A mixed-methods systematic review and meta-analyses of the effectiveness of telehealth management of functional and inflammatory bowel diseases

Abstract Background Telehealth use in functional and inflammatory bowel diseases (FIBD) has expanded since COVID-19, yet its clinical and psychological effectiveness remains uncertain. Methods We conducted a JBI mixed-methods systematic review of studies published from January 2020 onward to evaluate effectiveness and identify barriers and enablers influencing its success. MEDLINE, Embase, Scopus, CINAHL and grey literature were searched. Quantitative data were synthesised using random-effects meta-analysis, and qualitative studies were meta-aggregated and conceptualised using the COM-B and TAM2 frameworks. Results Forty-four studies (6784 patients; 37 professionals) from 14 countries were included. Telehealth reduced gastrointestinal symptom severity (5 RCTs, n = 479; Hedges’ g = -0.71, 95% CI − 1.14 to − 0.28; I 2 = 74.6%), improved quality of life (10 RCTs, n = 1081; Hedges’ g = 0.31, 95% CI 0.01 to 0.61; I 2 = 76.9%), and reduced anxiety (7 RCTs, n = 522; Hedges’ g = -0.45, 95% CI − 0.83 to − 0.06; I 2 = 78.9%). Effects on depression, stress and disease activity were not significant. Qualitative synthesis identified behavioural and system-level factors influencing effectiveness, including digital capability, accessibility, usability, perceived value and patient-clinician interaction. Conclusion Telehealth may improve gastrointestinal symptoms and may provide modest benefits for quality of life and anxiety in FIBD, although heterogeneity across FIBD populations and telehealth modalities was substantial. Outcomes may vary across disease groups and delivery formats, and depend on usability, infrastructure and interaction quality.