Patient education interventions for the management of inflammatory bowel disease

**Background:** Inflammatory bowel disease (IBD) is a chronic, incurable condition affecting over 6.8 million people globally. Patient education interventions aim to deliver structured information to improve disease management, but their effectiveness in IBD was unclear. This Cochrane review sought to identify types of educational interventions and determine their effectiveness and safety.

**Methods:** The authors searched CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP on 27 November 2022 with no language or date restrictions. They included all RCTs comparing educational interventions for people with IBD to any other intervention or no intervention. Two review authors independently extracted data and assessed risk of bias. Data were analyzed using Review Manager Web, with dichotomous outcomes expressed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using GRADE methodology.

**Key Results:** Fourteen RCTs with 2708 randomized participants (aged 11–75 years) were included. Two studies examined exclusively ulcerative colitis populations; the rest included mixed IBD populations. Interventions ranged from 30 minutes to 12 months and included in-person workshops, printed materials, text messages, e-learning, and interactive videos. Thirteen studies compared patient education plus standard care versus standard care alone.

For disease activity (2 studies, n=479), patient education plus standard care was probably equivalent to standard care (SMD -0.03, 95% CI -0.25 to 0.20; moderate-certainty evidence). For flare-ups/relapse as a continuous outcome (2 studies, n=1022), there was no clear difference (MD -0.00, 95% CI -0.06 to 0.05; moderate-certainty evidence). As a dichotomous outcome (3 studies, n=307), the evidence was very uncertain (RR 0.94, 95% CI 0.41 to 2.18; very low-certainty evidence). For quality of life (6 studies, n=1364), patient education plus standard care was probably equivalent to standard care (SMD 0.08, 95% CI -0.03 to 0.18; moderate-certainty evidence).

Medication adherence and patient knowledge showed conflicting results. Only five studies reported adverse events; four reported zero events, and one reported one case of breast cancer and two surgeries in intervention groups. Two studies comparing delivery methods (web-based vs. printed; weekly vs. biweekly text messages) found no major differences.

Risk of bias was concerning across all studies; no study was free of unclear or high risk of bias judgments. Reporting of educational interventions was poor, with no studies describing theoretical underpinnings and few providing sufficient detail for replication.

**Clinical Implications:** The evidence suggests that adding formal patient education to standard care probably does not improve disease activity, quality of life, or reduce relapse rates in IBD patients. However, the poor reporting of both interventions and standard care limits the clinical utility of these findings. The authors recommend against further research on these primary outcomes and instead call for studies focusing on outcomes more directly targetable by education (e.g., medication adherence, healthcare access), with proper reporting of intervention details and stakeholder engagement.