Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers

Table 1 Studies of Telemonitoring in inflammatory bowel disease

Ref.	Disease	Type of study	n	Application	Outcomes
Cross et al[21]	IBD	Noncontrolled, clinical trial	10	Telemonitoring, home unit-server PC provider	Feasible method
					Excellent patient acceptance
Cross et al[113]	IBD	Noncontrolled clinical trial	25	Telemonitoring, home unit-server PC provider	Feasible method
					Excellent patient acceptance
					Improvement in QoL, disease activity, and disease knowledge
Cross et al[42]	UC	Controlled randomized clinical trial	47	Telemonitoring, home unit-server PC provider	Feasible method
					Excellent patient acceptance
					Improvement in QoL
Elkjaer et al[115]	UC	Validation study in 2 groups	21	Telemonitoring through the web	Feasible method
					Excellent patient acceptance
Elkjaer et al[22]	UC	Controlled randomized clinical trial	333	Telemonitoring through the web	Feasible method
					Excellent patient acceptance
					Improvement in QoL, disease knowledge, and adherence
Pedersen et al[10]	CD	Pilot study, controlled	27	Telemonitoring through the web	Feasible and safe method for individualized scheduling of maintenance IFX treatment
Pedersen et al[11]	UC	Prospective noncontrolled study	95	Telemonitoring through the web	Feasible and improve adherence to therapy
Torrejón et al[56]	IBD	Descriptive, observational, retrospective	1784	Telecare through e-mail, phone calls, fax	Increased telematic contacts and decreased in-person care
Johnson et al[27]	IBD	Telemonitoring project	420	A web-guided programme	Effective, safe and cost savings
De Jong et al[24]	IBD	Controlled randomized clinical trial	909	Telemonitoring through the web (mHealth)	Reduced outpatient visits and hospitalizations
Carlsen et al[43]	IBD	Controlled randomized clinical trial	53	Telemonitoring through the web (mHealth)	Reduced outpatient visits
					No differences in disease activity, QoL or adherence compared with standard care
Walsh et al[112]	UC	Pilot study, non controlled	66	Telemonitoring through the web (mHealth)	Feasible and usable to measure disease activity, QoL and medication use
Del Hoyo et al[52]	IBD	Controlled randomized clinical trial	63	Telemonitoring through the web	Higher improvement in disease activity compared to usual care
					Similar improvement in QoL, social activities and satisfaction between groups
Cross et al[25]	IBD	Controlled randomized clinical trial	348	Telemonitoring through the web (mHealth)	Improvement in disease activity and QoL, although not superior to usual care
					Decrease in hospitalizations and increase in distance contacts
Bilgrami et al[48]	IBD	Controlled randomized clinical trial	222	Telemonitoring through the web (mHealth)	No differences in self-efficacy or patient activation compared with standard care
Schliep et al[47]	IBD	Controlled randomized clinical trial	217	Telemonitoring through the web (mHealth)	No significant improvement in depressive symptoms or QoL compared with standard care
Heida et al[45]	IBD	Controlled randomized clinical trial	170	Telemonitoring through the web, e-mail and telephone	Similar improvement in QoL compared to conventional care
					Reduction in outpatient visits and societal costs
					Satisfaction
Linn et al[46]	IBD	Controlled randomized clinical trial	160	Telemonitoring through the web or SMS combined with tailored counselling	Improved self-efficacy
					Satisfaction
Bonnaud et al[51]	IBD	Controlled randomized clinical trial	54	Telemonitoring through the web (mHealth)	Significant improvement in QoL
					A trend to reduce outpatient visits
					Satisfaction
McCombie et al[50]	IBD	Controlled randomized clinical trial	100	Telemonitoring through the web (mHealth) and home-based FC	Non-inferiority of QoL and symptoms
					Reduced outpatient visits

IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn's disease; QoL: Quality of life

Table 2 Enablers and barriers for the implementation of telemonitoring in inflammatory bowel disease

	Enablers	Barriers
Technological	Adequate support	Lack of EMR integration
	Sufficient training	System maintenance required to avoid malfunction
	Fast internet connections
	5G network
Organizational	Continuous monitoring	Multidimensional nature: complex comparability between programmes
	Overcome geographic barriers
	Safe assistance during COVID-19 pandemic	Lack of robust data: small studies, short-term follow up periods
	Structured data collection
	Favours experimental studies and epidemiological surveillance	Lack of standardized remote medical practice (Interstate Mecial Licensure compact in the United States)[66]
	Multicentric access to data
		Reimbursement limitations
	Telementoring: professional support and education
Legal		Lack of legal framework[67,68]
		Data security
Acceptability/accessibility	Patient empowerment	Technological knowledge[69-71]; Some demographic factors increase the likelihood of a telematic encounter failure
		High drop-out rate in some clinical trials
	Wide use of smartphones
	Wide use of wearable devices
	Cheap internet plans
Costs	Potential decrease of direct and indirect costs	High initial investment
		Limited cost-effectiveness data