Distance management of inflammatory bowel disease: Systematic review and meta-analysis

Table 1 Summary of included studies on distance management of inflammatory bowel disease in adults

Author, yr	Patients randomized/baseline (N) intervention vs control	DiseaseDisease severity	Inclusion/exclusion	Mean age (yr) Control vs intervention	Male (%) Control vs intervention	Intervention	Control	Duration (mo)
Cross et al[26],2012	47 pts rand.14 web vs 18 BAC	UC	Not specified	40.3 vs 41.7	32 vs 40	UC HAT (Home telemanagement: - a home unit (laptop and electronic weight scale) a decision support server, -a web-based clinician portal	Best Available Care (educational material, action plan, clinics visits)	12
Elkjaer et al[27],2010	233 pts rand.105 web vs 106 control	UC mild/mod	Inclusion: 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 surgery	40 vs 44 (P = 0.03)	49.5 vs 31.1(P = 0.008)	Web-intervention (Educational training then http://http://www.constant-care.dk)	Conventional treatment and follow up in the IBD out-patient clinic	12
Elkjaer et al[27], 2010	100 pts rand.51 web vs 41 control	UC	Same as above	41 vs 46	60.8 vs 41.5	Web-intervention (Educational training then http://http://www.constant-care.dk)	Conventional treatment and follow up in the IBD out-patient clinic	12
Kennedy et al[28], 2004Richardson et al[29],2006	700 pts rand.270 interv.365 control	Mild/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 specified	46.3 vs 44.4	43 vs 41.5	Guided self-management- patient guidebook- self-management plan- patient centered approach to care by a trained clinician- direct access to services for patients to self-refer	Management process deemed appropriate by the hospital specialist-6 sites follow long term- 2 sites discharge quiescent IBD-1 site no consistent follow up	12
Robinson et al[30],2001	203 pts101 interv.102 control	UC	Inclusion: newly diagnosedExclusion: require hospital outpatient follow-up for other illnesses, unable to read informed consent or follow written instructions	48 vs 49	48 vs 49	Personalised guided self-management regimen with direct access to outpatient care on request	Clinician’s normal treatment and follow-up	Until 11 mo after last pt recruited
Williams et al[88], 2000	180 pts 88 interv.92 control	CD (n = 78) UC or ID (n = 77)Proctitis (n = 25)Inactive or mildly active	Inclusion: 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 collection	N/A (no significant difference reported)	N/A (no significant difference reported)	Open access follow up	Routine follow up	24

IBDQ: Inflammatory bowel disease questionnaire; SIBDQ: Short-IBDQ; NS: Not significant; ID: Indeterminate colitis; CD: Crohn’s disease; UC: Ulcerative colitis.

Table 2 Risk of bias of included studies on distance management compared with standard clinic follow-up for adult inflammatory bowel disease patients

Author, yr	Selection bias	Performance bias	Detection bias	Attrition bias	Reporting bias	Source of funding
Cross et al[26],2012	Low (random permuted block design; concealed)	High	Low (research staff blinded to treatment allocation)	High (more discontinued in intervention group 8/25 vs control 1/22)	Low	Broad 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],2010	Low (randomisation program; closed envelope)	High	High	High (LTF higher in the web group 24% vs control 17%)	Low	Colitis 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], 2010	Unclear (cluster randomization; no mention of concealment)	High	High	High (LTF higher in control group)	Low
Kennedy et al[28], 2004Richardson et al[29], 2006	Low (random number tables; concealed)	High	High	High (LTF higher in control group 24% vs intervention 13%)	Low	Health 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], 2001	Low (computer generated lists, concealed)	High	High	Low	Low	(AR) United Kingdom Medical Research Council Training Fellowship
Williams et al[88], 2000	Low (computer generated lists, concealed)	High	High	Low	Low	NHS research and development primary/secondary care interface programme, West Wales and Swansea Group of the National Association for Colitis and Crohn’s Disease.

LTF: Lost to follow-up; NCCR: National Center for Research Resources; NIH: National Institute of Health; NHS R and D: National Health Services Research and Development.