Meta-Analysis of mHealth Applications and Telemonitoring in Atopic Dermatitis Self-Management: Improving Quality of Life and Patient-Reported Outcomes, but Not Disease Severity
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Search Strategy We searched PubMed, Web of Science, Scopus, and Embase until May 2023 for peer-reviewed clinical trials evaluating the effectiveness of teledermatology, mobile apps, and electronic devices for managing atopic dermatitis. No language or date restrictions were applied during the searching process. The review adhered to the PRISMA 2020 guidelines 14. The study’s protocol was registered in PROSPERO (PROSPERO 2023: CRD42023421127). Eligibility Criteria Inclusion and Exclusion Criteria Inclusion: Reports on teledermatology, mobile apps, and electronic devices for AD for all age groups and settings and providing an assessment of the performance of the electronic tools on disease control were included. Studies were considered if they were in the English language and comprised randomized controlled trials (RCTs), non-randomized controlled trials, and observational studies. Exclusion: Studies were excluded if they were not AD-related, not related to mobile apps, not telemedicine, not electronic devices, or were reviews, non-human studies, guidelines. PICO Framework: P: Pediatric and adult patients with dermatological conditions including but not limited to atopic dermatitis I: mHealth Apps, Telemonitoring, and Smart Devices C: Standard care practices O: Enhanced Self-Management Outcomes for Dermatological Conditions (Improved Control; Patient-Reported Outcomes; Itch Intensity Reduction; Decreased Flare Frequency; Reduced Topical Medication Use; Enhanced Skin Barrier Function) Data Extraction and Synthesis The selection process for the included articles involved 3 independent reviewers (M.O., K.R., and A.O.) who proceeded in two phases. In the first phase, they assessed the titles and abstracts of the articles based on predetermined eligibility criteria. In the second phase, they reviewed the full-text articles using the same criteria as phase 1 and cross-checked all information obtained. Any discrepancies were resolved through discussion between the reviewers. If any essential data were missing or unclear, the corresponding authors of the study were contacted to provide clarification. Data Synthesis The meta-analysis was conducted for controlled trials in Review Manager 5.4.3 (Cochrane, USA). The data was analyzed and presented as Mean Difference with 95% confidence intervals. In addition, the effect size was computed as Standardized Mean Difference with 95% CI and reported as Cohen's d. Additionally, the Chi², I², and Z values, in addition to the P-value, were also presented as forest plots for the meta-analytical outcomes. Risk of Bias Assessment The risk of bias was evaluated at the study level based on characteristics like study design, sample size, participants, exposure, and outcome measures. The assessment also included a risk of bias evaluation using the ROB2 by Cochrane.