Glossary of key terms, categories (interventions, outcomes) and filters included in the Evidence and Gap Map. The table contains all categories in the map; a definition or example(s) is provided except where terms are in common use.
Key Terms
| Term | Definition |
| Evidence and gap map (EGM) | An Evidence and Gap Map (EGM) is an interactive tool, designed to provide visual presentations of the availability of rigorous evidence for a particular topic, theme, or policy area. EGMs commonly include systematic reviews and evaluations of impact on ‘what works’ in relation to a specified topic. Derived from a systematic and pre-defined search of available evidence, EGMs consist of a matrix of intervention categories (rows) and outcome domains (columns) placed into an intuitive graphical display. Navigating the map reveals areas for which there is strong, weak, or non-existent evidence available on the effect of interventions. In addition, filters may be available, for example for the type of study, or population characteristics. It is important to note that while EGMs show what evidence is available, they do not comment on what the evidence says1, 2. |
| Remote monitoring | An intervention, involving the monitoring of a patient (using medical devices, applications, clinical investigation results, or assessment tools), including self-monitoring, and which allows care professionals from a healthcare provider to assess and manage a patient’s condition remotely – without the need for the patient to be seen face-to-face. This includes monitoring – of objective or self-reported health status; – occurring in the place where a person lives, either their home or a residential setting such as a care home; – using a device or written output, as long as data is transferred to a care professional. |
| Systematic review | A study which systematically collects and synthesises all of the research available on a topic in order to answer a specific question3, 4. Systematic reviews seek to minimise bias by setting out their methods in advance, defining the types of study that will be included and methods that will be used to search for evidence, select studies for inclusion, and manage and analyse the data. |
| Randomised controlled trial | An experimental study in which people are randomly allocated into different groups and each group receives a different intervention5. |
INTERVENTIONS (type of remote monitoring)
| Category | Sub-category | Explanatory notes/examples |
| What is monitored | Blood glucose | Levels of sugar in the bloodstream |
| Blood pressure | The pressure of blood in the circulatory system, used to measure the force with which the heart is pumping blood around the body6 | |
| Heart rate, arrythmia, atrial fibrillation | Heart-related health indicators (other than blood pressure) | |
| Physical activity | As defined in the study | |
| Medication/treatment adherence | The extent to which patients follow the treatment regime prescribed by their physicians | |
| Oxygen related | E.g. blood oxygen levels | |
| Symptoms | Disease-specific symptoms e.g. breathlessness | |
| Other | E.g. weight | |
| How is it monitored | Implantable | Devices that are either partially or totally inserted into the body and remain there in order to measure health status e.g. a pacemaker |
| Wearable device | A device that needs to be worn in order to measure health status e.g. an activity tracker | |
| Other device | Devices used to measure health status which were not specified as wearable/implantable in the review; these might include blood pressure monitors or oximeters | |
| Symptom tracking | Where patients were asked to track symptoms related to their health condition e.g. using a standardised set of questions | |
| Method of passing on data | Automatic | Data on health status is automatically passed from the measurement device to a healthcare provider |
| App/website/email/patient portal | Any electronic means used by the patient to pass on data, such as apps, websites, emails or patient portals | |
| SMS | Text messages from a mobile telephone | |
| Telephone | Telephone calls from a mobile telephone or landline | |
| Videochat/conferencing | ||
| Face-to-face | ||
| Who is healthcare contact | Doctor | Including general practitioners and doctors with specialisms e.g. a cardiologist |
| Nurse | As defined in the study | |
| Other healthcare professional | As defined in the study e.g. physiotherapists, diabetes educators | |
| Method of feedback | App/website/email/patient portal | As defined under ‘Method of passing on the data’ |
| SMS | As defined under ‘Method of passing on the data’ | |
| Telephone call | As defined under ‘Method of passing on the data’ | |
| Videochat/conferencing | ||
| Face-to-face | ||
| Alert triggered | When the monitored health indicator reaches a critical value, the healthcare provider is alerted to take an action, e.g. contact the patient | |
| Content of feedback | Referral | Patients might be referred for an appointment with a doctor or specialist, or to an emergency department |
| Change to treatment/medication | Healthcare professionals may adjust treatment or medication as a result of a patient’s health status, or in consultation with a patient | |
| Motivation/education | Based on transmitted data, healthcare providers may contact the patient to encourage specific behaviour and/or provide information on the patient’s condition e.g. advice about diet and physical activity in response to consistently high blood pressure |
OUTCOMES
| Category | Sub-category | Explanatory notes/examples |
| Physical health | Mortality | All-cause and disease-specific |
| Blood glucose/glycaemic control | E.g. blood glucose level, HbA1c, hypoglycaemic events | |
| Blood pressure | E.g. systolic and diastolic blood pressure, mean arterial pressure | |
| Other cardiovascular metrics | Cardiovascular metrics other than blood pressure e.g. oxygen consumption | |
| Detection rate | Detection of disease-specific symptoms. These might indicate an exacerbation of a patient’s conditions e.g. in patients with chronic pulmonary obstructive disease | |
| Risk of adverse events | The effectiveness of remote monitoring in reducing the risk of adverse events, such as stroke or myocardial infarction | |
| Weight/BMI/waist circumference | As defined in the studies | |
| General health | Any measures of general/physical health and performance e.g. 6 Minute Walk Test | |
| Other | Any physical outcome not included in the above categories e.g. kidney related measures such as serum creatinine | |
| Mental health/ wellbeing | Anxiety/depression | As measured in the included studies e.g. Hospital Anxiety and Depression Scale (HADS) |
| Quality of life | Quality of life as measured by instruments such as EQ-5D, or the subjective perception of wellbeing, as ascertained through qualitative interviews | |
| Health behaviours/ self-regulation | Self-management or self-care | Learning and practicing skills to enable management of health and social needs on a day-to-day basis |
| Knowledge, understanding | Knowledge, understanding, information held about own health condition, how to meet own social needs etc. | |
| Risk factors | Changing behaviour to address risk factors associated with poor health e.g. increasing physical activity or adhering to a healthy diet | |
| Self-efficacy | Self-efficacy, empowerment. Self-advocacy. Self-esteem. Measures that quantify mental state and attitudes that are likely to translate into health behaviours | |
| Healthcare/ service use | Hospitalisation | Utilisation of healthcare resources, including hospitalisation, length of stay and readmissions e.g. readmission after discharge’ or rate of readmissions over a period of time |
| Emergency room visits | As defined in the studies | |
| Acceptability/ implementation | Acceptability and satisfaction | Acceptability and user satisfaction with remote monitoring, as established by surveys or interviews with patients/carers/healthcare professionals who have direct experience with remote monitoring |
| Usability | Patient/carer/healthcare professional perceptions of the degree to which the remote monitoring technology is fit for use | |
| Implementation-related | Patient/carer/healthcare professional views on factors that affect whether remote monitoring interventions are effective and acceptable | |
| Adherence/ compliance | With treatment | Any measure of the patient’s adherence to the prescribed treatment regime e.g. patients take their medications as prescribed |
| With intervention | Any measure of the patient’s adherence to the remote monitoring intervention e.g. patients measure and record their blood pressure as instructed |
FILTERS
| Category | Sub-category | Explanatory notes |
| Study year | Year of publication of study | |
| Type of synthesis | Meta-analysis | The review used established statistical methods to combine results from individual studies |
| Narrative | The review summarised the results of quantitative studies narratively (using tables and diagrams) without conducting meta-analysis | |
| Qualitative | The review reported a narrative synthesis of qualitative studies only | |
| Other | The review synthesised the results from both qualitative and quantitative studies e.g. using realist or integrative review methods | |
| Included study designs | RCT | As defined above |
| RCT + other study design | ||
| Other quantitative | Non-randomised comparative studies and non-comparative designs e.g. cohort studies | |
| Qualitative | Qualitative studies involving patients, carers or healthcare providers who have direct experience with remote monitoring | |
| Population | Patients | Adults (≥18 years old) with chronic conditions receiving remote monitoring at home or in residential care |
| Carers | Carers of adults with chronic conditions (as defined above) receiving remote monitoring | |
| Healthcare professionals | Healthcare professionals providing remote monitoring to adults with chronic conditions (as defined above) | |
| Patients | Cardiovascular disease | Patients with diagnosis of cardiovascular disease e.g. heart failure, hypertension, atrial fibrillation and stroke |
| Neurological | Patients with conditions including dementia, Alzheimer’s and Parkinson’s disease | |
| Diabetes | Patients with Type 1 or 2 diabetes | |
| Respiratory conditions | Patients with conditions including COPD and asthma | |
| Cancer survivors | ||
| Kidney disease | ||
| Other | Patients with conditions such as inflammatory bowel disease | |
| Study location(s) These categories were developed to indicate organisation of health systems of studies included in the reviews | United Kingdom (UK) | The review included at least one study conducted in the UK or in multiple countries one of which was the UK. The number of UK-based studies is also reported in the map. |
| Europe (other than UK) | The review included at least one study conducted in a European country (other than the UK) | |
| North America | The review included at least one study conducted in North America | |
| Australia or New Zealand | The review included at least one study conducted in Australia or New Zealand | |
| Other | The review included at least one study conducted in a location not specified above (e.g. Asia) | |
| Duration of interventions | Mean or median duration of interventions was 12 or more months | The mean or median duration of the intervention, as reported in the review, was 12 or more months |
| Included at least one study with duration of intervention 12 or more months | The review included at least one study in which the intervention continued for 12 or more months. If the mean/median duration was reported and was 12 or more months, the review was also included above | |
| Quality assessment overall confidence in quality of results (AMSTAR-2) | The following AMSTAR-2 categories were considered critical: 1. Objectives and methods pre-specified in a protocol and any deviations justified 2. Comprehensive and reproducible search strategy was used 3. The included studies were described in sufficient detail 4. Established method was used to assess the risk of bias/methodological quality of the included studies 5. Between-study heterogeneity was assessed using established methods and satisfactory explanation was provided | |
| High | No or one non-critical weakness: The systematic review provides an accurate and comprehensive summary of the results of the available studies that address the question of interest7 | |
| Moderate | More than one non-critical weakness: The systematic review has more than one weakness, but no critical flaws. It may provide an accurate summary of the results of the available studies that were included in the review. Upon discretion of the reviewers, some reviews with multiple non-critical weaknesses may have been downgraded to low quality to reflect diminished confidence in the review7 | |
| Low | One critical flaw with or without non-critical weaknesses: The review has a critical flaw and may not provide an accurate and comprehensive summary of the available studies that address the question of interest7 | |
| Critically low | More than one critical flaw with or without non-critical weaknesses: The review has more than one critical flaw and should not be relied on to provide an accurate and comprehensive summary of the available studies7 |
Sifting and sensemaking 