Management of Inflammatory Bowel Disease Using E-health Technologies: A Systematic Review and Meta-Analysis

Abstract

Background and aims: Technological advances have provided innovative, adaptive, and responsive models of care for inflammatory bowel diseases [IBD]. We conducted a systematic review to compare e-health interventions with standard care in management of IBD.

Methods: We searched electronic databases for randomised, controlled trials [RCT] comparing e-health interventions with standard care for patients with IBD. Effect measures were standardised mean difference [SMD], odds ratio [OR], or rate ratio [RR], calculated using the inverse variance or Mantel-Haenszel statistical method and random-effects models. Version 2 of the Cochrane tool was used to assess the risk of bias. The certainty of evidence was appraised with the GRADE framework.

Results: Fourteen RCTs [n = 3111; 1754 e-health and 1357 controls] were identified. The difference in disease activity scores (SMD 0.09, 95% confidence interval [CI]: -0.09-0.28) and clinical remission (odds ratio [OR] 1.12, 95% CI: 0.78-1.61) between e-health interventions and standard care were not statistically significant. Higher quality of life [QoL] [SMD 0.20, 95% CI: 0.05-0.35) and IBD knowledge [SMD 0.23, 95% CI: 0.10-0.36] scores were noted in the e-health group, and self-efficacy levels [SMD -0.09, 95% CI: -0.22-0.05] were comparable. E-health patients had fewer office [RR 0.85, 95% CI: 0.78-0.93] and emergency [RR 0.70, 95% CI: 0.51- 0.95] visits, with no statistically significant difference in endoscopic procedures, total health care encounters, corticosteroid use, and IBD related hospitalisation or surgery. The trials were judged to be at high risk of bias or to have some concerns for disease remission. The certainty of evidence was moderate or low.

Conclusion: E-health technologies may have a role in value-based care in IBD.

Keywords: Inflammatory bowel disease; e-health; telemedicine.

Figure 1.

Study flow diagram for identification, screening, eligibility, and inclusion of studies.

Figure 2.

Forest plot for [A] disease activity scores comparing e-health versus standard care; [B] patients in clinical disease remission for IBD [UC and CD combined] comparing e-health versus standard care. CI, confidence interval; CD, Crohn’s disease; IBD, inflammatory bowel disease, IV, inverse variance; SD, standard deviation; UC, ulcerative colitis; M-H, Mantel–Haenszel.

Figure 3.

Forest plot for [A] IBD knowledge comparing e-health versus standard care; [B] quality of life comparing e-health versus standard care; [C] patient self-efficacy comparing e-health versus standard care. CI, confidence interval; CD, Crohn’s disease; IBD, inflammatory bowel disease; IV, inverse variance; SD, standard deviation.

Figure 4.

Forest plot for total health care utilisation comparing e-health versus standard care. CI, confidence interval; IV, inverse variance; SE, standard error.

Figure 5.

Forest plot for [A] total office visits comparing e-health versus standard care; [B] emergency visits comparing e-health versus standard care; [C] IBD-related hospitalisation comparing e-health versus standard care. CI, confidence interval; IV, inverse variance; SE, standard error; IBD, inflammatory bowel disease.

Figure 6.

Forest plot for [A] IBD-related surgery comparing e-health versus standard care. [B] endoscopic procedures comparing e-health versus standard care. [C] corticosteroid use comparing e-health versus standard care. IBD, inflammatory bowel disease; CI, confidence interval; IV, inverse variance; SE, standard error.