Acta Dermato-Venereologica 99-13CompleteContent | Page 8

1210 REVIEW ARTICLE Outcome Measurements Used in Randomized Controlled Trials of Teledermatology: A Systematic Mapping Review Aloysius CHOW 1 , Charlene SOON 1 , Helen E. SMITH 1 and Christian J. APFELBACHER 1–3 1 Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 2 Institute of Epidemiology and Preventive Medicine, University of Regensburg, and 3 Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany Assessment of the effectiveness of teledermatology has been hampered by the variety of outcome meas­ ures used, limiting the possibility for meta-analysis. This systematic mapping review classified the outcome measurement instruments used in randomized con­ trolled trials of teledermatology conducted between 2008 and 2018 using the Core Outcome Measures in Effectiveness Trials taxonomy. Sixteen articles de­ scribing 12 studies were identified. Each trial used a mean of 3.7 outcome measurements (range 2–7), with a total of 55 different instruments employed. Most in­ struments mapped on the “skin and subcutaneous tis­ sue outcomes” domain. The most frequently used in­ strument (Dermatology Life Quality Index) was used in only 3 studies. Over 60% of the instruments used did not cite any evidence of validation. This mapping review provides a list of outcome measurement instru­ ments that can be used as a resource when designing teledermatology trials in the future and provides the foundation for the development of a core outcome set. Key words: outcome measure; outcomes research; randomized controlled trial; teledermatology. Accepted Sep 10, 2019; E-published Sep 10, 2019 Acta Derm Venereol 2019; 99: 1210–1217. Corr: Helen Elizabeth Smith, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232. E-mail: [email protected] S kin diseases are one of the most common reasons for patients to seek medical consultations (1). It is also recognized that there is a shortage of healthcare profes- sionals with the relevant skills (2). Dermatology, because of its visual character, is well suited to telemedicine for patient consultations, referrals and triage, which has the potential to increase accessibility to dermatological ex- pertise, maximize work-force potential, improve patient health outcomes, and reduce costs (3). Teledermatology consultations can be “store and forward”, with electronic digital images sent to review at a later time (also referred to as asynchronous), live and interactive (synchronous) or a combination of both (3). Literature reviews of tele- dermatology service evaluations have reported positive impacts, such as more rapid diagnoses (4), improved cost-effectiveness (5, 6), but also some negative impacts, such as increased referrals to secondary care (7). Syste- doi: 10.2340/00015555-3312 Acta Derm Venereol 2019; 99: 1210–1217 SIGNIFICANCE Assessment of the effectiveness of teledermatology is chal- lenging due to different outcome measurements utilized. This review mapped 55 different outcome measurements reported in clinical trials of teledermatology using the Core Outcome Measures in Effectiveness Trials taxonomy. Each trial used a mean of 3.7 measurements (range 2–7), and most measurements measured “skin and subcutaneous tissue outcomes”. The most frequently used measurement was used in only 3 studies. Over 60% of the measurements did not cite evidence of validation. This review provides a list of measurements for use in designing future teleder- matology trials, and provides the foundation to develop a core outcome set. matic literature reviews of randomized controlled trials (RCTs) of telemedicine tend to be more reserved about potential benefits because of the heterogeneity in quality, design, conditions and outcomes of the studies, which in turn limits the ability to pool data (8–10). The lack of standardization of outcome measurement instruments is a recurrent challenge when making evidence-based decisions to optimize patient care. However, this problem tends to persist, because within a tight project timeline, researchers may not have the resources to assess the range of outcome measurement instruments used previously, or to identify those that would enable direct comparisons with previous work. To address this issue the Core Outcomes Measures in Effectiveness Trials (COMET) Initiative (http://www. comet-initiative.org/) is now encouraging researchers to develop and adopt the use of evidence-based core outcome sets (COS) (11). These are agreed standardized sets of outcomes that the COMET Initiative recommends to be measured and reported as a minimum in all clinical trials in a particular condition or context (12). They may also be used in audit or other forms of research. A taxo- nomy to classify outcomes has also been developed by the COMET Initiative, to standardize the classification of all outcomes reported. This taxonomy is also used in the classification of outcomes in COS, which further encourages the standardized reporting of outcomes (11). One important step in the development of a COS for a particular field is to identify outcome measurement This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.