Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 7, 2020
Date Accepted: Mar 22, 2021
Comparative effectiveness of enhanced patient instructions for bowel preparation before colonoscopy: a systematic review and network meta-analysis
ABSTRACT
Background:
Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPI in increasing colonic polyp and adenoma detection rate, however the optimal method for adequate BP is not yet clear.
Objective:
We performed a network meta-analysis to determine optimal instruction.
Methods:
We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instruction (SPI) for BP. We performed direct and Bayesian network meta-analysis for all instructions, and used Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE) to appraise the quality of evidence.
Results:
We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of EPIs, but not visual aid or mobile app, increase adequate preparation rate (APR). Network meta-analyses showed that additional explanation was superior to visual aid (odds ratio [OR], 0.35; 95%credible interval [Crl], 0.19 to 0.59), phone call (OR, 0.62; 95%Crl, 0.37 to 0.99), educational video (OR, 0.79; 95%Crl, 0.50 to 0.77), or mobile app (OR, 0.33; 95%Crl, 0.14 to 0.68), with low to high quality evidence; and newly designed booklet (OR, 3.28; 95%Crl, 1.59 to 6.16), short message service (SMS) (OR, 2.33; 95%Crl, 1.28 to 3.91), phone call (OR, 1.86; 95%Crl, 1.03 to 1.78), educational video (OR, 2.33; 95%Crl, 1.40 to 3.65), or social media app (OR, 2.42; 95%Crl, 1.40 to 3.93) was superior to visual aid or mobile app, with low to high quality evidence. SMS, phone call or social media app increases adherence to regime and satisfaction with BP. Social media app reduces risk of adverse events. Phone call or social media app increases the polyp detection rate.
Conclusions:
Newly designed booklet, phone call, educational video, or social media app can improve the quality of BP. Phone call or social media app improves adherence to BP regime and satisfaction with BP, reduce the risk of adverse events, or increases polyp detection rate.
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