Distance management of inflammatory bowel disease: systematic review and meta-analysis

Abstract

Aim: To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease (IBD) patients.

Methods: A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients. Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program, electronic interface, or self-directs open access to clinic follow up. The search strategy included electronic databases (Medline, PubMed, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, KTPlus, Web of Science, and SCOPUS), conference proceedings, and internet search for web publications. The primary outcome was the mean difference in quality of life, and the secondary outcomes included mean difference in relapse rate, clinic visit rate, and hospital admission rate. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers.

Results: The search strategy identified a total of 4061 articles, but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis. Three trials involved telemanagement, and three trials involved directed patient self-management and open access clinics. The total sample size was 1463 patients. There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28 (95%CI: -3.25-17.81) points higher than standard clinic follow-up. There was a significant decrease in the clinic visit rate among distance management patients mean difference -1.08 (95%CI: -1.60--0.55), but no significant change in relapse rate or hospital admission rate.

Conclusion: Distance management of IBD significantly decreases clinic visit utilization, but does not significantly affect relapse rates or hospital admission rates.

Keywords: Distance management; Inflammatory bowel disease; Self-management; Telehealth; Telemanagement.

Figure 1

Flow chart of literature search results.

Figure 2

Mean change in quality of life between distance management and standard clinic follow up subgroup analysis by intervention and disease. A: Intervention; B: Disease.

Figure 3

Difference in relapse rate between distance management and standard clinic follow-up subgroup analysis by intervention and disease. A: Intervention; B: Disease.

Figure 4

Difference in number of clinic visits per patient per year between distance management and standard clinic follow-up subgroup analysis by intervention and disease. A: Intervention; B: Disease.