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Table 3 Characteristics of included studies

From: The use of advanced medical technologies at home: a systematic review of the literature

Study Country of study Study design and sample Medical technologies Medical diagnosis Content
Agar, J.W.M., Perkins, A., Tjipto, A., 2012. [96] Australia Separately metered and serially measured independent draws of each dialysis machine plus reverse osmosis pairing.
n = 4 (home dialysis equipment combinations)
Hemodialysis No medical diagnosis mentioned Evaluation of solar-assisted hemodialysis.
Alsaleh, F.M., Smith, F.J., Thompson, R., Al-Saleh, M.A., Taylor, K.M., 2014. [32] UK Cross-sectional face-to-face semi-structured interviews;
Qualitative and quantitative approaches for data analysis
n = 34 (patients, children/young people)
n = 38 (parents)
Insulin pump therapy Type 1 diabetes mellitus Examination of the impact of switching from multiple daily injections to insulin pumps on the glycaemic control and daily lives of children/young people and their families.
Amin, R.S., Fitton, C.M., 2003. [104] USA   Long-term mechanical ventilation;
Chronic respiratory failure (CRF) as indicated by hypoxemia and or hypercapnia;
Chronic progressive lung diseases;
Neuromuscular disorders;
Congenital muscular dystrophy;
Non-progressive chronic parenchymal lung disease;
Congenital central hypoventilation syndrome (CCHS);
Multiple genetic syndromes such as myelomeningocele with Arnold Chiari malformation, skeletal dysplasia, Möbius syndrome, Joubert and Prader-Willi syndromes, and inborn errors of metabolism such as pyruvate dehydrogenase complex deficiency, Leigh’s disease, and carnitine deficiency, could be associated with central hypoventilation;
Bronchopulmonary dysplasia (BPD);
Chest wall dysfunction such as asphyxiating thoracic dystrophy, short limb dwarfism, giant omphalocele;
Idiopathic scoliosis
An overview of indications for use of home mechanical ventilation, different methods and modes of mechanical ventilation, ventilator settings and outcomes of long-term mechanical ventilation in children.
Ao, P., Sebastianski, M., Selvarajah, V., Gramlich, L., 2015. [83] Canada Retrospective chart review
n = 560 (patients; n = 64 J-tube; n = 496 PEG tube)
Percutaneous endoscopic gastrostomy (PEG) tubes; Jejunostomy tubes (J-tubes) Esophageal/gastric cancer;
Head and neck cancer;
Comparison of complication rates, types, and average tube patency between jejunostomy tubes and percutaneous gastrostomy tubes in a Regional Home Enteral Nutrition Support Program.
Bezruczko, N., Chen, S.P., Hill, C.D., Chesniak, J.M., 2009. [45] USA Functional Caregiving (FC);
Survey methods guided by a caregiver content matrix validated by content and clinical reviews;
Survey forms, questionnaires
n = 53 (mothers)
Tracheostomy/ ventilator;
No medical diagnosis mentioned Development of an objective, linear measure of mothers’ confidence to care for children assisted with medical technology in their homes.
Bezruczko, N., Chen, S.P., Hill, C.D., Chesniak, J.M., 2011. [46] USA Functional Caregiving (FC);
Survey forms, questionnaires
n = 53 (mothers)
Tracheostomy/ ventilator;
No medical diagnosis mentioned Development of an objective, linear measure of mothers’ confidence to care for children assisted with medical technology in their homes.
Bortolussi, R., Zotti, P., Conte, M., Marson, R., Polesel, J., Colussi, A., Piazza, D., Tabaro, G., Spazzapan, S., 2015. [33] Italy Prospective observational study;
Structured interview;
Monitoring form (filled in by a nurse)
n = 48 (patients)
Peripherally inserted central venous catheters (PICCs);
Midline catheters
Pancreatic cancer;
Stomach cancer;
Other miscellaneous cancer;
Non-neoplastic diseases
Evaluation of distress and pain perceived by patients during the positioning of a PICC or midline catheter, both in the home and hospice settings, and the perceived quality of life.
Bostelman, R., Ryu, J.-C., Chang, T., Johnson, J., Agrawal, S.K., 2010. [93] USA Static stability tests;
Dynamic stability tests;
Method for autonomous maneuvers tested in simulation and experiments
Home Lift, Position and Rehabilitation (HLPR) Chair No medical diagnosis mentioned Evaluation of an advanced patient lift and transfer device for the home.
Brooks, D., King, A., Tonack, M., Simson, H., Gould, M., Goldstein, R., 2004. [29] Canada Study design based on grounded theory;
Semi-structured interviews
n = 26 (patients)
Long-term mechanical ventilation Neuromuscular diseases:
Amyotrophic lateral sclerosis (ALS);
Cerebral palsy (CP);
Duchenne muscular dystrophy (DMD);
Muscular dystrophy (MD);
Spinal cord injury (SCI);
Spinal muscular atrophy (SMA);
Transverse myelitis (TM)
Identify user perspectives on the issues that impact the quality of the daily lives of ventilator-assisted individuals living in the community.
Brown, K. A., Bertolizio, G., Leone, M., Dain, S.L., 2012. [100] Canada Review Noninvasive ventilation (NIV) Chronic stable respiratory failure;
Obstructive sleep apnea
An overview of the indications for home NIV therapy, of the medical devices currently available to deliver it, and a specific discussion of the management conundrums confronting anesthesiologists.
Buchman, A.L., Opilla, M., Kwasny, M., Diamantidis, T.G., Okamoto, R., 2014. [63] USA Retrospective evaluation of patient records
n = 143 (patients; n = 125 adults; n = 18 children)
Home parenteral nutrition (HPN) Short bowel syndrome (SBS);
Motility disorders;
Identification of risk factors for the development of catheter-related
bloodstream infections (CRBSI) in patients receiving home parenteral nutrition.
Chatburn, R.L., 2009. [86] USA Review Noninvasive ventilation (NIV) Chronic obstructive pulmonary disease (COPD);
Acute cardiogenic pulmonary edema;
Hematologic malignancy;
Bone marrow or solid-organ transplant;
Provision of the basis for a simple procedure for selecting the most appropriate NIV technology for the patient and the environment of care.
Craig, G.M., Scambler, G., Spitz, L., 2003. [44] UK Qualitative research study;
Semi-structured in-depth interview
n = 22 (parents of 22 children)
Gastrostomy feeding Severe neuro-developmental disabilities:
Cerebral palsy;
Syndrome of chromosomal or genetic origin;
Unconfirmed diagnoses
A study of parental perceptions of gastrostomy feeding before surgery to examine the factors parents consider when gastrostomy feeding is recommended and to identify the need for support.
Davenport, A., 2015. [64] UK Review Hemodialysis No medical diagnosis mentioned Complications of hemodialysis treatments due to dialysate contamination and composition errors, and how to recognize them promptly to provide appropriate management and minimize patient harm.
dos Santos-Fontes, R.L., Ferreiro de Andrade, K.N., Sterr, A., Conforto, A.B., 2013. [62] Brazil Experimental design
Pilot randomized double-blinded clinical trial,
Perform tasks of the Jebsen-Taylor Test (JTT), Measurement in time,
A written log by patients
n = 20 (patients)
Repetitive peripheral nerve stimulation (RPSS) Stroke A proof-of-principle study: Home-based nerve stimulation to enhance effects of motor training in patients in the chronic phase after stroke.
Dubois, P., Bérenger, E., 2009. [95] France Review Home artificial ventilation (HAV) Duchenne muscular dystrophy;
Acute anterior poliomyelitis;
Obesity hypo-ventilation syndrome;
Chronic obstructive pulmonary disease;
Dilatation of the bronchi;
Neuromuscular evolving;
Various other
An overview of patients to be monitored at home, their etiology, interfaces and specific ventilators outstanding developments and benefits from technological progresses.
Egan, G.M., Siskin, G.P., Weinmann, R., Galloway, M.M., 2013. [72] USA Multicenter, prospective postmarket study
n = 68 (adult patients)
Peripherally inserted central catheters (PICCs) for intravenous (IV) therapies Active infection;
Human immunodeficiency virus (HIV);
Cystic fibrosis
A study to evaluate the safety and efficacy of a new peripherally inserted central catheter stabilization system.
Faratro, R., Jeffries, J., Nesrallah, G.E., MacRae, J.M., 2015. [68] Canada   Home hemodialysis (HD) No medical diagnosis mentioned The article outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation.
Farrington, K., Greenwood, R., 2011. [87] UK   Home haemodialysis End-stage kidney failure. An overview of developments and trends in technology for home haemodialysis.
Fayemendy, P., Sourisseau, H., Jesus, P., Desport, J.C., 2014. [58] France A descriptive protocol Balloon gastrostomy feeding tubes No medical diagnosis mentioned The proposal of a descriptive protocol of the required equipment and the different steps of the replacement of a balloon gastrostomy feeding tube.
Feudtner, C., Villareale, N.L., Morray, B., Sharp, V., Hays, R.M., Neff, J.M., 2005. [99] USA Retrospective cohort study
A structured hospitalization chart review
n = 100 (patients, children)
Gastrostomy and jejeunostomy tubes; Central venous catheters;
Ventriculoperitoneal cerebrospinal fluid shunts;
Respiratory infections;
Epilepsy or seizures
Assessment of the proportion of children discharged from a children’s hospital who are judged to be technology-dependent, and determination of the most common devices and number of prescription medications at the time of discharge.
Fex, A., Ek, A.-C., Söderhamn, O., 2009. [25] Sweden Qualitative design
Descriptive phenomenological methodology;
n = 10 (patients)
Long-term oxygen therapy from a ventilator;
Long-term oxygen therapy from a oxygen cylinder;
Peritoneal and haemodialysis
Chronically sick patients with respiratory or kidney disorders Description of lived experiences of self-care among persons using advanced medical technology at home.
Fex, A., Flensner, G., Ek, A.-C., Söderhamn, O., 2011a. [26] Sweden Qualitative design;
Phenomenological hermeneutical method;
n = 10 (patients)
Long-term oxygen;
Peritoneal dialysis
Chronically ill patients with respiratory or kidney disorders A study to elucidate meanings of health–illness transition experiences among adult persons using advanced medical technology at home.
Fex, A., Flensner, G., Ek, A.-C., Söderhamn, O., 2011b. [42] Sweden Qualitative study;
Hermeneutic approach;
Interpretive phenomenology;
Gadamerian methodology
n = 11 (next of kin)
Long-term oxygen from a cylinder;
Long-term oxygen from a ventilator;
Peritoneal dialysis;
Haemo dialysis
Chronic kidney or respiratory disorders Gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home.
Fex, A., Flensner, G., Ek, A.-C., Söderhamn, O., 2012. [43] Sweden Descriptive, comparative, cross-sectional, quantitative design;
Self-care Agency scale; Antonovsky’s sense of coherence scale
n = 180 (patients)
Long-term oxygen;
Peritoneal dialysis
No medical diagnosis mentioned Report of a study of self-care agency and perceived health in a group of people using advanced medical technology at home.
François, K., Faratro, R., d’Gama, C., Wong, E., Fung, S., Chan, C.T., 2015. [69] Canada Single-center
retrospective cohort study
n = 84 (incident home hemodialysis patients);
n = 56 (patients surveyed by a baseline home visit audit)
Home hemodialysis Diabetes mellitus;
Ischemic nephropathy;
A study in a university hospital-based home hemodialysis program to evaluate the effectiveness of a home visit audit tool.
Fu, M., Weick-Brady, M., Tanno, E., 2012. [14] USA   Ventilators;
Intravenous therapy.
Invasive glucose sensor;
Implantable cardioverter defibrillators;
Ventricular (assist) bypass devices;
Insulin infusion pumps;
Piston Syringes;
Automatic implantable cardioverter defibrillators with cardiac resynchronization;
Peritoneal automatic delivery system;
Mechanical walkers;
Glucose Monitors
No medical diagnosis mentioned The role of the US Food and Drug Administration (FDA) regarding medical devices in the home and how to support safety and safe use in the home environment.
Fung, C.H., Igodan, U., Alessi, C., Martin, J.L., Dzierzewski, J.M., Josephson, K., Kramer, B.J., 2015. [49] USA Descriptive study;
Semi-structured in-depth interviews
n = 19 (patients)
Positive Airway Pressure (PAP) device Obstructive sleep apnea (OSA) Exploration in detail of the types of difficulties experienced by patients with physical/sensory impairments who use PAP devices.
Gavish, L., Barzilay, Y., Koren, C., Stern, A., Weinrauch, L., Friedman, D.J., 2015. [34] Israel Prospective, randomised
waiting-list-controlled trial (RCT);
Document daily Numeric rating scale (NRS) pain scores;
Oswestry disability index (ODI) questionnaires in a diary by participants
n = 36 (patients)
Continuous passive motion device Mild-to-moderate, non-specific, chronic Lower Back Pain (LBP). Evaluation of the efficacy of a novel, angular, continuous passive motion device for self-treatment at home in patients with mild-to-moderate, non-specific, chronic low back pain.
Glader, L.J., Palfrey, J.S., 2009. [38] USA   Nasogastric tubes;
Gastronomy tubes;
Indwelling venous catheters;
Invasive and noninvasive mechanical ventilation
An inability to consume
adequate calories to maintain reasonable nutritional status;
Short bowel syndrome; Malabsorptive states;
Inflammatory bowel disease:
Severe dysmotility states;
Other less common gastrointestinal
Chronic respiratory failure;
Chronic lung disease;
Neuromuscular disease;
Central hypoventilation;
Upper airway obstruction
Description of children who are dependent on technology, common indications for and complications of gastronomy tubes, invasive and noninvasive mechanical ventilation and the psychosocial effects of having a child dependent on technology.
Graf, J.M., Montagnino, B.A., Hueckel, R., McPherson, M.L., 2008. [59] USA Retrospective pilot case series (chart review);
n = 70 (patients, children and adolescents)
Positive pressure ventilation
Congenital abnormalities;
Neurologic diagnoses;
Primary lung disease
Description of an educational program and timeline for the discharge of children with a new tracheostomy and the identification of common impediments to the education and discharge process.
Greenwald, P.W., Rutherford, A.F., Green, R.A., Giglio, J., 2004. [78] USA Retrospective case series (chart review)
n = 23 (patients)
Oxygen conservers; Ventilators;
Airway suction equipment
No medical diagnosis mentioned During a widespread North American blackout, the authors identified a cluster of patients presenting to their northern Manhattan emergency department (ED) with complaints related to medical device failure. The characteristics of this group are described in an effort to better understand the resource needs of this population.
Gregoretti, C., Navalesi, P., Ghannadian, S., Carlucci, A., Pelosi, P., 2013. [85] Italy   Mechanical ventilation Many forms of severe chronic respiratory failure Providing useful information to help and guide the choice of device for long-term mechanical ventilation in the home setting.
Han, Y.J., Park, J.D., Lee, B., Choi, Y.H., Suh, D.I., Lim, B.C., Chae, J.-H., 2015. [102] South-Korea Retrospective medical record review
n = 57 (patients)
Home mechanical ventilation Hereditary neuro-muscular diseases (NMDs):
Spinal muscular atrophy;
Congenital myopathy;
Congenital muscular dystrophy;
GSD type II (Pompe disease);
End-stage myopathy, unspecified
Comparison of the various underlying neuromuscular diseases and an evaluation of home mechanical ventilation with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation.
Hanada, E., Kudou, T., 2014. [94] Japan   Medical devices only mentioned as an example No medical diagnosis mentioned The paper describes the current status of ensuring electromagnetic compatibility between medical devices and wireless communications and measures against electromagnetic noise.
Heaton, J., Noyes, J., Sloper, P., Shah, R., 2005. [31] UK Qualitative methods;
Purposive sampling strategy
Face-to-face semi structured interviews;
n = 36 (families)
Feeding pumps;
Dialysis machines; Oxygen therapy; Intravenous drug therapies; Tracheostomies;
Suction machines
Respiratory disability;
Renal disability;
Neuro-degenerative disability;
Gastrointestinal disability;
Cardiac disability;
Metabolic disability;
Congenital abnormality disability;
Haematological disability
Families’ experiences of caring for a technology-dependent child were examined, exploring the multiple rhythms and routines around which the families’ lives were variously structured.
Hendrickson, E., Corrigan, M.L., 2013. [106] USA Review Home parenteral nutrition (HPN) No medical diagnosis mentioned Provide nutrition support clinicians knowledge on navigating through the structured requirements of diagnosis driven billing to receive reimbursement for services related to HPN, provide information on coding, provide practical tips for surviving a Medicare billing audit, and discuss challenges of Medicare guidelines seen in clinical practice.
Hewitt-Taylor, J., 2004. [56] UK Descriptive study;
Quantitative survey;
Initial fact finding;
n = 21 (staff caring for children requiring assisted ventilation)
Long-term assisted ventilation;
Continuous Positive Airway Pressure (CPAP);
Bilevel Positive Airway Pressure (BiPAP).
No medical diagnosis mentioned A study of the perceived education and training needs of staff who care for children with complex needs, including assisted ventilation, and their families.
Hilbers, E.S.M., de Vries, C.G.J.C.A., Geertsma, R.E., 2013. [75] The Nether-lands Document analysis;
n = 34 (technical documents; n = 18 infusion pumps; n = 8 ventilators; n = 7 dialysis systems)
Infusion pumps;
Dialysis systems
No medical diagnosis mentioned Investigation of the technical documentation of manufacturers on issues of safe use of their device in a home setting.
Jayanti, A., Wearden, A.J., Morris, J., Brenchley, P., Abma, I., Bayer, S., Barlow, J., Mitra, S., 2013. [55] UK Integrated mixed methodology;
Convergent, parallel design;
Quantitative methods;
Qualitative study;
Multicentre prospective observational cohort study
Ethnographic interviews;
Clinical and biomarkers;
Psychosocial quantitative assessments;
Neuropsychometric tests
Economic evaluation;
In-depth semi-structured interviews
Groups/ study arms:
a. patient
b. organization
c. carer
d. economic evaluation
3 Patient study cohorts
n = 500 (patients; n = 200 pre-dialysis; n = hospital haemodialysis; n = 100 home haemodialysis)
Home haemodialysis
Chronic kidney disease (CKD)
End stage renal disease (ESRD)
A comprehensive and systematic study of the barriers to and enablers of successful uptake and maintenance of HHD across multiple centres with low,
medium and high prevalence rates of home HD. Care pathways of predialysis, incident and prevalent dialysis patients are also investigated under clinical, psychosocial and organisational domains.
Kaufman-Rivi, D., Hazlett, A.C., Hardy, M.A., Smith, J.M., Seid, H.B., 2013. [70] USA Descriptive study;
Exploratory study;
Semi-structured questionnaire for in-depth interviews and self-administration;
Web-based survey adapted from semi-structured instrument
n = 22 (professional healthcare providers)
Web survey:
n = 342 (professional healthcare providers)
Negative-pressure wound therapy (NPWT) systems No medical diagnosis mentioned Obtain additional information about device issues that healthcare professionals face in homes settings and in extended-care facilities, as well as challenges that caregivers might encounter using this technology at home.
Kaufman, D., Weick-Brady, M., 2009. [71] USA   There are no technologies specifically mentioned, but reference is made to complex medical devices in general.
As an example are mentioned, e.g. infusion pumps, intravascular administration sets, continuous ventilators,
No medical diagnosis mentioned The launch of the Medical Product Safety Network’s (MedSun) Subnetwork, HomeNet [a program sponsored by the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH)] hopes to learn about and address patient safety issues as it relates to expanding medical device usage in the home setting.
Keilty, K., Cohen, E., Ho, M., Spalding, K., Stremler, R., 2015. [39] Canada Systematic review;
Qualitative analysis;
Results presented as a narrative.
n = 13 (studies)
Home mechanical ventilation;
Non-invasive ventilation;
Insulin pump therapy;
Home enteral (tube) feeds;
Home oxygen;
Bronchopulmonary Dysplasia (BPD);
Cystic fibrosis (CF);
Inherited metabolic disorders (IMD);
Neuromuscular (NM)
The review systematically examines studies reporting on sleep outcomes in family caregivers of technology dependent children.
Khirani, S., Louis, B., Leroux, K., Delord, V., Fauroux, B., Lofaso, F., 2013. [89] France Test on a lung bench with different circuit configurations and with different levels of unintentional leaks.
n = 7 (ventilators)
Volume targeted pressure support ventilation (VT-PSV) No medical diagnosis mentioned Determination of the ability ofhome ventilators to maintain the preset minimal VT during unintentional leaks in a VT-PSV
Kirk, S., 2010. [27] UK Grounded theory approach;
In-depth interviews (parents were present)
n = 28 (children/young people)
Gastrostomy/ jejunostomy;
Intravenous drug therapies;
Mechanical ventilation;
Oxygen therapy;
Parenteral nutrition;
Peritoneal dialysis
No medical diagnosis mentioned The study explores how children who need the support of medical technology for their survival and wellbeing experience and construct medical technology and its influence on their identity and social relationships.
Kirk S, Glendinning C, Callery P., 2005. [47] UK Grounded theory techniques;
Qualitative research methods;
In-depth interviews (some individual, some with both parents)
n = 24 (children, parents of them)
Oxygen therapy;
Mechanical ventilation;
Intravenous drugs;
Parenteral nutrition;
Peritoneal dialysis;
Others (e.g. gastrostomy)
Medical diagnoses mentioned in general: pre-term infants, infants with congenital impairments and children with chronic illnesses and cancer. No medical diagnoses mentioned in the study itself. A study exploring parents’ experiences of caring for a childwho is dependent on medical technology, and in particular of performing clinical procedures on their own children.
Kropff, J., Del Favero, S., Place, J., Toffanin, C., Visentin, R., Monaro, M., Messori, M., Di Palma, F., Lanzola, G., Farret, A., Boscari, F., Galasso, S., Magni, P., Avogaro, A., Keith-Hynes, P., Kovatchev, B.P., Bruttomesso, D., Cobelli, C., DeVries, J.H., Renard, E., Magni, L., 2015. [90] France, Italy,
the Nether-lands
Multinational randomised crossover trial (open label study)
n = 32 (patients)
Insulin pump treatment Type I diabetes The study assessed the effect on glucose control with use of an artificial pancreas during the evening and night plus patient-managed sensor-augmented pump therapy (SAP) during the day, versus 24 h use of patient-managed SAP only, in free-living conditions.
Lee, A.D.W., Galvao, F.H.F., Dias, M.C.G., Cruz, M.E., Marin, M., Pedrol, C.N., David, A.I., Pecora, R.A.A., Waitzberg, D.L., D'Albuquerque, L.A.C., 2014. [103] Brazil Patients were evaluated for a period of 6 months
n = 128 (patients)
Home parenteral nutrition therapy (HPNT) Intestinal failure:
Mesenteric thrombosis;
Colon cancer;
Non-hodgkin lymphoma;
Crohn disease;
Gardner’s syndrome;
Peritonitis (+ dialisis);
Provoked abortion
The article profiles a Brazilian single-center experience with 128 cases of HTPN followed for the last 30 years and appraise the referral for potential intestinal and multivisceral transplantation.
Leger, S.S., 2005. [84] France Review Mechanical ventilation Chronical diseases The article aims to examine the different indications of a humidification system in patients with mechanical ventilation in the home, to review the literature in order to identify the positive results obtained by humidification and, finally, to describe the most efficient types of humidifiers.
Lehoux, P., 2004. [48] Canada Qualitative study, relied on the triangulation of three sources of data:
1) interviews with patients (n = 16);
2) interviews with carers (n = 6);
3) direct observation of nursing visits of a different set of patients (n = 16).
Intravenous therapy; Parenteral nutrition; Peritoneal dialysis; Oxygen therapy No medical diagnosis mentioned Documentation, from the patient’s perspective, of how the level of user-friendliness of medical technology influences its integration into the private and social lives of patients. Understanding what makes a technology user-friendly should help improve the design of home care services.
Lehoux, P., Charland, C., Richard, L., Pineault, R., St-Arnaud, J., 2002. [5] Canada Postal questionnaire
n = 97 (local centers)
Intravenous pump therapy;
Oxygen therapy;
Peritoneal dialysis;
Haemo dialysis;
Parenteral nutrition;
No medical diagnosis mentioned The article describes various medical technologies that are used frequently in the home and the responsibility of local community service centers in the region of Quebec, Canada.
Lehoux, P., Saint-Arnaud, J., Richard, L., 2004. [30] Canada Biographical interview, interview questionnaire;
Direct observations;
Document analysis (patient manuals, brochures, leaflets)
n = 16 (patients)
n = 6 (caregivers)
n = 16 (home visits by nurses)
n = 26 (documents)
Intravenous therapy, Parenteral nutrition, Peritoneal dialysis; Oxygen therapy Patients with recurring infections;
Chronic obstructive pulmonary disease;
Renal failure
Determination of how specialised medical equipment by patients at home was supposed to be used versus how it was actually used.
Lemke, M.R., Mendonca, R.J., 2013. [50] USA   Dialysis;
Intravenous therapies
No medical diagnosis mentioned The article describes several aspects of accessibility of medical devices for home healthcare recipients, especially lay users.
Lewarski, J.S., Gay, P.C., 2007. [22] USA   Home mechanical ventilation Medical diagnoses only mentioned as an example. The article explains several issues in home mechanical ventilation, such as policies and practice standards, costs, reimbursement and coverage
Matsui, K., Kataoka, A., Yamamoto, A., Tanoue, K., Kurosawa, K., Shibasaki, J., Ohyama, M., Aida, N., 2014. [98] Japan Clinical data review/ charts review
n = 10 (patients)
Suction apparatus;
Tube feeding; Gastrostomy; Tracheostomy;
Oxygen therapy; Ventilator
Möbius syndrome Investigation of the outcome of patients with Möbius syndrome, including the mortality rate, rate of neonatal intensive care unit (NICU) admission, neurological findings, developmental problems, and medical home care and device needs.
McGoldrick, M., 2010. [67] USA Article presents evidence based guidelines and recommendations on the preferred methods. Oxygen concentrators,
Continuous positive airway pressure (CPAP);
Bilevel positive airway pressure (BiPAP);
Nasal cannulas;
Tracheostomy tubes;
Tracheal suction catheter;
An immune-compromised individual with a chronic underlying illness This article presents evidenced based guidelines and recommendations on the preferred methods for managing respiratory equipment and supplies commonly used by patients in the home setting and conducting surveillance activitiesto ultimately prevent respiratoryinfections.
Michihata, N., Matsui, H., Fushimi, K., Yasunaga, H., 2015. [101] Japan Database analysis
(The Japanese Diagnosis Procedure Combination (DPC) database)
n = 4729 (patients)
Tracheostomy tube; Gastrostomy tube;
Home respirator;
Home centralvenous alimentation
Chromosomal anomaly;
Inborn error of metabolism (IEM);
Congenital heart disease (CHD);
Immune deficiency;
Endocrine diseases;
Cerebral palsy;
Other congenital anomalies;
Other diseases
Ischemic heart diseases, including angina pectoris;
Acute myocardial infarction;
Cerebrovascular diseases;
Lung, gastric, colon, hepatic, breast, uterus, and prostate cancer
Determination of the clinical
details of adult patients admitted to pediatric wards in Japanese acute-care hospitals.
Munck, B., Fridlund, B., Mårtensson, J., 2011. [53] Sweden Descriptive design;
Phenomenographic approach;
Qualitative study;
Semi-structured interview
n = 16 (nurses)
There are no technologies specifically mentioned in the study itself, but reference is made to complex medical devices according to a definition and examples.
‘Medical technology was defined and confined to the more advanced devices that may be present in the home, such as ventilators, suction devices, oxygen and various ports and pumps’.
No medical diagnosis mentioned Description of district nurses’ conceptions of medical
technology in palliative homecare.
Munck, B., Sandgren, A., Fridlund, B., Mårtensson, J., 2012a. [36] Sweden Explorative descriptive design;
Phenomenographic approach;
Qualitative study
Semi-structured interview
n = 15 (next-of-kin)
Pain, nutrition and volume pumps;
Oxygen concentrators; Suctions and inhalation devices;
Percutaneous endoscopic gastronomy (PEG);
Subcutaneous vein ports.
No medical diagnosis mentioned Description of next-of-kin’s conceptions of medical technology in palliative homecare.
Munck, B., Sandgren, A., Fridlund, B., Mårtensson, J., 2012b. [52] Sweden Qualitative analysis;
Explorative descriptive design;
Phenomenographic approach;
n = 15 (patients)
Pain pumps;
Nutrition and volume pumps;
Intravenous infusion: Disetronic pen for subcutaneous injections;
Oxygen concentrators and cylinders;
Nephrostomy catheters; Percutaneous endoscopic gastronomy;
Subcutaneous venous port implantation.
Different types of cancer;
Amyotrophic lateral sclerosis (ALS);
Heart failure;
Chronic obstructive disease.
Description of the patients’ ways of understanding medical technology in palliative home care.
Nakayama, T., Tanaka, S., Uematsu, M., Kikuchi, A., Hino-Fukuyo, N., Morimoto, T., Sakamoto, O., Tsuchiya, S., Kure, S., 2014. [76] Japan Retrospective study;
Medical records were hand-reviewed to identify inpatients
Survey by questionnaire
n = 24 (patients)
Peritoneal dialysis;
Oxygen condenser
Neurological disorders:
Periparturient disorder;
Mitochondrial disease;
Congenital myopathy;
Cerebral sequelae of acute encephalopathy;
Perizeus Merzback disease
Kidney disorders:
Hypoplastic kidney;
Nephrotic syndrome
Diabetes mellitus type 1;
Long QT syndrome;
Effects from bone marrow transplantation, chronic respiratory failure
Effect of a blackout in pediatric patients with home medicaldevices during the 2011 eastern Japan earthquake
Paddeu, E.M., Giganti, F., Piumelli, R., De Masi, S., Filippi. L., Viggiano, M.P., Donzelli, G., 2015. [40] Italy Pittsburgh Sleep Quality Index (PSQI) questionnaire; Epworth Sleepiness Scale (ESS);
Beck Depression Inventory (BDI-II);
Beck Anxiety Inventory (BAI)
n = 23 (parents of 23 children with CCHS)
n = 23 (parents of 23 healthy children)
Mechanical ventilation (via nasal mask or tracheostomy) Congenital central hypoventilation syndrome (CCHS) The daily challenges associatedwith caring for technology-dependent children can place primary caregivers under significant stress, especially at night. The study investigated how this condition affects mothers and fathers by producing poor sleep quality, high-level diurnal sleepiness, anxiety, and depression.
Paul, J., Otvos, T., 2006. [82] Canada Randomized crossover study;
Measurement by oximeter;
n = 25 (patients)
Oxygen therapy Ex-smokers with severe chronic obstructive pulmonary disease Comparison of the
performance of a new oxygen delivery device, the OxyArm (OA)
(Southmedic Inc., Canada), with a standard nasal cannula (NC)
(Salter-Style 1600, Salter Labs, USA) for both oxygen delivery and
patient preference in patients on long-term oxygen therapy (LTOT).
Pourrat, M., Neuville, S., 2007. [73] France Survey;
n = 12 (by law authorized centres)
n = 6 (service providers)
n = 0 (custom-made makers)
n = 0 (laboratories)
Home parenteral nutrition No medical diagnosis mentioned For Home Parenteral Nutrition (HPN), pharmacy had to deliver some medical devices and drugs. It comes up the following and taking care of incidents that’s occurring at home with those products. The article describes an inventory on vigilance’s organization, incident’smanagement and assessment, about HPN in France.
Pourtier, J., 2013. [97] France   Patient-controlled
analgesia pumps.
No medical diagnosis mentioned Technology for improving pain management in the home; various aspects related to analgesia pumps.
Prenton, S., Kenney, L.P., Stapleton, C., Cooper, G., Reeves, M.L., Heller, B.W., Sobuh, M., Barker, A.T., Healey, J., Good, T.R., Thies, S.B., Howard, D., Williamson, T., 2014. [92] UK Feasibility study
Purposive questionnaires
Paper diary
n = 7 (patients)
Functional electrical stimulation system Unilateral foot-drop of central neurologic origin (>6mo) Investigation of the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for
current foot-drop functional electrical stimulation (FES) users.
Rajkomar, A., Farrington, K., Mayer, A., Walker, D., Blandford, A., 2014. [51] UK Qualitative method
Ethnographic observations;
Semi-structured Interviews
n = 19 (patients and their carers)
Home haemodialysis technology No medical diagnosis mentioned An inventory of patients’ and carers’ experiences of interacting with home haemodialysis (HHD)
technology, in terms of user experience, how the design of the technology supports safety and fits with home use, and how the broader context of service provision impacts on patients’ use of the technology.
Rajkomar, A., Mayer, A., Blandford, A., 2015. [79] UK Ethnographic observations;
Semi-structured interviews;
Distributed cognition for
teamwork methodology
Home hemodialysis technology (HHT) Renal patients / kidney failure In this study, Distributed Cognition (Dcog) was applied to understand renal patients’ interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device.
Rand, D.A., Mener, D.J., Lerner, E.B., DeRobertis, N., 2005. [77] USA Retrospective case series (medical record review)
n = 83 (medical records)
Home respiratory equipment;
Home nebulizers;
Oxygen devices
No medical diagnosis mentioned Description of the experience of an urban, commercial ambulance provider during the multistate August 2003 electrical power outage (EPO) and to identify how such an event can affect an emergency medical services (EMS) system.
Scala, R., 2004. [88] Italy n = 29 (devices) Bi-level home ventilators for non invasive positive pressure ventilation Chronic respiratory failure (due to neuro-muscular disorders);
Severe chest wall deformity;
The author describes the technical aspects, the individual characteristics and the clinical applications of the most common used bi-level ventilators.
Short, D., Norwood, J., 2003. [108] UK Phase 1:
(Semi-structured interview);
Phase 2:
Case study analyses
(in-depth case study analyses of selected districts)
n = 98 (health authorities)
Parenteral nutrition;
Intravenous antibiotics; Intravenous chemotherapy; Continuous ambulatory peritoneal dialysis
Cystic fibrosis;
The study addresses questions: Why is high-tech healthcare at home purchasing underdeveloped and what could be done to improve it
Siewers, V., Holmøy, T., Frich, J.C., 2013. [54] Norway Qualitative study;
Semi-structured in-depth interviews
n = 5 (patients)
Mechanical insufflation –
exsufflation (MI-E)
Amyotrophic lateral sclerosis (ALS) The study explores patients’, family carers’ and health professionals’ experiences with using mechanical insufflation – exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) in the home setting.
Southey, D., Pullinger, D., Loggos, S., Kumari, N., Lengyel, E., Morgan, I., Yiu, P., Nandi, J., Luckraz, H., 2015. [105] UK Observational study;
Data collected prospectively on the thoracic database;
Data logged in a specific data sheet
n = 20 (patients)
Portable digital suction device ‘All patients who underwent a thoracic procedure and who required suction postoperatively for a persistent air leak and a confirmed air-space within the pleural cavity’ Patients undergoing thoracic surgical procedures who met strict discharge criteria were allowed to continue their treatment at home with the device. They were monitored in a designated follow-up clinic. Data were collected to identify the impact of this service in relation to the duration of follow-up required, bed-days saved, and potential cost/benefits.
Stieglitz, S., George, S., Priegnitz, C., Hagmeyer, L., Randerath, W., 2013. [66] Germany Case series
n = 3 (patients)
Invasive and non-invasive ventilators COPD;
Lung cancer;
Chronic ventilator failure as a consequence of chronic obstructive pulmonary disease
The article describes life-threatening events in respiratory medicine: misconnections of invasive and non-invasive
ventilators and Interfaces
Su, C.-L., Lee, C.-N., Chen, H.-C., Feng, L.-P., Lin, H.-W., Chiang, L.-L., 2014. [81] Taiwan Retrospective, cross-sectional, observational survey design;
Walking test (patient self score)
n = 42 (patients using LOG)
n = 102 (patients using OCG)
Long-term oxygen therapy Chronic respiratory insufficiency;
Chronic obstructive pulmonary disease (COPD);
Restrictive lung disease;
Neuromuscular diseases;
Interstitial lung diseases
The study compared oxygen usage between patients from a liquid oxygen group (LOG) and an oxygen concentrator group (OCG). The authors also assessed the
physiologic responses of patients with chronic obstructive pulmonary disease (COPD) to ambulatory oxygen use at home.
Sunwoo, B.Y., Mulholland, M., Rosen, I.M., Wolfe, L.F., 2014. [57] USA   Home noninvasive ventilation technology Neuromuscular disease (including amyotrophic lateral sclerosis and Duchenne muscular dystrophy);
Restrictive chest wall disease;
Restrictive thoracic disorders;
COPD/severe COPD;
The overlap syndrome or coexisting COPD and OSA;
Sleep-related breathing disorders;
Central or complex sleep apnea;
Obesity hypoventilation syndrome (OHS);
Hypoventilation syndromes
The article provides a practice management perspective for clinicians providing home noninvasive ventilation, including coverage, coding, and reimbursement to optimize clinical care and minimize lost revenue.
Szeinbach, S.L., Pauline, J., Villa, K.F., Commerford, S.R., Collins, A., Seoane-Vazquez, E., 2015. [65] USA Retrospective chart review
Qualitative study (the interview part)
One-on-one interviews
n = 163 (patients)
Home parenteral nutrition Intestinal obstruction;
Acute pancreatitis;
Hyperemesis metabolism;
Regional enteritis;
Intestinal disorders, ulceration; Intestinal malabsorption;
Stomach ulceration with perforation;
Acute intestinal vascular insufficiency;
Intestinal fistula;
Persistent vomiting, pneumonitis;
Other gastrointestinal issues, disturbances;
Oncology-related diagnoses
The article describes catheter complications and outcomes in patients who received home parenteral nutrition (HPN) therapy.
Tanno, E., 2010. [74] USA n = 6 (hospitals) There are no technologies specifically mentioned in the study itself, but reference is made to complex medical devices as an example. No medical diagnosis mentioned Because patients, who use home medical technologies, are so dependent on these devices they bring them into hospitals when they seek treatment. Many hospitals have developed specific protocols, including safety inspections by clinical engineers, to follow when a home-use device is brought in. This article summarizes the policies that 6 hospitals have developed to address this situation.
Tearl, D.K., Cox, T.J., Hertzog, J.H., 2006. [61] USA Demographic data are prospectively collected from databases;
Surveys conducted over the telephone or via facsimile
n = 74 (patients)
Respiratory technology;
Continuous positive airway pressure (CPAP);
Tracheostomy collar;
Negative-pressure ventilator (NVP);
Bi-level positive airway pressure (BiPAP)
Respiratory failure:
Airway obstruction;
Neuromuscular/ Spinal-cord injury (SCI);
Bronchopulmonary dysplasia (BPD)
Preparation of respiratory-technology-dependent children for hospital discharge presents many challenges. Adequate training and education of parental caregivers, discharge planning, and coordination with the durable-medical-equipment and home-nursing companies must be completed. The role of a dedicated Respiratory care discharge coordinator has been evaluated in this study.
Tennankore, K.K., D’Gama, C., Faratro, R., Fung, S., Wong, E., Chan, C.T., 2014. [80] Canada Retrospective cohort study (all characteristics collected based on identification in electronic records and patient charts)
n = 202 (patients)
Home hemodialysis End-stage renal disease:
Polycystic kidney disease
The study describes adverse technical events in a large cohort of home hemodialysis patients.
Thomson, R., Martin, J.L., Sharples, S., 2013. [28] UK Qualitative study;
In-depth semi-structured interview
n = 12 (patients)
Transcutaneous electrical nerve stimulation device;
Oxygen concentrator;
Continuous ambulatory peritoneal dialysis;
Diabetes The article describes the psychosocial impact of home use medical devices on the lives of older people and how the devices are integrated into their lives.
Toly, V.B., Musil, C.M., Carl, J.C., 2012. [37] USA Descriptive, correlational, dross-sectional study;
Structured interview, face-to-face, using the Demographic Characteristics Questionnaire, the Functional Status II–Revised Scale, the Center for Epidemiological Studies–Depression Scale, a Normalization Scale subscale, and the Feetham Family Functioning Survey.
n = 103 (mothers)
Mechanical ventilation;
Intravenous nutrition/ medication;
Respiratory/ nutritional support;
Apnea monitors;
Feeding tube;
Tracheostomy tube;
Supplemental oxygen
Respiratory conditions;
Gastrointestinal conditions;
Cardiac conditions;
Cystic fybrosis;
Metabolic disorders;
Renal disorders
The study describes various issues related to family functioning and normalization in mothers of children dependent on medical technology following initiation of home care.
Toly, V.B., Musil, C.M., Zauszniewski, J.A., 2014. [41] USA Longitudinal randomized controlled pilot trial;
Structured interviews;
Semi-structured exit Interviews
n = 22 (mothers)
Mechanical ventilation;
Intravenous nutrition/ medication;
nutritional support.
Respondents recruited from pulmonology and gastroenterology clinics The purpose of the study was to determine the feasibility, acceptability, and efficacy ofresourcefulness training (RT), a cognitive–behavioral intervention, among mothers of technology-dependent children.
Wang, K.-W.K., Barnard, A., 2004. [35] Australia Empirical review Mechanical ventilation;
Oxygen therapy;
Enteral nutrition;
Parenteral nutrition;
Intravenous drug therapies;
Peritoneal dialysis; Haemodialysis;
Suction devices
No medical diagnoses mentioned, only as an example. The paper provides a comprehensive literature review on caring for technology-dependent children living at home to gain an understanding of the development of paediatric home care, and its impact on technology-dependent children and their families, and social implications.
Weiler-Ravell, D., 2002. [107] Israel   Respiratory support, ventilators Neuromuscular respiratory failure
Chronic obstructive pulmonary disease
The article describes the quandary of home-care respiratory management.
Wong, J., Eakin, J., Migram, P., Cafazzo, J.A., Halifax, N.V.D., Chan, C.T., 2009. [60] Canada Qualitative study;
Semi-structured interviews;
n = 23 (patients; 15 interviews; 8 focus group)
Home hemodialysis End stage renal disease (ESRD). The study explores patient training experiences with learning a complex medical device for the selfadministration of nocturnal hemodialysis at home.
Yik, Y.I., Ismail, K.A., Hutson, J.M., Southwell, B.R., 2012. [91] Australia Prospective study;
Bowel diaries;
Colonic transit studies
n = 32 (patients)
Transcutaneous electrical stimulation Slow-transit constipation (STC) The article describes the test of the effectiveness of home transcutaneous electrical stimulation (TES) when patients with slow-transit constipation (STC) were trained by a naive clinician.