Electronic, mobile health interventions improve JIA management

Harnessing electronic (eHealth) and mobile health (mHealth) interventions appears to be an efficient way of supplementing the management of juvenile idiopathic arthritis (JIA), as shown by the results of a systematic review and meta-analysis.

However, this evidence warrants caution due to its small sample size, wide confidence intervals (CIs), and moderate-to-high statistical heterogeneity. In addition, no similar effect is seen across studies.

“More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based paediatric rheumatologist–children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given,” the researchers said.

A systematic search was conducted on 15 databases from 2018 to 2021 to identify studies that assessed children and young people (aged 1‒18 years) with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions.

Two reviewers independently screened the studies for inclusion and appraised the quality using the Downs and Black checklist. The researchers summarized outcomes using a narrative, descriptive method and, where possible, combined for a meta-analysis via a random-effects model.

Overall, 301 studies were identified, of which 15 (5 percent) met the eligibility criteria and evaluated 10 interventions for JIA (aged 4‒18.6 years). Half (50 percent) of these interventions monitored symptoms by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). [J Med Internet Res 2022;24:e30457]

Pain assessment

Individual studies reported a preference for real-time pain monitoring over recall pain assessments due to a peak-end effect, improved time efficiency (p=0.002), and meeting children’s and young people’s HRQoL needs (p<0.001) during paediatric rheumatology consultations.

Two interventions (20 percent) promoted physical activity through a web-based program or a wearable activity tracker. The web-based platform had a moderate effect, which led to increased endurance time, physical activity levels, and moderate-to-vigorous physical activity (standardized mean difference [SMD], 0.60, standard deviation, 0.02‒1.18; I², 79 percent; p=0.04).

The last three (30 percent) interventions supported self-management development through web-based programs or apps, which facilitated a small effect, reduced pain intensity (SMD, ‒0.14, 95 percent CI, ‒0.43 to 0.15; I², 53 percent; p=0.33), and improved disease knowledge and self-efficacy (SMD, 0.30, 95 percent CI, 0.03‒0.56; I², 74 percent; p=0.03).

“These results were not statistically significant,” the researchers said. “No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence.”

Of note, the methodologies employed by the eligible studies ranged from fair to good. [Arthritis Care Res (Hoboken) 2017;69:1040-1049; Pediatrics 2013;131:e533-e543; Pediatr Rheumatol Online J 2016;14:48; Clin J Pain 2014;30:1044-1050; Pediatr Rheumatol Online J 2012;10:7; J Rheumatol 2010;37:1944-1952; Pain Res Manag 2008;13:375-382; Pain Res Manag 2008;13:375-382]