Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review

Abstract

Background Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. Objective This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. Methods We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. Results A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. Conclusions While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.

What is the clinical value of mHealth for patients?

“…There is a lack of randomized controlled trials investigating the educational value of such mHealth interventions; however, preliminary evidence does exist to support the use of specific educational mHealth interventions for patients with heart disease, inflammatory bowel disease and pediatric tonsillectomy, pediatric forearm fracture, and in patients with breast, colon, lung, prostate, and stomach cancers. [26][27][28][29] Anecdotally such educational platforms may hold value to patients by facilitating improvements in communication with healthcare providers and enabling a level of disease understanding that supports shared decision making in clinic. Disease-related education may also hold value for patients in remote regions to support self-management.…”

Impact of mobile health and medical applications on clinical practice in gastroenterology

“…Potential use cases are patient education, the management of disease monitoring, tracking of symptoms, support of medication adherence, the tracking of dietary logs and the support of patient empowerment through access to social media channels[ 39 ]. There is a large number of literature reviews that have summarized the potential of using MHAs to support patients with IBD[ 15 , 39 - 41 ]. In a recently published review from Yin et al[ 15 ], apps available in the official Google and Apple digital stores were investigated.…”

“…There is a large number of literature reviews that have summarized the potential of using MHAs to support patients with IBD[ 15 , 39 - 41 ]. In a recently published review from Yin et al[ 15 ], apps available in the official Google and Apple digital stores were investigated. Eleven MHAs and 4 MAs were identified in this review.…”

Role of mhealth in the management of Tuberculosis: A new approach to improve adherence

“…Amnesia, incomprehension of mechanism of after effects, and impression of ineffectiveness drugs which are considered to be the most common reasons for medication non-adherence can be adequately addressed with the help of a mobile app. One of the recent studies revealed that 762 apps in the play store/app store use behavioural strategies to enhance medication adherence with the help of reminders, occasional alerts and logs (Yin et al, 2019). Interestingly many of the patients gave positive feedback on customized medication regimen details and reminders.…”