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Design of telehealth trials - Introducing adaptive approaches

Lookup NU author(s): Professor James WasonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).


© 2014 The Authors.Background: The field of telehealth and telemedicine is expanding as the need to improve efficiency of health care becomes more pressing. The decision to implement a telehealth system is generally an expensive undertaking that impacts a large number of patients and other stakeholders. It is therefore extremely important that the decision is fully supported by accurate evaluation of telehealth interventions. Objective: Numerous reviews of telehealth have described the evidence base as inconsistent. In response they call for larger, more rigorously controlled trials, and trials which go beyond evaluation of clinical effectiveness alone. The aim of this paper is to discuss various ways in which evaluation of telehealth could be improved by the use of adaptive trial designs. Results: We discuss various adaptive design options, such as sample size reviews and changing the study hypothesis to address uncertain parameters, group sequential trials and multi-arm multi-stage trials to improve efficiency, and enrichment designs to maximise the chances of obtaining clear evidence about the telehealth intervention. Conclusion: There is potential to address the flaws discussed in the telehealth literature through the adoption of adaptive approaches to trial design. Such designs could lead to improvements in efficiency, allow the evaluation of multiple telehealth interventions in a cost-effective way, or accurately assess a range of endpoints that are important in the overall success of a telehealth programme.

Publication metadata

Author(s): Law LM, Wason JMS

Publication type: Review

Publication status: Published

Journal: International Journal of Medical Informatics

Year: 2014

Volume: 83

Issue: 12

Pages: 870-880

Print publication date: 01/12/2014

Online publication date: 16/09/2014

Acceptance date: 05/09/2014

ISSN (print): 1386-5056

ISSN (electronic): 1872-8243

Publisher: Elsevier Ireland Ltd


DOI: 10.1016/j.ijmedinf.2014.09.002

PubMed id: 25293533