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World J Gastroenterol. Jan 21, 2014; 20(3): 829-842
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.829
Distance management of inflammatory bowel disease: Systematic review and meta-analysis
Vivian W Huang, Krista M Reich, Richard N Fedorak
Vivian W Huang, Krista M Reich, Richard N Fedorak, Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada
Author contributions: Huang VW designed the study and wrote the manuscript; Huang VW and Reich KM performed the systematic review and meta-analysis; Fedorak RN contributed to the systematic review and meta-analysis, and reviewed the manuscript.
Correspondence to: Vivian W Huang, MD, Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada.
Telephone: +1-780-2481031 Fax: +1-780-2481041
Received: August 15, 2013
Revised: September 15, 2013
Accepted: September 29, 2013
Published online: January 21, 2014

AIM: To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease (IBD) patients.

METHODS: A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients. Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program, electronic interface, or self-directs open access to clinic follow up. The search strategy included electronic databases (Medline, PubMed, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, KTPlus, Web of Science, and SCOPUS), conference proceedings, and internet search for web publications. The primary outcome was the mean difference in quality of life, and the secondary outcomes included mean difference in relapse rate, clinic visit rate, and hospital admission rate. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers.

RESULTS: The search strategy identified a total of 4061 articles, but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis. Three trials involved telemanagement, and three trials involved directed patient self-management and open access clinics. The total sample size was 1463 patients. There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28 (95%CI: -3.25-17.81) points higher than standard clinic follow-up. There was a significant decrease in the clinic visit rate among distance management patients mean difference -1.08 (95%CI: -1.60--0.55), but no significant change in relapse rate or hospital admission rate.

CONCLUSION: Distance management of IBD significantly decreases clinic visit utilization, but does not significantly affect relapse rates or hospital admission rates.

Keywords: Telemanagement, Telehealth, Inflammatory bowel disease, Distance management, Self-management

Core tip: Distance management of inflammatory bowel disease (IBD) involves the use of telemedicine, web-based intervention, telephone clinics, patient directed open access clinics, and other methods that incorporate patient self-management strategies to manage patients remotely. This systematic review and meta-analysis of six randomized controlled trials shows that distance management of IBD significantly decreases clinic visit utilization, and can improve quality of life in certain groups. Consideration should be made in tailoring distance management approaches to select IBD patient populations.