Plain language summary The use of technology for remote care in inflammatory bowel disease Key messages • Remote care is probably the same as usual care (e.g. face‐to‐face care in clinics and hospitals) for improving inflammatory bowel disease symptoms in adults; there is limited evidence for children. • Remote care is probably the same as usual care for avoiding relapses and flare‐ups; the same may be true for children. • Remote care is probably the same as usual care for improving quality of life in adults; there is limited evidence for children. What is inflammatory bowel disease? Inflammatory bowel disease refers to two main conditions that cause inflammation of the gut. These are ulcerative colitis and Crohn’s disease. Ulcerative colitis only affects the large intestine. Crohn’s disease can affect any part of the digestive tract, from mouth to bottom. Inflammatory bowel disease mainly causes stomach pain or discomfort, diarrhoea that can be bloody, weight loss, and tiredness. What did we want to find out? Providing care from a distance, also called telehealth, is becoming more common, especially since the coronavirus 2019 (COVID‐19) pandemic. Using technology to provide remote care could benefit people with inflammatory bowel disease. Telehealth can take place via telephone, instant messaging, video, text message, web‐based services, or other means. We wanted to find which communication technologies are used for remote care in inflammatory bowel disease, how they are used, if they are accessible to everyone, and what are their benefits or drawbacks. What did we do? We searched for randomised controlled trials (RCTs; studies where participants are randomly assigned to one of two or more treatment groups) comparing telehealth with any other treatment for people with inflammatory bowel disease. RCTs give us the highest standard of evidence. We applied no limitations for age or type of remote care in our search, but we excluded studies that did not focus on providing care, such as studies providing only patient information or education. We also excluded studies that provided remote blood or stool test monitoring with no other type of remote monitoring. What did we find? We found 19 relevant RCTs, which enroled a combined total of 3489 people aged eight to 95 years. Remote care was delivered online (e.g. smartphone applications, websites) or by telephone. Twelve studies compared web‐based care to usual care, three compared telephone‐based care to usual care, three compared web‐based care to “sham” care, one compared web‐based care to self‐care, and one compared psychological and telephone support to usual care. Web‐based remote care is probably no different to usual care in adults for improving symptoms, avoiding relapses or flare‐ups, and enhancing quality of life. We also found that people who receive web‐based care are probably less likely to skip their medicines compared to those that receive usual care. We are moderately certain about these results based on the current evidence. The evidence on children is limited. With the currently available information, we cannot make any judgements on other parameters such as access to care, whether people with inflammatory bowel disease approve of these programmes and are encouraged to attend appointments, to what degree clinical professionals are involved in them, and costs or time. The evidence on other forms of remote care was also very limited. What are the limitations of the evidence? One limitation of the evidence was that the RCTs provided unclear descriptions of the remote care programmes, which means that any organisation wishing to copy and adopt these interventions would have difficulty doing so. The descriptions of usual care (the alternative treatment group in many studies) were also unclear. This means that standard care might be different from one study to another, which could make our findings less accurate. Few studies looked at forms of remote care other than web‐based care. Another limitation is that the different studies measured different results (outcomes) of treatment. Finally, some studies used poor quality research methods. What next? No further studies comparing web‐based care to usual care in adults are necessary, unless they last for longer periods of time or give more details that would help clinicians adopt them anywhere in the world. This includes details on the type and number of staff needed, resources, equipment, costs, accessibility, and data security. More studies on children may be useful, as well as studies that examine differences based on sex and social or financial status. In any case, future studies should concentrate on measuring the results that matter most to people with inflammatory bowel disease and their care providers. How up‐to‐date is this review? This review is up‐to‐date as of January 2022.
【저자키워드】 COVID-19, Adult, Telemedicine, chronic disease, Crohn disease, humans, Child, Quality of life, Colitis, ulcerative, Crohn Disease/therapy, Neoplasm Recurrence, Local,