A Systematic Review of The Efficacy of E-Health Intervention in The Management of Inflammatory Bowel Diseases Among Children and Adolescents
Abstract
Abstract
Background: Electronic-health interventions (EHI) seems to be a new direction in inflammatory bowel disease management (IBD) in children and adolescents (CAAs).
Objective: Evaluating the effectiveness of E-HI in IBD management in CAA to explore whether E-HI can help CAAs manage their condition without the risk of rising disease activity (DA), by comparing it to usual care intervention; and whether E-I can improve their medical behaviour (medication adherence [MA] and nutritional therapy adherence [NA]) as that plays important roles in managing IBD.
Methodology: The protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was followed. Three electronic databases—The Cochrane Controlled Trials Register, Web of Science and PubMed—were used to search for randomised controlled trials (RCT) published in English over the last 10 years which evaluated the efficiency of E-HI compared against usual interventions when managing IBD among CAAs.
Result: It included six RCTs (three RCTs high-quality) in CAA (age: 8 to 19 years) with IBD. All RCTs evaluated the efficiency of the intervention that included E-HI vs usual intervention: two RCTs over two years and three RCTs over one year. Four RCTs evaluated DA by assessing self-reported symptoms, finding no significant differences between the e-health intervention groups (E-HIGs) and usual intervention groups (CGs). Two studies that assessed changes of DA outcomes with biomarkers found that no significant difference in changes existed between the two groups (one RCT assessed changes by testing FC and C-RP, while one RCT only assessed FC). In terms of flare-up incidences (FI), one RCT found that no significant difference in the changes between the groups in flare-up incidences (FIs). No RCT reported finding any risk of increasing DA or FIs in the E-HIGs. Similar improvements were found in two groups in their MA (two RCTs) and NA (one RCT). Significantly, no clinical dietitian collaborated with any E-HI.
Conclusion: it seems that E-HIs can help manage IBD in CAAs without risking increased DA (safe to use) and it can improve MA. However, further studies in IBD management among CAAs using E-HIs designed in collaboration with a clinical dietitian are required for improving NA.