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A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease
Lien Tran1, Kathleen Mulligan1,2
1Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK.
Insights
Self-management of pediatric inflammatory bowel disease (IBD) is challenging. While some interventions show potential benefits for children and adolescents with IBD, most studies were underpowered, yielding inconsistent results for improving adherence and well-being.
Area of Science:
- Pediatric Gastroenterology
- Health Psychology
- Evidence-Based Medicine
Background:
- Self-management of pediatric inflammatory bowel disease (IBD) presents significant challenges for children and adolescents (CA).
- Difficulties in self-management can lead to poor treatment adherence and compromised psychosocial functioning.
- Existing self-management interventions aim to support CA and their families in managing IBD effectively.
Purpose of the Study:
- To systematically review and evaluate the efficacy of self-management interventions specifically designed for children and adolescents with IBD.
- To synthesize findings from controlled trials assessing the impact of these interventions on key IBD management aspects.
Main Methods:
- A systematic literature search was conducted across major databases (Medline, Embase, Cochrane, CINAHL, PsychINFO) following PRISMA guidelines.
- Controlled trials focused on enhancing IBD self-management in CA were identified and screened by two independent reviewers.
- Nine trials, totaling 11 articles, met the inclusion criteria for the review.
Main Results:
- Most included trials were underpowered, with 7 recruiting fewer than 50 participants.
- Interventions primarily targeted psychological well-being (5 trials), medication adherence (3 trials), and calcium intake (1 trial).
- While some studies reported benefits in disease activity, adherence, and psychological well-being, the findings were inconsistent due to heterogeneity in intervention content and outcome measures.
Conclusions:
- Self-management remains a significant hurdle for CA with IBD, with a limited number of supportive interventions identified.
- Most interventions were underpowered, and only one was conducted outside the United States, highlighting a need for broader research.
- Further adequately powered trials are essential, alongside clinical consensus on recommended self-management activities and core outcome assessments, to effectively support CA with IBD.
Background:
Self-management of inflammatory bowel disease is complex. Children and adolescents (CA) with inflammatory bowel disease (IBD) often have difficulty with managing aspects of their condition, resulting in treatment nonadherence and impaired psychosocial function. Self-management interventions are developed to help support patients and their parents/carers to effectively self-manage. The aim of this systematic review was to evaluate the efficacy of self-management interventions in children and adolescents with IBD.
Methods:
The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search of the following databases was conducted to identify controlled trials of interventions aiming to enhance IBD self-management in CA: Medline, Embase, Cochrane, CINAHL, and PsychINFO. Two reviewers screened articles for inclusion.
Results:
Nine trials (11 articles) met the inclusion criteria. Most were underpowered, with 7 recruiting fewer than 50 participants. The interventions aimed to enhance psychological well-being (n = 5), medication adherence (n = 3), or calcium intake (n = 1). There was considerable heterogeneity in intervention content and outcomes assessment. Some benefits were reported in disease activity, adherence, and psychological well-being, but findings were inconsistent.
Conclusions:
Self-management is difficult for CA with IBD; however, this review identified only a small number of interventions to support self-management, most of which were underpowered and only 1 that was conducted outside the United States. Clinical consensus is required on which self-management activities should be recommended to patients and targeted in interventions and which core outcomes should be assessed. Adequately powered trials of interventions are required to identify how best to support self-management in CA with IBD.
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