Disclaimer
This information collection is a core HTA, i.e. an extensive analysis of one or more health technologies using all nine domains of the HTA Core Model. The core HTA is intended to be used as an information base for local (e.g. national or regional) HTAs.

Structured telephone support (STS) for adult patients with chronic heart failure

Structured telephone support (STS) for adult patients with chronic heart failure compared to Usual care defined as regular schedules of visits of the patient at the heart center/ GP/cardiologist or patient has to move (≠ at home) in the prevention of Chronic cardiac failure in adults and elderly with chronic heart failure (CHF) AND hospitalization due to heart failure at least once AND without implanted devices

(See detailed scope below)

HTA Core Model Application for Medical and Surgical Interventions (2.0)
Core HTA
Published
Tom Jefferson (Agenas - Italy), Marina Cerbo (Agenas - Italy), Nicola Vicari (Agenas - Italy)
Neill Booth (THL - Finland), Plamen Dimitrov (NCPHA - Bulgaria), Mirjana Huic (AAZ - Croatia), Valentina Rupel (IER - Slovenia), Alessandra Lo Scalzo (Agenas - Italy), Ingrid Wilbacher (HVB - Austria)
Agenas - Agenzia nazionale per i servizi sanitari regionali
AAZ (Croatia), Agenas (Italy), ASSR RER (Italy), Avalia-t (Spain), CEM (Luxembourg), GÖG (Austria), HVB (Austria), IER (Slovenia), ISC III (Spain), NCPHA (Bulgaria), NIPH (Slovenia), NSPH (Greece), NSPH MD (Romania), SBU (Sweden), SNHTA (Switzerland), THL (Finland), UTA (Estonia).
9.9.2014 11.18.00
4.12.2015 17.51.00
Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 30 June 2022]. Available from: http://corehta.info/ViewCover.aspx?id=305

Structured telephone support (STS) for adult patients with chronic heart failure

<< Organisational aspectsLegal aspects >>

Social aspects

Authors: Alessandra Lo Scalzo, Ingrid Wilbacher

Summary

The aspects related to patients’ quality of life and satisfaction with STS, patients’ views, perceptions and probable improvements in self care allowed by the use of this intervention, are an important part of the success of this technology.

In the studies where quality of life (QoL) is measured with standardised instruments, there is a significant improvement of QoL in the intervention group or no difference between the usual care and the intervention. Pandor’s systematic review shows that 4 studies which had quality of life as a secondary outcome and where about STS, reported improvements in QoL, with significant improvements in physical [Angermann, 2011] and overall [Barth, 2001, Wakefiled, 2008] measures, but one study found no significant differences between the groups [Riegel, 2006]. Oher (primary) studies we selected gave scattered results. Dunagan et al. 2005 found that nurse-administered, telephone-based disease management intervention had some impact on functional status and quality of life. Piotrowicz et al. 2015 found that the in the intervention group there was a similar improvement in total QoL index as in the control group. Patients who underwent home-based tele rehabilitation observed an improvement mainly in the mental categories. On the other hand Ramachandran et al, 2007 found and increase in quality of life, as a whole and in many dimensions the intervention group that persisted over time. For Jerant 2003 telenursing at least did not have any large negative impact on patient satisfaction or health status. In the study by Boyne et al. 2014 authors conclusions says that tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy. Domingues and collegues state that in thier study (2011) the educational nursing intervention performed during the hospitalization period brought improved knowledge of HF and self-care in all patients regardless of telephone contac.

The organisational differences among the variuos STS interventions in the selected studies (programs offering exercise, education and behavioral interventions on patients’ psychological outcomes, or monitoring systems of vital signs led by nurses or physician etc.) can help to explain those differences in findings and results and make trasferability and comparability of them difficoult.

To have a deeper understanding about how patients experience the care when it is moved outside of the hospital to their homes with  the support of STS, we also selected qualitative studies which allow to highlight perceptions of patients about complex interventions. From this perspective selected qualitative studies show that there can be positive and negative aspects in using telemedicine and its application such as STS. Lynga et al. 2013 interviews to patients who used the intervention showed, that  the technology was easy to perform, made patients active in their own care, and increased their self-care activities. However, there were concerns of potential deterioration: transmission of body weight reminded patients of illness, deterioration in their health, increase of diuretic dose (inconvenience in the patient’s daily life) and some experienced also a perception of fear that affected their psychological well being.

As regard tro the barriers to the use of the technology, digital divide related to the age or socio-economical status which could avoid patients to use the facilities related to the intervention, we could not retrive definitive and conclusive studies. The qualitative literature that gave an answer to this reaserch question would show digital divide due to age as not being a relevant problem. Seto et al. shows that relatives of those not technology-accustomed would be able to provide support to patient [Seto 2012]. Bond, 2014 finds that most people found the telehealth system easy to use and in the study of Prescher, 2013 most of the patients reported an easy and robust handling of the devices. Nontheless more quantitative studies about the influence of age, gender etc. on the use of STS should be developed to better understand implications of thoses macrosocial variables on the use of STS.

Introduction

Structured telephone support for adult patients with chronic heart failure is an application of telemedicine whose results largely depend on the patients acceptance of this different way of caring for their disease. Its characteristics, such as the indirect or at distance contact that the health professional has with the patient, mediated by the telephone, which does not allow a personal face to face visit, can be seen at the same time as a positive or a negative factor, this depending on the patient’s preference. In turn this preference and acceptance can be related to macro social variables as gender, age, literacy, ethnicity etc. and on the patients’ own psychlogical structure and personal/social/familiy life.

HF Patients who are telemonitored via STS could positively modify their perceptions of quality of life (both social life and individual well being, by e.g. reducing anxiety and feeling more secure) and their self-care behaviors such as obtaining daily weights, doing physical activity, eating a low salt diet, and being in compliance with medication regimes.  Those two aspects can be seen as strictly related according to some authors. Indeed the decrease in QoL for HF patients has been associated mainly to the frequent hospital admissions and this imposes the most relevant personal, social and economic burden [Ferrante et al. 2010]. Since hospital admissions are mainly due to preventable causes (diet, treatment concompliance, inappropriate social support, delayed medical consultation for symptom sof HF progessions) any interventions like telephone support that aim to affect thoses prevenatable causes by enhancing self care behaviors can also enhance quality of life. Quality of life is determined by different components, at individual level and at social level. Anxiety, well being, feeling more secure and monitored, being able to have normal social reletionship at familial, work and firendships level, experiencing a better mental and physical health thanks to any interventions, are some of the aspects that will be analysed in this domain.

 

According to Paradis et al. 2010 the theory of HF Self-care grounded on the principles that patients are the main actors in health decision making and that they should have the tools to manage their health problems, is based on 3 concepts: the concept of self-care maintenance, which includes symptom monitoring and treatment adherence; the concept of self-care management, which includes symptom recognition and evaluation and treatment initiation and evaluation; and the concept of self-care confidence, which is the patients’ perceived capacity to perform self-care. According to the theory, maintenance of self-care will lead to management of self-care, and these two processes will be facilitated if the patient has confidence in performing self-care behaviors. Thus, improving HF patients’ conviction and confidence in their self-care capabilities by education, information and STS monitoring, could improve their health.

 

Including this isues of this domain in the HTA on STS is thus relevant as patient-reported outcomes are to be considered, being integral part of the succes of the technology. What is generally called patient satisfaction is in itself an indicator of quality of care and, e.g., in terms of cost-benefit a satisfied patient can have fewer complaints, fewer second opinions, and fewer repeated investigations, this affecting patients’ adherence to medical treatment regimens [Kraii et al. 2011]. Those aspects related to the patients quality of life with STS and its acceptance and views about it, and the comfort with a program of selfcare and information delivered (training program, check of vital signs etc.) are thus the focus of this chapter.

Methodology

Frame

The collection scope is used in this domain.

TechnologyStructured telephone support (STS) for adult patients with chronic heart failure
Description

Telemonitoring via structured telephone support with focus on patient reported signs (symptoms of congestion, peripheral edema, pulmonary congestion, dyspnea on exertion, abdominal fullness), medication adherence, physiological data (like heart rate, blood pressure, body weight – measured by the patient with home-device), activity level; done in regular schedules using risk stratification (with fixed algorithm by call center staff or experience-based by specialized staff); done by dedicated call centers, center-based staff, nurses, AND reduced visits to a GP or heart center

Intended use of the technologyPrevention

Remote transmission of information to alleviate symptoms, relieve suffering and allow timely treatment for chronic heart failure

Target condition
Chronic cardiac failure
Target condition description

Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

Target population

Target population sex: Any. Target population age: adults and elderly. Target population group: Patients who have the target condition.

Target population description

Patients with chronic heart failure (CHF; defined as I50 http://www.icd10data.com/ICD10CM/Codes/I00-I99/I30-I52/I50-/I50 ) AND hospitalization due to heart failure at least once  AND without implanted devices

ComparisonUsual care defined as regular schedules of visits of the patient at the heart center/ GP/cardiologist or patient has to move (≠ at home)
Description

Usual care defined as regular schedules of visits of the patient at the heart center/ GP/cardiologist; patient has to move (≠ at home)

Outcomes

Mortality (disease specific and all cause) progressions, admissions, re-admissions, QoL or HRQoL, harms

Assessment elements

TopicIssue RelevantResearch questions or rationale for irrelevance
H0006IndividualHow do patients, citizens and the important others using the technology react and act upon the technology?yesHow adult patients with CHF (and their important others) who uses Structured telephone support (STS) react and act upon this technology and how this affects their satisfaction, quality of life, empowerment?
H0004IndividualWhat kind of changes may the use of the technology generate in the individual's role in the major life areas?yesWhat kind of changes may the use of Structured telephone support (STS) generate in the patients' social life (changes in work, travel ability, family life, patient/physician relationship)
H0012IndividualAre there factors that could prevent a group or persons to participate?yesAre there socio cultural factors that could prevent a group CHF patients (defined by e.g. age, ethnicity, income, geographic area, working staus, geneder etc.) to use Structured telephone support (STS)?
H0003IndividualWhat kind of support and resources are needed for the patient or citizen as the technology is introduced?yesWhat kind of support and resources (e.g. ergonomic changes) are needed for the patient as STS is introduced? This imlies a descriptive response.
H0100IndividualWhat kind of changes do patients or citizens expect?noSelection of H0006 is enough as it includes this question
H0002IndividualWho are the important others that may be affected, in addition to the individual using the technology?noThis question just implies for investigators of SOC to list the probable important other that can be affected. This is something that is preliminary when answering to H0006.
H0007Information exchangeWhat is the knowledge and understanding of the technology in patients and citizens?yesWhat is the knowledge and understanding of Structured telephone support (STS) in CCD patients?
H0013Information exchangeWhat are the social obstacles or prospects in the communication about the technology?noSelection of AE H0007 is enough
H0001Major life areasWhich social areas does the use of the technology influence?noThis AE is important, but subsumable in H0004. So we exclude this as we alredy selected the H0004. Experinece with the production of other core hTA suggests that it is better to stay strict in the selection of AEs, since at the end of the work you usually find many INTRA domain overlaps.
H0011Major life areasWhat kinds of reactions and consequences can the introduction of the technology cause at the overall societal level?noI would stay more focused on the effects of the STS on the CHF patients and important others, and would not deal with overall society/citizens perspective. That is a perspective of people which is not involved in the actual use of this technology.
H0009Major life areasWhat influences patients’ or citizens’ decisions to use the technology?noBy selecting AE H0001-H0006-H0012 and H0007 we alreday try to answer to this question (which is very generic) in a more detailed manner (individual/familial/social factors and factors releted to communication/information that can influence the use of STS).

Methodology description

A review of the literature about structured telephone support and the quality of life, self care, emopowerment, acceptance and impact of gender, age, etc. was performed. We aimed at identifying, first good quality secondary literature (HTA reports, quantitative or qualitative systematic reviews) that included the above outcomes and that could be updated. In the absence of existing reviews we identified primary studies, both qualitative and quantitative.

Information sources

Searches have been run on: Medline, Embase, Cochrane Library, PsycoINFO, CINAHL, CRD database. We searched articles in English published from 1995 to 2015 (see Appendix 1 for the Search Strategy). We retrieved 497 references, 17 were doubles We excluded 394 articles on the basis of the abstract and selected 78 studies for the full text reading. Records were read and excluded in double.

Inclusion criteria

We included studies about individuals aged 16 or more with chronic heart failure who have been admitted to hospital at least once for chronic heart failure (excluding recipients of implantable cardiac defibrillators, CRTs  or pacemakers), that focussed on structured telephone support and had as an outcome the following domain specific outcomes: patients preferences, views, satisfaction, acceptance, adaptation, adherence, compliance, quality of life, worries, anxiety, confidence,work/family/social life, effect of ethnicity/gender/social and economic status/working status/urban–rural areas on the use of the technology, patient-physician communication/information.

Study Designs

We aimed at including systematic reviews (quantitative) on quality of life with STS and qualitative systematic reviews on patients perceptions/views. We selected primary studies with a quantitative design to update and/or integrate the retrived systematic reviews and selected the relevant qualitative studies for the qualitative part. After the full text reading of the selected articles we excluded 33 studies for the following reasons 1) not our population (5) 2) not our intervention (17) 3) not our outcomes (6) 4) opinions/case/protocols (3)  5) Not in english/not available (2) (see Appendix 2 ). Studies eventually  included were 34 (see Appendix 3. In applying the above general inclusion criteria we needed to be more strict in case of some assessment elements which implied a quantitative response, and less strict (e.g. in the study design) for those assessment elements that allowed more descriptive answers (e.g. reasoning by analogy for tecnhnology and include not comparative study designs etc.). This has been explained in the methods section of each AE’s results card.  

SOC Figure 1

 

Quality assessment tools or criteria

We used the quality checklists AMSTAR for systematic reviews, the CONSORT for RCTs, STROBE for observational studies and the Cochrane guidance for assessments for qualitative studies. See Appendix 4 for the included studies’ quality assessment.

Analysis and synthesis

For each AE’s Results card we gave a qualitative report of the main results of the included secondary and primarty studies that provided an answer to it. 

Result cards

Individual

Result card for SOC1: "How adult patients with CHF (and their important others) who uses Structured telephone support (STS) react and act upon this technology and how this affects their satisfaction, quality of life, empowerment?"

View full card
SOC1: How adult patients with CHF (and their important others) who uses Structured telephone support (STS) react and act upon this technology and how this affects their satisfaction, quality of life, empowerment?
Method
Short Result
Result
Comment

Importance: Important

Transferability: Partially

Result card for SOC2: "What kind of changes may the use of Structured telephone support (STS) generate in the patients&#39; social life (changes in work, travel ability, family life, patient/physician relationship)"

View full card
SOC2: What kind of changes may the use of Structured telephone support (STS) generate in the patients&#39; social life (changes in work, travel ability, family life, patient/physician relationship)
Method
Short Result
Result

Importance: Critical

Transferability: Partially

Result card for ETH11 / SOC3: "Are there socio cultural factors that could prevent a group CHF patients (defined by e.g. age, ethnicity, income, geographic area, working staus, geneder etc.) to use Structured telephone support (STS)?"

View full card
ETH11 / SOC3: Are there socio cultural factors that could prevent a group CHF patients (defined by e.g. age, ethnicity, income, geographic area, working staus, geneder etc.) to use Structured telephone support (STS)?
Method
Short Result
Result

Importance: Important

Transferability: Partially

Result card for SOC4: "What kind of support and resources (e.g. ergonomic changes) are needed for the patient as STS is introduced? This imlies a descriptive response."

View full card
SOC4: What kind of support and resources (e.g. ergonomic changes) are needed for the patient as STS is introduced? This imlies a descriptive response.
Method
Short Result
Result

Importance: Important

Transferability: Completely

Information exchange

Result card for SOC5: "What is the knowledge and understanding of Structured telephone support (STS) in CCD patients?"

View full card
SOC5: What is the knowledge and understanding of Structured telephone support (STS) in CCD patients?
Method
Short Result
Result
Comment

Importance: Important

Transferability: Completely

Discussion

There was a high focus within the included studies on quality of life for the participants within STS projects.

Nontheless evidence is scattered about improvements in QoL and Self-care abilities and sense of self-efficacy in the intervention group: some studies show a significant improvement, others found no difference. Differences in interventions characteristics and organisational factors ca explain this.  For the impact of age, economic status, ethnicity  and other macrosocial variables on patients perceptions of STS we could not find definitive conclusions. Qualitative literature suggests that digital divide due to age is not a relevant problem, above all in near future as new generations, who are accustumed to new technologies, get older and enter the HF more at risk age. In depth understanding of pateints perceptins of this interventions highlights some positive and negative aspects of the intervention: perceptions of being safer and well cared, easy intergartion of selfcare activities and telemonitoring in everyday life, increased empowerment but also, for some patients, increase awarness about their daily health (e.g. weighting everyday) made increase concerns of potential deterioration in HF.

References

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Appendices

APPENDIX 1 – Search strategy for the Social Domain

Searches has to be run on: Medline, Embase, Cochrane Library, PsycINFO, CINAHL, CRD database.  English only. Time: 1995-2015

Keywords for Population and Disease

P: Adults with chronic heart failure (with previous hospital stay due to chronic  heart failure)

I/C: telemonitoring via structured telephone support  (non invasive telemonitoring via structured telephone support human to human or human to machine) VS standard of care

Keywords for outcomes/AEs:

  • Patients preferences/views/satisfaction/acceptance/ Acceptability/ Adaptation/Adherence/compliance/quality of life/Health Related Quality of Life/worries/anxiety/confidence/
  • Travel abilities/work/family life/social life/leisure time/lifestyle/daily activities/ patient’s everyday life/changes in daily routines
  • Access, accessibility ethnicity/gender/social and economic status/working status/urban–rural areas
  • Patients information/communications/patient-physician communication/information

Design: SR, HTA, RCTs, Qualitative studies (interviews, focus groups), observational studies, Patient Related Outcomes studies

3th june 2015 (date for latest updating)

 

Cochrane

Heart Failure, MESH descriptor  explode all trees.

Entry terms:

  • Cardiac Failure
  • Heart Decompensation
  • Decompensation, Heart
  • Heart Failure, Right-Sided
  • Heart Failure, Right Sided
  • Right-Sided Heart Failure
  • Right Sided Heart Failure
  • Myocardial Failure
  • Congestive Heart Failure
  • Heart Failure, Congestive
  • Heart Failure, Left-Sided
  • Heart Failure, Left Sided
  • Left-Sided Heart Failure
  • Left Sided Heart Failure

OR Heart AND (Failure OR Attack)

OR CHF

OR HF

OR congestive heart failure

AND

“Remote Sensing Technology”, MESH descriptor

Explode all tree:

Entry terms:

  • Remote Sensing Technologies
  • Technologies, Remote Sensing
  • Technology, Remote Sensing

OR

“telemedicine” MESH descriptor Explode all tree. Entru terms:

  • Telehealth
  • eHealth
  • Mobile Health
  • Health, Mobile

OR

MeSH descriptor “home care services” this term only OR

  • MeSH descriptor” Home Care Services, Hospital-Based” this term only
  • OR “remote monitoring”
  • OR Telemonitoring
  • OR “Home monitoring”
  • OR teleconsultation
  • OR tele-monitoring
  • OR “distance monitoring”
  • OR “telemedicine system”
  • OR “home care”

OR

Tele*: (title/astract/keyword) AND (monitoring OR contact OR support OR homecare) (title/astract/keyword

Telephone-monitoring: title/astract/keyword OR

Telephone-support: (title/astract/keyword OR

Telephone-contact* (title/astract/keyword OR

“Post-discharge monitoring” : (title/astract/keyword OR

“tele-watch”  :title/astract/keyword OR

“tele home care”title/astract/keyword OR

“tele homecare” : title/astract/keyword OR smartphone: title/astract/keyword OR

smartphone-based: title/astract/keyword OR

telecardiology: title/astract/keyword OR telecoaching: title/astract/keyword

 

AND

MESH descriptor: “quality of life” OR

MESH descriptor:  “activities of daily living” OR

MESH descripto: “leisure activities” OR

MESH descriptor: “Return to work” OR

MESH descriptor: “Physician-Patient Relations” OR

MESH descriptor: “Patient Satisfaction

OR  "length of stay"

 

Ricerca in [Title/Abstract/keyword] per

 

“quality of life” OR

QoL  OR HRQOL

 “patient* preferences OR

 satisfaction OR worries OR anxiety OR comfort

 

(Patients AND (“travel abilities” Or freedom OR “family life” OR “social life” OR “leisure time” OR lifestyle OR “daily activities”)) OR

 

(Patients AND  (preferences OR views OR satisfaction OR worries OR acceptance OR acceptability)  OR adaptation OR adherence OR confidence OR compliance  OR “social and economic status” OR “working status” OR un-employement OR “employement status” OR “working status” OR

 

“patient’s everyday life” OR “changes in daily routines” OR Access OR  accessibility OR ethnicity OR gender OR  OR “urban areas” OR “rural areas” OR information OR communications OR information OR comfort OR  Social Support

 

 

 

NOT

ehealth OR

 web-based OR

 "web based" OR

 internet OR

web OR

 computer OR

internet-based

 

 

 

 

 

 

 

 

MEDLINE

 

Heart Failure, MESH descriptor, explode all trees.

Entry terms:

  • Cardiac FailureHeart Decompensation
  • Decompensation, HeartHeart Failure, Right-Sided
  • Heart Failure, Right Sided
  • Right-Sided Heart Failure
  • Right Sided Heart Failure
  • Myocardial Failure
  • Congestive Heart Failure
  • Heart Failure, Congestive
  • Heart Failure, Left-Sided
  • Heart Failure, Left Sided
  • Left-Sided Heart Failure
  • Left Sided Heart Failure

OR

heart adj6 failure

OR

cardiac adj6 failure

OR

Heart AND (failure OR attack)

  • OR CHF
  • OR HF
  • OR “Cardiac Failure”
  • OR “Heart Decompensation”
  • OR “Decompensation, Heart”
  • OR “Myocardial Failure”
  • OR “Congestive Heart Failure”
  • OR “Heart Failure, Congestive”

AND

“Remote Sensing Technology”

MESH descriptor Explode all tree:

Entry terms:

  • Remote Sensing Technologies

  • Technologies, Remote Sensing

  • Technology, Remote Sensing

OR

“telemedicine” MESH descriptor  Explode all tree. Entru terms:

  • Telehealth

  • eHealth

  • Mobile Health

  • Health, Mobile

OR

MeSH descriptor “home care services” this term only

OR

MeSH descriptor” Home Care Services, Hospital-Based” this term only

  • OR “remote monitoring”

  • OR Telemonitoring

  • OR “Home monitoring”

  • OR teleconsultation

  • OR tele-monitoring

  • OR “distance monitoring”

  • OR “telemedicine system”

  • OR “home care”

  • OR teleconsultation

  • OR tele-consultation

OR

"cell phone"[MeSH Terms] OR "telephone"[MeSH Terms] OR

Tele*: title/astract AND (monitoring OR contact OR support OR homecare)

Telephone-monitoring: title/abstract OR

Telephone-support: title/astract OR

Telephone-contact* : title/astract OR

“Post-discharge monitoring” : title/astract OR smartphone OR smartphone-based:

“tele-watch”  : title/astract OR

“tele home care” : title/astract OR

“tele homecare” : title/astract OR

Telecardiology: title/astract OR

Telecoaching: title/abstract OR

 

 

AND

 

 

MESH descriptor: “quality of life” OR

MESH descriptor:  “activities of daily living” OR

MESH descripto: “leisure activities” OR

MESH descriptor: “Return to work” OR

MESH descriptor: “Physician-Patient Relations” OR

MESH descriptor: “Patient Satisfaction

OR "length of stay"

 

Ricerca in [Title/Abstrac] per

 

“quality of life” OR

QoL  OR HRQOL

 “patient* preferences OR comfort

 

(Patients AND (“travel abilities” Or freedom OR “family life” OR “social life” OR “leisure time” OR lifestyle OR “daily activities”)) OR

 

(Patients AND  (preferences OR views OR satisfaction OR worries OR acceptance OR acceptability)  OR adaptation OR adherence OR confidence OR compliance  OR “social and economic status” OR “working status” OR un-employement OR “employement status” OR “working status” OR

 

“patient’s everyday life” OR “changes in daily routines” OR Access OR  accessibility OR ethnicity OR gender OR  OR “urban areas” OR “rural areas” OR information OR communications OR information OR  Social Support

 

 

 

NOT

ehealth OR

 web-based OR

 "web based" OR

 internet OR

web OR

computer OR

internet-based

EMBASE

“Congestive heart failure”/exp

 

OR  “heart failure” /exp

 

OR ’congestive cardiomyopathy’/exp

 

OR CHF

 

OR HF

 

OR  “cardiac failure”/exp

 

OR “cardiac insufficiency”/exp

 

AND

  • 'telemonitoring'/exp
  • OR Teleconsultation/exp
  • OR Telemedicine/exp
  • OR telecommunications/exp
  • Or  telecare$.tw
  • OR  telecardiol$.tw.
  • OR  telemonitor$.tw.
  • OR teleconsult$.tw
  • OR telecare$.tw
  • OR homecare$.tw
  • OR home care$.tw OR

"cell phone" OR telephone  OR Telephone-monitoring OR telephone-support OR

 telephone-contact OR

“Post-discharge monitoring” OR smartphone OR

 smartphone-based OR

 “tele-watch” OR

 “tele home care” OR

 “tele homecare”  OR

 Telecardiology OR

 Telecoaching  OR tele*

 

 

.

 

AND

EMTREE TERM: 'quality of life'/exp OR

EMTREE TERM: work capacity/exp OR

EMTREE TERM: 'life satisfaction'/exp OR

EMTREE TERM: 'patient satisfaction'/exp OR

EMTREE TERM: 'patient information'/exp OR

EMTREE TERM: 'social aspects and related phenomena'/exp OR "length of stay"

 

“quality of life” OR QoL OR “Travel abilities”  OR recreation or work or “family life” OR “social life” OR “leisure time” OR lifestyle” OR “daily activities” OR “patient* preferences OR satisfaction OR worries OR anxiety OR “working staus” OR un-employment” OR employment  OR –“SF-36 mental score”  OR

“SF-36 physical score” OR

(Patients and (“travel abilities” Or freedom OR word OR “family life” OR “social life” OR “leisure time” OR lifestyle OR “daily activities”)) OR

(Patients AND  (preferences OR views OR satisfaction OR worries OR anxiety OR religion OR ethnic  OR gender OR “social and economic status” OR “working status” OR un-employement OR “employement status” OR “working status” OR ((urban or rural) and patients) OR i((nformation OR communication OR information) AND  (patients OR physician)

OR Self-Care OR comfort OR  Social Support

NOT

ehealth OR

 web-based OR

 "web based" OR

 internet OR

web OR

computer OR

internet-based

Cinhal

(MH“Congestive heart failure”)

 

OR (MH “heart failure” )

 

OR “congestive cardiomyopathy”

 

 OR  cardiomyopathy

 

OR CHF

 

OR HF

 

OR  cardiac and (failure or insufficiency)

 

AND

"cell phone" OR telephone  OR Telephone-monitoring OR telephone-support OR

 telephone-contact OR

“Post-discharge monitoring” OR smartphone OR

 smartphone-based OR

 “tele-watch” OR

 “tele home care” OR

 “tele homecare”  OR

 Telecardiology OR

 Telecoaching  OR tele*

 

AND

(MH "Quality of Working Life") OR (MH "Employment Status") OR (MH "Job Satisfaction") OR (MH "Job Re-Entry") OR (MH "Self Employment") OR (MH  "Work Experiences") OR (MH " OR "quality of life" OR QoL  OR HRQOL ) OR preferences OR views OR satisfaction OR worries OR anxiety OR religion OR ethnic  OR “social and economic status” OR “working status” OR un-employement OR “employement status” OR   Patients  AND (urban or rural) OR information OR communication OR "leisure activities" OR "work retun"  OR 'social aspects” OR “social activities” OR “rural areas” OR "length of stay"

 

Psychinfo

Congestive heart failure OR   heart failure OR congestive cardiomyopathy OR CHF OR HF OR  cardiac and (failure or insufficiency)

 AND

"cell phone" OR telephone  OR Telephone-monitoring OR telephone-support OR  telephone-contact OR “Post-discharge monitoring” OR smartphone OR

 smartphone-based OR  “tele-watch” OR  “tele home care” OR  “tele homecare”  OR  Telecardiology OR  Telecoaching  OR tele*

AND

 quality of life OR preferences OR job satisfaction life OR satisfaction working OR social OR employement OR worries OR anxiety OR communicationOR information OR social status OR working status OR urban areas OR rural areas OR social aspects or leisure activities

APPENDIX 2 List of excluded studies with reasons

Excluded not our population

Barlow J, Singh D, Bayer S, Curry R. A Systematic Review Of The Benefits Of Home Telecare For Frail Elderly People And Those With Long-Term Conditions. 2007;13(4):172-9.

Barnason S, Zimmerman L, Nieveen J, Schmaderer M, Carranza B, Reilly S. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning. Heart Lung. 2003;32(3):147-58.

Bekelman DB, Hooker S, Nowels CT et al. Feasibility and acceptability of a collaborative care intervention to improve symptoms and quality of life in chronic heart failure: mixed methods pilot trial. J Palliat Med 2014; 17(2):145-5

O'Neil, Hawkes A.L. Atherton J.J. et al. Telephone-delivered health coaching improves anxiety outcomes after myocardial infarction: The 'ProActive Heart' trial. Eur J Prev Cardiol. 2014;21(1):30-8.

Keeling A.W., Dennison P.D. Nurse-initiated telephone follow-up after acute myocardial infarction: A pilot study. HEART LUNG J. CRIT. CARE 1995; 24(1):45-9.

Excluded not our intervention

Blum K, Gottlieb SS. The effect of a randomized trial of home telemonitoring on medical costs, 30-day  readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. J Card Fail 2014; 20(7):513-21

Boyne JJ, Vrijhoef HJ, Spreeuwenberg M, De Weerd G, Kragten J, Gorgels AP. Effects of tailored telemonitoring on heart failure patients' knowledge, self-care, self-efficacy and adherence: a randomized controlled trial. Eur J Cardiovasc Nurs. 2014;13(3):243-52

Cardozo L, Steinberg J. Telemedicine for recently discharged older patients. Telemed J E Health. 2010;16(1):49-55.

Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, et al. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs. 2014.

Dansky KH, Vasey J, Bowles K. Use of telehealth by older adults to manage heart failure. Res Gerontol Nurs 2008; 1(1):25-32.

Dinesen B, Nohr C, Andersen SK, Sejersen H, Toft E. Under surveillance, yet looked after: telehomecare as viewed by patients and their spouse/partners. Eur J Cardiovasc Nurs. 2008;7(3):239-46.

Domingo M, Lupon J, Gonzalez B, Crespo E, Lopez R, Ramos A, et al. Evaluation of a telemedicine system for heart failure patients: feasibility, acceptance rate, satisfaction and changes in patient behavior: results from the CARME (CAtalan Remote Management Evaluation) study. Eur J Cardiovasc Nurs. 2012;11(4):410-8.

Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, et al. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs. 2014;23(1-2):132-44.

Konstam V, Gregory D, Chen J et al. Health-related quality of life in a multicenter randomized controlled comparison  of telephonic disease management and automated home monitoring in patients recently hospitalized with heart failure: SPAN-CHF II trial. J Card Fail 2011; 17(2):151-7.

Louis AA, Turner T, Gretton M, Baksh A, Cleland JG. A Systematic Review Of Telemonitoring For The Management Of Heart Failure. Eur J Heart Fail. 2003;5(5):583-90.

Mayour R, Welstand J, Tyndel S, J Setting up and auditing guideline- and evidence-based cardiac rehabilitation. Eur J Cardiovasc Nurs. 2005;4(1):23-8.

Obeh B, Kayyali R, Nabhani-Gebara S, Philip N, Robinson P, Wallace CR. Evaluation of a Telehealth Service for COPD and HF patients: Clinical outcome and patients' perceptions. J Telemed Telecare. 2015.

Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients. J Cardiovasc Nurs. 2010;25(2):130-41.

Schwarz KA, Mion LC, Hudock D, Litman G. Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial. Prog Cardiovasc Nurs. 2008;23(1):18-26.

Shaw JD, O'Neal DJr, Siddharthan K, Neugaard BI. Pilot program to improve self-management of  patients with heart failure by redesigning care coordination. Nurs Res Pract. 2014;2014:836921.

Takeda A, Taylor Stephanie JC, Taylor Rod S, Khan F, Krum H, Underwood M, et al. Clinical Service Organisation For Heart Failure: Structured Telephone Support Or Telemonitoring Programmes For Patients With Chronic Heart Failure. Cochrane Database of Systematic Reviews: Cochrane Database of Systematic Reviews.

Young B, Purden M, Sauve N, Dufour L, Common C. A "basket of care" for heart failure patients managing at home: evaluating a community-based nursing intervention from a patient's perspective. Can J Cardiovasc Nurs. 2008;18(4):10-9.

Roth A, Korb H, Gadot R, Kalter E. Telecardiology for patients with acute or chronic cardiac complaints: the 'SHL' experience in Israel and Germany. Int J Med Inform. 2006;75(9):643-5.

Hobban MB, Fedor M, Reeder S, Chernick M. The effect of telemonitoring at home on quality of life and self-care behaviors of patients with heart failure. Home Healthc Nurse. 2013;31(7):368-77.

Mittag O., China C., Hoberg E. et al. 2006Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): Overall and gender-specific effects.

Nanevicz

Hawkes, T.A. P, J. A, R.S. W, C.B. T, A. ON, et al. Effect of a telephone-delivered coronary heart disease secondary prevention program (proactive heart) on quality of life and health behaviours: primary outcomes of a randomised controlled trial. Int J Behav Med. 2013;20(3):413-24.

Quinn C. 2006Low-technology heart failure care in home health: improving patient outcomes.

Radhakrishnan K, Jacelon C2012Impact of telehealth on patient self-management of heart failure: a review of literature.

Saunders MM. Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure. Home Healthc Nurse. 2012;30(2):82-90.

Wang XH, Qiu JB, Ju Y et al, 2014. Reduction of heart failure rehospitalization using a weight management education  intervention.

Whitten P., Mickus M. 2007. Home telecare for COPD/CHF patients: outcomes and perceptions.

Excluded not our outcomes

Galbreath A.D., Krasuski R.A., Smith B. et al. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation 2004; 110(23):3518-26.

Guiraud T, Granger R, Gremeaux V et al. Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program. Arch Phys Med Rehabil 2012; 93(12):2141-7.

Maric B, Kaan A, Ignaszewski A, Lear SA. A SYSTEMATIC REVIEW OF TELEMONITORING TECHNOLOGIES IN HEART FAILURE. Eur J Heart Fail. 2009;11(5):506-17.

Paget T, Jones C, Davies M, Evered C, Lewis C. Using home telehealth to empower patients to monitor and manage long term conditions. Nurs Times. 2010;106(45):17-9.

Rahimpour M, Lovell NH, Celler BG, McCormick J. Patients' perceptions of a home telecare system. Int J Med Inform. 2008;77(7):486-98.

Riegel B, Carlson B, Glaser D, Romero T. Randomized controlled trial of telephone case management in Hispanics of Mexican  origin with heart failure. J Card Fail. 2006;12(3):211-9.

Shearer NB, Cisar N, Greenberg EA. 2007. A telephone-delivered empowerment intervention with patients diagnosed with heart failure.

Sohn S, Helms TM, Pelleter JT, Muller A, Krottinger AI, Schoffski O. 2012. Costs and benefits of personalized healthcare for patients with chronic heart failure in the care and education program "Telemedicine for the Heart".

Venter A, Burns R, Hefford M, Ehrenberg N2012Results of a telehealth-enabled chronic care management service to support people with long-term conditions at home.

Letter to editors/protocols/abstract/editorial

Grancelli HO, Ferrante DC. Telephone interventions for disease management in heart failure. BMJ. 2007;334(7600):910-1.

Piette JD, Rosland A-M, Marinec NS, Bernstein SJ, Silveira MJ. Engagement with automated patient monitoring and self-management support calls: Experience with a thousand chronically ill patients. 2013;51(3):216-23.

Saxon LA, Boehmer JP, Neuman S, Mullin CM. Remote Active Monitoring in Patients with Heart Failure (RAPID-RF): design and rationale. J Card Fail. 2007;13(4):241-6.

Excluded not English text

Brotons C, Falces C, Alegre J et al. Randomized clinical trial of the effectiveness of a home-based intervention in patients with heart failure: the IC-DOM study. Rev Esp Cardiol 2009; 62(4):400-8.

Not available

Riegel B, Carlson B, Kopp Z, LePetri B, Glaser D, Unger A. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002;162(6):705-12.

APPENDIX 3 List of included studies
  1. Achelrod D. Policy expectations and reality of telemedicine - a critical analysis of health care outcomes, costs and acceptance for congestive heart failure. J Telemed Telecare. 2014;20(4):192-200.
  2. Bohme S, Geiser C, Muhlenhoff T, Holtmann J, Renneberg B. Telephone counseling for patients with chronic heart failure: results of an evaluation study. Int J Behav Med. 2012;19(3):288-97.
  3. Bond CS, Worswick L. Self Management and Telehealth: Lessons Learnt from the Evaluation of a Dorset Telehealth Program. Patient. 2014.
  4. Brandon AF, Schuessler JB, Ellison KJ, Lazenby RB. The effects of an advanced practice nurse led telephone intervention on outcomes  of patients with heart failure. Appl Nurs Res. 2009;22(4):e1-7.
  5. Ciere Y, Cartwright M, Newman SP. A Systematic Review Of The Mediating Role Of Knowledge, Self-Efficacy And Self-Care Behaviour In Telehealth Patients With Heart Failure. J Telemed Telecare. 2012;18(7):384-91.
  6. Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007;334(7600):942.
  7. Clark RA, Inglis SC, McAlister FA, Cleland JGF, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. 2007;334(7600):942.
  8. Clark RA, Yallop JJ, Piterman L, Croucher J, Tonkin A, Stewart S, et al. Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring. Eur J Heart Fail. 2007;9(11):1104-1
  9. Clarke M, Shah A, Sharma U. Systematic review of studies on telemonitoring of patients with congestive heart  failure: a meta-analysis. J Telemed Telecare. 2011;17(1):7-14.
  10. Cui Y, Doupe M, Katz A, Nyhof P, Forget EL. Economic evaluation of Manitoba Health Lines in the management of congestive heart failure. Healthc Policy. 2013;9(2):36-50.
  11. Domingues FB, Clausell N, Aliti GB, Dominguez DR, Rabelo ER. Education and telephone monitoring by nurses of patients with heart failure: randomized clinical trial. Arq Bras Cardiol. 2011;96(3):233-9.
  12. Dunagan WC, Littenberg B, Ewald GA, Jones CA, Emery VB, Waterman BM, et al. Randomized trial of a nurse-administered, telephone-based disease management program for patients with heart failure. J Card Fail. 2005;11(5):358-6
  13. Ferrante D, Varini S, Macchia A, Soifer S, Badra R, Nul D, et al. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up. J Am Coll Cardiol. 2010;56(5):372-8.
  14. Garc¡a-Lizana F, Sarr¡a-Santamera A. New technologies for chronic disease management and control: A systematic review. 2007; 13(2):62-8.
  15. Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, et al. STRUCTURED TELEPHONE SUPPORT OR TELEMONITORING PROGRAMMES FOR PATIENTS WITH CHRONIC HEART FAILURE. Cochrane Database Syst Rev. 2010(8):CD007228.
  16. Inglis sc, clark ra, mcalister fa, stewart s, cleland jg. which components of heart failure programmes are effective? a systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged cochrane review. eur j heart fail. 2011;13(9):1028-40.
  17. Jerant a.f., azari r., martinez c., nesbitt t.s. a randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators. home health care serv q 2003; 22
  18. Kraai ih, luttik ml, de jong rm, jaarsma t, hillege hl. heart failure patients monitored with telemedicine: patient satisfaction, a review of the literature. j card fail. 2011;17(8):684-90.
  19. Lind l, karlsson d. telehealth for "the digital illiterate"--elderly heart failure patients experiences. stud health technol inform. 2014;205:353-7.
  20. Lynga p, fridlund b, langius-eklof a, bohm k. perceptions of transmission of body weight and telemonitoring in patients with heart failure? Int J Qual Stud Health Well-being. 2013;8:21524.
  21. Martinez A, Everss E, Rojo-Alvarez JL, Figal DP, Garcia-Alberola A. A SYSTEMATIC REVIEW OF THE LITERATURE on home monitoring for patients with heart  failure. J Telemed Telecare. 2006;12(5):234-41.
  22. Nanevicz T, Piette J, Zipkin D, Serlin M, Ennis S, De Marco T, et al. The feasibility of a telecommunications service in support of outpatient congestive heart failure care in a diverse patient population. Congest Heart Fail. 2000;6(3):140-5.
  23. Pandor A, Gomersall T, Stevens JW, Wang J, Al-Mohammad A, Bakhai A, et al. remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis. heart. 2013;99(23):1717-26.
  24. Pandor A, Thokala P, Gomersall T, Baalbaki H, Stevens JW, Wang J, et al. home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation. health technol assess. 2013;17(32):1-207, v-vi.
  25. Piotrowicz E, Stepnowska M, Leszczynska-Iwanicka K et al2015. Quality of life in heart failure patients undergoing home-based telerehabilitation versus outpatient rehabilitation - a randomized controlled study
  26. Prescher S, Deckwart O, Winkler S, Koehler K, Honold M, Koehler F. Telemedical care: feasibility and perception of the patients and physicians: a survey-based acceptance analysis of the Telemedical Interventional Monitoring in  Heart Failure (TIM-HF) trial. Eur J Prev Cardiol. 2013;20(2 Suppl):18-24.
  27. Ramachandran K, Husain N, Maikhuri R et al. 2007. Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure.
  28. Riegel B, Carlson B, Glaser D, Romero T. Randomized controlled trial of telephone case management in Hispanics of Mexican  origin with heart failure. J Card Fail. 2006;12(3):211-9.
  29. Riley JP, Gabe JP, Cowie MR. Does telemonitoring in heart failure empower patients for self-care? A qualitative study. J Clin Nurs. 2013;22(17-18):2444-55.
  30. Sanders C, Rogers A, Bowen R, Bower P, Hirani S, Cartwright M, et al. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. BMC Health Serv Res. 2012;12:220.
  31. Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. 2012;14(1):180-9.
  32. Seto E, Leonard KJ, Masino C, Cafazzo JA, Barnsley J, Ross HJ. Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring. 2010;12(4):56-65.
  33. Wakefield B.J., Holman J.E., Ray A. et al. 2009Outcomes of a home telehealth intervention for patients with heart failure.
  34. Wakefield BJ, Ward MM, Holman JE, Ray A, Scherubel M, Burns TL, et al. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Telemed J E Health. 2008;14(8):753-61.
APPENDIX 4 – Quality Assessment of included studies

For the quality assessment of the included studies we used

  • The AMSTAR guideline for systematic reviews {1}
  • The CONSORT 2010 checklist for RCTs {2}
  • The STROBE checklist for observational studies {3}
  • The Cochrane guideline for critical appraisal of qualitative studies {4}

The different checklists were merged by using the percentage rates of „yes“, „no“ or „n.a.“ of the checklists divided per number of items.

Results

Green – low bias risk, yellow – unclear bias risk, red – high bias risk

SOC Figure 2

Basic list to the graph about the Quality assessment of included studies for SOC domain STS for patient with CHF 2015

 

checklist used

yes

no

n.a.

total

yes %

n.a. %

no %

Achelrod 2014

AMSTAR

5

4

1

10

50,0

10,0

40,0

Martinez 2006

AMSTAR

10

1

0

11

90,9

0,0

9,1

Ciere 2012

AMSTAR

7

2

2

11

63,6

18,2

18,2

Garcia 2007

AMSTAR

4

7

0

11

36,4

0,0

63,6

Inglis 2011

AMSTAR

10

0

1

11

90,9

9,1

0,0

Kraii 2011

AMSTAR

6

5

0

11

54,5

0,0

45,5

Pandor 2013 (24)

AMSTAR

10

1

0

11

90,9

0,0

9,1

Pandor 2013 (23)

AMSTAR

10

1

0

11

90,9

0,0

9,1

Cui 2013

CONSORT

22

10

5

37

59,5

13,5

27,0

Clark 2007 (d314)

CONSORT

24

2

11

37

64,9

29,7

5,4

Brandon 2010

CONSORT

17

11

9

37

45,9

24,3

29,7

Piotrowitz 2015

CONSORT

24

8

5

37

64,9

13,5

21,6

Domingues 2011

CONSORT

22

10

5

37

59,5

13,5

27,0

Dunagan 2005

CONSORT

29

7

1

37

78,4

2,7

18,9

Ferrante 2010

CONSORT

35

1

1

37

94,6

2,7

2,7

Lynga 2013

Cochrane Guidance for qualitative studies

6

0

1

7

85,7

14,3

0,0

Seto 2010

Cochrane Guidance for qualitative studies

1

6

0

7

14,3

0,0

85,7

Prescher 2013

Cochrane Guidance for qualitative studies

0

6

1

7

0,0

14,3

85,7

Lind 2012

Cochrane Guidance for qualitative studies

2

3

2

7

28,6

28,6

42,9

Riley 2013

Cochrane Guidance for qualitative studies

4

0

2

6

66,7

33,3

0,0

Seto 2012

Cochrane Guidance for qualitative studies

4

0

2

6

66,7

33,3

0,0

Bond 2014

Cochrane Guidance for qualitative studies

3

1

2

6

50,0

33,3

16,7

Boehme 2012

STROBE obs.

29

3

0

32

90,6

0,0

9,4

Wakefilked 2009

CONSORT

14

18

0

32

43,8

0,0

56,3

Ramachandran 2007

CONSORT

19

11

0

30

63,3

0,0

36,7

Jerant, AF 2003

CONSORT

13

17

0

30

43,3

0,0

56,7

Sanders C. 2012

Cochrane Guidance for qualitative studies

3

1

2

6

50,0

33,3

16,7

Lind L. 2014

Cochrane Guidance for qualitative studies

3

1

2

6

50,0

33,3

16,7

[1] http://amstar.ca/Amstar_Checklist.php

[2] http://www.consort-statement.org/Media/Default/Downloads/CONSORT%202010%20Checklist.doc

[3]http://www.google.at/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CDUQFjADahUKEwi7zO6o7aDIAhUCPRQKHXInBck&url=http%3A%2F%2Fbmjopen.bmj.com%2Fsite%2Fabout%2FSTROBE_checklist_BMJ-Open_cohort-studies.doc&usg=AFQjCNHsziTBKuZyCAO88GQJVuP7hTT0HA

[4] Hannes K. Chapter 4: Critical appraisal of qualitative research. In: Noyes J, Booth A, Hannes K, Harden A, Harris J, Lewin S, Lockwood C (editors), Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Version 1 (updated August 2011). Cochrane Collaboration Qualitative Methods Group, 2011. Available from URL http://cqrmg.cochrane.org/supplemental-handbook-guidance (chapter 4)

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