Citation, summary and comment from me below.
CITATION: Efficacy of digital health technologies in the management of inflammatory bowel disease: an umbrella review
Marco Gasparetto et al.
Lancet Digital Health
https://www.thelancet.com/journals/landig/article/PIIS2589-7500(24)00290-5/fulltext?dgcid=raven_jbs_aip_email
SUMMARY
The use of digital health technology (DHT) is increasing worldwide. Clinical trials assessing available health tools for the management of patients with inflammatory bowel disease (IBD) are sparse, with limited evidence-based outcome data. In this umbrella review, we investigated the effectiveness of DHT in the care of patients with IBD and identified areas for future research following the Joanna Briggs Institute methodology. Systematic reviews published between January, 2012, and September, 2024, were identified through searches across nine databases (Ovid Embase, Ovid MEDLINE, ProQuest PsycINFO, Epistemonikos, Cochrane, Health Evidence, DoPHER, PROSPERO, and CINAHL via EBSCO), and the results were imported into Covidence software. Inclusion criteria included systematic reviews of randomised controlled trials (RCTs) involving patients of all ages with Crohn’s disease or ulcerative colitis, using DHT for diagnostics, treatment support, monitoring, self-management, or increasing participation in research studies, compared with standard care or alternative interventions. Outcomes included the efficacy and effectiveness of digital interventions, as reported in the studies. The primary outcome was clinical efficacy reported as one or more of the following: clinical response or remission, disease activity, flare-ups or relapses, and quality of life. Secondary outcomes included medication adherence, number of health-care visits, patient engagement (satisfaction and adherence or compliance with interventions), attendance for all terms of engagement, rate of interactions, knowledge improvement, psychological outcomes, and cost or cost–time effectiveness. The review protocol was registered in PROSPERO (registration number: CRD42023417525). AMSTAR-2 was used for methodological quality assessment. Nine relevant reviews were included, including five with meta-analyses comprising 13–19 RCTs in each review; four reviews were rated as high quality and five as critically low quality. DHT was not directly beneficial in achieving or maintaining clinical remission in IBD. In four trials, DHT use was associated with a reduced number of hospital attendances and increased treatment adherence, supporting its role as an adjuvant to standard clinical practice in IBD. Although current evidence from several RCTs and systematic reviews does not indicate better clinical outcomes with DHT in maintaining IBD remission and reducing relapse rates, DHT could be used as an adjuvant resource contributing towards treatment adherence and reducing hospital visits.
COMMENT (NPW): I have not had a chance to read the whole paper in full, but I find it hard with such studies to disentangle the interventions (which are mostly about digital information and educational resources) from the various contexts in which they are applied. Nevertheless it 's interesting that most of the studies seemed to find no difference between the intervention and standard care. An alternative approach to this issue would be to assess to what extent the information needs of patients (and their healthcare providers) are met, and the effectiveness of different interventions in meeting those needs.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org