148 6 Chapter 6 features that overlap. For the purposes of this systematic review, we adopted the term ‘telemonitoring’, de ned as use of information and communication technologies to monitor and transmit items related to patient health status between geographically separated individuals (Maric 2009). Telemonitoring best describes the di erent interventions used in clinical studies, and is the term most studies have used themselves to describe their intervention. Hence, for this update, we have added telemonitoring as a possible additional component of IDM. How the intervention might work There is great variation in the symptoms, functional limitations, and degrees of psychological well-being of patients with COPD, as well as in the speed of progression of COPD towards more severe stages (Agusti 2010). This calls for a multi-faceted response, including di erent elements (e.g. smoking cessation, physiotherapeutic reactivation, self-management, optimal medication adherence) targeted at the patient, the professional, and/or the organisation. Ideally, COPD care is based on active self-management to slow down progression of the disease, including daily self-care, patient-physician collaboration, and exacerbation management. Information should be tailored to patients’ needs, knowledge level, and clinical pro le and should be accessible to patients when they need it most (Bourbeau 2013; Tiep 1997). Another potential bene t of IDM is that without proper self-management, patients often refrain from reporting episodes of exacerbation to healthcare providers (Seemungal 2000). An important reason for this is fear of being sent to the hospital. Unfortunately, neglecting worsening of COPD leads to a negative spiral of increasing dyspnoea, deconditioning, and social deprivation. Eventually, this avoidant behaviour can lead to a respiratory crisis, which necessitates urgent referral to the hospital and might cause further damage to the lungs. To break through this self-reinforcing negative spiral, healthcare professionals must collaborate with their patients. This requires focus on improving and maintaining self-management skills, for example, by urging patients to respond rapidly and seek help to prevent further worsening (Chavannes 2008). More recently, it has been argued that the addition of telemonitoring to IDM programmes allows for more continuous guidance and might lead to detection of deterioration earlier because of the potential for more frequent assessments. This could lead to more personalised management and prevention of exacerbations (Kruse 2019). However Kruse 2019 also concluded that it is unclear whether this approach enables people with COPD to self-manage more easily. Telemonitoring for pulmonary rehabilitation showed e ects similar to those seen with conventional face-to-face, centre-based pulmonary rehabilitation for numerous outcomes (Cox 2021).
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