BACKGROUND
The importance of self-management of chronic condition has been highlighted during the COVID-19 pandemic, including the management of chronic liver disease. The use of technology in disease self-management could assist task-shifting, which involves the delegation of tasks from highly qualified healthcare workers to healthcare workers with fewer qualifications or technology, where appropriate. This can optimise the allocation of human resources in healthcare as well as patients’ disease self-management and health.
OBJECTIVE
Our systematic review with meta-analyses aimed to summarise characteristics of mobile app-based interventions with a focus on resource use among patients with underlying conditions related to chronic liver disease and explore the possibility of task-shifting using mobile apps in liver disease management.
METHODS
The six databases MEDLINE, CINAHL, Web of Science, Embase, PsycInfo, and Cochrane Library were searched for randomised controlled trials about mobile app-based interventions in patients with four chronic liver disease-related conditions: overweight and obesity, type 2 diabetes, metabolic abnormalities, and risky alcohol drinking. The Cochrane Risk of Bias assessment tool was used. Random-effects nested meta-analyses of the intervention effectiveness were performed with unadjusted results, unadjusted intention-to-treat results, and adjusted results for each of the four outcomes: HbA1c, weight, body mass index, and waist circumference when available.
RESULTS
Twenty-two articles were included in the systematic review. Nine key intervention characteristics were identified including self-monitoring platform, education, and data sharing with intervention providers. Eighteen studies were considered to be at ‘high risk’ of bias mainly due to excluding randomised participants from the analysis and insufficient description on dealing with missing outcome data. Unadjusted pooled mean differences showed that app-based interventions could have small benefits on reducing HbA1c (Mean difference [MD]=-0.28, 95% Confidence Interval [95% CI]: -0.55 to -0.02), weight (MD=-1.44 kg, 95% CI: -2.39 to -0.49), body mass index (MD=-0.48, 95% CI: -0.85 to -0.12), and waist circumference (MD=-1.88 cm, 95 %CI: -3.04 to -0.72).
CONCLUSIONS
The available evidence was suboptimal due to high rates of lost to follow-up and lack of intention-to-treat analysis. The following three considerations may be required for the implementation of task-shifting in the management of chronic liver disease: careful deliberations for intervention designs; matching each stakeholder’s needs; accumulation of evidence. Further research on stakeholders’ preference on app characteristics is needed for the successful implementation of app-based interventions as the task-shifting approach.
CLINICALTRIAL
Not applicable.
