Role of Telemedicine in Inflammatory Bowel Disease: a Systematic Review and Meta-analysis of Randomized Clinical Trials (Preprint)

Abstract

BACKGROUND Telemedicine plays an important role in the management of patients with inflammatory bowel disease (IBD), which is especially evident during the pandemic such as COVID-19. However, the exact effectiveness and efficiency of telemedicine in managing IBD is unclear. OBJECTIVE We aimed to compare the impact of telemedicine on management of IBD patients with the standard care. METHODS We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus (search date April 22, 2020). Randomized controlled trials (RCTs) comparing telemedicine with standard care in IBD patients were included, while conference abstracts, letters, reviews, laboratory studies, or case reports were excluded. The IBD-specific quality of life (QoL), disease activity and remission rate of IBD patients were assessed as primary outcomes, and the number of clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were regarded as secondary outcomes. The Review Manage 5.3 and Stata 15.1 were used for the data analysis. RESULTS 17 RCTs (n=2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group [standard mean difference (SMD) 0.18, 95% confidence interval (CI) 0.01 to 0.34，P=0.03)]. Furthermore, the number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (SMD -0.71, 95%CI -1.07 to -0.36, P<0.0001). Subgroup analysis showed that adolescents had a significantly higher IBD-specific QoL in telemedicine group than that in standard care group (SMD 0.42, 95%CI 0.15 to 0.69, I2=0%, P=0.002), while there was no significant differences between two groups among adults. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between telemedicine and standard care group. CONCLUSIONS Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits of IBD patients. Further researches are warranted to identify the ideal group of IBD patients who could benefit from telemedicine most.