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 randomized controlled trials (RCT) comparing e-health interventions to standard care for patients with IBD. Effect measures were standardized 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 & 1357-controls) were identified. The difference in disease activity scores (SMD 0.09, 95% CI: -0.09-0.28) and clinical remission (OR 1.12, 95% CI: 0.78-1.61) between e-health interventions and standard care were not statistically significant. Higher 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, while 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 healthcare encounters, corticosteroid use, and IBD related hospitalization or surgery. The trials were judged to be high risk of bias or 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.