Copyright ©2014 Baishideng Publishing Group Co.
World J Gastroenterol. Jan 21, 2014; 20(3): 829-842
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.829
Table 1 Summary of included studies on distance management of inflammatory bowel disease in adults
Author, yrPatients randomized/baseline (N) intervention vs controlDiseaseDisease severityInclusion/exclusionMean age (yr) Control vs interventionMale (%) Control vs interventionInterventionControlDuration (mo)
Cross et al[26],201247 pts rand.14 web vs 18 BACUCNot specified40.3 vs 41.732 vs 40UC HAT (Home telemanagement: - a home unit (laptop and electronic weight scale) a decision support server, -a web-based clinician portalBest Available Care (educational material, action plan, clinics visits)12
Elkjaer et al[27],2010233 pts rand.105 web vs 106 controlUC mild/modInclusion: age 18-69 yr, mild/moderate UC, treated with 5- ASAExclusion: acute phase of co-morbid conditions, drug dependence or substance abuse, use of immunomodulators, frequent treatment with high dose systemic corticosteroids, likely requirement of IBD surgery, previous IBD surgery40 vs 44 (P = 0.03)49.5 vs 31.1(P = 0.008)Web-intervention (Educational training then http:// treatment and follow up in the IBD out-patient clinic12
Elkjaer et al[27], 2010100 pts rand.51 web vs 41 controlUCSame as above41 vs 4660.8 vs 41.5Web-intervention (Educational training then http:// treatment and follow up in the IBD out-patient clinic12
Kennedy et al[28], 2004Richardson et al[29],2006700 pts rand.270 interv.365 controlMild/modCD (n = 231)UC or ID (n = 404)Inclusion: UC or CD, over age of 16 yr, able to write English, attending a follow-up clinicExclusion: Not specified46.3 vs 44.443 vs 41.5Guided self-management- patient guidebook- self-management plan- patient centered approach to care by a trained clinician- direct access to services for patients to self-referManagement process deemed appropriate by the hospital specialist-6 sites follow long term- 2 sites discharge quiescent IBD-1 site no consistent follow up12
Robinson et al[30],2001203 pts101 interv.102 controlUCInclusion: newly diagnosedExclusion: require hospital outpatient follow-up for other illnesses, unable to read informed consent or follow written instructions48 vs 4948 vs 49Personalised guided self-management regimen with direct access to outpatient care on requestClinician’s normal treatment and follow-upUntil 11 mo after last pt recruited
Williams et al[88], 2000180 pts 88 interv.92 controlCD (n = 78) UC or ID (n = 77)Proctitis (n = 25)Inactive or mildly activeInclusion: over 18 yr, inactive or mildly active but stable IBDExclusion: active disease requiring treatment, stoma, other disease requiring regular follow up, unable to comply with data collectionN/A (no significant difference reported)N/A (no significant difference reported)Open access follow upRoutine follow up24
Table 2 Risk of bias of included studies on distance management compared with standard clinic follow-up for adult inflammatory bowel disease patients
Author, yrSelection biasPerformance biasDetection biasAttrition biasReporting biasSource of funding
Cross et al[26],2012Low (random permuted block design; concealed)HighLow (research staff blinded to treatment allocation)High (more discontinued in intervention group 8/25 vs control 1/22)LowBroad Medical Research Program, University of Maryland General Clinical Research Center Grant, General Clinical Research Centers Program, NCRR, NIH, Baltimore Education and Research Foundation
Elkjaer et al[27],2010Low (randomisation program; closed envelope)HighHighHigh (LTF higher in the web group 24% vs control 17%)LowColitis Crohn Patient Organization, Moran’s Foundation, Vibeke Binder and Povl Riis’ Foundation, Bayer Health Care Funding, Augustinus Foundtaion, Munkholms Foundation, Tillotts Funding, Scientific Councel at Herlev Hospital, Prof. Fagerhol Research Foundation, Aase and Einar Danielsen Foundation, Ole Trock-Jansen and Hustrus Foundation, and European Crohn Colitis Organization
Elkjaer et al[27], 2010Unclear (cluster randomization; no mention of concealment)HighHighHigh (LTF higher in control group)Low
Kennedy et al[28], 2004Richardson et al[29], 2006Low (random number tables; concealed)HighHighHigh (LTF higher in control group 24% vs intervention 13%)LowHealth Technology Assessment Programme of the United Kingdom NHS (MS) Career Scientist Award in Public Health, NHS R and D(GS) Researcher Development Award, NHS R and D
Robinson et al[30], 2001Low (computer generated lists, concealed)HighHighLowLow(AR) United Kingdom Medical Research Council Training Fellowship
Williams et al[88], 2000Low (computer generated lists, concealed)HighHighLowLowNHS research and development primary/secondary care interface programme, West Wales and Swansea Group of the National Association for Colitis and Crohn’s Disease.