Can Chronic-Condition Follow-Up Move to Phone or Video? What Three Meta-Analyses Report

Three systematic reviews with meta-analyses, published in the Journal of Medical Internet Research between 2022 and 2024, compared remote or digital delivery of chronic-condition care with usual or face-to-face care ^[1][2][3]. They covered adults with chronic wounds, children and adolescents with type 1 diabetes, and community-dwelling patients in nurse-led rehabilitation ^[1][2][3]. Together they show where remote delivery matched the comparison care, where it did better on specific measures, and where it made no measurable difference ^[1][2][3].

How the reviews were conducted

All three reviews pooled results with a random-effects model ^[1][2][3]. The wound review pooled relative risks (RRs) with 95% confidence intervals (CIs) and assessed heterogeneity with the I2 statistic ^[1]. The diabetes review reported mean differences (MDs), and the rehabilitation review reported both MDs and standard mean differences (SMDs) ^[2][3]. Risk of bias was assessed with Cochrane tools in all three reviews, and the wound review added ROBINS-I and Joanna Briggs Institute checklists for its cohort and quasi-experimental studies ^[1][2][3].

Chronic wounds: healing was similar

The 2024 wound review examined digital health interventions (DHIs) in adults with chronic wounds, searching 9 databases up to August 1, 2023 ^[1]. It included randomized controlled trials (RCTs), cohort studies and quasi-experimental studies: 25 studies with 8125 patients entered the systematic review, and 20 studies with 6535 patients entered the meta-analysis ^[1].

In the RCTs, wound healing did not differ significantly between DHIs and control groups (RR 1.02, 95% CI 0.93-1.12; P=.67), nor did all-cause mortality at around 1 year (RR 1.08, 95% CI 0.55-2.12; P=.83) ^[1]. DHI use was associated with fewer adverse events (RR 0.44, 95% CI 0.22-0.89; P=.02), and a subgroup analysis suggested a positive effect of digital platforms on wound healing (RR 2.19, 95% CI 1.35-3.56; P=.002) ^[1]. Wound size, cost, patient satisfaction and wound reporting rates could not be meta-analyzed, although most individual studies found DHIs not inferior to usual care ^[1].

Type 1 diabetes in children and adolescents: a modest HbA1c reduction

The authors describe type 1 diabetes as the most common chronic autoimmune disease among children and adolescents ^[2]. Their 2024 review pooled 20 RCTs with 1704 participants from 12 countries, comparing telemedicine with usual care, and judged only 1 of the 20 trials (5%) to be at high risk of bias ^[2]. The primary outcome was glycated hemoglobin (HbA1c) ^[2].

Telemedicine reduced HbA1c by 0.22 compared with usual care (95% CI -0.33 to -0.10; P<.001; I2=35%) ^[2]. Changes in self-monitoring of blood glucose (MD 0.54, 95% CI -0.72 to 1.80; P=.40) and hypoglycemia incidence (MD -0.15, 95% CI -0.57 to 0.27; P=.49) were not statistically significant, and youth-specific diabetes quality-of-life scores showed no convincing effect ^[2]. Non-youth-specific quality of life improved (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%) ^[2].

Subgroup analyses found larger HbA1c effects in studies involving children (MD -0.41), studies lasting less than 6 months (MD -0.32), studies in which providers communicated with patients through smartphone apps (MD -0.37), and studies with medication dose adjustment (MD -0.25) ^[2]. The authors described telemedicine as a useful supplement to usual care ^[2].

Nurse-led telerehabilitation: gains for some conditions

The 2022 review examined nurse-led telehealth interventions for rehabilitation, which the authors term telerehabilitation, as a way for nurses to manage chronic diseases at a distance ^[3]. It searched 6 databases for studies published from 2015 to 2021 comparing telerehabilitation with face-to-face rehabilitation in people with hypertension, cardiac disease, chronic respiratory disease, diabetes, cancer or stroke, and meta-analyzed 26 studies ^[3]. Telephone follow-up was the most common delivery approach ^[3].

Telerehabilitation improved quality of life in cardiac disease (SMD 0.45, 95% CI 0.09 to 0.81; P=.01) and chronic respiratory disease (SMD 0.18, 95% CI 0.05 to 0.31; P=.007) ^[3]. Self-care improved in cardiac disease (MD 5.49, 95% CI 2.95 to 8.03; P<.001) and diabetes (SMD 1.20, 95% CI 0.55 to 1.84; P<.001), although the diabetes estimate showed high heterogeneity (I2=91%) ^[3]. For systolic blood pressure the review reported MD 10.48 (95% CI 2.68 to 18.28; P=.008), for diastolic blood pressure MD 1.52 (95% CI -10.08 to 13.11; P=.80), and for HbA1c MD 0.19 (95% CI -0.19 to 0.57; P=.32) ^[3]. There was no statistically significant effect on anxiety, depression or hospital admission rate ^[3].

What this suggests for planning remote follow-up

• Remote formats were compared with usual or face-to-face care, not with no follow-up, so the findings bear on substituting or supplementing visits ^[1][2][3].
• Every nurse-led telerehabilitation program included nurse-patient communication, self-management support and regular follow-up ^[3].
• The format can be simple: telephone was the most common telerehabilitation approach ^[3].
• In pediatric type 1 diabetes, larger effects appeared in subgroups using smartphone app communication and medication dose adjustment, although these are comparisons between studies ^[2].
• Benefits were outcome-specific, with improvements in quality of life and self-care for some conditions but not in anxiety, depression or admissions ^[3].

Where scheduling tools fit

The reviews evaluated clinical programs, not scheduling software, so they say nothing about any particular product ^[1][2][3]. SmartMeet combines booking pages and video meetings, sends reminders by email and text, checks the host's calendar to prevent double bookings, lets guests reschedule themselves, and has no meeting time limit ^[SmartMeet]. It includes a Business Associate Agreement that clinics and health teams accept at sign-up, and compliance also depends on how the customer uses it ^[SmartMeet].

Limitations

• The wound review combined RCTs with cohort and quasi-experimental designs, several outcomes could not be pooled, and the authors called for larger, high-quality RCTs ^[1].
• Heterogeneity in the telerehabilitation review was moderate to high, and the authors called for better-designed programs ^[3].
• The pediatric review's authors called for larger, higher-quality RCTs focused on hard clinical outcomes, cost-effectiveness and quality of life ^[2].
• Populations were specific, covering adults with chronic wounds, young people with type 1 diabetes and community rehabilitation in six conditions, so results may not transfer to other groups ^[1][2][3].
• Literature searches ended in 2021, May 2023 and August 2023, and the figures reported here come from the published abstracts ^[1][2][3].