Patient adherence and satisfaction and changes in anthropometric parameters with e-health versus in-person monitoring in bariatric surgery candidates: a systematic review and non-inferiority meta-analysis of cohort studies

Background: Obesity is a risk factor for cardiovascular diseases and associated with reduced life expectancy. Surgery is a treatment approach for weight loss in some cases and patient monitoring is cost-effective and feasible. However, there is no strong evidence on the differences between e-health and in-person monitoring in bariatric surgery candidates. Methods and analyses: This review study will include cohort studies involving individuals with obesity (aged ≥18 years) and e-health or in-person patient monitoring before and after bariatric surgery. We will conduct searches in the following databases: PubMed, EMBASE (Elsevier), Cochrane (CENTRAL), Web of Science, SCOPUS and CINAHL (EBSCO), LILACS-VHL and SciELO. We will also search databases in the gray literature. The primary outcomes will be changes in body mass index (BMI), total body mass (kg) and body fat percentage (BF%) and patient adherence and satisfaction. The risk of bias of individual eligible studies will be assessed using the Newcastle-Ottawa Quality Assessment Scale and the overall quality will be assessed using the GRADE tool. Our analyses will involve comparisons of mean differences (MDs) or standardized mean differences (MSDs) across the groups using random-effects models and 95% confidence intervals. Statistical analyses will be performed with RStudio for Windows (v1.3.959) using R package meta (v3.6.1).

【背景】肥胖症是心血管疾病的危险因素，且与预期寿命缩短密切相关。手术是部分肥胖患者的减重治疗方案，而患者监测兼具成本效益与可行性。然而，目前尚无确凿证据表明，减重手术（bariatric surgery）候选者接受电子健康（e-health）监测与线下面对面监测之间存在何种差异。【方法与分析】本综述研究将纳入针对年龄≥18岁肥胖人群、且在减重手术前后开展电子健康或线下患者监测的队列研究。我们将在以下数据库中进行文献检索：PubMed、EMBASE（爱思唯尔Elsevier）、Cochrane中心对照试验资料库（Cochrane CENTRAL）、Web of Science、SCOPUS、CINAHL（EBSCO）、LILACS-VHL及SciELO，同时还将检索灰色文献数据库。本研究的主要结局指标包括体重指数（body mass index, BMI）、总体体质量（kg）与体脂百分比（body fat percentage, BF%）的变化情况，以及患者依从性与满意度。我们将采用纽卡斯尔-渥太华质量评价量表（Newcastle-Ottawa Quality Assessment Scale）对符合纳入标准的单项研究进行偏倚风险评估，并使用GRADE工具（GRADE tool）评价整体研究质量。分析过程中，我们将借助随机效应模型与95%置信区间，对各组间的均数差（mean differences, MDs）或标准化均数差（standardized mean differences, MSDs）进行比较。统计分析将通过Windows版RStudio（v1.3.959）结合R包meta（v3.6.1）完成。