JMIR Publications

ABSTRACT

Background:

The main goal in Juvenile Idiopathic Arthritis (JIA) management is to promote remission through timely, individualized, well-coordinated interdisciplinary care, through a range of pharmacological, physical, psychological and educational interventions. However, achieving this level of support has been difficult due to an insufficient number of experienced Pediatric Rheumatologists (PR); and the high rates of non-adherence by young people to prescribed treatments. A resource-efficient way to supplement JIA management and the development of self-management skills could be through harnessing the burgeoning eHealth and mobile Health (mHealth) interventions.

Objective:

This systematic review aims to evaluate the effectiveness of eHealth and mHealth interventions available for young people living with JIA. It is anticipated this review may aid the clinical use of eHealth and mHealth interventions, and their integration into arthritis management.

Methods:

Following the PRISMA (Preferred Reporting Items for Reviews and Meta-Analyses) guidelines, 15 databases were systematically searched between 2018 and November 2020. Studies were eligible if they considered young people (1-18 years) diagnosed with JIA, and an eHealth or mHealth intervention. In total, 2 reviewers independently screened studies for inclusion, and appraised study quality using the Down and Black (modified) checklist. Study outcomes were summarised using a narrative descriptive method, and where possible, combined for a meta-analysis, using a random-effect or fixed-effect model.

Results:

Of the 265 studies identified in the search strategy, 13 studies met the inclusion criteria to be introduced into this review; and the quality of these studies ranged from fair to good. From these studies, a total of 8 interventions for JIA were identified; 4 of these interventions captured patient data through electronic diaries or web-based portals, to monitor pain or health related quality of life (HRQoL), potentially aiding healthcare decisions. Within individual studies, preference was demonstrated towards real-time pain monitoring over recall pain assessments due to the peak end effect; improved time efficiency (P=.002); and meeting HRQoL needs (P<.001) during paediatric rheumatology consultation. Further, 4 interventions supported self-management through Web-based or online programs; or a wearable activity tracker. A limited meta-analysis demonstrated a small post-intervention effect in reducing pain intensity (SMD -0.14, CI -0.43-0.15, i2=53 P=.33); increasing physical activity (endurance time, moderate to vigorous physical activity) (SMD =0.54, SD 0.28-0.80, i2=79%, P<.0001), and disease knowledge (SMD =0.29, CI =0.04-0.55, i2=74%, P=.03). However, the overall pooled effect also identified substantial statistical heterogeneity between the studies using the same intervention and outcome measurements, reducing confidence in these results. No effect was seen in reducing pain interference, or improving HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence.

Conclusions:

Evidence is on the rise supporting the inclusion of eHealth and mHealth interventions into JIA management. However, this evidence needs to be considered cautiously because of low sample size, wide confidence intervals; and moderate to significant statistical heterogeneity. More rigorous research is needed that focuses on the longitudinal effects of real-time pain monitoring, self-management strategies, and the use of wearable technology as an objective measurement for monitoring physical activity, before any recommendations informing current practice can be given.