Background/Purpose: Recent advancements in the delivery and utilization of information and communication technologies (ICTs) have led to an increased application of telehealthcare services. Global coronavirus disease (COVID-19) has further accelerated pressure on healthcare systems. Patients with rheumatological disease, particularly those on immunosuppressant therapy, are potentially at increased risk of COVID-19 and developing the severe consequences of the disease. Furthermore, this group have been advised to shield during the COVID-19 pandemic. This review aims to assess the baseline use of telehealthcare in rheumatology before COVID-19, to which future comparisons of newer interventions adapted during the crisis can be made.

Methods: A registered systematic literature search (CRD42020180695) was performed using MEDLINE, EMBASE, CENTRAL and PubMed databases. All full-length articles comparing telehealthcare delivery models to standard care in the management of patients with rheumatic conditions were assessed for inclusion. This systematic review was conducted in accordance with The Cochrane Collaboration principles of Systematic Reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: 4809 studies were identified. 108 studies were suitable for review by full text of which 13 studies met full criteria for this review. Five studies (38%) included patients with rheumatoid arthritis, four studies (31%) included patients with mixed disease cohorts, two studies (15%) included patients with osteoarthritis, one study (8%) included patients with juvenile idiopathic arthritis and one study (8%) included patients with fibromyalgia. The majority of patients were female representing 38-100% of patients and the average age of patients ranged from 13.1-64.4 years. Six studies (46%) used telephone, three studies (23%) used mixed method communication, three studies (23%) used videoconferencing and one study (8%) used website delivered telecommunication as their method of telehealthcare delivery. Modality of telehealthcare intervention ranged throughout studies with six studies (46%) delivering virtual consultation, three studies (23%) delivering a self-management program, two studies (15%) delivering a health education program, one study (8%) delivering cognitive behaviour therapy and one study (8%) delivering a self-efficacy program. Seven studies (54%) identified the telehealthcare intervention to be effective and superior to standard care and six studies (46%) identified the telehealthcare intervention as non-inferior to standard care.

Conclusion: Current evidence for telehealthcare in rheumatology is lacking and the evidence for superiority or non-inferiority is limited by methodological bias and clinical heterogeneity of telehealthcare interventions. With a paradigm shift in the nature of patient consultation, fit for purposeful assessment is essential in rheumatology following the COVID-19 crisis. Scrutinous assessment of the current telehealthcare interventions used during COVID-19 is required to accommodate recommendations directed from international working groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-exploring-pre-covid-19-telehealthcare-models-used-in-the-management-of-patients-with-rheumatological-disease/