Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care.To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation).We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies.We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions.For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes.We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups.The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.

/pdf/interactive-telemedicine-effects-on-professional-practice-1xxbw8tg81.pdf

Interactive telemedicine: effects on professional practice and health care outcomes

Rationale The optimal way of assessing the impact of pulmonary rehabilitation on functional status in chronic obstructive pulmonary disease (COPD) is currently unknown. The minimal clinically important difference for the constant work rate cycling exercise also needs to be investigated to facilitate its interpretation. Objective. To evaluate the changes in the 6-minute walk test and in the constant work rate cycle endurance test immediately following and 1 year after pulmonary rehabilitation, along with the importance of these changes in terms of health status in patients with COPD. Methods. Patients with COPD (age: 65 8 years, mean SD; FEV1: 45 15% predicted) were recruited from a multicenter prospective cohort study and were examined at baseline, immediately after (n 157), and at 1 year after (n = 106) a pulmonary rehabilitation program. The 6-minute walk test and the cycle endurance test were performed at each evaluation. Health status was evaluated with the St George’s Respiratory Questionnaire. Measurements and Main Results. Following pulmonary rehabilitation, cycle endurance time increased (198 352 seconds, P .0001) and stayed over baseline values at 1 year (P .0001). The 6-minute-walk distance also showed improvements following rehabilitation (25 52 m, P .0001) but returned to baseline values at the 1-year follow-up. Changes in cycle endurance time were more closely associated with changes in health status than those of the 6-minute-walk-test. A 100to 200-second improvement in the cycle endurance time was associated with clinically meaningful changes in the St George's Respiratory Questionnaire scores. Conclusions. The cycle endurance test was more responsive than the 6-minute walk test to detect improvement in exercise tolerance following pulmonary rehabilitation and was also better correlated with improvements in health status. An improvement in the cycle endurance time ranging from 100 to 200 seconds appeared to be clinically meaningful. Editor’s Comment. Clinically meaningful changes in standard assessment tests are often somewhat arbitrarily defined. Objectively validated levels of significance help define the value of interventions and also provide indices that can be used to robustly define longitudinal trends. This study compares the de facto standard, the 6-minute-walking distance, with the perhaps more rigorous, cycle endurance time. Although both improve significantly with rehabilitation exercise training, the improvement in cycle endurance time is more durable and more clearly associated with improvements in disease-related quality of life, especially when remeasured 1 year after exercise training. The 6-minute-walking test needs to be viewed in this context as its simplicity is offset by its lack of sensitivity in identifying clinically relevant changes in patients with COPD undergoing rehabilitation. —

Objectively measured light-intensity physical activity is independently associated with 2-h plasma glucose

Health literacy in the eHealth era: A systematic review of the literature

This work was funded by the National Institute for Health and Care Excellence (NICE), invitation to tender reference DDER 42013, and supported by the National Institute for Health Research School for Public Health Research. The scope of the work was defined by NICE and the protocol was agreed with NICE prior to the start of work.

/pdf/barriers-and-facilitators-to-the-uptake-and-maintenance-of-2le9v4y30z.pdf

Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review.

Identifying the difference in barriers and motivators between middle-age and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on barriers and motivators for physical activity in middle-aged (50-64 years) and older adults (65-70 years). The review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9400 results from seven databases. A total of fifty-five articles meeting the inclusion criteria. Results indicate that barriers are comparable across the two age groups with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement and assistance in managing change were the most identified motivators. Middle-aged identified goals settings, believe that activity will be beneficial and social influences were most important. Findings can be used by professionals to encourage engagement with and adherence to physical activity.

/pdf/barriers-and-motivators-of-physical-activity-participation-4j2iolpnjv.pdf

Barriers and motivators of physical activity participation in middle-aged and older-adults – a systematic review

Little attention has been paid to the physical activity (PA) and nutrition behaviors of middle-aged men; thus, the aim of this study was to gather information and gain insight into the PA and nutrition behaviors of these men. Six focus group sessions were undertaken with middle-aged men (N = 30) from regional Australia to explore the challenges and motivations to PA participation and healthy eating. Men had a good understanding of PA and nutrition; however, this was sometimes confounded by inconsistent media messages. Work commitments and family responsibilities were barriers to PA, while poor cooking skills and abilities were barriers to healthy eating. Disease prevention, weight management, and being a good role model were motivators for PA and healthy eating. By understanding what a man wants, PA and nutrition interventions can be designed and delivered to meet the needs of this hard-to-reach population.

https://journals.sagepub.com/doi/pdf/10.1177/1557988312444718

What a man wants : understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men

Background: Compared to females, males experience higher rates of chronic disease and mortality, yet few health promotion initiatives are specifically aimed at men. Therefore, the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males (aged 35–54 years). Method/Design: The study design was a two-arm randomised controlled trial, having an IT-based (applying website and mobile phones) and a print-based intervention arm, to deliver intervention materials and to promote self-monitoring of physical activity and nutrition behaviours. Participants (n=317) were randomised on a 2:1 ratio in favour of the IT-based intervention arm. Both intervention arms completed assessments at baseline, 3, and 9 months. All participants completed self-report assessments of physical activity, sitting time, nutrition behaviours, physical activity and nutrition literacy, perceived health status and socio-demographic characteristics. A randomly selected sub-sample in the IT-based (n=61) and print-based (n=30) intervention arms completed objective measures of height, weight, waist circumference, and physical activity as measured by accelerometer (Actigraph GT3X). The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively. The majority of participants were employed in professional occupations (IT-based 57.6%, Print-based 54.2%) and were overweight or obese (IT-based 90.8%, Print-based 87.3%). At baseline a lower proportion of participants in the IT-based (70.2%) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based (82.3%) group (p=.026). The IT-based group consumed a significantly lower number of serves of red meat in the previous week, compared to the print-based group (p=.017). No other significant between-group differences were observed at baseline. (Continued on next page)

/pdf/effectiveness-of-a-website-and-mobile-phone-based-physical-2feausv18c.pdf

Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: Trial protocol and baseline findings of the ManUp Study

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online t...

What Kinds of Website and Mobile Phone–Delivered Physical Activity and Nutrition Interventions Do Middle-Aged Men Want?

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What a man wants : understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men

Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: Trial protocol and baseline findings of the ManUp Study

What Kinds of Website and Mobile Phone–Delivered Physical Activity and Nutrition Interventions Do Middle-Aged Men Want?