Effectiveness of Telemedicine for Distant Wound Care Advice towards Patient Outcomes: Systematic Review and Meta-Analysis

Abstract

Background & Hypothesis: Telemedicine in wound care allows communication between the general practitioner and specialist, thus effectively reducing the wait for specialist and allowing the patient to get treated faster. As patients with complicated wounds increased, the demand for specialist wound advice increased but there are limited resources in this area in our polyclinics. A review was necessary as the outcomes measured varied widely in many studies with inconsistent evidence on its clinical effectiveness. The aim of this review is to evaluate whether the use of telemedicine for distant wound care advice is effective in improving wound outcomes through meta-analysis of the combined trials. Methods: Database searches were performed in Medline, Embase and CINAHL. Study methodologies were assessed using JBI-MASTARI. Results: Four randomised controlled trials and before-and-after studies involving 319 wounds were involved in the meta-analysis and studies were of low to moderate risk of bias. Though there was an increase in wound healing/improvement rate in the interventional group, there was high heterogeneity (I2 = 87%) between studies and random-effect model showed it was non-significant (RR 1.47, CI 0.75 to 2.87, P = 0.26). Results of one trial was biased with unadjusted baseline characteristics and removal of that trial from the analysis showed low heterogeneity (I2 = 43%) with fixed-effect model showing a significant increase in wound healing rate in the telemedicine group (RR 1.80, CI 1.23 to 2.63, P = 0.002). Discussion & Conclusion: Our review suggests that the use of telemedicine in wound care could effectively improve clinical outcomes.