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Chronic obstructive pulmonary disease (COPD) is a common chronic disease that can be treated and monitored with various digital technologies. Digital technologies offer unique opportunities for treating and monitoring people with chronic diseases, but little is known about whether the outcomes of such technologies depend on sex, gender, or age in people with COPD.
The general objective of this study is to assess the possible influence of sex, gender, or age on outcomes of digital technologies for treatment and monitoring of COPD through an overview of systematic reviews.
The study is planned as an overview of systematic reviews. Study reporting is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines because guidelines for overviews are not available as of this writing. The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. The electronic search strategy will be developed and conducted in collaboration with an experienced database specialist. The search results will be presented in accordance with the PRISMA 2020 guidelines. The eligibility of studies is based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria: (1) people with COPD (population), (2) digital technology intervention for treatment or monitoring (intervention), (3) any control group or no control group (comparison), (4) any outcome, and (5) systematic review of randomized controlled trials or non–randomized controlled trials with or without a meta-analysis (study design). Critical appraisal of the included systematic reviews will be performed using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data will be extracted using a standardized data extraction sheet.
The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022.
There is a growing recognition that the influence of sex, gender, or age should be considered in research design and outcome reporting in the context of health care interventions. Our overview will identify systematic reviews of various digital technologies for treatment or monitoring of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex, gender, or age-based) recommendations for the use of digital technologies among people with COPD.
PROSPERO International Prospective Register of Systematic Reviews CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924
Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease associated with a high disease burden and premature death [
In general, sex and gender appear to be inconsistently defined in the literature on COPD. Some studies refer exclusively to sex [
Digital technologies offer unique opportunities for treatment and monitoring of people with chronic diseases [
In recent years, many systematic reviews have been published on the use of digital technologies in COPD. If methodologically sound systematic reviews on a similar topic already exist, a new method of research synthesis, a so-called overview (a systematic review of systematic reviews) [
Systematic reviews should provide a comprehensive and objective assessment of existing evidence. This includes appropriate consideration of sex, gender, or age differences in the outcomes of any health care intervention. It is unclear if and to what extent systematic reviews have thus far addressed the influence of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD. According to a search of the International Prospective Registry of Systematic Reviews (PROSPERO), MEDLINE, and the Cochrane Database of Systematic Reviews, no currently planned or completed overviews of systematic reviews on this topic were identified.
Thus, our main objectives are to (1) describe the terminology and definitions of sex or gender used in the systematic reviews; (2) determine if the systematic reviews focus on sex, gender, or age in any planned analyses and result reporting; (3) assess whether the systematic reviews include sex, gender, or age in their implications for clinical practice or policy and regulation development; and (4) create an evidence map that could inform individualized recommendations for people with COPD that take into account sex, gender, or age.
The study is planned as an overview of systematic reviews [
The overview of systematic reviews was prospectively registered on PROSPERO (CRD42022322924). Any changes to the protocol will be amended in PROSPERO and reported once the overview is complete.
Patients and the public were not involved in the design of this protocol. Thus, ethics approval is not required for the overview of systematic reviews.
The eligibility criteria for this overview of systematic reviews are based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria (
We intend to include only systematic reviews in the languages in which we are proficient (English and German). We will report the number of systematic reviews that were excluded in the full-text screening owing to language considerations and discuss any possible implications of excluding such literature on the results of the overview.
Population: diagnosis of chronic obstructive pulmonary disease (COPD) with or without any comorbidities
Intervention: any digital technology for treatment and monitoring of COPD. Digital technologies are defined as any intervention delivered or supported by digital tools with the aim of targeted client communication or personal health tracking [
Comparison: any other intervention or no intervention
Outcome: any outcome
Study type: systematic review of randomized controlled trials (RCTs), non-RCTs, or both with or without meta-analysis. A study will be classified as a systematic review if it has explicitly stated objectives and reproducible methodology, including a literature search in at least 2 bibliographic databases
Publication status: systematic review published in a peer-reviewed journal
Publication language: English or German
Full text accessible
Population without COPD
Digital interventions are not applied or are not the primary intervention
Other study type: rapid, scoping, or narrative review; overview of systematic review; primary study; comment; correction; letter; editorial; or protocol
Other publication status: conference paper, unpublished report, thesis, or book
Language other than English or German
A review that does not fulfill the requirements for a systematic review (eg, no explicitly stated objectives or reproducible methodology or a literature search in only one bibliographic database) or has low or critically low appraisal ratings on AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, version 2) [
Full text not accessible
The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. These databases were selected because they identified the most relevant studies in our preliminary search for systematic reviews and were accessible at our institution.
The electronic search strategy will be developed iteratively by the team in consultation with an experienced database specialist. The development and reporting of the search strategy adheres to the Peer Review of Electronic Search Strategies [
Summary of the search strategy in MEDLINE.
Variable | Search topic 1: digital technologies | Search topic 2: chronic obstructive pulmonary disease |
Example search terms | Telemed*, telehealth*, ehealth*, mhealth*, mobile applications, wearable electronic devices, digital*, healthcare application*, internet* | Chronic obstructive pulmonary disease*, chronic obstructive airways disease*, COPD, COAD |
Search fields | Titles or abstracts | Titles or abstracts |
Comments | Relevant Medical Subject Headings terms were included | Relevant Medical Subject Headings terms were included |
The electronic search results will be stored in EndNote 20 (Clarivate). Following the removal of duplicates in EndNote, the remaining studies will be screened by 2 authors for inclusion in 3 steps using Covidence (Veritas Health Innovation). First, 2 authors will independently screen all titles and abstracts and reach consensus by discussion. Second, 2 authors will independently screen the studies selected for full-text inspection and reach consensus through discussion. In the case of no consensus, a third author will intervene. Third, once the study selection from the electronic search is complete, all systematic reviews will be appraised with AMSTAR 2 [
A list of included and excluded studies following full-text screening and individual reasons for exclusion will be reported once the overview is complete.
Modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram.
The critical appraisal of systematic reviews will be performed using AMSTAR 2 [
A form for appraising systematic reviews with AMSTAR 2 will be self-developed in Excel (version 10; Microsoft Corp). AMSTAR 2 appraisals will be performed in 2 phases independently by 2 authors as described in our protocol for a scoping review [
An overlap in overviews occurs when the same primary studies are cited in 2 or more systematic reviews. We will determine the overlap among primary studies in the included systematic reviews. Although there is currently no standardized methodological approach for addressing overlap in overviews [
A form for coding and capturing of all data will be self-developed in Excel and calibrated within the team. Part of the data charting form will be adapted from the Sex and Gender Equity in Research guidelines [
Data items that will be coded in the overview are reported in
Bibliographic information
Population characteristics
Intervention details
Comparison type
Outcome type
Study (systematic review) type: Cochrane or non-Cochrane review
Study aim according to review authors
Primary studies in systematic review (number of studies, designs, and overlap among published studies)
Risk of bias in primary studies according to review authors
Data items for sex, gender, or age (eg, sensitivity analyses of outcomes taking into account sex, gender, or age)
The data will be synthesized using descriptive statistics (absolute frequencies) or narratively. The overall confidence ratings for all systematic reviews, obtained using AMSTAR 2, will be graphically synthesized using a bar graph to visualize the outcomes of the critical appraisal.
Subgroup analyses will be performed to assess if considerations of sex, gender, or age in a systematic review are associated with the type or AMSTAR 2 appraisal rating of systematic reviews in accordance with methods applied in our previous work [
The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022.
Preliminary literature searches have shown that systematic reviews so far identified various digital technologies for the treatment or monitoring of COPD, including remote and Web 2.0–based interventions, internet-based telecommunication with health care professionals, telerehabilitation, smartphone interventions, and home telemonitoring. The overview will provide a detailed list of such technologies once the studies are selected. We will also assess the outcomes of such digital technologies in the context of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews have considered sex, gender, or age in their data synthesis or discussion of outcomes of such digital technologies in COPD.
There is a growing recognition of the importance of sex, gender, or age considerations in research design and reporting [
In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.
Thus, our overview will provide all terminology and definitions of sex and gender used in the systematic reviews of digital technologies for COPD.
Our overview focuses on the potential influence of only 3 sociodemographic variables (sex or gender and age) on the outcomes of digital technologies in COPD. We assume that these variables are regularly collected and reported in primary studies, at least in aggregate form (ie, as frequencies or means). According to the Global Burden of Disease Study 2019 [
This protocol has been rigorously developed, and the electronic search syntax was iteratively tested and revised by an experienced database specialist. Nevertheless, we cannot exclude the possibility that some relevant systematic reviews in this new field may have been overlooked in our electronic search. Hence, a manual search for additional literature will be performed by screening the bibliographies of the included systematic reviews. The overview will also have further limitations. We have decided not to search the gray literature—this choice is guided by the general difficulty in assessing any financial interests associated with digital health technologies that may be present in gray literature. Our appraisal of systematic reviews will be based on AMSTAR 2 [
Evidence from the overview could be used to guide more individualized (sex-, gender-, or age-based) recommendations for the use of digital technologies by people with COPD. Considering the rapid technological advancement in the field of digital health technologies, the findings from the overview could be of interest for various stakeholder groups, including researchers, policy makers, health professionals, people with COPD, and companies that develop digital technologies for COPD. Therefore, the dissemination plan for this overview is to publish the findings in a peer-reviewed journal and present them at scientific conferences. We will also attempt to summarize the findings using a plain-language summary designed for the nonscientific community, which can be uploaded on our research profiles on the internet.
There is a growing recognition that the influence of sex, gender, or age should be considered in reporting research designs and outcomes in the context of health care interventions. Our overview will help identify systematic reviews of various digital technologies for the treatment or monitoring of COPD. The most interesting aspect of the overview will be the ability to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex-, gender-, or age-based) recommendations for use of digital technologies by people with COPD.
A Measurement Tool to Assess Systematic Reviews, version 2
corrected covered area
chronic obstructive pulmonary disease
population, intervention, comparison, outcomes, and study design
Preferred Reporting Items for Overviews of Reviews
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
International Prospective Registry of Systematic Reviews
randomized controlled trial
risk of bias in systematic reviews
We thank the database specialist, Jaqueline Schirm, for their assistance in designing the search strategy. The publication of this article was funded by the Open Access Fund of the University of Applied Science Stralsund.
This overview of systematic reviews will be based on previously published data. All relevant data will be made available once the overview is complete.
KM conceptualized the study, developed the methodology, wrote the first draft of the manuscript, and reviewed and edited the manuscript. IH conceptualized the study and reviewed and edited the manuscript. KKDS conceptualized the study, developed the methodology, and reviewed and edited the manuscript.
None declared.