Effect of telemedicine on wound-related and patient-reported outcomes in chronic wound patients: A systematic review and meta-analysis (Preprint)

BACKGROUND Telemedicine (TM) may bring new vitality and opportunities to the field of wound care and has been advocated as a potential and feasible strategy for chronic wound management. OBJECTIVE This systematic review and meta-analysis aimed to assess the effectiveness of TM on wound-related outcomes and patient-reported outcomes (PROs) in patients with chronic wounds. METHODS A comprehensive search of nine databases—PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, China National Knowledge Infrastructure database, Wanfang Database, and VIP Database—was performed to identify eligible randomized controlled trials (RCTs) that investigated the effectiveness of TM for patients with chronic wounds. Two reviewers independently conducted the study selection, data extraction, risk of bias assessment, and evaluation of evidence quality. Meta-analyses were performed where feasible; otherwise, narrative summaries were provided. RESULTS A total of 22 RCTs involving 2370 participants met the inclusion criteria. Overall, the utilization of TM significantly improved the healing rate, healing score, healing time, amputation rate, pain, and quality of life of chronic wound patients. However, no significant differences in mortality, depression, anxiety, or patient satisfaction were observed. Furthermore, the subgroup analyses revealed significant effects in TM of short-term, for pressure injuries and venous ulcers, as well as TM in conjunction with a face-to-face component on improvements to the healing rate. The subgroup analyses showed a significant decrease in healing time with TM for venous ulcers or in conjunction with a face-to-face component. The subgroup analyses also indicated significant effects of TM with ≥ 2 types, for diabetes foot ulcers, in conjunction with a face-to-face component, or in combination with communication components in improving the amputation rate. Therefore, TM appears to be an effective method for chronic wound management. CONCLUSIONS A total of 22 RCTs involving 2370 participants met the inclusion criteria. Overall, the utilization of TM significantly improved the healing rate, healing score, healing time, amputation rate, pain, and quality of life of chronic wound patients. However, no significant differences in mortality, depression, anxiety, or patient satisfaction were observed. Furthermore, the subgroup analyses revealed significant effects in TM of short-term, for pressure injuries and venous ulcers, as well as TM in conjunction with a face-to-face component on improvements to the healing rate. The subgroup analyses showed a significant decrease in healing time with TM for venous ulcers or in conjunction with a face-to-face component. The subgroup analyses also indicated significant effects of TM with ≥ 2 types, for diabetes foot ulcers, in conjunction with a face-to-face component, or in combination with communication components in improving the amputation rate. Therefore, TM appears to be an effective method for chronic wound management. CLINICALTRIAL CRD42023462475