECOPD readmission rate significantly lower in I vs. C (3.8% vs. 11.9%, p = 0.040)		I group: attrition rate was 17.5% (for completing at least 20 PR sessions)
Burkow 2015			Total program cost/patient: €581 (355 healthcare personnel, 120 travel, 46 equipment, 35 set up, 25 technical issues)	9-wk median SGRQ total score significantly lower in I vs. C (mean change score (pre to post) −6.53, 95% CI −12.68 to −0.38, p = 0.04, sample size n = 9 vs. n = 9)
Donesky 2017			Adherence in I vs. C: 90% (14.5/16 yoga classes) vs. 100% (phone calls), sample size n = 6 vs. n = 6	8-wk mean SGRQ total score not significantly different in I vs. C (effect size 0.242, p = 0.74, sample size n = 6 vs. n = 6)
Godtfredsen 2020				62-wk change score from baseline in CCQ total score not significantly different in I vs. C (n = 99; adjusted difference (C-I) 0.1, 95% CI −0.2, 0.4), also not significantly different within groups (I: −0.0, 95% CI −0.3 to 0.3, C: 0.1, 95% CI −0.2 to 0.3)
Hansen 2020	No significant difference in COPD-related hospitalizations at 22-wk follow-up in I vs. C (38 vs. 36, p = 0.97)	No significant difference in mortality at 22-wk follow-up in I vs. C (p = 1.0)	Program retention significantly higher in I vs. C: 57/67 vs 43/67, OR 3.18, 95% CI: 1.37–7.35, p < 0.01	22-wk change from baseline in CAT score not significantly different in I vs. C (adjusted difference (C-I) −0.2, 95% CI −2.1 to 1.8, p > 0.05)
Holland 2013			I group: patients attended 76% of sessions	8-wk mean change in CRQ dyspnea score exceeded minimum important difference in I vs. C (4 SD 4)
Jansen-Kosterink 2015			Adherence in I vs. C: 13 vs. 29 patients completed the full treatment	12-wk mean CRQ score not significantly different in I vs. C (p = 0.531, sample size n = 29 vs. n = 13)
Marquis 2015	8-wk no of exacerbations in I vs. C was 5 (19.2%) vs. 4 (15.4%), sample size n = 22 vs. n = 23		I group (sample size n = 22): mean number of sessions completed was 14.4 SD 0.9/15 supervised and 7.2 SD 3.4/9 unsupervised	8-wk mean change in CRQ dyspnea score not significantly different in I vs. C (difference (I-C) 0.5 SD 1.3, p = 0.084), sample size n = 22 vs. n = 23
Rosenbek Minet 2015			I group: completers had a mean of 7.5 video links with PT; total expenditures for hospital were between € 852–956	3-wk median CCQ score significantly lower in I vs. C (p = 0.039)
Stickland 2011			Mean number of sessions attended in I vs. C: 12.6 vs. 13.2	6-mo mean SGRQ total score not significantly different in I vs. C (p > 0.05, sample size n = 47 vs. n = 88)
Tsai 2017			I group: mean attendance 22 SD 5 /24 total sessions	8-wk mean CAT score not significantly different between I vs. C: (MD (I-C) −3, 95% CI −7,0, p = 0.06)
Zanaboni 2017	COPD-related hospitalizations in I vs. C: 11 vs. 5		I group: mean number of training sessions/week was 1.7 and mean number of measurements recorded via website/week was 3.0	I group: mean CAT total score not significantly different at baseline vs. yr 1 vs. yr 2 (p > 0.05)
Zanaboni 2013	Number of hospital admissions in I vs. C: 2 vs. 2		No significant differences in hospital costs in I vs. C: p = 0.50; I group: mean number of video sessions per week: 0.5 SD 0.1
Domain 2—Clinical assessment and monitoring interventions with videoconferencing
Dyrvig 2015	PRE-RCT: 42-d all-cause readmission rate significantly higher in I vs. C (OR 3.18, 95% CI 2.40 to 4.22, p < 0.0001)	5-yr mortality rate significantly lower in I vs. C (hazard ratio for all three study periods 0.50, 95% CI 0.37 to 0.68, p < 0.0001)
	DURING RCT: 42-d all-cause readmission rate significantly higher in I vs. C (OR 3.44, 95% CI 2.59 to 4.57, p < 0.0001)
	POST-RCT: 42-d all-cause readmission rate significantly higher in I vs. C (OR 6.04, 95% CI 5.09 to 7.16, p < 0.0001)
Emme 2014				3-mo mean CSES score not significantly different in I vs. C (adjusted difference −4.1 (95% CI −24.1, 16.0) p = 0.680, sample size n = 22 vs. n = 17);
Jakobsen 2015	30-d COPD-related readmission-free survival probability not significantly different in I vs. C (difference (I-C) −6.2%, lower 95% CI −24.8%, non-inferiority p = 0.35)	30-d mortality in I vs. C was 0 vs. 0		30-d mean change in SGRQ total score not significantly different in I vs. C (p = 0.2015, sample size n = 21 vs. n = 22)
Kim 2012				6-mo BCKQ score not significantly different between groups (p = 0.450)
Ringbaek 2015	6-mo mean number of ECOPD-related admissions not significantly different in I vs. C (0.55 range 0–5 vs. 0.54 range 0.4, p = 0.74)	Mortality rate not significantly different in I vs. C (p = 0.87)	I group: patients were scheduled for 7 video consultations during the study period and 82.6% participated in at least 6
Saleh 2014	12-mo ECOPD-related admissions not significantly different in I vs. C (43 vs. 41 patients, p = 0.827, sample size n = 56)	I group: consulted nurses through a median of 10 IQR 9–11 planned consultations		I group: mean oxygen saturation was not significantly different at baseline vs. after intervention (93.9% SEM 0.29% to 93.8% SEM 0.46%, p = 0.26)
Schou 2014				6-wk mean score on Neuropsychological test for VVL – cumulated recall not significantly different in I vs. C (p = 0.78; sample size n = 21 vs. n = 21); 6-wk FEV1 not significantly different from baseline in I or C: 1.2L vs. 1.0L
Schou 2013				3-mo SGRQ total score not significantly different in I vs. C (p = 0.19, sample size n = 21 vs. n = 19);
Sorknaes 2016	26-wk mean number of AECOPD readmissions not significantly different in I vs. C (MD (C-I) 0.06, 95% CI −0.43 to 0.54, p = 0.82, sample size n = 121 vs. n = 121)
Sorknaes 2013	30-d ECOPD mean readmissions not significantly different in I vs. C (p > 0.05)	Time to death not significantly different in I vs. C (75 vs. 74 d)	I group patients had a median of 6.6 video consultations (range 0–9)
Sorknaes 2011	28-d number of ECOPD readmissions not significantly different in I vs. C (12% vs. 22%, difference [I-C] −10%, 95% CI −25%, 5%)		I group: each patient had median of 8 (range 1–18) consultations
Tupper 2018		No significant differences in mortality between study groups (p = 0.87)		6-mo mean CAT score not significantly different in I vs. C (between-group difference (I-C) −0.59, 95% CI −1.86, 0.67, p = 0.36)
Domain 3—Patient education interventions with videoconferencing
Nield 2012			Logbook use to record practice times in I vs. C: 100% vs. 64%	12-wk VAS intensity not significantly different in I vs. C (p = 0.11)
Thomas 2017				CRQ dyspnea scores significantly improved I vs. C (from baseline to follow-up) + 0.3 points, p = 0.01

Note: For feasibility, lifestyle, patient satisfaction, and barrier outcomes, when multiple time points were recorded, we reported the longest available follow-up. Significant findings are noted in bold. See Table A3 for the hierarchy used to select relevant outcomes for this summary table.

AECOPD: acute exacerbation of chronic obstructive pulmonary disease; BCKQ: Bristol COPD Knowledge Questionnaire; C: control group; CAT: COPD Assessment Test; CCQ: Clinical COPD Questionnaire; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CRQ: Chronic Respiratory disease Questionnaire; CSES: COPD Self-Efficacy Scale; d: day; ECOPD: exacerbation of chronic obstructive pulmonary disease; FEV1: forced expiratory volume in 1 s; I: intervention group; IQR: interquartile range; MD: mean difference; mo: month; NIV: non-invasive ventilation; OR: odds ratio; PR: pulmonary rehabilitation; PT: physiotherapist; RC: retrospective cohort; RCT: randomized controlled trial; SD: standard deviation; SEM: standard error of the mean; SGRQ: St George's Respiratory Questionnaire; SUS: System Usability Scale; VAS: Visual Analog Scale; VVL: visual verbal learning; wk: week.

Five studies compared resource utilization outcomes between groups and the results were varied. In a matched comparison of patients receiving PR via videoconference versus those receiving the standard of care (no PR), Bhatt et al.⁴⁰ (LRB) reported a significant reduction in 30-day all-cause and acute exacerbation of COPD (AECOPD) readmissions (readmission rate in PR via videoconferencing vs. standard of care for all-cause: 6.2% vs. 18.1%, p = 0.013 and for AECOPD: 3.8% vs. 11.9%, p = 0.040). In a comparison of PR via videoconference and conventional PR, Hansen et al.⁴³ (LRB) found no significant difference in COPD-related hospitalizations after the intervention period (p = 0.77) or the 22-week follow-up (p = 0.97).

Three studies reported cost-related feasibility outcomes.^39,47,51 A 3-week study of physiotherapist training plus occupational therapist counseling in Denmark found that total expenditures cost up to €956 per patient (LRB).⁴⁷ In a pre-post evaluation of a telerehabilitation program, Zanaboni and colleagues⁵¹ (LRB) reported a 27% reduction in 6-month COPD-related hospital costs compared to the 6 months before the program (p = 0.50).

The exercise-based interventions were largely successful in improving lifestyle-related outcomes. An RCT conducted by Hansen et al.⁴³ (LRB) identified significant improvements on the Hospital Anxiety and Depression Scale among those receiving videoconference-based PR compared to those receiving conventional PR (10-week change from baseline adjusted difference [conventional videoconference] on anxiety scale: 1.2, 95% confidence interval [CI] 0.2–2.3, p < 0.05, depression scale: 0.9, 95% CI 0.1–1.7, p < 0.05). Another RCT, Tsai et al.⁴⁹ (LRB), reported similar improvements among those receiving videoconferencing versus usual care. Burkow and colleagues³⁹ (LRB) reported significantly better health-related quality of life (HRQoL) as measured by St George's Respiratory Questionnaire at post-intervention compared to baseline (mean change score pre to post: −6.53, 95% CI −12.68 to −0.38, p = 0.04). However, some studies found null or negative results in terms of lifestyle outcomes (e.g., Godtfredsen et al.,⁴¹ Hansen et al.,⁴³ and Stickland et al.⁴⁸).

To summarize, while no overwhelming evidence was found in support of exercise-based videoconferencing, we observed promising improvements in lifestyle outcomes. The majority of rehabilitation studies had a significant improvement in this category (n = 7/12). The one study that looked at a yoga intervention also found a significant improvement in one or more lifestyle factors (Table 4).

Table 4.

Summary of outcomes for all included quantitative studies (n = 27).

Intervention Type	Study IDs	Resource Utilization	Mortality	Lifestyle Factors
Domain 1—Exercise-based interventions with videoconferencing
Rehabilitation	12 studies: Bhatt 2019, Burkow 2015, Godtfredsen 2020, Hansen 2020, Holland 2013, Jansen-Kosterink 2015, Marquis 2015, Rosenbek Minet 2015, Stickland 2011, Tsai 2017, Zanaboni 2017, Zanaboni 2013	✓		✓✓✓✓✓✓✓X
Yoga	1 study: Donesky 2017			✓
Domain 2—Clinical assessment and monitoring interventions with videoconferencing
Daily nurse video consultations	5 studies: Dyrvig 2015, Saleh 2014, Sorknaes 2016, Sorknaes 2013, Sorknaes 2011	✓	✓
Independent symptom monitoring and video consultations	3 studies: Kim 2012, Ringbaek 2015, Tupper 2018	✓		✓
Virtual Hospital	4 studies: Emme 2014, Jakobsen 2015, Schou 2014, Schou 2013	✓✓
Domain 3—Patient education interventions with videoconferencing
Pursed lip breathing education	1 study: Nield 2012			✓
Inhaler training	1 study: Thomas 2017			✓

Note: The number of check marks (✓) indicates the number of studies with significant positive outcomes in a particular category (i.e., favoring the intervention group). The number of X's (X) indicates the number of studies with significant negative outcomes in a particular category (i.e., favoring the control group). Blank boxes represent no significant positive outcomes in a category, and grey boxes represent no measured outcomes in a category.

Qualitative outcomes

Five studies presented qualitative outcomes (four qualitative and one mixed method; Table 5, Table A10).^39,52–55 Among these studies, two main themes were identified. The first theme was patient experience living with COPD (n = 4 studies).^52–55 Most patients agreed that videoconferencing interventions improved feelings of support, increased disease knowledge, coping ability, and accessibility to healthcare professionals and provided reassurance, greater clinical insight, and opportunities to participate actively in care.

Table 5.

Summary of key outcomes for the n = 13 studies reporting the main qualitative themes.

Study ID	Main qualitative findings
Study ID	Living with COPD	Perceived Feasibility	Perceived Safety
Domain 1—Exercise-based interventions with videoconferencing
Bødker 2015	Most patients agreed receiving the intervention improved: support, accessibility, clinical insight, COPD knowledge, nurse/patient relationships, active participationConcerns regarding living with COPD: patients own health status, reduced quality of life	Technological challenges: loss of sound, brief disconnection, no sessions able to take place while systems were fixed, staff had to travel to patients’ home to fix the systemOverall: large infrastructure needed to initiate and maintain the program
Burkow 2015		Overall: easy to learn and use, technical problems associated with wireless connection did not impact acceptability of the program
Rayce 2020	Training as part of routine: online training gave patients more time and energy for other daily activities and helped establish a routineLiving with COPD: patients worked hard in training with the hopes of achieving a stable or better everyday life in terms of their condition, also experienced fears of getting worse	Obligation: patients felt obligated to train, in some cases creating a sense of frustration
Selman 2015	Concerns regarding living with COPD: high symptom burden, poor physical function, social isolation, limited free time due to treatments
Simony 2020	Living with COPD: online training helped patients master daily living with COPD, became more empowered, gained more knowledge about their diseaseTraining as part of routine: online training gave patients more time and energy for other daily activities, strengthened communication pathways
Domain 2—Clinical assessment and monitoring interventions with videoconferencing
Barken 2018	Most patients agreed receiving the intervention improved: support, accessibility, patients’ sense of security and peace of mind, clinical insight, COPD knowledge, nurse/patient relationships, active participation
Emme 2014b	Most patients agreed receiving the intervention improved: acknowledgment from health care professionals regarding need for hospitalisation, ability to return to daily life and stay in their usual surroundings, interactions with staff, ability to cope with COPD-related problemsIntervention drawbacks: at admission patients were reliant on relatives, medical equipment, and medical professionals for disease management
Kim 2012		Technological challenges: difficulties determining the precise area to apply the devices, display results disappearing too quickly, Incorrectly connecting the device, unease in using video phones, difficulties in adjusting the device volume, server error, operational error, difficulty in portabilityRequested Improvements: acknowledgment on transmission of the biometrics, live feedback on the test results, ability to check blood pressure
Mathar 2015			Security/Obligations: patients with active symptoms: consultations were a source of security, non-active symptom patients: felt the service was an obligation and did not want to receive the service again
Nissen 2017	Most patients agreed receiving the intervention improved: COPD knowledge	Overall: patients more personal and relaxed meetings, technology easy to handle, quick to repair, some patients missed personal proximity common in normal check-ups
Sølling 2020	Most patients agreed receiving the intervention: saved them time, improved their health, wellbeing, and body awareness, and allowed them to take more responsibility and play an active role in their treatmentBuilding connections with others: all patients perceived the consults as personal and meaningful, most felt it was important to meet their care provider in person first	Technological challenges: patient experienced some problems related to the equipment and network coverage but overall embraced the technology	Safety: patients felt safe and confident with the online consults
Vatnoy 2017	Most patients agreed receiving the intervention improved: accessibility, reassurance, COPD knowledge	Technological challenges: difficulty using touch screen, frustrations related to application questionnaireOverall: TM reduced time and effort at routine checks, TM was comprehensible and manageable, homecare services were more flexible, those in good health found daily contact restricting, dissatisfaction on lack of ability to provide specific feedback, most felt equipment design was good	Security: one participant found TM to be intrusive
Domain 3—Patient education interventions with videoconferencing
Nield 2012		Technological challenges: weak broadband signalOverall: all participants were reached at prescheduled times

Note: Outcome sample sizes are equal to sample sizes at baseline unless otherwise specified. Qualitative outcomes were summarized based on the detailed findings presented in the supplementary table. See Table A3 for the hierarchy used to select relevant outcomes for this summary table.

COPD: chronic obstructive pulmonary disease; TM: telemonitoring.

The second theme was the perceived usability and technological feasibility of the videoconferencing interventions (n = 3 studies).^39,52,53 The findings within this theme were varied. For example, one study reported that the participants found the equipment user-friendly (LRB).³⁹ However, two studies noted a variety of technological challenges including connection problems and loss of sound,^39,52 and another reported that patients found the videoconferencing intervention to be an obligation (LRB).⁵³

Patient satisfaction and barriers to use

Twelve studies reported patient satisfaction outcomes (two qualitative, seven quantitative, and three mixed methods; Table 6, Table A11).^{39,40,42,43,45–47,49,51,54,56} Patient satisfaction was consistently high. Qualitative evidence suggested that the videoconferencing programs were well received and that patients felt they experienced positive health changes as a result of the intervention.^39,47,51,54 Quantitatively, Burkow and colleagues³⁹ (LRB) reported a mean System Usability Scale score of 94.4/100 for the videoconferencing users. Several studies reported technology issues as a barrier to the use of videoconferencing. For example, Donesky et al.⁴² (HRB) found that just 23% (n = 7) of their sessions occurred without technical issues.

Table 6.

Summary of key outcomes for the studies reporting on patient satisfaction and/or barriers to use (n = 11 studies reporting qualitative outcomes, n = 15 studies reporting quantitative outcomes).

Study ID	Qualitative satisfaction and barriers to use		Quantitative satisfaction and barriers to use
Study ID	Patient satisfaction	Barriers	Patient satisfaction	Barriers
Domain 1—Exercise-based interventions with videoconferencing
Bhatt 2019				I group: no adverse events occurred
Burkow 2015	Program, group education, exercise session, and consultations were well-perceived. The program was useful for integrating health behaviors and forming social connection. Video camera was not intrusive. And program was well organized		I group: 9-wk mean SUS score was 94.4 (range 87.5–100, median 92.5)
Donesky 2017			I group (sample size n = 6): mean class enjoyment 8.3 SD 2.7 /10	I group (sample size n = 6):n = 7 (23%) classes occurred without technical issues
Hansen 2020				I group: major technical issues affected 2/360 sessions, minor temporary technical issues affected 49/360 sessions
Holland 2013			Median SUS score in I group was 81 (range 43–100)	Technical problems occurred in 36% of sessions
Jansen-Kosterink 2015			Mean satisfaction score in I group was 6.0 SD 2.0 /10 (for n = 55 total sample, not just COPD patients)
Marquis 2015			I group: mean score of 97.3% SD 2.4% on the Telemedicine Satisfaction Questionnaire (sample size n = 22)	Only minor adverse events were reported
Rosenbek Minet 2015	Patients felt that the intervention provided reassurance and feelings of safety and confidenceThe intervention was perceived as accessible and improved treatment adherence and physical and mental capacity
Selman 2015	Questionnaires were found to be acceptable and straightforwardBoth the control and intervention groups reported positive experiences
Sølling 2015	Patients’ opinion: “Online Viva” reduced their anxiety and need for hospitalization.
Tsai 2017				I group: 24 technical issues occurred in 197 sessions (poor internet)
Zanaboni 2013	All participants felt the intervention improved their physical health and had an overall positive experience			I group: reasons for not performing a videoconference included health-related problems, absence from home, unavailability, and personal reasons
Domain 2—Clinical assessment and monitoring interventions with videoconferencing
Barken 2018	Overall Intervention was perceived as easy to use and manage	Encountered technological challenges
Emme 2014b	Virtual admission allowed patients to become familiar with medical equipment, at end of intervention patients returned to usual ways of coping
Jakobsen 2015			I group (sample size n = 20): all felt confident using the equipment	Common barriers to recruitment: too tired/ill on admittance, no reason, do not want to participate, etc.
Kim 2012			Across all experimental groups (n = 144): I think it is easy to use this device – n = 27 strongly agree, n = 102 agree, n = 13 disagree, n = 2 strongly disagree
Mathar 2015	The intervention was reassuring and introduced a sense of control, while patients did not feel knowledge was increased, many found the intervention helped coping with acute exacerbation.
Nissen 2017	Patients experienced considerable satisfaction and a sense of increased security, described self-management competence and enhanced well-being
Saleh 2014			I group: 52.4% reported safety when discharged from hospital without I, 90.5% of patients reported safety when discharged to I at home (p < 0.001)
Sorknaes 2016b	Patients’ self-image changed according to activity, treatment, and care.
Sorknaes 2011			I group (sample size n = 41): 76% of patients felt more safe or safe with discharge (7% no, 17% don’t know)
Vatnoy 2017	Intervention improved patient's coping skills, management of daily lives, reduced stress, and facilitated living as normally as possible
Domain 3—Patient education interventions with videoconferencing
Nield 2012	Patient experience was consistently positive based on comments offered at the end of the study			Delivery of sessions was not possible for one patient due to weak signal
Thomas 2017			I group (n = 35): 86% prefer videoconference training to in-person visits

Note: Qualitative outcomes were summarized based on the detailed findings presented in the supplementary table. See Table A3 for the hierarchy used to select relevant outcomes for this summary table.

COPD: chronic obstructive pulmonary disease; I: intervention group; SD: standard deviation; SUS: System Usability Scale; wk: week.

Domain 2—Clinical assessment and monitoring interventions with videoconferencing

Quantitative outcomes

Twelve studies (11 quantitative and 1 mixed method) presented quantitative outcomes for clinical assessment/monitoring videoconferencing interventions (Table 3; Table A9).^37,57–67 Four studies evaluated a virtual hospital intervention where patients received home treatment using telemedical equipment.^57,58,62,63 Five studies provided daily nurse video consultations.^{37,60,64–66} Three studies tested a combination of independent symptom telemonitoring and video consultations.^59,61,67

Findings were mixed in terms of resource utilization. One study reported an increased rate of readmissions among their videoconference intervention group (42-day all-cause readmissions in videoconferencing vs. usual care: odds ratio 3.18, 95% CI 2.40–4.22, p < 0.0001)³⁷ (LRB) and the remaining six reported non-significant results.^{58,60,61,64–66} However, the clinical assessment and monitoring interventions showed promise in reducing patient length of stay.^58,60 In addition, among patients on long-term oxygen therapy, Ringbaek et al.⁶¹ (LRB) reported significantly fewer 6-month respiratory-related outpatient clinic visits among the group receiving telemonitoring plus video consults compared to usual care (video consults: mean 1.34 visits vs. usual care mean 1.41 visits, p < 0.001).

In an RCT by Sorknaes et al.⁶⁵ (LRB), each patient was expected to receive between 5 and 9 nurse video consultations and received a mean of 6.6 (range 0–9). In Saleh et al.'s⁶⁰ pre-post study (HRB), patients were expected to receive at least 10 nurse video consultations and received a median of 10 (IQR 9–11).

To summarize, while the clinical assessment and monitoring interventions were feasible, the majority of outcomes in all categories were non-significant (Table 4). Half (n = 2/4) of the studies examining virtual hospitals reported significant positive findings for resource utilization. This proportion was greater than that of the studies examining daily nurse video consultations (n = 1/5) or independent symptom monitoring with video consultations (n = 1/3), which reported positive significant findings for resource utilization (Table 4).

Qualitative outcomes

Seven studies presented qualitative outcomes and three main themes were identified (six qualitative and one mixed method; Table 5, Table A10).^{36,57,59,68–71} The first theme was patient perspectives on living with COPD (n = 5 studies).^57,68–71 All studies found that patients perceived improvements in their ability to live with COPD related to the videoconferencing intervention. Areas of benefit included increased feelings of support, ability to cope with COPD, COPD knowledge, and access to care.

The second theme was the perceived feasibility and usability of the videoconferencing interventions (n = 4 studies).^59,69–71 Three studies reported that patients had positive feelings towards the technology. Video consults were found to reduce the time and effort of routine follow-up checks; the technology was easy to handle and problems that did occur did not change the overall acceptance of the programs.^69–71 Three studies reported technological challenges.^59,70,71

The final theme was perceived safety (n = 3 studies).^36,70,71 Two opposing views stood out within this theme. Sølling et al.⁷⁰ (LRB) and Mathar et al.³⁶ (HRB) found that patients with active symptoms felt the videoconferencing intervention was a source of safety and security. Conversely, Mathar et al.³⁶ (HRB) reported that patients without active symptoms found the intervention to be an obligation.

Patient satisfaction and barriers to use

Ten studies reported patient satisfaction outcomes (six qualitative, three quantitative, and one mixed method; Table 6, Table A11).^{36,38,58–60,66,68,69,71,72} All studies reporting qualitative outcomes found that patients were considerably satisfied. The interventions were seen as reassuring and allowed patients to continue with their daily lives. This was supported by quantitative measures. For example, 95% of patients receiving daily nurse teleconsultations recommended this as a replacement for standard care (LRB).⁶⁶ Technological challenges were a barrier to the telemonitoring intervention in Barken et al.⁶⁸ (LRB).

Domain 3—Patient education interventions with videoconferencing

Quantitative outcomes

Two studies evaluated quantitative outcomes for educational videoconferencing interventions (Table 3, Table A9).^73,74 Nield et al.⁷³ (HRB) conducted a mixed methods RCT of video-based weekly pursed lips breathing education sessions. After 4 weeks, the videoconferencing group reported significantly higher social and emotional support compared to the control group receiving a single in-person education session and brochure (mean social support score: Skype 74.1 standard error (SE) 6.6 vs. control 51.6 SE 7.2, p = 0.02; mean emotional support score: Skype 33.8 SE 2.8 vs. control 23.5 SE 3.0, p = 0.02); however, these differences were attenuated by the end of 12-week study (social p = 0.12, emotional p = 0.14). Thomas et al.⁷⁴ (LRB) conducted a quantitative pre-post study of monthly inhaler training sessions via videoconference. The authors reported significant improvements in the Chronic Respiratory Disease Questionnaire subscales from baseline to follow-up (dyspnea +0.3 points, fatigue +0.6 points, emotional +0.5 points, mastery +0.7 points; all p ≤ 0.01).

Overall, very few studies examined patient education interventions with videoconferencing (Table 4). Although promising findings were observed for lifestyle factors in both studies (n = 1 pursed lip breathing education intervention, n = 1 inhaler training intervention), further examination is required.

Qualitative outcomes

One study examined qualitative outcomes (HRB) (Table 5, Table A10). They found that despite weak broadband signals, all participants completed their sessions at the prescheduled time.⁷³

Patient satisfaction and barriers to use

Both studies reported patient satisfaction outcomes (one quantitative and one mixed methods; Table 6, Table A11). Thomas et al.⁷⁴ (LRB) found that 86% of patients preferred videoconference training over in-person training. Similarly, Neild et al.⁷³ found patients were highly satisfied with the intervention and reported few technical problems (HRB).

Summary of qualitative themes

Three common themes emerged across the intervention domains, reported by 13 of the 17 qualitative and mixed methods studies (Table 5, Table A10). Firstly, patients agreed that videoconferencing interventions improved life with COPD by providing increased support, accessibility, and COPD knowledge. Secondly, patient perceptions of the feasibility of videoconferencing were cautiously optimistic, with positive feedback balanced almost equally by varying levels of technological challenges. Finally, due to conflicting findings among the small number of studies that reported on patient-perceived safety, no conclusions could be drawn. The remaining four studies reported patient satisfaction and barrier qualitative outcomes only.

Discussion

This systematic review summarizes recent evidence on videoconferencing for COPD follow-up care. We identified 39 studies exploring videoconferencing in the context of exercise, clinical assessment/monitoring, and education. Overall, videoconferencing interventions were well-received by patients and showed improvements in resource utilization and lifestyle-related outcomes in certain settings. However, we also identified potential issues regarding technological feasibility.

This review found that some videoconferencing interventions reduced resource utilization while others did not. Several studies comparing video-based care to its in-person equivalent found null effects in terms of resource utilization (e.g., virtual hospital care,⁵⁸ virtual PR,⁴³ and telemonitoring⁶¹), indicating that in these settings videoconferencing may be as equally effective as in-person care. Given that videoconferencing reduces common barriers to in-person care (e.g., access to transportation, travel time),^10,75 it may be advantageous for COPD patient follow-up. Future research should focus on better understanding the effects of these types of videoconferencing interventions on clinical outcomes and quantifying their advantages over in-person care. However, we also acknowledge there were few significant differences in resource utilization within studies comparing videoconferencing interventions to standard care.^60,64–66 This observation may in part be due to heterogeneity in the definition of standard care.

We found that videoconferencing interventions were associated with high levels of patient satisfaction. Videoconferencing allowed patients to participate in their own care, improved the relationship between patients and providers, and gave greater clinical insight. These findings are consistent with the existing literature; a recent review of reviews examining videoconferencing among patients with long-term conditions reported that despite finding no concrete evidence for or against improvements in clinical outcomes, patient satisfaction was high.⁷⁶

Our review identified technological issues as the main barrier to the use of videoconferencing. Although videoconferencing can improve access to care among those who live in rural areas or have limited mobility,¹⁰ it is important to consider that some of these populations may lack access to the internet and/or videoconferencing devices or may lack skills in navigating this technology. For example, inexperience with technology and lack of caregiver support may contribute to lower uptake of videoconferencing among older adults.^77,78 Lower income and racialized populations experience a disproportionate lack of access to the internet and videoconferencing devices.^79,80 Several studies in our review excluded participants based on their lack of internet access^39,42,51 or lack of technology skills,⁶⁷ which may have limited the generalizability of their samples to the aforementioned populations.

Importantly, internet coverage and access to videoconferencing-enabled devices have been steadily improving among rural and low-income populations over recent years.⁸¹ In cases of inaccessibility, satellite care sites can also provide access to videoconferencing technologies with greatly reduced travel times.^82–84 In addition, various other solutions can be applied to improve access to videoconferencing within hard-to-reach populations. For example, mobile-friendly platforms may provide greater ease of use for patients who only have access to the internet through a mobile phone.⁸⁵ Subsidizing the costs of technology may also support access.⁸⁵ Ultimately, increasing access to videoconferencing will allow patients to develop the knowledge and skills to manage their condition without the need to travel to a care center.⁸⁶

Overall, the exercise-based interventions were successful in improving lifestyle-related outcomes such as anxiety and depression and, in some cases, HRQoL. This aligns with the work of Almojaibel,²² which identified positive trends in exercise capacity, dyspnea, HRQoL, and sense of social support among COPD patients receiving video-based PR. One possible mechanism supporting this effect may be the association between technology use and increased self-efficacy through the development of positive emotional functioning, coping, and self-management skills.^49,87,88 In turn, this may contribute to improvements in mental health and HRQoL.^89,90

Strengths and limitations

Our review has a number of strengths. Firstly, we examined a novel topic that has the potential to impact policy and practice, particularly given the ongoing COVID-19 pandemic. Restricting to studies from the past 11 years allowed us to present the current state of videoconferencing in COPD follow-up care. Further, this review captured quantitative, qualitative, and mixed methods studies, creating a comprehensive picture of the literature. Lastly, a bias assessment was performed using a validated risk of bias tools,^29–32 allowing us to identify studies at high risk of bias and consider their findings accordingly.

Our review also had several weaknesses we would like to acknowledge. For feasibility reasons, our search was limited to English-language peer-reviewed studies, which may introduce publication bias. Only two studies explored videoconferencing for education, limiting our ability to draw conclusions within this domain. More generally, a high level of heterogeneity in study design, outcomes, and quality made it difficult to compare studies. In the future, the use of standardized outcome measures may improve comparability. Lastly, 12 of 39 (31%) included studies were at a high risk of bias, limiting our ability to draw accurate conclusions. However, this may be due, in part, to the use of the Cochrane Risk of Bias tool to assess bias in RCTs. This tool penalizes studies that are unable to blind participants, such as the studies included in this review, resulting in a higher assessed bias.

Conclusion

The COVID-19 pandemic has increased the need for remote patient-care strategies such as videoconferencing, which enables real-time face-to-face communication with patients. Our review identified three domains of videoconferencing interventions for COPD follow-up care: exercise-based, clinical assessment and monitoring, and education. Despite encountering technological issues, patients using videoconferencing interventions reported consistently high levels of satisfaction and improved perceptions of living with their condition. In addition, some studies found no significant difference in healthcare resource utilization when comparing videoconference-based care to an in-person equivalent. This suggests that in some cases, videoconferencing may be as effective as in-person care. Additional promising findings were seen for lifestyle outcomes within exercise-based studies. Going forward, additional high-quality research is needed to better understand these potential effects and to make further comparisons with in-person equivalents.

Supplemental Material

sj-docx-1-jtt-10.1177_1357633X231158140 - Supplemental material for Videoconferencing interventions and COPD patient outcomes: A systematic review

Supplemental material, sj-docx-1-jtt-10.1177_1357633X231158140 for Videoconferencing interventions and COPD patient outcomes: A systematic review by Meghan Bowman, Matthew Jalink, Isobel Sharpe, Siddhartha Srivastava and Don Thiwanka Wijeratne in Journal of Telemedicine and Telecare

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Southeastern Ontario Academic Medical Organization (SEAMO) Innovation Grant (Don Thiwanka Wijeratne, Siddhartha Srivastava); Don Thiwanka Wijeratne received funding from Ontario Drug Policy Research Network and Canadian Institute of Health Research, Cardiovascular Network.

ORCID iD

Meghan Bowman

Supplemental material

Supplemental material for this article is available online.

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