Telemedicine for neurological diseases: A systematic review and meta-analysis

Abstract

Background: To systematically review the effectiveness and safety of telemedicine combined with usual care (in-person visits) compared to usual care for the therapeutic management and follow-up assessment of neurologic diseases. Methods: The electronic databases MEDLINE, EMBASE, WOS, and Cochrane Central Register of Controlled Trials were searched (June 2021). We considered randomized controlled trials (RCTs) on patients of any age with neurologic diseases. Two reviewers screened and abstracted data in duplicate and independently and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 2). When possible, pooled effect estimates were calculated. Results: Of a total of 3018 records initially retrieved, 25 RCTs (n=2335) were included: 11 (n=804) on stroke, 4 (n=520) on Parkinson’s disease, 3 (n=110) on multiple sclerosis, 2 (n=320) on epilepsy, 1 (n=63) on dementia, 1 (n=23) on spina bifida, 1 (n=40) on migraine, 1 (n=22) on cerebral palsy, and 1 (n=433) on brain damage. Types of telemedicine assessed were: online visits (11 studies), tele-rehabilitation (7 studies), telephone calls (3), smartphone apps (2), and online computer software (2). The evidence was quite limited except for stroke. Compared to usual care alone, telemedicine plus usual care was found to improve depressive symptoms, functional status, motor function, executive function, generic quality of life, health care utilization, and healthy lifestyle in patients in post-stroke follow-up. Conclusions: Well-designed and executed RCTs are needed to confirm our findings on stroke and to have more scientific evidence available for the other neurologic diseases.