Telemonitoring in children and adolescents with inflammatory bowel disease: a systematic review using alternative synthesis and reporting methods

2024 Prague [Global Evidence Summit]

Kusters M¹, Yang B¹, Vernooij R², Huis in ‘t Veld L¹, Bouhuys M³, van Rheenen P³, van Limbergen J⁴

¹Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, the Netherlands

²Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, the Netherlands ; Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands

³Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Beatrix Children’s Hospital, Groningen, the Netherlands, Groningen, Groningen, The Netherlands

⁴Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands, Amsterdam, Noord-Holland, The Netherlands

Background:

Telemonitoring, or remote measurement of disease markers followed by a change of therapy in case of out-of-range results, could be an alternative for standard face-to-face consultations. In adults with inflammatory bowel disease (IBD), telemonitoring has been associated with improved quality-of-life (QoL) and reduced costs without increasing the risk of a flare.

Objectives:

Our primary objective was to evaluate whether telemonitoring of paediatric IBD patients is non-inferior to standard care regarding disease activity. Other outcomes included QoL, costs, patient-reported experience and engagement measures, face-to-face clinician-patient contacts, and unplanned emergency room (ER) attendances or hospitalizations.

Methods:

We searched Medline and Embase until 31st August 2023 for randomised trials comparing telemonitoring with standard care in IBD patients under 18 years. Risk of bias and certainty of evidence were assessed using, respectively, the Risk of Bias 2 tool and GRADE. Meta-analyses could not be performed due to outcome heterogeneity. Data was synthesised and reported in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Alternative synthesis methods were applied for two of seven outcome domains. For the remaining five we structurally reported the effects, which is in accordance with the methodological scenarios provided by the Cochrane handbook.

Results:

Three studies including 309 patients were identified. Risk of bias was rated as ‘high’ for one study and as ‘some concerns’ for the remaining two studies. We found low certainty of evidence that telemonitoring may not worsen disease activity. Telemonitoring may result in little to no improvement in QoL (low certainty). Two studies reported a slight cost reduction with telemonitoring (moderate certainty). Patient-reported satisfaction with telemonitoring was good, while findings regarding medication and protocol adherence were inconsistent (low certainty). Telemonitoring may reduce the total number of face-to-face clinician-patient contacts (low certainty). We found that telemonitoring probably results in no more unplanned ER visits or hospitalizations (moderate certainty).

Conclusions:

Telemonitoring may not increase disease activity compared to standard care. Between-group differences regarding other outcome domains are either small, inconsistent, or absent. Although meta-analyses were not possible, we were able to provide transparent, complete, and nuanced conclusions by following the SWiM-reporting guideline and the Cochrane handbook.