Remote care through telehealth for people with inflammatory bowel disease

**Background:** Inflammatory bowel disease (IBD), encompassing ulcerative colitis, Crohn's disease, and IBD unclassified, requires intensive follow-up after diagnosis. Telehealth—remote delivery of healthcare via phone, instant messenger, video, text, or web-based services—has gained relevance, particularly after the COVID-19 pandemic. This Cochrane Review aimed to identify communication technologies used for remote IBD care and assess their effectiveness.

**Methods:** The authors searched CENTRAL, Embase, MEDLINE, three other databases, and three trials registries on 13 January 2022 with no language or date restrictions. They included all published, unpublished, and ongoing RCTs evaluating telehealth interventions for people with IBD versus any comparator. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 1 tool. Certainty of evidence was evaluated using GRADE. Dichotomous outcomes were expressed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs).

**Key Results:** Nineteen RCTs with 3489 randomised participants (aged 8–95 years) were included. Three studies examined only UC, two only CD, and the remainder mixed IBD. Interventions lasted 6 months to 2 years. Twelve studies compared web-based disease monitoring to usual care. For adults, web-based monitoring was probably equivalent to usual care for disease activity (SMD 0.09, 95% CI −0.11 to 0.29; 3 studies, n=428; moderate certainty), flare-ups (RR 1.09, 95% CI 0.93 to 1.27; 5 studies, n=868; moderate certainty), and quality of life (SMD 0.08, 95% CI −0.04 to 0.20; 4 studies, n=1099; moderate certainty). Web-based monitoring probably led to slightly higher medication adherence in adults (MD 0.24 points, 95% CI 0.01 to 0.47; 1 study, n=671; moderate certainty). In children, web-based monitoring may be equivalent to usual care for flare-ups (RR 0.99, 95% CI 0.65 to 1.51; 1 study, n=170; low certainty). Telephone-based monitoring versus face-to-face care showed very uncertain results across all outcomes (very low certainty). Evidence for other comparisons (sham monitoring, self-screening, CBT with telephone support) was insufficient to draw conclusions.

**Clinical Implications:** Web-based disease monitoring is a reasonable alternative to standard care for routine IBD follow-up in adults, with no evidence of inferiority for key clinical outcomes and a possible small benefit for medication adherence. However, the evidence does not support superiority over usual care. The very low certainty of evidence for telephone-based monitoring and other telehealth modalities means no firm recommendations can be made for these approaches. Clinicians should consider patient preferences, access to technology, and local resources when deciding between telehealth and in-person care. Future research should focus on longer follow-up periods, clearer intervention descriptions, paediatric populations, and under-reported outcomes such as healthcare utilisation and cost-effectiveness.