远程医疗在炎症性肠病患者中应用效果的系统评价再评价

Effectiveness of telemedicine in patients with inflammatory bowel disease: an overview systematic review

目的对远程医疗在炎症性肠病(IBD)患者中应用效果的系统评价/Meta分析进行再评价。方法计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science、Ovid、CINAHL,获取有关远程医疗应用于IBD患者中有效性的系统评价/Meta分析,检索时限均为建库至2022年4月30日。由2名研究者独立筛选文献、提取资料后,采用系统评价方法学质量评价工具(AMSTAR 2)对纳入文献进行方法学质量评价,采用证据质量分级和推荐强度(GRADE)系统对纳入文献的主要结局指标进行证据质量分级,采用描述性分析法对远程医疗在IBD患者中应用的有效性进行分析。结果共纳入6篇系统评价/Meta分析,AMSTAR 2评价结果显示,1项研究的方法学质量为低,5项研究的方法学质量为极低;未报告前期研究方案、全文阅读阶段中被排除研究的清单、纳入研究的资金来源及发表偏倚是导致各项研究方法学质量较低的主要原因。GRADE系统评价结果显示,6项研究中共涉及10个结局指标进行Meta分析,其中3个指标的GRADE系统分级为中级,4个指标的GRADE系统分级为低级,3个指标GRADE系统分级为极低级;主要降级因素为研究局限性,其次为不一致性、不精确性、发表偏倚。结论远程医疗在IBD患者中应用效果的系统评价/Meta分析的方法学质量及结局指标证据质量偏低,结论可靠性较低,未来需开展更多高质量的系统评价/Meta分析来证实远程医疗在IBD患者中应用的有效性。

Objective To reevaluate the systematic review/Meta-analysis of effectiveness of telemedicine in patients with inflammatory bowel disease(IBD).Methods Systematic reviews/Meta-analyses of the effectiveness of telemedicine in patients with IBD were searched through computers on China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,Cochrane Library,Embase,Web of Science,Ovid,and CINAHL.The search time limit was from the establishment of the database to April 30,2022.After independently selecting and extracting data from the article,two researchers used the A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2)to evaluate the methodological quality of the included study.The Grades of Recommendations Assessment,Development and Evaluation(GRADE)system was used to grade the main outcome indicators of the included study by two researchers.Descriptive analysis was used to analyze the effectiveness of telemedicine in patients with IBD.Results A total of six systematic reviews/Meta-analyses were included.The AMSTAR 2 evaluation results showed that the methodological quality of one study was low,while the methodological quality of five studies was extremely low.The main reasons for the low methodological quality of various studies were the failure to report the previous research protocol,the list of excluded studies during the full text reading stage,the funding sources of included studies,and publication bias.The results of the GRADE system evaluation showed that a total of 10 outcome indicators were involved in the six studies for Meta-analysis,with three indicators having a GRADE system rating of intermediate,four indicators having a GRADE system rating of low,and three indicators having a GRADE system rating of extremely low.The main degradation factors were research limitations,followed by inconsistency,imprecision,and publication bias.Conclusions Systematic reviews/Meta-analyses of the effectiveness of telemedicine in patients with IBD have low methodological quality and outcome indicators,and the reliability of conclusions is low.More high-quality systematic reviews/Meta-analyses are needed in the future to confirm the effectiveness of telemedicine in patients with IBD.