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Telehealth review

This is a review of the effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain.

Aim of the project: To systematically review the evidence on the effectiveness of exercise-based telemedicine in chronic pain.

Publication details: Published in Journal of Telemedicine and Telecare 2018 Vol 24(8): 511-526. Adamse C, Dekker-Van Weering MGH, van Etten-Jamaludin FS and Stuiver MM

Stakeholders involved:

  • Antonius Hospital, The Netherlands
  • Roessingh Research and Development
  • Medical Library, Academic Medical Centre, Amsterdam, The Netherlands
  • University of Amsterdam

Background

  • Chronic pain has a large and detrimental impact on quality of life, daily function, sleep, working status and depression
  • Telemedicine for the treatment of chronic pain has potential advantages:
    • Increase accessibility
    • Enables treatment in the home
    • Enables personalised feedback in a functional setting
    • Can increase quality of care through integration
    • Lower cost.

Results

  • Exercise-based telemedicine showed:
    • significantly lower pain scores, better physical activity versus no intervention, but not versus usual care or in addition to usual care
    • No differences in quality of life
  • Patient satisfaction was good (average 6/10) and interactive features and support were valued
    Exercise-based telemedicine did not seem to add value to usual care but may be applicable as a substitute to usual care.

Discussion

  • Most exercises in this review were low intensity – high intensity programs have been shown in other studies to be more effective than low intensity programs
  • These findings suggest telemedicine is equal to usual face-to-face care and could be used as a substitute
  • We need to be aware that telemedicine may be more relevant to younger, computer literate people
  • There is still need for further research due to limited quality of the evidence.

Recommendations

  • Treatment of chronic pain often requires multidisciplinary interventions such as education, self-management and exercise
  • Exercise-based telemedicine interventions appear to be  effective in reducing pain and improving physical activity for chronic pain patients compared to no intervention
  • Telemedicine might not be feasible for all chronic pain patients as previous research suggests drop-out rates of about 27%.

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