Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease

Abstract

Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised. Objectives: To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease. Methods: Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach. Results: Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence. Conclusions: Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.