Mobile health technologies supporting colonoscopy preparation: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background Mobile health (mHealth) technologies are innovative solutions for delivering instructions to patients preparing for colonoscopy. Objective To systematically review the literature evaluating the effectiveness of mHealth technologies supporting colonoscopy preparation on patient and clinical outcomes. Methods MEDLINE, EMBASE, CINAHL and CENTRAL were searched for randomized controlled trials (RCTs) that evaluated the effectiveness of mHealth technologies for colonoscopy preparation on patient and clinical outcomes. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality using the Cochrane Risk-of-Bias tool. Data were pooled using random effects models and when heterogeneity, assessed using I2, was statistically significant, a qualitative synthesis of the data was performed. Publication bias was assessed using a funnel plot. Results Ten RCTs (3,383 participants) met inclusion criteria. MHealth interventions included smartphone apps, SMS text messages, videos, camera apps, and a social media app. Outcomes were bowel cleanliness quality, user satisfaction, colonoscopy quality indicators (cecal intubation time, withdrawal time, adenoma detection rate), adherence to diet, and cancellation/no-show rates. MHealth interventions were associated with better bowel cleanliness scores on the Boston Bowel Preparation Scale [standardized mean difference (SMD) 0.57, 95%CI 0.37–0.77, I2 = 60%, p = 0.08] and the Ottawa Bowel Preparation Scale [SMD -0.39, 95%CI -0.59–0.19, I2 = 45%, p = 0.16], but they were not associated with rates of willingness to repeat the colonoscopy using the same regimen [odds ratio (OR) 1.88, 95%CI 0.85–4.15, I2 = 48%, p = 0.12] or cancellations/no-shows [OR 0.96, 95%CI 0.68–1.35, I2 = 0%]. Most studies showed that adequate bowel preparation, user satisfaction and adherence to diet were better in the intervention groups compared to the control groups, while inconsistent findings were observed for the colonoscopy quality indicators. All trials were at high risk of bias for lack of participant blinding. Visual inspection of a funnel plot revealed publication bias. Conclusions MHealth technologies show promise as a way to improve bowel cleanliness, but trials to date were of low methodological quality. High-quality research is required to understand the effectiveness of mHealth technologies on colonoscopy outcomes.

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

“…Consistent with improved rates of adequate bowel preparation, supplemental education also improved bowel quality scores ( Fig 6 ). This is in line with a recent meta-analysis [ 56 ] that found that mobile health technology is associated with better bowel preparation quality scores. This is also in line with a meta-analysis published in 2021 [ 40 ], which showed that reinforced education increases colonoscopy BBPS scores and decreases OBPQS scores.…”

“…Our meta-analysis showed that supplementary education had no statistically significant difference in reducing the nonattendance rate of outpatient colonoscopy (9.5% vs 11.5%, RR:0.82, 95% CI: 0.72 to 0.94, I 2 = 38%, p = 0.10). A recently published meta-analysis also shows that mobile health technology cannot reduce the no-show rate of colonoscopy [ 56 ]. It is worth noting that there was no obvious heterogeneity (I 2 = 38%, p = 0.09) in the research.…”

Mitigating the impact of COVID-19 on colorectal cancer screening: Organized service screening perspectives from the Asia-Pacific region

“…Screening organizers may also consider applying modern technology such as a smartphone app or telemedicine at many steps of FIT screening, such as consultation about eligibility for CRC screening, notification of FIT results, scheduling colonoscopy, pathology result notification, and advising about the timing of surveillance colonoscopy, to facilitate CRC screening during the COVID pandemic ( Azulay et al, 2019 ; El Bizri et al, 2021 ). In fact, telehealth technology has been boosted and widely adopted in the past year owing to the COVID-19 pandemic, and many healthcare systems have observed a tremendously increased number of telemedicine visits ( McCall, 2020 ).…”

Effects of Different Intervention Methods on Intestinal Cleanliness in Children Undergoing Colonoscopy

“…During clinical colonoscopy for children, the examination is often performed under general anesthesia, considering the acceptance degree, physical dosage, and tolerance of children. Intestinal examination preparation should be arranged according to child's age, physical condition, clinical symptoms, digestive status, and examination willingness [ 6 ]. At present, there are many preparation programs, among which physiological saline enema, oral magnesium sulfate, or mannitol are important drugs for adults to clean the intestine before examination.…”