Summary of findings 1. Patient education and standard care compared to standard care for the management of inflammatory bowel disease.
| Patient education and standard care compared to standard care for the management of inflammatory bowel disease | ||||||
| Patient or population: people with inflammatory bowel disease Setting: hospitals and tertiary centres in USA, Canada, Germany, Sweden, UK, the Netherlands Intervention: patient education plus standard care (the patient education interventions were information booklets, text messages, e‐learning, a multi professional group‐based programme, guidebooks, a staff‐delivered programme based on an illustrated book, a standardised programme followed by group session, lectures alternating with group therapy, educational sessions based on an inflammatory bowel disease guidebook, internet blog access and text messages, a structured education programme, and interactive videos) Comparison: standard care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with standard care | Risk with patient education and standard care | |||||
| Disease activity (3‐12 months) |
‐ | SMDa 0.03 lower (0.25 lower to 0.2 higher) | ‐ | 479 (2 studies) | ⊕⊕⊕⊝ moderate b | As a rule of thumb (i.e. a broadly accurate guide), 0.2 SMD represents a small difference, 0.5 SMD a moderate one, and 0.8 SMD a large effect. |
| Flare‐ups or relapse (mean number during study period, start‐12 months) (continuous outcome) | ‐ | MD 0.00 lower (0.06 lower to 0.05 higher) | ‐ | 1022 (2 studies) | ⊕⊕⊕⊝ moderate b | ‐ |
| Flare‐ups or relapse (4‐12 months) (dichotomous outcome) | Study population | RR 0.94 (0.41 to 2.18) | 307 (3 studies) | ⊕⊝⊝⊝ very lowc | ‐ | |
| 67 per 1000 | 63 per 1000 (27 to 188) | |||||
| Quality of life (2 weeks‐12 months) | ‐ | SMDa 0.08 higher (0.03 lower to 0.18 higher) | ‐ | 1364 (6 studies) | ⊕⊕⊕⊝ moderate b | As a rule of thumb, 0.2 SMD represents a small difference, 0.5 SMD a moderate one, and 0.8 SMD a large effect. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
a SMD was used when a continuous outcome was measured on two or more different scales by the studies included in the meta‐analysis
bDowngraded one level due to concerns with risk of bias, related mainly to blinding and allocation concealment
cDowngraded three levels: one level due to serious concerns with risk of bias, related mainly to blinding and allocation concealment, and two levels due to imprecision due to very low event numbers.