Telemedicine and digital health for chronic conditions in pediatrics: A systematic review

Abstract

Background

The prevalence of chronic diseases in children and adolescents has significantly increased. The COVID-19 pandemic accelerated telemedicine adoption, leading to improved healthcare access and outcomes. Despite its benefits, telemedicine is still not fully integrated into standard care. Previous reviews have been limited in scope. This systematic review aims to provide a comprehensive overview of recent trials on web or app-based telemedicine for chronically ill children and adolescents, identifying interventions and outcomes for future healthcare strategies.

Methods

A comprehensive search was conducted on PubMed on November 21, 2023, and updated on January 9, 2025. Results were filtered to include prospective intervention studies involving children and adolescents with chronic conditions and limited to publications from 2017 onwards. A total of 8699 results were retrieved, and 1506 titles were screened for eligibility, resulting in 116 studies included in the review.

Results

These studies covered 45 different conditions, with the highest numbers for diabetes, asthma, and obesity. Telemedicine interventions varied, including gamification, video meetings, integrated devices, psychological components, symptom tracking, and educational content. Most studies reported high feasibility and patient satisfaction. Clinical outcomes improved in some cases, and none were worse than standard care. The heterogeneity limited direct comparisons and meta-analysis, and small sample sizes in many studies affected the generalizability and statistical significance of the findings.

Conclusions

Our study highlights the potential of telemedicine in managing chronic illnesses among children, emphasizing the need for standardized methodologies, larger sample sizes, and continued investment in infrastructure and equitable policies to fully realize its benefits in improving accessibility, convenience, cost savings, and overall health outcomes.

Keywords

Telemedicine pediatrics children adolescents chronic conditions chronic illness systematic review‌

Introduction

In the US, prevalences of chronic disease in children rose from 12% to 26% between 1994 and 2006.¹ In Germany, 16% of children and adolescents (0–17 years) have a reported chronic disease.² The most common chronic conditions include obesity (prevalence 15–25% in Europe³), attention deficit hyperactivity disorder (ADHD) (∼5% worldwide⁴), asthma (2–32%⁵).

Chronic conditions in children and adolescents also severely impact their caregivers. Not only do they have to invest time and money, but chronic illness also affects quality of life and perceived burden.^6–8

The COVID-19 pandemic has pushed the development and acceptance of telemedicine, especially teleconsultations, to a new level. Remote and digital services played a vital role in ensuring health care accessibility.^9,10

The World Health Organization (WHO) highlights various benefits of digital technologies in medicine, such as improved clinical outcomes and overall advantages for both patients and healthcare professionals.¹¹ These include enhanced access to information, education, and health care services; reduced healthcare costs and travel time; greater flexibility; and improved interdisciplinary collaboration for healthcare providers.^10,12

Despite its growing popularity, several difficulties still hinder the full integration of telemedicine into routine healthcare.^12–14 Barriers to telemedicine include poor internet access, lack of interest and resources to implement new technologies, and poor digital literacy,¹¹ as well as bureaucratic and organizational challenges.¹² Some individuals are concerned about a weakened relationship with their healthcare providers or the quality of information.¹²

Previous reviews have shown that telemedicine for children and adolescents is comparable or better than regular in-person care. However, they also emphasize the need for more research¹⁵ and broader application beyond clinical studies¹⁶ Existing interventions are often limited to specific conditions, such as cardiology,^17,18 obesity,¹⁹ and asthma.²⁰ Medical complexity²¹ targets various chronic conditions, but is limited to those with serious functional limitations.

Existing reviews are characterized by a narrow scope of included conditions or a low number of studies. The last systematic review about telemedicine in pediatrics from Shah (2021) only included eleven randomized controlled trials.¹⁵ There are no reviews that provide a complete overview of the topic. The COVID-19 pandemic accelerated the development of telemedicine options, leading to a surge in recently published studies, which have yet to be included in a systematic review.

This systematic review aims to provide a comprehensive overview of the latest trials focused on the application of telemedicine for chronically ill children. Recently, the importance of telemedicine in managing the healthcare needs of this marginalized population has become increasingly evident. Identifying the diseases and interventions used in telemedicine for chronically ill children is crucial for understanding the healthcare landscape and developing future strategies. This analysis aims to provide insights into tailored telemedicine methodologies, highlight the diversity of approaches, and identify best practices to inform future healthcare strategies for this population.

Methods

Following the PRISMA guidelines, the research question for this review was formulated using the Population, Intervention, Comparison, Outcome (PICO) framework: What telemedicine interventions exist for chronically ill children, which conditions do they cover, and how effective are they? The objectives of this review were to assess the clinical outcomes of telemedicine and evaluate its feasibility.

Population: children and adolescents with a chronic or long-term condition

Intervention: app- or web-based medical interventions

Comparison: no specified comparison

Outcome: clinical outcomes, feasibility

Inclusion and exclusion criteria

Studies were included if they met the following criteria: patients under 18 years of age, with conditions not expected to resolve within three months and/or requiring ongoing medical attention or care; telemedicine delivered via smartphone or web app, website, or video meeting; actively involving the patients; published in 2017 or later; and categorized as intervention studies.

Exclusion criteria were studies involving patients over 25 years, short-term conditions, studies on vaccinations, prevention, or screening/diagnosis; interventions primarily used by parents or caregivers rather than the children themselves. Remote monitoring was included if it was managed by patients themselves (e.g., diabetes). Additionally, studies were excluded if telemedicine was optional or consisted only of phone calls, text messages, social media interactions, or fitness trackers.

An exception was made for studies that conducted a separate analysis on a subgroup meeting the inclusion criteria. Patients aged 18 to 25 were included due to the variable transition from pediatric to adult care, particularly for adolescents with chronic conditions.

Search strategy

A comprehensive search was conducted using the PubMed database (November 21, 2023). An update was made on January 9, 2025. The following search terms were used: telemedicine, telehealth, mobile health, mhealth, ehealth, combined with pediatrics, children, adolescents, or teenagers. Results were filtered for ‘clinical trials’ and ‘randomized controlled trials’. The search was limited to publications from 2017 to the retrieval date, considering the noticeable increase in results for all search terms during this period.

Quality assessment

Study quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for randomized controlled trials²² or quasi-experimental studies,²³ depending on study type.

All authors independently reviewed, rated, and selected the studies based on the above criteria. Initial disagreements among authors during study selection were resolved through discussion, after which no further disagreements remained. Information was extracted on condition, study design, age, number of participants, intervention, control, and results. R was used to automate various workflows and generate figures and tables.

Results

Study selection

A total of 8699 results were retrieved from the database. After removing duplicates, 1506 titles were screened for eligibility. The reasons for exclusion are detailed in the PRISMA diagram (Figure 1). Two secondary analyses were excluded from the total count but were incorporated into the primary publication. This review includes 116 studies. The flow diagram was generated using the PRISMA2020 online tool.²⁴

Figure 1.

PRISMA flow diagram.

Study characteristics

For readability, the remaining 116 studies were stratified by targeted condition (Table 1). Interventions for 45 different conditions were identified. The highest number of studies were focused on diabetes (n = 14), asthma (14), and obesity (13) (Table 2). Seventy-Nine studies were randomized controlled trials, 18 were clinical trials, two were quasi-experimental studies, and 13 assessed feasibility. The number of participants ranged from 7 to 428 (mean ± SD= 96.34 ± 95.11) with ages from 0 to 25 years. Most studies included between 40 and 101 participants, with ages primarily between 10 and 17 (Figures 2 and 3).

Figure 2.

Number of studies that include n participants.

Figure 3.

Number of studies that include patients at a certain age (years).

Table 1.

Conditions stratified by groups.

Disease Group	Condition
asthma	asthma
chronic pain	chronic pain, fibromyalgia, functional abdominal pain disorder
diabetes	diabetes type 1
genetic and congenital diseases	Duchenne muscular dystrophy, Marfan syndrome, sickle cell disease, spina bifida
neurological and developmental disorders	ASD, ME/CFS, MS, ADHD, amblyopia, apraxia of speech, brain damage, cerebral palsy, epilepsy, migraine, tic disorders
obesity	obesity
other rheumatic and immunological diseases	HIV, arthritis, celiac disease, inflammatory bowel disease, neurofibromatosis
psychiatric disorders	OCD, anxiety disorder, depression, insomnia, suicidality
various/other conditions	cancer, chronic condition and depression or anxiety, chronic medical conditions, heart transplant, medical complexity, transplantation, visible difference

ASD: autism spectrum disorder; ME/CFS: myalgic encephalomyelitis/chronic fatigue syndrome; MS: multiple sclerosis; ADHD: attention deficit/hyperactivity disorder; HIV: human immunodeficiency virus; OCD: obsessive-compulsive disorder.

Table 2.

Number of studies by disease group.

Disease Group	n
neurological and developmental disorders	24
asthma	14
diabetes	14
obesity	13
various/other conditions	13
genetic and congenital diseases	12
psychiatric disorders	12
other rheumatic and immunological diseases	9
chronic pain	5

Location

The distribution of studies across continents shows North and South America leading, with a combined total of 54 studies. Most were conducted in North America, while one was multi-centered across both continents. Europe follows with 34 studies, while Asia and Australia contributed 17 and 11 studies, respectively. This highlights the geographical distribution of research, with a higher concentration in North America and Europe compared to Asia and Australia.

Telemedicine approaches

Diabetes type 1

Diabetes was the most commonly studied condition with 14 studies. Four studies^25–28 used video consultations as an add-on or substitute for regular inpatient visits. Satisfaction was high, but HbA1C decreased in only two cases.^26,27 App-based interventions included educational content, bolus calculation, and communication facilitation between patients and caregivers; all rated highly acceptable. Remote sharing of blood glucose and insulin pump data was implemented in six studies. HbA1C improvements were greater in intervention groups, but statistically significant in only five cases. Quality of life was measured in four studies. It improved in one case28 and in another case for caregivers but not for patients.²⁹ Some technical issues were reported, such as difficulties using the video conferencing or data- sharing system.^26,30 One study reported increased distress associated with inpatient visits.²⁵ (Table 3).

Table 3.

Diabetes.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Maxwell TK et al. 2023 USA ³¹	A Randomized Pilot Trial Using Mobile Health and Financial Incentives to Motivate Heart-Healthy Behaviors in Adolescents With Type 1 Diabetes	RCT	diabetes	14–19	44/22	psychoeducational/ behavioral intervention. step-tracking app with team challenges, financial rewards	CAU	– no substantial changes in body weight, BP, lipid levels, or HbA1c – Adolescent Food Habits Checklist scores improved significantly in both groups (IG: 2.9-point increase, p = 0.008; CG: 2.0-point increase, p = 0.02) – 82% in IG reported an increase in at least one heart-healthy behavior
Hannon TS et al. 2018 USA ³²	Advancing diabetes management in adolescents: Comparative effectiveness of mobile self-monitoring blood glucose technology and family-centered goal setting	RCT	diabetes	12–18	97/33/33/31	(1) blood glucose monitoring using web portal, phone or text messages by health care provider (2) family-centered goal-setting (3) combined approach	-	– no change in mean HbA1c in IG1 – non-significant decrease in HbA1c of −0.3% (p = 0.26) in IG2 from baseline to 6 months – significant decrease in HbA1c of −0.6% (p = 0.02) in IG3 from baseline to 3 months, but the decrease of −0.4% at 6 months was non-significant (p = 0.51) – the change in HbA1c from baseline to 3 months was greater for IG3 than for IG1 (p = 0.05) or IG2 (p = 0.01)
Klee P et al. 2018 Switzerland ³³	An Intervention by a Patient-Designed Do-It-Yourself Mobile Device App Reduces HbA1c in Children and Adolescents with Type 1 Diabetes: A Randomized Double-Crossover Study	RCT	diabetes	10–18	55/28	app with bolus calculation, list of nutrients, meal sizes	waitlist control	– reduction of HbA1c by 0.33% in IG, compared to CG 0.21% (p = 0.048) in patients with HbA1c values >8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia – no changes or differences in QoL scores – the app was well accepted by the users who completed the study (46.4% rated as good and 39.3% as excellent)
Holtz B et al. 2021 USA ³⁴	An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study	feasibility CT	diabetes	10–15	25	app with symptom tracking, treatment advice, education, parent communication	-	– diabetes care adherence (p = 0.02) and QoL (p = 0.01) significantly improved – HbA1c levels (p = 0.51) and family conflict (p = 0.14) changed in the hypothesized direction, but not significant – higher use of app was associated with more improvement in HbA1c levels (p < 0.005) – adolescents and parents were satisfied with the app intervention
Alfonsi JE et al. 2020 Canada ³⁵	Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial	RCT	diabetes	8–17	44/22	app that identifies food through images by using machine learning, support in counting carbohydrates	CAU	– improved carbohydrate counting accuracy (total grams per meal, p = 0.008), reduced frequency of individual counting errors greater than 10 g (p = 0.047), and lower HbA1c levels (p = 0.03) in IG – positive qualitative interviews – high acceptability – no major technical challenges
Garcia JF et al. 2023 USA ²⁵	Greater Telehealth Use Results in Increased Visit Frequency and Lower Physician Related-Distress in Adolescents and Young Adults With Type 1 Diabetes	RCT	diabetes	16–25	68/22/10	(1) person- centered care clinic visits; virtual peer group and doctor's appointments via video meeting (2) CAU via video meeting	(1) person-centered care clinic visits; virtual peer group in person (2) CAU	– increased attendance to diabetes care visits for those who had most visits (>50%) online (3.3 visits vs 2.5 visits; p = .007) – increased physician-related distress in patients with more in-person visits (p = .03)
Crossen SS et al. 2020 USA ²⁶	Home Visits for Children and Adolescents with Uncontrolled Type 1 Diabetes	CT	diabetes	3–17	57	monthly video consultation with doctor + CAU	-	– significant improvement in mean HbA1c in both intention-to-treat (N = 57) analysis (10.8% [95 mmol/mol] to 10.0% [86 mmol/mol], p = 0.01) and per-protocol (N = 30) analysis (10.8% [95 mmol/mol] to 9.6% [81 mmol/mol], p = 0.004) – completion of ≥4 annual diabetes clinic visits improved significantly from 21% at baseline to 83% during the study period for the entire cohort, p < 0.0001 – no significant change in frequency of diabetes-related emergency and hospital encounters
Mulvaney SA et al. 2018 USA ³⁶	Mobile Momentary Assessment and Biobehavioral Feedback for Adolescents with Type 1 Diabetes: Feasibility and Engagement Patterns	RCT	diabetes	13–19	44/30	app + meter; tracking of meals, blood glucose, insulin bolus; data visualization; text message reminders	meter only	– the median number of momentary assessments per participant was 80.0 (range 32–120) with 2.60 per day. By 2 weeks participants had an average of 40.77 ± 12.23 assessments. – number of app assessments submitted were significantly related to higher mean daily blood glucose measurements (r = −0.44, p < 0.05) and to lower% missed mealtime blood glucose measurements (r = −0.47, p < 0.01). – number of feedback viewing sessions was related to a lower% missed mealtime blood glucose measurement (r = −0.44, p < 0.05) – no group × time differences in mean daily blood glucose measurements – three trajectory groups distinguished by assessment frequencies and rates of decline; engagement group membership was significantly related to gender, mean daily blood glucose measurements, and HbA1c values
von Sengbusch S et al. 2020 Germany ²⁷	Outcomes of monthly video consultations as an add-on to regular care for children with type 1 diabetes: A 6-month quasi-randomized clinical trial followed by an extension phase	RCT	diabetes	1–16	240/120	monthly video consultations with doctor + CAU	waitlist control/CAU	– HbA1c at 6 months was 0.11% lower in the IG than that in the CG (95% CI −0.31 to 0.09, p = 0.277) – significant HbA1c improvement after 12 months (−0.31 [CI −0.49 to −0.14]; p < 0.001), which increased further until month 15 (−0.35 [CI −0.55 to −0.15]; p < 0.001) – lower diabetes burden of the main caregivers and higher parental treatment satisfaction in IG than in CG (p < 0.005)
Crossen SS et al. 2023 USA ³⁰	Remote glucose monitoring is feasible for patients and providers using a commercially available population health platform	CT	diabetes	1–20	39	remote data sharing of CGM devices with clinician	-	– data-sharing was successful for 36 of 39 participants (92%) – between 33%-66% of participants merited outreach each month, and clinician outreach required a median of 10 min per event – remote patient monitoring (RPM) was reported to be helpful by 94% of participants – RPM was associated with a glucose management indicator (GMI) change of -0.25% (p = 0.047) for the entire cohort; stratified analysis revealed greatest treatment effects among participants with baseline GMI of 8.0–9.4% (GMI change of -0.68%, p = 0.047; 19.84% reduction in time spent >250 mg/dl, p = 0.005)
Tonyushkina KN et al. 2018 USA ²⁸	Televisits to Partially Substitute for Clinic Visits Are Feasible and Well Accepted by Tech-Savvy Patients With T1DM and Their Families: A Prospective Pilot Study	CT	diabetes	9–22	10	substituting three of four yearly recommended clinic visits with videocalls	-	– HbA1C did not change significantly over the year – all participants expressed high satisfaction with care and asked to continue with the televisits – Televisits lasted on average for 34 min (25–45 min), were preceded by review of the blood glucose (BG) data that were sent 100% of the time in advance (within 3–24 h before the visit) ensured by ∼3 reminders – 8 of 10 participants used an insulin pump and a half of them needed a review of the upload process – all visits were followed by a written communication (e-mailed securely) including insulin adjustments and recommendations regarding diabetes self-management. – one or both parents participated in televisits with children and adolescents
Chatzakis C et al. 2019 Greece ³⁷	The Beneficial Effect of the Mobile Application Euglyca in Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial	RCT	diabetes	7–17	80	app for calculation of bolus insulin dose	no intervention	– significant decrease in HbA1c values and increase in percentages of normoglycemias and DTSQ scores in IG compared to CG (p < 0.05) – significant positive linear correlation between DTSQ score and percentages of normoglycemias and significant negative correlation between changes in percentages of normoglycemias (Δnormoglycemias) and changes in HbA1c (ΔHbA1c) in IG (p < 0.05)
Di Bartolo P et al. 2017 Italy ³⁸	Young patients with type 1 diabetes poorly controlled and poorly compliant with self-monitoring of blood glucose: can technology help? Results of the i-NewTrend randomized clinical trial	RCT	diabetes	14–24	182/92	experimental glucose meter + app for diabetes management	traditional glucose meter	– HbA1c changes (±SE) were -0.44% ± 0.13 in IG and -0.32% ± 0.13 in CG (p = 0.51) after 6 months – in the post-trial phase, HbA1c changes from 6 months (±SE) were -0.07% ± 0.14 in IG and -0.31% ± 0.14 in CG (p = 0.24) – compliance end point was reached by 53.6% in IG and 55.0% in CG (p = 0.86) – mean daily SMBG measurements increased from 1.1 to 2.3 in both groups without worsening QoL – compliant subjects showed a greater reduction in HbA1c levels (-0.60% ± 0.23 in IG; -0.41% ± 0.21 in CG; p = 0.31) – within IG group, telemedicine users (38.0%) reduced HbA1c by -0.58 ± 0.18.
Holtz BE et al. 2024 USA ²⁹	The effect of an mHealth intervention for adolescents with Type 1 diabetes and their parents	pilot RCT	diabetes	10–15	43/31	app that mediates communication between patient and parent and provides videos from peers	CAU	– high satisfaction – stable HbA1c in IG, worse in CG – improvements in treatment adherence and parent QoL in IG – no improvements in QoL for adolescents

BP: blood pressure; CAU: care as usual; CG: control group; CGM: continuous glucose measurement; CI: confidence interval; CT: clinical trial; DTSQ: Diabetes Treatment Satisfaction questionnaire; HbA1c: glycated hemoglobin; IG: intervention group; QoL: quality of life; RCT: randomized controlled trial; SMBG: self-monitoring of blood glucose.

Asthma

Telemedicine options for asthma patients include asthma education, symptom tracking, lung function monitoring, and medication tracking. Most interventions (8/14) included educational content, three of which were delivered via video call. Two interventions evaluate online outpatient visits; one peer support; and one follow-ups after emergency visits. Results in measured categories were either better in the intervention group (IG) or not significantly different from the control group (CG). Significantly better results were achieved in asthma control,^39–45 medication adherence,³⁹ symptom-free days,^40,46,47 economic burden,^39,41 disease knowledge,⁴⁸ and quality of life.^41,45,48 No outcome in the IG was worse than in the CG. Patient satisfaction was high with video calls and apps. (Table 4).

Table 4.

Asthma.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Lv S et al. 2019 China ³⁹	A randomized controlled trial of a mobile application-assisted nurse-led model used to improve treatment outcomes in children with asthma	RCT	asthma	6–11	152/77	mobile app to manage asthma + CAU	CAU	– frequency of asthma exacerbations decreased in both IG and CG, with a greater decrease in IG (p < 0.05) – better secondary outcomes in IG: improved adherence, higher Childhood Asthma Control Test scores, decreased respiratory tract infections, days of antibiotic use, days of school absence, parental work loss, medical expenses (all p < 0.05)
van den Wijngaart LS et al. 2017 Netherlands ⁴⁰	A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control	RCT	asthma	6–16	210/105	online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring).	CAU	– higher symptom-free days in IG (difference of 1.23 days, 95% CI 0.42–2.04; p = 0.003) after follow-up – higher improvement in asthma control in IG (difference of 1.17 points, 95% CI 0.09–2.25; p = 0.03) – no differences for other outcome measures
Shdaifat MBM et al. 2022 Jordan ⁴¹	Clinical and economic impact of telemedicine in the management of pediatric asthma in Jordan: a pharmacist-led intervention	RCT	asthma	5–11	90	education by pharmacist through synchronized video call	CAU	– more significant improvement in clinical and economic outcomes in IG than CG – Childhood Asthma Control Test mean scores [p = 0.0134], – decreased parental loss of wages [p = 0.0015] – decreased economic burden [p < 0.001] – overall improvement in QoL – satisfaction with telemedicine sessions
Ljungberg H et al. 2019 Sweden ⁴²	Clinical effect on uncontrolled asthma using a novel digital automated self-management solution: a physician-blinded randomised controlled crossover trial	RCT	asthma	6–17	40	app with symptom and lung function tracking by Bluetooth spirometer, feedback and medication advice, cloud-based data storage	crossover TAU	– asthma control significantly improved in IG compared to CG (mean difference 0.70, 95% CI 0.06–1.34; p = 0.03) – adherence did not improve significantly (p = 0.67)
Al Raimi AM et al. 2022 Malaysia ⁴⁸	Effect of Health Education via Mobile Application in Promoting Quality of Life Among Asthmatic Schoolchildren in Urban Malaysia During the COVID-19 Era: A Quasi-experimental Study	QE	asthma	13–16	214/107	health education via a mobile app	face-to-face health education	– total QoL improved for both groups (IG: 5.01 ± 1.36 to 5.85 ± 1.29; CG: 5.31 ± 1.27 to 5.66 ± 1.28), with a significant difference between groups and between pre- and post-intervention (p < 0.001 for all)
Kosse RC et al. 2019 Netherlands ⁴³	Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial	RCT	asthma	12–18	234/147	app with symptom monitoring, education, reminders, chat with pharmacist and peers + CAU	CAU	– adherence rates of patients with low baseline adherence (MARS scores ≤19) increased by 1.42 points in IG, 0.70 points in CG (MARS +2.12, p = 0.04) – this effect was stronger (MARS +2.52, p = 0.02) in poor adherent adolescents with uncontrolled asthma – no effect of the intervention on asthma control or QoL
Halterman JS et al. 2018 USA ⁴⁶	Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial	RCT	asthma	3–10	400/200	supervised administration of medication at school, school-based telemedicine visits for assessment, medication prescription, follow-up care	enhanced CAU	– IG had more symptom-free days per 2 weeks postintervention compared with CG (11.6 vs 10.97; difference, 0.69; 95% CI, 0.15–1.22; p = 0.01), largest difference at final follow-up (difference, 0.85; 95% CI, 0.10–1.59). – IG were less likely to have an emergency department visit or hospitalization for asthma (7% vs 15%; odds ratio, 0.52; 95% CI, 0.32–0.84) – in IG, 196 (98.0%) had 1 or more telemedicine visits; 165 (82.5%) received supervised therapy through school
Stukus DR et al. 2018 USA ⁴⁹	Real-world evaluation of a mobile health application in children with asthma	RCT	asthma	0–21	98	app with medication and trigger reminders and treatment plan	online information	– groups were similar in having more than 2 comorbidities (34% vs 32%) and receiving National Heart, Lung, and Blood Institute step 3 treatment or higher (69% vs 57%) – no significant decrease in emergency department or urgent care visits or hospitalizations between groups – IG participants were more likely to report improvement in asthma management 6 months after study enrollment (79% vs 64%; p = 0.06)
Perry TT et al. 2018 USA ⁴⁷	Results of an asthma education program delivered via telemedicine in rural schools	RCT	asthma	7–14	363/180	school-based asthma education via video meeting	CAU	– no significant group differences in reported symptom-free days – significantly higher use of peak flow meters (p < 0.01) and medication adherence (p = 0.03) in IG compared to CG – no changes in other outcome measures (QoL, self-efficacy, asthma knowledge, lung function) between groups
Montalbano L et al. 2019 Italy ⁵⁰	Targeting quality of life in asthmatic children: The MyTEP pilot randomized trial	RCT	asthma	6–11	50/25	app connected to spirometer; on-site education, skill training, group sessions	app	– Pediatric Asthma QoL score improved in both IG (p = 0.014) and CG (p = 0.046) with the minimally clinically significant difference of ⩾0.5 points reached in 23% of IG and in 16% of CG – changes in QoL were greater in IG (LS mean difference: 0.269 p = 0.05) – QoL score was positively associated with IG (p = 0.023) and study time (p = 0.002); and inversely associated with current passive smoke exposure (p = 0.003)
Al Raimi AM et al. 2022 Malaysia ⁴⁴	The effect of mobile applications in enhancing asthma knowledge among school children with asthma in Malaysia	QE	asthma	13–16	214/107	app with health education	routine face-to-face education	– the mean knowledge score increased post-intervention in IG from 15.5 ± 8.77 to 24.6 ± 6.69 – the proportion of children with a high level of knowledge was the highest in IG post-intervention – the intervention led to a statistically significant improvement in the asthma knowledge of the children (F [1, 288] = 22.940, p ≤0.01)
Fedele DA et al. 2021 USA ⁵¹	Using Mobile Health to Improve Asthma Self-Management in Early Adolescence: A Pilot Randomized Controlled Trial	RCT	asthma	12–15	33/17	app with medication reminders, symptom tracking, education	self-guided attention control	– very high satisfaction with content, functionality, and helpfulness of intervention – significant improvements in asthma control scores (p = 0.04) in IG compared to CG (surpassed the minimally clinically important difference threshold) – the magnitude of improvements in family asthma management, asthma-related quality of life, and family communication was larger in IG, but not statistically significant
Halterman JS et al. 2024 USA ⁴⁵	Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial	RCT	asthma	3–12	373/185	school-based telemedicine follow-ups, point-of-care prompting	enhanced CAU	– more follow-up visits and use of preventive medication in IG – no group differences in medication adherence or asthma morbidity – greater improvements in symptom free days in IG (only prepandemic)

CAU: care as usual; CG: control group; CI: confidence interval; IG: intervention group; LS: least square; MARS: Medication Adherence Report Scale; QE: quasi-experimental study; QoL: quality of life; RCT: randomized controlled trial; TAU: treatment as usual.

Other rheumatic and immunological diseases

The conditions in this subgroup were celiac disease (n = 1), HIV (2), neurofibromatosis (1), inflammatory bowel disease (2), and juvenile idiopathic arthritis (3). All but one study targeted children aged 10 years and older.

Two very different approaches (mobile game and video coaching) for HIV treatment led to improved medication adherence in both studies.

Health-related quality of life improved in two of three interventions for arthritis patients. Pain levels significantly improved in all of them. All interventions used self-management, two via web and one via mobile app. The mobile app also included peer support.

Although health problems were detected more frequently in the celiac disease study and more than half of the patients wanted to continue online treatment, patient satisfaction was slightly lower in the intervention group.⁵²

The two trials for inflammatory bowel disease were conducted by the same researchers, both reported non-inferiority to regular in-patient treatment.^53,54 Issues with evaluation due to faulty app usage recording were reported in one case.⁵⁵ (Table 5).

Table 5.

Other rheumatic and immunological diseases.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Hightow-Weidman L et al. 2021 USA ⁵⁵	Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men	RCT	HIV	16–24	146/78	app with medication reminders, adherence-monitoring, feedback, quizzes	control app with information	– both groups showed improved virulogic suppresion at 26-weeks (62.9% IG; 73.5% CG; ARR = 0.93 (95% CI 0.73, 1.18)) and antiretroviral adherence – intervention effects were amplified in IG – issues with recruitment and app usage metrics limit the ability to say that the app was effective in causing behavior changes resulting in improved health outcomes
Amico KR et al. 2022 USA ⁵⁶	Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV	RCT	HIV	13–24	89/43	video coaching	CAU	– median [Q1, Q3] percent days medication adherence was higher in IG (72% (47%, 89%)) versus CG (41% (21%, 59%); p < 0.001) – incidence of numbers of 7-day gaps between medication were lower (IG to CG ratio: 0.40; 95% CI 0.30, 0.53; p < 0.001) – no differences in viral suppression at week 12 (IG 35%; 95% CI 21%, 51% versus CG 36%; 95% CI 22%, 51%; p > 0.99) or later time-points
Connelly M et al. 2019 USA ⁵⁷	Multisite Randomized Clinical Trial Evaluating an Online Self-Management Program for Adolescents With Juvenile Idiopathic Arthritis	RCT	arthritis	12–18	145	self-management program including psychoeducation, coping skills, stress management via web portal	online disease education program	– significant improvements in pain intensity, pain interference, and HRQoL in both groups, no significant group differences – effect sizes for improvements were small – the amount of improvement in self-efficacy, emotional avoidance coping, disease knowledge, and emotional functioning in part predicted improvement in pain and HRQoL outcomes
Stinson JN et al. 2020 Canada ⁵⁸	Teens Taking Charge: A Randomized Controlled Trial of a Web-Based Self-Management Program With Telephone Support for Adolescents With Juvenile Idiopathic Arthritis	RCT	arthritis	12–18	333	web-based self-management	web-based education	– significant overall reductions in pain intensity (p = 0.02) and pain interference (p = 0.007) in IG compared with CG – significant overall improvement in HRQoL related to problems with pain (p = 0.02) and problems with daily activities (p = 0.01) – significant difference in IG over time (p = 0.008) for HRQoL related to treatment problems, with IG demonstrating improved HRQoL by 12 months compared with CG – nonsignificant improvements in both groups compared with baseline in other primary outcomes – no significant differences between groups in any secondary outcomes or caregiver-reported outcomes
Lalloo C et al. 2021 Canada ⁵⁹	The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial	feasibility RCT	arthritis	12–18	60	app with symptom tracking, psychological advice, education, peer support	app version with symptom tracking only	– rates of accrual and attrition were 82 and 13%, respectively – both apps were deployed with high success (over 85%) and were rated as highly acceptable – similar adherence for both groups, most participants demonstrating moderate-to-high adherence – clinically meaningful reduction in pain intensity (≥1 point) in both group; no group differences – no significant changes in activity limitations or HRQoL
Vriezinga S et al. 2018 Netherlands ⁵²	E-Healthcare for Celiac Disease-A Multicenter Randomized Controlled Trial	RCT	celiac disease	2–24	304/156	video meeting in follow-up	CAU	– performance of the point-of-care (POC) test was inferior to laboratory testing (2/156 positive POC tests vs 13/148 positive laboratory tests; p = 0.003) – significantly more frequent detection of health problems in online consultation. – similar detection of growth problems and dietary transgressions – improvement in HRQoL improved in IG (3.25 to 3.16 [p = 0.013] vs CG 3.10 to 3.23; p = 0.810) – patient satisfaction 7.6 (IG) vs 8.0 (CG; p = 0.001); – 58% wished to continue online consultations – €202 less mean costs per participant during the studied period for the IG (p < 0.001)
Carlsen K et al. 2017 Denmark ⁵³	Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease	CT	inflammatory bowel disease	10–17	50/29	web-based symptom tracking and medication calculation	TAU	– 94 infusions in IG (mean interval 9.5 ± 2.3 weeks) vs 105 infusions in CG (mean interval 6.9 ± 1.4 weeks) – longer treatment intervals in IG (p < 0.001). – QoL did not change – no group difference of IFX (Infliximab) antibodies – 80% of patients reported increased disease control – 63% (86% of parents) reported improved knowledge of the disease
Carlsen K et al. 2017 Denmark ⁵⁴	Self-managed eHealth Disease Monitoring in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Controlled Trial	RCT	inflammatory bowel disease	10–17	53/27	web-app with symptom-tracking, lab results and feedback	CAU	– no group differences in treatment and disease activity (symptoms, fecal calprotectin, and blood) – the number of total outpatient visits (mean: IG 3.26, SEM 0.51; CG 7.31, SEM 0.69; p < 0.0001) and IBD-related school absence (mean days: IG 1.6, SEM 0.5; CG 16.5, SEM 4.4; p < 0.002) was significantly lower in IG – no differences in medical adherence and QoL – adherence to intervention was 81% (384 of the 475 expected entries) – none of the patients or parents felt unsafe using the eHealth system
Lester E et al. 2020 USA, Canada, Colombia ⁶⁰	Virtual mind-body treatment for geographically diverse youth with neurofibromatosis: A pilot randomized controlled trial	RCT	neurofibro- matosis	12–17	51/27	virtual mind-body group treatment, sessions led by psychologist	educational control	– high satisfaction in both conditions – greater baseline to posttreatment improvements in physical health QoL (10.18; 95% CI: 0.47–19.90; p = 0.040), psychological QoL (9.45; 95% CI: 0.78–18.11; p = 0.033), social relations QoL (13.19; 95% CI: 1.87–24.50; p = 0.023), and environmental QoL (9.26; 95% CI: 3.49–15.49; p = 0.002), in IG compared to CG (between group effects – greater pre-to-post improvements in IG in gratitude (Mdifference = 4.38; 95% CI-0.52–8.23; p = 0.027) and mindfulness (Mdifference= 9.41; 95% CI 4.40–14.42.; p < 0.001) compared to CG ⁶¹ – no group differences on any additional resiliency factors []- pre-to-post- improvements in IG in coping (Mdifference= 9.16; 95% CI 2.93–15.39; p = 0.005), and social support (Mdifference= 6.79; 95% CI 1.96–11.63; p = 0.007 ⁶¹ – improvements were significant and maintained through follow-up at 6 months

ARR: adjusted risk ratio; CAU: care as usual; CG: control group; CI: confidence interval; CT: clinical trial; HRQoL: health-related quality of life; IBD: inflammatory bowel disease; IG: intervention group; QoL: quality of life; RCT: randomized controlled trial; SEM: standard error of the mean; TAU: treatment as usual.

Obesity

Of the 13 studies, four used a gaming intervention, five interventions employed a self-control or addiction-based approach, one used image recognition to calculate calories,⁶² and another implemented a web-based education program.⁶³ A Bluetooth scale connected to an app was used in two studies: one for body weight⁶⁴ and one for weighing meals.⁶⁵

Six of nine studies examining weight loss reported a significant improvement in the intervention group. One study examining dietary intake showed worse results after the intervention and compared to the control group, but better intervention adherence.⁶² Quality of life was assessed in only one study and improved significantly compared to the control group⁶³ (Table 6).

Table 6.

Obesity.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Naets T et al. 2020 Belgium ⁶⁶	Adherence and barriers in e-health self-control training for enhancing childhood multidisciplinary obesity treatment	RCT	obesity	11–19	68	online self-control training + TAU, comparing high and low adherence groups	-	– the low adherence group had a significantly higher weight status throughout the entire study period – low adherence group frequently experienced practical obstacles; no group difference in contextual treatment barriers – end of inpatient treatment and high weight status are risk factors for low adherence
Vidmar AP et al. 2019 USA ⁶⁷	An addiction model-based mobile health weight loss intervention in adolescents with obesity	CT	obesity	12–18	18	interactive, addiction-based, weight loss smartphone app with coaching	no control, data compared to age-matched on-site multidisciplinary weight management program	– higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs. $1428.00) – significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001) in IG, which was comparable to control (p = 0.31 and p = 0.06)
Vidmar AP et al. 2023 USA ⁶⁸	An addiction-based digital weight loss intervention: A multi-centre randomized controlled trial	RCT	obesity	14–18	161	app intervention, with or without coaching	in-person multidisciplinary obesity intervention	– all participants lost weight over 24-weeks (−1.29%, [-1.82, -0.76], p < 0.0001, no significant weight loss difference between groups (p = 0.3)) – Girls lost more weight than boys – binge eating behavior at baseline was associated with increase in %BMIp95; no association between ethnicity, mood, timing of intervention in relation to the pandemic, or executive function and change in %BMIp95
Vidmar AP et al. 2022 USA ⁶⁹	Can a Behavioral Weight-Loss Intervention Change Adolescents’ Food Addiction Severity?	RCT	obesity	14–18	117/39/39	(1) mHealth intervention (AppAlone) (2) mHealth intervention+coaching (AppCoach)	in-person intervention	– 57% of adolescents showed a decrease in symptom count (median change: -0.3 [0 to -1.5]), with a significant change by intervention arm in the intention-to-treat analysis (p = 0.045) – positive linear relationship between change in symptom count and change in depressive symptomatology (p < 0.01) and stress (p < 0.01), with no association with change in weight (p = 0.3)
Memarian S et al. 2022 Iran ⁷⁰	Can sweet food-specific inhibitory control training via a mobile application improve eating behavior in children with obesity?	RCT	obesity	7–11	46/23	go/no-go training in which sweet foods cues were paired with no-go signals	non-food cues	– significant reduction in sweet food choice and intake from pre to post-training in IG relative to CG – effects on reducing sweet food intake persisted over 3-month follow-up – no significant changes in weight loss were observed
Salahshoornezhad S et al. 2022 Iran ⁷¹	Effect of a multi-disciplinary program on anthropometric and biochemical parameters in obese and overweight elementary school girls: A randomized clinical trial	RCT	obesity	9–12	62/31	multi-disciplinary intervention with nutrition education via smartphone game, on- site aerobic exercise and CBT	nutritional education	– more promising results in IG in weight loss, waist circumference (WC), hip circumference (HC), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and FBS compared to CG (p < 0.05) – MET and DEBQ scores in all three sections of emotions, stimuli, and restriction were better in IG than in CG (p < 0.05) – no significant difference between groups regarding serum leptin and waist-to-hip ratio (WHR; p > 0.05)
Hagman E et al. 2022 Sweden ⁶⁴	Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a 1-year pragmatical clinical trial	CT	obesity	4–17	428/107	Bluetooth scale connected to app, automatic data transfer to clinic, frequent written communication between the clinical staff and families via app	CAU	– after 1 year, the mean ± SD change in BMI Z-score in IG was -0.30 ± 0.39 BMI Z-score units and in CG -0.15 ± 0.28, p = 0.0002 – the outcome was better for both sexes and all age groups in the IG (p < 0.05)
Stasinaki A et al. 2021 Switzerland ⁷²	Effects of a novel mobile health intervention compared to a multi-component behaviour changing program on body mass index, physical capacities and stress parameters in adolescents with obesity: a randomized controlled trial	RCT	obesity	10–18	31/18	gamified app with peer and virtual coach chat + CAU	CAU (behavior changing interventions)	– BMI-SDS decreased significantly in CG at T1, but not at T2, and did not decrease in IG during the study. – Muscle mass, strength and agility improved significantly in both groups at T2; only IG reduced significantly their body fat at T1 and T2. – average daily app usage rate in IG was 71.5%. – cortisol serum levels decreased significantly after biofeedback but with no association between stress parameters and BMI-SDS. – no side effects were observed
Tugault-Lafleur CN et al. 2023 Canada ⁷³	Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial	RCT	obesity	10–17	214/107	gamified app: healthy eating, active living, reducing screen time, and healthy sleeping habits + coach	waitlist control	– no significant differences in zBMI or any of the health behaviors between groups after 3 months – among CG participants, zBMI (p = 0.02), discretionary calories (p = 0.03), and physical activity outside of school (p = 0.001) declined, whereas daily screen time increased (p < 0.001) after receiving access to the app compared with before receiving app access – participants in IG with live coaching reported more time active outside of school compared with intervention without coaching over 3 months (p = 0.001) – app use did not modify any changes in outcomes in IG
Staiano AE et al. 2018 USA ⁷⁴	Home-based exergaming among children with overweight and obesity: a randomized clinical trial	RCT	obesity	10–12	46/23	exergaming (video gaming that involves physical activity), video chat sessions with coach	waitlist control	– significant improvement in IG in BMI z-score excluding one control outlier (intervention [standard error] vs. control [standard error]: -0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent-to-treat analysis (-0.06 [0.03] vs. 0.02 [0.03], p = 0.065). – improvement in IG in systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein-cholesterol and moderate-to-vigorous physical activity (all p values < 0.05) compared to CG
Browne S et al. 2020 Ireland ⁶⁵	Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention	feasibility RCT	obesity	9–16	20/8	app connected to Bluetooth plate scale to visualize eating rate + CAU	CAU	– higher attrition rates in IG (5/8, 63%) than in CG (3/12, 25%) – IG participants undertook a median of 1.0 training meal using Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. – only 50% (9/18) of participants with smart watches logged physical activity data – significant differences at baseline between groups – the Child Behavior Checklist mean total score was 71.7 (SD 3.1) in IG vs 57.6 (SD 6.6) in CG, p < 0.001, and also different among those who completed the planned protocol compared with those who withdrew early (mean total score 59.0, SD 9.3, vs 67.9, SD 5.6, respectively; p = 0.04)
Oei K et al. 2024 Canada ⁶²	An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial	pilot RCT	obesity	12–18	32/16	app that analyses nutritional content from photos, data sharing with dietitian, personalized tips	taking photos of all meals	– app and clinician portal were easy to use, efficient, well-liked by patients and physicians – significant technical challenges were encountered – patient engagement was higher in IG, not significant; outliers in IG with very high engagement and self-efficacy – significant increase in caloric intake and saturated fat intake in IG
Zhu D et al. 2025 Australia ⁶³	The effectiveness of a 10-week family-focused e-Health healthy lifestyle program for school-aged children with overweight or obesity: a randomised control trial	RCT	obesity	7–13	148/73	web-based program with education, quizzes, goalsetting	waitlist control	– significant decrease in BMI, QoL, diet quality scores, physical activity levels in IG compared to CG (p < 0.05)

BMI: body mass index; CAU: care as usual; CBT: cognitive behavioral therapy; CG: control group; CT: clinical trial; IG: intervention group; QoL: quality of life; RCT: randomized controlled trial; TAU: treatment as usual.

Neurological and developmental disorders

The 24 studies in this subgroup targeted attention deficit hyperactivity disorder (ADHD, n = 3), autism spectrum disorder (ASD, 6), amblyopia (1), apraxia of speech (2), brain damage (1), cerebral palsy (1), epilepsy (3), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, 2), migraine (2), multiple sclerosis (MS, 1), and tic disorders (3). Four interventions targeting ADHD, MS, brain damage, and cerebral palsy used cognitive training. Most measured clinical outcomes improved during the intervention in the IG, often more so than in the CG. No outcomes in the IG were worse than in the CG. One study showed greater parental involvement in video meetings, but also some communication and technical issues.⁷⁵ Quality of life was assessed in only two studies and significantly improved during the intervention.^76,77 Medication adherence improved in all measured cases.^78–81 All measured acceptance was high. (Table 7).

Table 7.

Neurological and developmental disorders.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Medina R et al. 2021 Spain ⁸²	Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial	RCT	ADHD	8–11	40/18	smart, cognitive stimulation training via game	commercial video games	– improvements in inhibitory control performance in IG – Improvements in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in IG – improvements in inhibitory control were related to increases in alpha-band power in both groups in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex; only significant in IG
Weisman O et al. 2018 Israel ⁷⁸	Testing the Efficacy of a Smartphone Application in Improving Medication Adherence, Among Children with ADHD	RCT	ADHD	6–16	39/19	mobile app for treatment adherence; symptom and medication side-effect tracking; reminders; education	TAU	– higher overall pill counts over 8-weeks period in IG, F = 4.33, p < 0.05 – significant improvement in total CRS (Clinical Rating Scale) score was found in IG compared to CG in week 4 and week 8, F = 4.74, p < 0.05
Parsons D et al. 2019 Australia ⁸³	A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia	RCT	ASD	2–6	59	iPad app with visual motor; imitation; language; social exercises	waitlist TAU	– improvements in receptive and pragmatic language and social skills in both groups – significantly greater improvement in IG in expressive language with medium effect size – no significant group differences for visual motor, imitation, receptive language and social skills – improvements in receptive and pragmatic language and social skills were maintained after 3 months
Lindgren S et al. 2020 USA ⁸⁴	A Randomized Controlled Trial of Functional Communication Training via Telehealth for Young Children with Autism Spectrum Disorder	RCT	ASD	21m - 7	38	functional communication training via video meeting	waitlist TAU	– mean reduction in problem behavior of 98% in IG, limited improvement in CG – significant improvement in social communication and task completion in IG – low occurrence of problem behavior in both groups at follow-up – high level of acceptance in parents
Voss C et al. 2019 USA ⁸⁵	Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial	RCT	ASD	6–12	71/40	Superpower Glass intervention via Google Glass and smartphone app + CAU	CAU (applied behavioral analysis therapy)	– significant improvements in IG on the Vineland Adaptive Behaviors Scale socialization subscale (mean [SD] treatment impact, 4.58 [1.62]; p = 0.005) – other 3 primary measures improved, but not significantly
Su WC et al. 2023 USA ⁷⁵	Telehealth Versus Face-to-Face Fine Motor and Social Communication Interventions for Children With Autism Spectrum Disorder: Efficacy, Fidelity, Acceptability, and Feasibility	RCT	ASD	5–14	15/8	seated play intervention via video meeting	face to face intervention	– similar improvements in fine motor skills and socially directed verbalizations in both groups – longer preparation time and effort reported by parents in IG – greater parental involvement, but more communication and technological issues in IG
Lewis S et al. 2024 Australia ⁸⁶	A pilot randomised controlled trial of a telehealth-delivered brief 'Sleeping Sound Autism' intervention for autistic children	pilot RCT	ASD	5–12	61/30	sleep intervention via video meeting	TAU	– significant group by time difference in child sleep (d = .87–1.05), emotion and behavior (d = .40 - .57), caregiver mental health (d = .60 - .28) in IG – no group differences in QoL – intervention was reported as useful by all caregivers, most would recommend it to others – not all children were able to engage effectively with clinician over telehealth
Conaughton RJ et al. 2017 Australia ⁸⁷	Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: A randomised controlled trial	RCT	ASD and anxiety	8–12	42/21	online CBT with therapist support by phone and mail	waitlist control	– significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms in IG compared to CG – significantly greater increases in overall functioning in IG compared to CG – loss of primary diagnosis was lower than in previous studies
Anderson E et al. 2020 UK ⁸⁸	Recruiting Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis to Internet-Delivered Therapy: Internal Pilot Within a Randomized Controlled Trial	feasibility CT	ME/CFS	11–17	89	(1) web-based CBT; regular, scheduled therapeutic message exchanges with therapist (2) Skype- delivered activity management with a clinician	-	– web-based treatment was acceptable – advantages: less travel time, home environment – disadvantages: technical issues, personal preference – no serious adverse events were reported
Crawley E et al. 2024 UK ⁸⁹	Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT	RCT	ME/CFS	11–17	314/155/159	1) web-based CBT, asynchronous consultations with clinician 2) activity management via video meeting	-	– improved physical function in IG1 compared to IG2 (p = 0.003) at 6 months – no group difference in physical function at 12 months – half a day more school attendance for IG1 – similar improvements in pain in both groups – greater costs in IG1, mostly driven by larger amount of consultations
Simone M et al. 2018 Italy ⁹⁰	Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial	RCT	MS, ADHD	NA - 17	36/18	computerized training for retraining attention	nonspecific computerized training	– more pronounced improvement of cognitive impairment in IG for MS patients (p < 0.0001) and on cognitive test exploring attention, concentration, planning strategies and visuo-spatial memory performances in comparison to CG – the difference in cognitive impairment between IG and CG was not statistically significant (p = 0.06) in ADHD patients – greater effect of the intervention on cognitive test exploring attention and delayed recall of visuo-spatial memory performances
Li L et al. 2022 China ⁷⁹	Comparison of compliance among patients with pediatric amblyopia undergoing virtual reality-based and traditional patching method training	RCT	amblyopia	4–14	76	smartphone virtual reality-based training method	patching	– significantly better compliance-related behavior and attitudes in parent and children in IG (p < 0.05) – the intervention was acceptable
Ahmed B et al. 2018 Australia ⁹¹	Speech-driven mobile games for speech therapy: User experiences and feasibility	CT	apraxia of speech	6–11	10	five different games with speech recognition	-	– speech-controlled games were rated interesting and fun – children preferred more complex and fast-paced games that mimic popular gameplay, including rewards, challenge and multiple difficulty levels – individual preferences not based on age – all children were able to understand the complex gameplay, in contrast to adults – automatic speech recognition had some limitations
McKechnie J et al. 2020 Australia ⁹²	The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech	RCT	apraxia of speech	4–10	16/8	tablet-based speech therapy: 3 of 4 sessions without therapist feedback to simulate home practice	face-to-face intervention	– significantly improved speech outcomes at 4-months post-treatment in both groups – post-hoc comparisons suggested that only CG showed a significant change from pre- to immediately post-treatment but group difference had dissipated by 1-month post-treatment – heterogeneity in response to intervention within the groups suggests that other factors, not measured here, may be having a substantive influence on response to intervention and feedback type
Corti C et al. 2018 Italy ⁹³	Feasibility of a home-based computerized cognitive training for pediatric patients with congenital or acquired brain damage: An explorative study	feasibility CCT	brain damage	11–16	32	computerized cognitive training (CCT)	-	– all 9 feasibility criteria were met. – high adherence; 94.2% completion of training sessions in the recommended timeframe – no significant technical issues – performance increased significantly between first day (M = 682.58; SD = 202.43) and last day (M = 917.03; SD = 363.60) of training (t (30) = 5.06, p < 0.001; Cohen's d = 0.80). – marginally significant correlation between increase in performance and IQ (r = 0.35, p = 0.053), suggesting that individuals with higher intellectual abilities saw greater improvement from the CCT. – no significant correlation with age (r = −0.01; p = 0.956) or sex differences t (29) = 1.17; p = 0.250)
Piovesana A et al. 2017 Australia ⁹⁴	Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy	RCT	cerebral palsy	8–18	102/51	multi-modal web-based program: Executive Function (EF), working memory (WM), visual processing (VP), upper limb co-ordination and physical activity	waitlist control, CAU	– no significant group differences in attentional control (DSB; p = 0.20; CI = −0.40,1.87); cognitive flexibility (Inhibition, p = 0.34; CI = −0.73,2.11; number/letter sequencing, p = 0.17; CI = −0.55,2.94); problem solving (Tower; p = 0.28; CI = −0.61,2.09), information processing (Symbol; p = 0.08; CI = −0.16, 2.75; Coding; p = 0.07; CI = −0.12,2.52) or EF performance (p = 0.13; CI= −10.04,1.38)
Le Marne FA et al. 2018 Australia ⁸⁰	EpApp: Development and evaluation of a smartphone/tablet app for adolescents with epilepsy	CT	epilepsy	13–19	51	app with medication reminders, seizure diary, education	-	– both self and general epilepsy knowledge increased (p ≤ 0.005) – significantly fewer medication reminders were required during intervention (M = 2.93, p = 0.002) and follow-up (M = 3.54, p = 0.030) compared to baseline (M = 6.64) – measures of app design, content, functionality and utility were very favorable – no significant improvement in seizure burden, or psychosocial parameters – Educational page-visits reflected interests and concerns
Tutar Güven Ş et al. 2020 Turkey ⁹⁵	Evaluation of the efficiency of the web-based epilepsy education program (WEEP) for youth with epilepsy and parents: A randomized controlled trial	RCT	epilepsy	9–18	70/35	web-based epilepsy education program	CAU	– significant increase in mean knowledge, seizure self-efficacy, attitude, and e-health literacy scores (p < 0.05) – increase in scores of knowledge, anxiety, self-management, and e-health literacy scale in parents in IG (p < 0.05).
Modi AC et al. 2023 USA ⁸¹	Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy	RCT	epilepsy	13–17	40/19	app with reminders, individualized and social norms adherence feedback	app with reminders and individualized adherence feedback	– moderately high recruitment (75%), retention (78%), and treatment satisfaction – moderate engagement with the intervention (64% engaging with intervention notifications) – higher adherence over time in IG compared to CG – small to moderate effect sizes for seizure severity and HRQoL between groups
Ramsey RR et al. 2018 USA ⁹⁶	A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine	CT	migraine	13–21	35	app with adherence-promotion and progressive reminder system	-	– significant improvement in treatment adherence during first month compared to baseline – self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates – participants rated the intervention as acceptable and easy to use
Hershey AD et al. 2021 USA ⁹⁷	Remote electrical neuromodulation for acute treatment of migraine in adolescents	CT	migraine	12–17	39	remote electrical neuromodulation (stimulation of upper arm peripheral nerves)	-	– one device-related adverse event (2%) was reported (temporary feeling of pain in the arm) – pain relief and pain-free at 2 h were achieved by 71% (28/39) and 35% (14/39) participants, respectively – at 2 h, 69% (23/33) participants experienced improvement in functional ability
Rachamim L et al. 2022 Israel ⁹⁸	Internet-based guided self-help comprehensive behavioral intervention for tics (ICBIT) for youth with tic disorders: a feasibility and effectiveness study with 6 month-follow-up	RCT	tic disorders	7–18	41/25	web based comprehensive behavioral intervention guided by parents with minimal therapist support	waitlist crossover	– the intervention was feasible at implementation and post-treatment – 64% of the participants improved significantly – reductions in tic severity – improved youth global impairment and functioning – improvements were maintained at 6-month follow-up – effect size for primary outcome measure (Yale Global Tic Severity Scale) ranged between large effect size (Cohen's d = 0.91) at post-intervention to very large effect size (Cohen's d = 2.25) at 6 months follow-up – results were comparable to face-to-face treatment – participants rated the intervention as highly acceptable and satisfactory. – participants in IG experienced improvement in self-esteem and comorbidity – the ICBIT program enabled the delivery of the intervention consecutively without interruption during the COVID-19 pandemic
Andrén P et al. 2019 Sweden ⁷⁶	Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up	feasibility RCT	tic disorders	7–17	23/11/12	therapist-guided and parent-guided internet-delivered behavior therapy (1) habit rehearsal training (2) response prevention	-	– patients and parents rated the interventions as highly acceptable, credible and satisfactory – both interventions resulted in reduced tic-related impairment, parent-rated tic severity and improved quality of life – only (2) resulted in a significant improvement on the primary outcome measure – within-group effect sizes and responder rates were, respectively: d = 1.12 and 75% for (2), and d = 0.50 and 55% for (1) – therapeutic gains were maintained up to 12 months after the end of the treatment – adverse events were rare in both groups – average therapist support time was around 25 min per participant per week
Hollis C et al. 2021 UK ⁷⁷	Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial	RCT	tic disorders	9–17	224/ 112	online, therapist-supported Exposure and Response Prevention	psycho-education (active control)	– mean tic severity at 3 months was 23.9 (SD 8.2) in IG and 26.8 (7.3) in CG – mean total decrease in tic severity at 3 months was 4.5 (16%, SD 1.1) in IG vs 1.6 (6%, 1.0) in CG – the estimated mean difference in tic severity change between the groups adjusted for baseline and site was -2.29 points (95% CI -3.86 to -0.71) in favor of IG; effect size of -0.31 (95% CI -0.52 to -0.10) – 2 serious adverse events occurred (one collapse and one tic attack), both in CG, neither of which were related to study treatment

ADHD: attention deficit/hyperactivity disorder; ASD: autism spectrum disorder; CAU: care as usual; CBT: cognitive behavioral therapy; CCT: controlled clinical trial; CG: control group; CT: clinical trial; IG: intervention group; ME/CFS: myalgic encephalomyelitis/chronic fatigue syndrome; MS: multiple sclerosis; RCT: randomized controlled trial; TAU: treatment as usual.

Chronic pain

All 5 trials included a psychological intervention; four used an app. Feasibility and satisfaction were generally good. No study reported criticism. Clinical symptoms improved in all non-feasibility studies. Quality of life was only assessed in one study,⁹⁹ improvements after the intervention were significant and greater than in the control group. Cost savings were reported in one study.⁹⁹ (Table 8).

Table 8.

Chronic pain.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Palermo TM et al. 2020 USA ¹⁰⁰	A digital health psychological intervention (WebMAP Mobile) for children and adolescents with chronic pain: results of a hybrid effectiveness-implementation stepped-wedge cluster randomized trial	RCT	chronic pain	10–17	143/73	pain self-management skills via app for adolescents and website for parents	CAU	– similar changes over time in pain and disability in IG and CG – IG perceived greater improvement (patient global impression of change) at post-treatment and follow-up (d's = 0.54 and 0.44, p < 0.05) – use of the digital intervention was modest and variable; approximately 30% of youth and parents completed treatment. – greater engagement was associated with significantly greater reductions in pain and disability from pre-treatment to follow-up (d's = −0.57 and −0.38, p < 0.05)
Lalloo C et al. 2019 Canada ¹⁰¹	Capturing Daily Disease Experiences of Adolescents With Chronic Pain: mHealth-Mediated Symptom Tracking	feasibility RCT	chronic pain	15–18	60/32	app with symptom reporting, goal setting, pain coping, social support	only symptom reporting	– high feasibility – moderate-to-high adherence over 55 days – most participants chose to view their symptom m history – stable symptomology of moderate severity
Shaygan M et al. 2021 Iran ¹⁰²	The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain	RCT	chronic pain	12–19	128/64	app with pain management program	no intervention	– significant improvements (pre-post) in pain intensity (d = 0.47 (IG)/0.02 (CG), p < 0.001), emotional (d = 0.68 (IG)/0.05 (CG), p < 0.006), social (d = 0.81 (IG)/0.13 (CG), p < 0.001), and school functioning (d = 0.95 (IG)/0.28 (CG), p < 0.001) but not in the physical functioning (d = 0.30 (IG)/0.12 (CG), p < 0.11) – significant group differences in pain intensity (p < 0.02), emotional (p < 0.01), social (p < 0.004), and school functioning (p < 0.03); not in physical functioning (p < 0.46) – high level of adherence (78.12%) and satisfaction (Mean = 26.45, SD = 6.45) with the intervention – based on qualitative interviews, adolescents' pain management strategies can be classified in three main categories: physical management, psychological management, and interpersonal resources
de la Vega R et al. 2018 Spain ¹⁰³	Fibroline: A mobile app for improving the quality of life of young people with fibromyalgia	feasibility CT	fibromyalgia	13–24	25	CBT via app	-	– all participants rated the app as ‘Easy to use.’ – all participants would use the app if they needed it – the app is error-free and acceptable
Lalouni M et al. 2019 Sweden ⁹⁹	Clinical and Cost Effectiveness of Online Cognitive Behavioral Therapy in Children With Functional Abdominal Pain Disorders	RCT	functional abdominal pain disorder	8–12	90/46	therapist-guided, internet-delivered CBT	TAU	– larger improvement in IG in gastrointestinal symptom severity with medium effect size (Cohen's d = 0.46; 95% CI, 0.05–0.88; number needed to treat, 3.8) compared to CG – significant improvement in IG in QoL, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children's symptom compared to CG – effects of Internet-CBT persisted through 36 weeks of follow-up evaluation – significantly less health care use in IG than in CG, average cost difference of US $137 (p = 0.011) – cost savings of US $1050 for every child treated with Internet-CBT compared with TAU

CAU: care as usual; CBT: cognitive behavioral therapy; CG: control group; CI: confidence interval; CT: clinical trial; IG: intervention group; RCT: randomized controlled trial; TAU: treatment as usual.

Genetic and congenital diseases

Several genetic and congenital conditions (arthrogryposis, congenital heart disease, cystic fibrosis, Duchenne muscular dystrophy, Marfan syndrome, sickle cell disease, spina bifida) were examined in 12 studies. Clinical outcomes improved in six studies; in four of these, improvements were greater than in the control group.^104–107 Quality of life improved in one case.¹⁰⁸ No outcomes compared to baseline or the control group. Acceptance levels were high in all measured cases.^109,110 (Table 9).

Table 9.

Genetic and congenital diseases.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Gagnon M et al. 2021 Canada ¹⁰⁹	Using Telerehabilitation to Deliver a Home Exercise Program to Youth With Arthrogryposis: Single Cohort Pilot Study	feasibility CT	arthogryposis	8–21	7	home exercise program, self-guided and via video meeting	-	– the participants performed their HEP 2.04 times per week (95% CI 1.25–4.08) and reported good satisfaction with the approach – a general intraclass correlation coefficient of 0.985 (95% CI 0.980–0.989) was found for the web-based ROM measurement – individualized goals were related to pain management; endurance in writing, standing, or walking; sports; and daily activities – 12 of the 15 goals set with the participants were achieved – significant improvements in the pain and comfort domain of the Pediatrics Outcomes Data Collection Instrument (pre: median 71; 95% CI 34–100; post: median 85; 95% CI 49–100; p = 0.08) and Physical Activity Questionnaire for Adolescents (pre: median 1.62; 95% CI 1.00–2.82; post: median 2.32; 95% CI 1.00–3.45; p = 0.046)
Meyer M et al. 2021 Germany ¹¹¹	E-Health Exercise Intervention for Pediatric Patients with Congenital Heart Disease: A Randomized Controlled Trial	RCT	congenital heart disease	10–18	70/35	exercise instructed by videos	no intervention	– no change in total physical fitness z score (IG: 0.14 ± 0.38 vs CG: 0.09 ± 0.38, p = 0.560) – no change in total HRQoL (IG: −1.73 ± 8.33 vs CG: 1.31 ± 7.85, p = 0.160) – for all subcategories of physical fitness and HRQoL – no adverse events associated with the intervention
Lin PJ et al. 2021 Taiwan ¹¹²	Long-term effectiveness of an mHealth-tailored physical activity intervention in youth with congenital heart disease: A randomized controlled trial	RCT	congenital heart disease	15–24	143/ 49/47	self-regulation theory-based app 1) app only 2) app, Health Promotion Cloud system, game-based interactive platforms	CAU	– no significant group differences in any domain of disease knowledge after 6 months or 1 year – no significantly greater physical activity intensity in both IG compared to CG in any month during 1 year – overall attrition rate was 28%
Calvo-Lerma J et al. 2021 Spain, Netherlands, Italy, Belgium ¹¹³	Change in Nutrient and Dietary Intake in European Children with Cystic Fibrosis after a 6-Month Intervention with a Self-Management mHealth Tool	CT	cystic fibrosis	2–18	84	app for nutrition self-management	-	– macronutrient distribution better approximated the guidelines compared to baseline – increase in protein and lipid by 1.0 (p = 0.001) and 2.1% (p = 0.02) of the total energy intake – decrease in carbohydrate (−2.9%, p = 0.001) and simple carbohydrate (−2.4%, p < 0.001) intake of the total energy intake – decrease in ultra-processed foods – increase in meat and dairy
Kenis-Coskun Ö et al. 2022 Turkey ¹⁰⁴	The effect of telerehabilitation on quality of life, anxiety, and depression in children with cystic fibrosis and caregivers: A single-blind randomized trial	RCT	cystic fibrosis	6–13	28/14	exercise program via video meeting	no intervention	– significant improvement of mean RCADS-Major depressive disorder score in IG (6.21 ± 3.11 to 3.92 ± 3.79, p < 0.02) – significant decrease in RCADS-generalized anxiety disorder score (6.28 ± 2.81 to 3.42 ± 2.65 (p < 0.01)) in IG – significant improvement in body image in IG – no similar significant changes in CG – caregivers' anxiety and depression levels did not change significantly
Boon M et al. 2020 Spain, Italy, Portugal, Belgium, Netherlands ¹⁰⁸	Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis	CT	cystic fibrosis	2–18	171	app with sypmtom tracking, medication advice, education	-	– self-reported CF-PedsQL-GI improved significantly from month 0 (84.3, 76.4–90.3) to month 6 (M6) (89.4, 80.35–93.5) (p< 0.0001) – similar improvements were reported by parents – lower baseline CF-PedsQL-GI was associated with a greater improvement at M6 (p < 0.001)
Kilic K et al. 2024 Turkey ¹⁰⁵	Exercise intolerance, oxidative stress, and irisin in pediatric cystic fibrosis: Can telehealth-based exercise training make a difference?	RCT	cystic fibrosis	8–18	39/13/13	exercise via video meeting 1) combined exercise training 2) core stabilization	physical activity recommendations	– exercise capacity improved significantly in both IGs compared to CG – two markers of oxidative stress decreased (p < .05), the rest remained unchanged
Kenis-Coskun O et al. 2022 Turkey ¹⁰⁶	Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy: a single-blind randomized study	RCT	duchenne muscular dystrophy	6–15	19/10	live online exercises	video exercise	– significant improvement in neck extension, bilateral shoulder abduction, and left shoulder flexion, bilateral knee flexion and extension, bilateral ankle dorsiflexion, and left ankle plantar flexion strength in IG (p < 0.05 for all), better than CG – no significant improvement in 6-min walking test of IG (p = 0.94) or CG (p = 0.63) – no significant improvement in ambulation in IG (p = 0.24) or CG (p = 0.87) – no significant changes between groups at the end of the treatments
Chen A et al. 2021 USA ¹¹⁰	Tele-Clinic Visits in Pediatric Patients with Marfan Syndrome Using Parentally Acquired Echocardiography	feasibility CT	marfan syndrome	5–19	15	doctor's visit via video meeting; parents measuring echocardiographic images and vital signs	-	– tele-clinic visits are feasible – parents took a median of 70 (IQR 60–150) minutes to obtain the height, weight, heart rate, BP, cardiac sounds, and echocardiographic images before tele-clinic visits – systolic BP was greater on-site than at home (median +13 mm Hg, p = 0.014). – height, weight, diastolic BP, heart rate, and aortic root measurements were similar
Hardy SJ et al. 2021 USA ¹⁰⁷	A Randomized Controlled Trial of Working Memory Training in Pediatric Sickle Cell Disease	RCT	sickle cell disease	7–16	47	Working Memory Training on tablet device	waitlist TAU	– greater improvement in IG in visual working memory (WM) compared to CG (N = 22; p = .03, d = 0.70 [CI95 = 0.08, 1.31]) – significant improvements in verbal short-term memory, visual WM, and math fluency when ≥10 training sessions completed – adherence was lower than expected (M = 9.07 sessions, SD = 7.77), with 19 participants (41%) completing at least 10 sessions
Anderson LM et al. 2018 USA ¹¹⁴	Mobile health intervention for youth with sickle cell disease: Impact on adherence, disease knowledge, and quality of life	CT	sickle cell disease	7–18	32	education and medication compliance monitoring via app	-	– average adherence tracking rate of 0.6 (standard deviation = 0.34) – increased medication possession ratio (0.57–0.74, p < 0.001, d = 0.75) and disease knowledge (59.6–88.6%, p < 0.001) in all participants – completers of the intervention demonstrated significantly better disease-related functioning (p < 0.05), higher parent-reported treatment functioning (p < 0.05), and lower pain impact than noncompleters (p < 0.05)
Kuhn EN et al. 2022 USA ¹¹⁵	Telemedicine and Spina Bifida Transition: A Pilot Randomized Trial	RCT	spina bifida	14 - NA	24	video consultation with doctor every 3 months + CAU	CAU	– the study was stopped early for lack of participation in the intervention; only 1 patient completed any of the planned telemedicine sessions – in a single-group, as-treated analysis, there was no significant change in the Transition Readiness Assessment Questionnaire score between enrollment and 1-year follow-up (Δ = 0.36, p = 0.46). – significant improvements in subscores for Managing Medications, Appointment Keeping, and Managing Daily Activities

CAU: care as usual; CF-PedsQL-GI: cystic fibrosis specific version of the Pediatric Quality of Life Inventory; gastrointestinal symptoms module; CG: control group; CI: confidence interval; CT: clinical trial; HEP: home exercise program; HRQoL: health-related quality of life; IG: intervention group; IQR: interquartile range; RCADS: Anxiety and Depression Scale in Children-Revised; RCT: randomized controlled trial; ROM: range of motion

Psychiatric disorders

Psychiatric disorders were examined in 12 studies. With one exception of partial improvement,¹¹⁶ all measured clinical outcomes improved during the study. Patients and mothers rated the therapeutic alliance lower in video meetings, while therapists and fathers found it comparable.¹¹⁷ In three studies, improvements at post-intervention were better than in the control group,^116,118,119 one of them matched the control group at follow-up.¹¹⁶ In four studies,^120–123 the improvements were comparable to the control group. Quality of life was assessed in only one study,¹²¹ but did not change in either group. Acceptance was high in all of the four measured cases.^{120,123–125} One study reported lower medication costs.¹²¹ (Table 10).

Table 10.

Psychiatric disorders.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Comer JS et al. 2017 USA ¹²⁰	Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial	RCT	OCD	4–8	22/11	family based CBT via video meeting	TAU	– high treatment retention, engagement, alliance and satisfaction in both groups – symptom trajectories and family accommodation improved in both groups from baseline to posttreatment, sustained in follow-up – 72.7% of IG and 60% of CG showed "excellent response"; 80%(IG) and 66.7%(CG) at follow-up – no significant group differences across outcomes
Pitrat B et al. 2024 France ¹²⁶	Mobile app measuring sleep and behaviors: A trial in adolescents with addiction	pilot RCT	addiction	12–18	36/18	diary app, tracking sleep and consumption	paper diary	– IG showed significantly more compliance (p = 0.08) – perceived impact of the intervention was significantly higher in IG (p = 0.002)
Cooper M et al. 2024 USA ¹¹⁷	Therapeutic Alliance in Family-Based Treatment of Anorexia Nervosa: In-Person Versus Telehealth	RCT	anorexia	12–18	53/33	family-based psychotherapy via video meeting	in-person psychotherapy	– no significant differences between groups for fathers and therapists – patients and mothers reported significantly higher therapeutic alliance for in-person sessions
Nordh M et al. 2021 Sweden ¹²¹	Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder: A Randomized Clinical Trial	RCT	anxiety disorder	10–17	103	therapist-guided internet-delivered cognitive behavioral therapy (ICBT)	internet-delivered supportive therapy (ISUPPORT)	– significantly greater reduction in severity of anxiety symptoms in IG than CG – CSR baseline to 3-month follow-up mean 5.06 ± 0.95 to 3.96 ± 1.46 in IG; 4.94 ± 0.94 to 4.48 ± 1.30 in CG with significant between-group effect size of d = 0.67 (95% CI, 0.21–1.12) at 3-month follow-up – significant differences in all of the secondary outcome measures with small to large effect sizes, except for child-rated quality of life (nonsignificant) – cost savings associated with IG compared to CG; main drivers of the savings being lower medication costs (z = 2.38, p = 0.02) and increased school productivity (z = 1.99, p = 0.047) in IG – 1 suicide attempt in CG; no other serious adverse events occurred in either group
Beidel DC et al. 2021 USA ¹²²	Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial	RCT	anxiety disorder	7–12	42/26	AI web-based application to replace peer generalization sessions and enhance homework compliance (Pegasys-VR™)	TAU (Social Effectiveness Therapy for Children (SET-C))	– both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters – 63% in CG and 60% in IG did not meet diagnostic criteria for social anxiety disorder at posttreatment
Silk JS et al. 2020 USA ¹²⁴	Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders	CT	anxiety disorder	9–14	34	CBT skills practice by gamified app; 2-way communication with therapist	-	– strong feasibility and usability of the app/portal and high satisfaction with the intervention – participants used the app an average of 12 times between each therapy session (M = 5.8 min per day) – at posttreatment, 67% no longer met diagnostic criteria for an anxiety disorder; this percentage increasing to 86% at 2-month follow-up – reduced symptom severity over time across raters and improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance
Lindqvist K et al. 2020 Sweden ¹¹⁸	Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial	RCT	depression	15–18	76/34	therapist-supported self-help modules on online platform: texts and videos, exercises	supportive contact via internet with weekly symptom monitoring	– higher reduction in depression in both measures in IG (d = 0.82, p = 0.01; d = 0.80, p < 0.001) – higher reduction in anxiety (d = 0.78, p < 0.001) and increase in emotion regulation (d = 0.97, p < 0.001) and self-compassion (d = 0.65, p = 0.003) in IG – more patients in IG compared to CG met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively) – results on depression and anxiety symptoms were stable at 6 months follow-up – participants completed 5.8 (SD 2.4) of the 8 modules on average – no negative effects reported by majority (82%), no serious adverse events were reported
Rice S et al. 2018 Australia ¹²⁵	Moderated online social therapy for depression relapse prevention in young people: pilot study of a 'next generation' online intervention	CT	depression	15–25	42	social networking, peer and clinical moderator, therapy components via online platform	-	– high system usage, with 3034 user logins (mean = 72.2 per user) and 2146 posts (mean = 51.1) – Almost 70% of users had ≥10 logins over the 12 weeks, with 78.5% logging in over at least 2 months of the pilot. – 32 (84%) participants rated the intervention as helpful – significant improvement between the number of participants in full remission at baseline (n = 5; none of whom relapsed) relative to n = 19 at 12-week follow-up (p < 0.001) – 6 (14.3%) participants relapsed to full threshold symptoms at 12 weeks – significant improvement to interviewer-rated depression scores (p = 0.014, d = 0.45) and a trend for improved strength use (p = 0.088, d = 0.29)
Peake E et al. 2024 USA ¹²⁷	Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial	RCT	depression	13–21	160/80	CBT app	psycho-educational app	– higher completion in IG (p = 0.08) – no significant difference in depressive symptom change, treatment response (p = 0.07) between groups – significantly higher remission rate in IG (p = 0.01)
de Bruin EJ et al. 2018 Netherlands ¹¹⁹	Improvements of adolescent psychopathology after insomnia treatment: results from a randomized controlled trial over 1 year	RCT	insomnia	12–19	116/39/38	CBT by 1) online treatment or 2) face-to-face group treatment	waitlist control	– decrease in Psychopathology symptoms, insomnia and sleep problems as measured by actigraphy and sleep logs in both IGs compared with CG at 2-month follow-up with medium to large effect sizes (ESs). – psychopathology symptoms remained stable or further improved for up to 12-month follow-up – ESs at 12-month follow-up for IG1 and IG2 were respectively: affective (d = −0.87 and −0.97), anxiety (d = −0.81 for IT), somatic (d = −0.38 and d = −0.52), oppositional (d = −0.42 for GT) and attention deficit hyperactivity disorder (ADHD) problems (d = −0.47 and −0.46). – reduction of insomnia symptoms after intervention fully mediated the effects on affective and anxiety problems, and partially mediated the effect on ADHD problems
Werner-Seidler A et al. 2023 Australia ¹¹⁶	The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis	RCT	insomnia, depression	12–16	264/131	app-delivered cognitive behavioral therapy	weekly text message sleep tips	– greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d = .41) and 14 weeks (95% CI: −3.34 to −0.19, d = .39) in IG compared to CG – greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d = .28) but not 14 weeks (p < 1) in IG compared to CG – change in insomnia mediated change in depression – no adverse events were reported
Kennard BD et al. 2018 USA ¹²³	As Safe as Possible (ASAP): A Brief App-Supported Inpatient Intervention to Prevent Postdischarge Suicidal Behavior in Hospitalized, Suicidal Adolescents	RCT	suicidality	12–18	66/34	app with psychological support content + in-person intervention	TAU	– intervention did not have a statistically significant effect on suicide attempt – findings were in the hypothesized direction for occurrence of an attempt (16% compared with 31%; χ2 = 1.86, df = 1, g = −0.36) and time to an attempt (hazard ratio = 0.49, 95% CI = 0.16, 1.47) – past history of a suicide attempt was a significant moderator of treatment outcome, with a stronger, nonsignificant, effect of the intervention among participants with a history of suicide attempt (hazard ratio = 0.23, 95% CI = 0.05, 1.09) – no treatment effects on suicidal ideation – majority of participants (70%) used the app (median usage, 19 times) – participants reported high satisfaction with both the intervention and the app

CG: control group; IG: intervention group; OCD: obsessive-compulsive disorder; RCT: randomized controlled trial; TAU: treatment as usual.

Various/other conditions

The 13 studies focused on cancer, transplantation, visible differences, or multiple conditions. Eight studies reported better clinical outcomes compared to pre-intervention, two of which showed only partial improvements.^128,129 One study reported a medium-term benefit.¹³⁰ Four studies^{128,131–133} reported better clinical outcomes than the control group, while two others showed comparable outcomes.^134,135 Quality of life was assessed in only two studies; it improved in one¹³⁶ and remained unchanged in the other.¹³² (Table 11).

Table 11.

Various/other conditions.

Source	Title	Design	Condition	Age	n (IG)	Intervention	Control	Results
Hunter JF et al. 2020 USA ¹³⁴	A pilot study of the preliminary efficacy of Pain Buddy: A novel intervention for the management of children's cancer-related pain	RCT	cancer	8–18	48/20	remote symptom monitoring and skills training for pain management via app	CAU + pain documentation (attention control)	– significant reductions in average daily pain in both IG and CG (B = −0.10, z = −3.40, p = 0.001), no group differences (z = −0.83, p = 0.40) – IG reported significantly fewer instances of moderate to severe pain compared to CG, t(4125) = 2.67, p = 0.007 – IG reported no instances of moderate to severe pain toward the end of the study period
Devine KA et al. 2020 USA ¹²⁸	Feasibility of FitSurvivor: A technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer	RCT	cancer	13–25	49/25	in-person group sessions with mobile app and FitBit followed by 4 weeks of app and FitBit only	waitlist control	– significantly greater improvement in lower body muscle strength in IG compared to CG (p = 0.02) – small but not significant changes in other secondary measures – Satisfaction with the app was moderately high (M = 3.4, SD = 0.97) – on average, participants attended 5.7 of eight sessions (range 1–8) – Overall intervention satisfaction was high (M = 4.3, SD = 0.58 on 1–5 scale) – no statistically significant group × time differences across psychosocial outcomes
Jibb LA et al. 2017 Canada ¹³⁶	Implementation and preliminary effectiveness of a real-time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study	CT	cancer	12–18	40	app with pain self-management advice, nurse contacts to assist in pain care	-	– adherence was 68.8 ± 38.1% – outcome measure completion rates were high and the intervention was acceptable to participants – trends in improvements in pain intensity, pain interference, and HRQoL were significant, with effect sizes of 0.23–0.67 (p < 0.05)
Eliasen A et al. 2020 Denmark ¹³⁷	Smartphone App to Self-Monitor Nausea During Pediatric Chemotherapy Treatment: User-Centered Design Process	CT	cancer	0–18	20	app to monitor nausea and vomiting	-	– app was rated user-friendly, intuitive, and time spent on data entry was fair – response rates were on average 92%, 93%, and 80% for the day before, the first day of, and the next 3 days after chemotherapy, respectively – researchers and clinicians were able to obtain an overview of the patient's chemotherapy dates and responses through a secure and encrypted web-based administrative portal – data could be downloaded for further analysis
Semerci R et al. 2022 Turkey ¹³¹	The effect of using an interactive mobile application for the management of chemotherapy-induced nausea and vomiting in children: Randomized controlled study	RCT	cancer	8–18	62/31	app with distraction methods to reduce chemotherapy-induced nausea and vomiting	symptom tracking	– lower Adapted Rhodes Index of Nausea and Vomiting for Pediatrics by Child (ARINVc) and Parent (ARINVp) mean scores in IG compared to CG (p < 0.05) – signiﬁcant difference between the group's ARINVc and ARINVp mean scores in group, time, and grouptime interaction – signiﬁcant difference mean scores between IG and CG of group, time, and grouptime for the acute CINV (p < 0.05) – no signiﬁcant difference for delayed CINV between groups scores in terms of the time, and group*time interaction (p > 0.05)
Geirhos A et al. 2022 Germany ¹³⁰	Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACH(CD)): a randomized controlled pilot trial	feasibility RCT	chronic condition and depression or anxiety	12–21	30/15	guided internet-CBT, mood diary app	waitlist control	– intervention satisfaction (M = 25.42, SD = 5.85) and perceived therapeutic alliance (M = 2.83, SD = 1.25) were moderate and comparable to other iCBTs – no subjective and objective negative side effects of the intervention – estimated potential efficacy showed potential medium-term benefit of the intervention (β = −0.55, 95%CI: −1.17; 0.07), but probably not short-term (β = 0.20, 95%CI: −0.47; 0.88) – feasibility: intervention completion was 60%
Finlay-Jones AL et al. 2023 Australia ¹²⁹	Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial	RCT	chronic medical conditions	16–25	151/76	self-guided, web-based self-compassion training program	waitlist control	– treatment effects were observed for self-compassion (p = 0.01; partial η2 = 0.05; small effect); well-being (p≤.001; partial η2 = 0.07; medium effect); and distress (p = 0.003; partial η2 = 0.054; small-medium effect) at posttest and maintained at follow-up – no intervention effects for emotion regulation difficulties or maladaptive coping strategies – improvements in adaptive coping at posttest were not maintained at follow-up – self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being – only 29% (22/76) completed 100% of the program; the main reported barrier to completion was a lack of time
Chen AC et al. 2020 USA ¹³⁸	Healthy Hearts via Live Videoconferencing: An Exercise and Diet Intervention in Pediatric Heart Transplant Recipients	CT	heart transplant	8–19	14	live video-supervised exercise and nutrition, self-directed exercise sessions	-	– significant improvement in body mass index percentile (median, −27%; p = 0.02), endothelial function (median, +0.29; p = 0.04), maximum oxygen consumption (median, +2 mL/kg per minute; p = 0.002)., functional Movement Screening total score (median, +2.5; p = 0.002) and daily consumption of saturated fat (median, −6 g; p = 0.02) after intervention – improvements in maximum oxygen consumption (median, +3.2 mL/kg per minute; p = 0.02) and Functional Movement Screening total score (median, +5; p = 0.002) were sustained at follow-up
Looman WS et al. 2018 USA ¹³²	Health-Related Quality of Life Outcomes of a Telehealth Care Coordination Intervention for Children With Medical Complexity: A Randomized Controlled Trial	RCT	medical complexity	2–15	163/108	advanced practice nursing via phone or phone and video + CAU	CAU	– significant predictors of child HRQoL were baseline HRQoL and the presence of both neurologic impairment and technology dependence – no significant intervention effect on child HRQoL or family impact after 24 months – decreased number of unplanned visits over time across all groups, with the greatest decrease in IG ¹³⁹ – planned visits were higher in IG across all time periods ¹³⁹
Notario PM et al. 2019 USA ¹⁴⁰	Home-Based Telemedicine for Children with Medical Complexity	feasibility RCT	medical complexity	0–18	24/15	video consultation with doctor for acute and routine appointments	CAU	– device connectivity was successful 96% of the time – image and sound quality were acceptable in 98% of visits – caregivers expressed their overall satisfaction with the device – lower hospitalization rate in IG (0.77 vs. 1.14 intensive care unit days/patient-months), resulting in $9425/USD per patient savings compared to CG
Mosquera RA et al. 2021 USA ¹³³	Telemedicine for Children With Medical Complexity: A Randomized Clinical Trial	RCT	medical complexity	NA	422/209	comprehensive care (CC) and video meetings with primary care providers	comprehensive care	– the probability of a reduction with CC with telemedicine versus CC alone was 99% for care days outside the home (12.94 vs 16.94 per child-year; Bayesian rate ratio, 0.80 [95% credible interval, 0.66–0.98]) – 95% for rate of children with a serious illness (0.29 vs 0.62 per child-year; rate ratio, 0.68 [0.43–1.07]) and – 91% for mean total health system costs (US$33 718 vs US$41 281 per child-year; Bayesian cost ratio, 0.85 [0.67–1.08]).
Korus M et al. 2020 Canada ¹³⁵	Assessing the acceptability and efficacy of teens taking charge: Transplant-A pilot randomized control trial	feasibility RCT	transplantation	12–18	44/22	web-based self-management program including educational and stress management content	CAU	– no significant group differences for health-related outcomes – overall satisfaction with the intervention, would recommend – reported barriers: being too busy, computer too slow, not able to access on mobile device – time spent using the website was low for the majority of participants
Zelihić D et al. 2022 Norway, Netherlands ¹⁴¹	Reducing social anxiety in adolescents distressed by a visible difference: Results from a randomised control trial of a web-based intervention	RCT	visible difference	11–18	189	self-guided web-based psychosocial intervention	CAU	– reductions in social anxiety symptoms in IG (ηp2 = 0.06) – no significant improvements in other outcomes (body esteem, perceived stigmatization, life disengagement)

CAU: care as usual; CBT: cognitive behavioral therapy; CG: control group; CT: clinical trial; HRQoL: health-related quality of life; IG: intervention group; RCT: randomized controlled trial

Gamification

Gamification and serious games are effective tools for delivering health-related content to children and adolescents, as they enhance engagement, motivation, and learning outcomes. By integrating game mechanics such as challenges, rewards, and interactive storytelling, gamification can improve health knowledge and encourage positive behavior change.¹⁴² Additionally, serious games can make complex medical information more accessible, helping young patients develop essential skills for managing their health in an engaging and age- appropriate way.¹⁴³ Twelve studies used a gaming or gamification approach, with the highest number (n = 4) targeting obesity. Six of the interventions delivered (psycho-)educational content, while five included a contact option with a therapist, coach, or nurse. One study incorporated reminders and medication monitoring, another offered financial rewards, and a third had an additional on-site intervention. Two studies integrated peer groups, one through chat and one via team challenges.

Seven studies showed significant improvements in clinical outcomes, one of which demonstrated improvements only in some measures. Two studies reported no improvement, but no outcomes worsened post-intervention. Quality of life improved in one study. All studies reported high feasibility and satisfaction.

Video meetings

Video meetings were used in 30 studies. Physician or nurse consultations were conducted in 12 studies, while therapeutic or coaching interventions (including psychotherapy and exercise) were applied in 15 studies. Three studies focused on educational content delivered via video, while two additional studies conducted video group sessions. Video meetings were used across a wide age range, with some interventions starting from birth. One study was stopped early due to lack of participation.

Additional devices

Twelve studies incorporated additional devices beyond smartphones and PCs. Among these, three studies used continuous glucose monitoring (CGM) devices. Another three studies integrated scales, with two focusing on obesity and one as part of a comprehensive home-based examination during digital doctor appointments for Marfan syndrome. Two studies employed smart glasses or virtual reality (VR), while two others used step-tracking devices. In nine studies, acquired measurements were directly transmitted to patients’ smartphones and/or physicians. Of the six studies that reported improvements in clinical outcomes, three demonstrated superior outcomes compared to the control group, while the remaining three showed comparable results. No outcomes worsened during interventions. One study reported no improvement in clinical outcomes but noted enhanced quality of life, while another study observed better quality of life improvements in the intervention group. Additionally, two studies reported better health-related habits. One study reported limited results due to baseline group differences and high dropout rates.

Psychological components

A total of 43 studies used psychotherapy or psychological components, ranging from cognitive behavioral therapy to self-management training, delivered through various methods including video sessions, self-help modules on websites or apps, and group treatments. Some of these interventions included feedback mechanisms. Of these studies, 27 reported improved clinical outcomes post-intervention, with 8 of them demonstrating superior outcomes compared to the control group. In one instance, BMI outcomes were worse than in the control group, but body fat measurements improved. In one study on anorexia,¹¹⁷ therapeutic alliance was partially rated better for in-person treatment. However, no other outcomes were worse than the control group, and most were comparable. Quality of life was improved in 7 of 9 studies, of which 4 showing superior improvement to the control group.

Symptom tracking and treatment adherence

26 studies implemented symptom tracking, including triggers, medication, and other disease-related values. Adherence strategies were used in 32 studies and included reminders for medication or triggers, treatment planning, or medication calculation (e.g., insulin doses for diabetes patients). Following the intervention, all clinical outcomes improved in 19 studies, with 11 showing greater improvements than the control group. One study demonstrated improvements in one intervention condition, while another showed medium-term benefits. A third study reported improvements in some outcomes. One study using image recognition for calorie tracking reported worse outcomes in the intervention group, while acceptance and adherence were high.⁶² Quality of life improved in four studies and remained unchanged in seven. Only one study reported worsened outcomes after the intervention, while all other improvements were comparable to the control condition.

Education

Disease-specific education is crucial for chronically ill children and adolescents, as it fosters health literacy, enabling them to understand their condition, adhere to treatment plans, and make informed health decisions. Higher health literacy is associated with better self- management, improved treatment outcomes, and reduced complications.¹⁴⁴ Particularly in conditions like type 1 diabetes, structured education enhances glycemic control and empowers young patients to take an active role in their care.¹⁴⁵ Educational content was incorporated into 30 interventions. Among these, clinical outcomes significantly improved in 14 studies, with 9 showing greater improvements than the control group. Two studies showed an improvement in some outcomes, which were also better than those of the control group. Nine of 13 interventions resulted in improved quality of life, with 6 showing significantly greater improvements than the control condition. The remaining interventions showed comparable outcomes, with no reports of worsened outcomes.

Quality assessment

Study quality was evaluated using the JBI appraisal tools for randomized controlled trials (RCTs) and quasi-experimental studies. Due to the nature of the interventions, blinding of participants and staff was often not feasible, affecting the assessment of this dimension. However, other quality dimensions were generally rated favorably across most studies, though some studies received lower ratings or lacked sufficient information for certain criteria. Blinding of treatment delivery personnel in the RCT appraisal was not applicable in several cases where the intervention was self-administered by participants, eliminating the need for additional personnel. The same applied to blinding of outcome assessors in cases where assessments were solely questionnaire-based. Intention-to-treat-analysis was not always conducted, and descriptions of randomization methods and blinding were missing in some cases. Furthermore, most quasi-experimental studies lacked a control group, which is a critical component for comparative analysis. A detailed quality assessment is provided in the supplement. (Figures 4 to 7, Tables 12 and 13)

Discussion

Summary of evidence

High feasibility and satisfaction rates across various telemedicine interventions were observed. A diverse range of approaches, including smartphone applications, video meetings with healthcare providers, and educational content delivery, was tailored to meet the needs of chronically ill children and their families. By offering multiple modalities of engagement, such as apps or websites, our study recognized the importance of catering to individual preferences and optimizing usability.

Importantly, clinical outcomes and quality of life either improved or remained stable, with no observed worsening of outcomes during the intervention period, nor were outcomes inferior to traditional in-person care. In two cases, worse outcomes in the telemedicine group were recorded, measuring therapeutic alliance and dietary intake.

Preferences for medical treatment vary among individuals, with some expressing a preference for face-to-face interactions, while others favor communication through video conferencing or text-based messaging. By offering flexibility in communication modalities, telemedicine accommodates diverse preferences and enhances patient engagement. In consideration of the target group's needs, smartphone applications were prioritized over websites to enhance usability. This approach resonated well with participants, who appreciated the convenience of accessing healthcare services and educational resources directly from their mobile devices. Moreover, the use of smartphone applications facilitated real-time tracking of symptoms, medication adherence, and disease management, empowering patients and caregivers to actively participate in their healthcare journey.

The advantages of telemedicine were consistently highlighted, encompassing reduced travel time, the convenience of appointments in the comfort of one's home environment, and high satisfaction with digital interventions. These benefits are particularly relevant to chronically ill children and their families, who often face significant logistical and financial challenges associated with frequent medical appointments. By eliminating the need for travel and offering appointments in the comfort of one's home environment, telemedicine alleviates the burden placed on families and enhances overall quality of life.

The cost-effectiveness of telemedicine for children and adolescents remains an underexplored aspect, with only three studies directly addressing financial implications. The findings are mixed: one study reported lower medication costs, due to improved adherence and optimized prescriptions, another found reduced overall treatment costs, while a third study observed increased costs attributed to more frequent patient-provider interactions. This variation suggests that cost outcomes may depend on the specific telemedicine model and its implementation. Beyond direct healthcare expenditures, telemedicine has the potential to reduce indirect costs for families, particularly travel-related expenses and time away from work. Moreover, automation and digital tools integrated into telemedicine platforms could further enhance cost-effectiveness by streamlining routine processes, such as patient monitoring, appointment scheduling, and data management. While initial investment in technology and training is required, these advancements could lead to long-term cost reductions by optimizing healthcare resource allocation. However, the scarcity of robust cost analyses in the literature underscores the need for further research to assess the economic sustainability of telemedicine interventions, particularly in comparison to traditional care models. Future studies should consider not only direct medical costs but also broader economic implications, including healthcare system efficiency and family-level financial impact.

Despite the overwhelmingly positive feedback, our study also identified some challenges associated with telemedicine, primarily related to technical issues and individual preferences. However, these disadvantages were relatively minor compared to the numerous advantages offered by telemedicine interventions. As technology continues to evolve and healthcare systems adapt to embrace telemedicine, addressing these challenges will be critical to ensuring widespread adoption and sustained success.

For patients, especially chronically ill children and adolescents, the findings underscore the significant benefits of telemedicine in terms of improved access to care, convenience, and overall quality of life. Telemedicine reduces the burden of frequent travel to medical appointments, allowing patients to receive timely interventions and support from the comfort of their homes. By offering various communication modalities and user-friendly smartphone applications, telemedicine caters to individual preferences and empowers patients to actively participate in their healthcare journey. Overall, telemedicine enhances patient-centered care and promotes better health outcomes for children with chronic illnesses.

Telemedicine offers parents of chronically ill children invaluable support by alleviating the logistical and financial burdens associated with managing their child's healthcare needs. The convenience of remote consultations and the availability of smartphone applications streamline communication with healthcare providers and facilitate real-time monitoring of their child's health status. By reducing travel time and providing access to specialized care from anywhere, telemedicine empowers parents to better manage their child's condition while minimizing disruptions to family life. Additionally, the cost savings associated with telemedicine interventions relieve financial strain on families, enhancing their overall wellbeing.

Telemedicine enables healthcare providers to deliver high-quality care more efficiently while addressing the diverse needs of their patients. Through video meetings, remote monitoring, and educational content delivery, doctors can engage with patients and their families in a more flexible and personalized manner. Telemedicine also facilitates better coordination of care among multidisciplinary teams, leading to improved patient outcomes and increased satisfaction. By leveraging technology to overcome geographical barriers and enhance communication, telemedicine empowers doctors to optimize resource utilization and deliver patient-centered care.

The findings of this study have significant implications for health insurance providers, highlighting the safety, effectiveness, high patient satisfaction, strong engagement, reduced burden on families, and improved healthcare coverage associated with telemedicine interventions. By reducing the need for in-person visits and hospitalizations, telemedicine lowers healthcare utilization costs and minimizes unnecessary expenditures. Moreover, telemedicine interventions promote preventive care and early intervention, leading to better health outcomes and reduced long-term healthcare costs. As such, health insurance providers stand to benefit from supporting the integration of telemedicine into healthcare delivery systems, thereby enhancing the value and efficiency of their coverage offerings. To translate these findings into practice, policymakers should prioritize the development of regulatory frameworks that ensure the continued integration and reimbursement of telemedicine, particularly for managing chronic conditions in children and adolescents. Health insurance providers can support this shift by expanding coverage for telemedicine services, recognizing their potential to reduce long-term healthcare costs through preventive care and early intervention. Additionally, healthcare providers should adopt telemedicine as a standard option for appropriate cases, leveraging its benefits to enhance patient engagement, improve adherence to treatment, and minimize logistical challenges for families. By aligning financial incentives, clinical guidelines, and digital infrastructure, stakeholders can optimize telemedicine's role in pediatric care, ultimately improving health outcomes and reducing strain on both families and the healthcare system.

Telemedicine represents a critical component of healthcare policy discussions, particularly in the context of improving access to care, reducing healthcare disparities, and optimizing healthcare resource allocation. The findings of this study underscore the importance of policies that support the widespread adoption and integration of telemedicine into healthcare delivery systems. By prioritizing investments in telemedicine infrastructure, expanding reimbursement policies, and addressing regulatory barriers, policymakers can facilitate the equitable provision of telemedicine services to all patients, regardless of geographical location or socioeconomic status. Moreover, by promoting telemedicine as a cost-effective solution for enhancing healthcare access and quality, policymakers can drive systemic changes that benefit both patients and healthcare systems as a whole.

Post-COVID-19 research indicates a growing acceptance of digital interventions among patients, caregivers, and physicians, reflecting increased familiarity and confidence in telemedicine. However, significant challenges remain in fully integrating telemedicine into routine care. Policy frameworks and reimbursement structures often lag behind technological advancements, limiting widespread adoption. Additionally, many healthcare systems face barriers to implementation, including infrastructure limitations, regulatory constraints, and inconsistent digital literacy among users. Overcoming these challenges requires targeted policy adaptations and structural investments to ensure telemedicine can transition from an emergency response to a sustainable component of regular healthcare delivery.

Study quality is a crucial factor that is sometimes overlooked in the studies presented in this paper. The frequent inability to blind participants and staff underscores a potential source of bias that may affect the reliability of the results. While most studies performed well on other quality dimensions, the inconsistencies and occasional lack of information highlight the need for more comprehensive reporting and adherence to methodological standards. The absence of control groups in many quasi-experimental studies further limits the ability to draw robust causal inferences. These factors collectively suggest that while the overall study quality is reasonable, there are significant areas for improvement that should be addressed in future research to enhance the validity and reliability of findings.

Limitations

The studies included in our analysis exhibited considerable heterogeneity in their methodologies and outcome measures, posing challenges to direct comparisons of results. Consequently, conducting a meta-analysis to synthesize the findings was not feasible. Additionally, due to the relatively small sample sizes in many of the studies, the statistical significance of the results may be limited. Only 34 (29.3%) studies had over 100 participants, which may restrict the generalizability of the findings.

Another limitation of this review is its focus on intervention studies with short evaluation periods, leaving the long-term impact of telemedicine unclear. Short-term studies may not fully capture sustained patient engagement, adherence, or cost-effectiveness. Future research should include retrospective analyses of established telemedicine programs to provide insights into long-term clinical benefits, cost trends, and implementation challenges, supporting more sustainable healthcare integration.

Furthermore, despite efforts to systematically evaluate the literature, the breadth of studies prevented an in-depth analysis of all factors and nuances. Additionally, the limitations of this study include the reliance on a single database.

Conclusions

Our study underscores the transformative potential of telemedicine interventions in managing chronic illnesses among children and adolescents. Through diverse modalities such as smartphone applications and video consultations, telemedicine offers enhanced accessibility, convenience, and time and cost savings for patients and families. Despite the clear benefits demonstrated, challenges such as methodological heterogeneity and small sample sizes across studies highlight the need for standardized outcome measures and larger-scale research endeavors. Standardization would facilitate comparability between studies and increase statistical significance, thereby strengthening the evidence base for telemedicine interventions in pediatric healthcare.

Moving forward, concerted efforts are required to address these challenges and fully capitalize on the potential of telemedicine. This includes continued investment in telemedicine infrastructure and technology, as well as the implementation of policies that support equitable access and reimbursement. Moreover, future research should prioritize standardized methodologies, larger sample sizes, and longitudinal studies to elucidate the long-term impact of telemedicine on health outcomes and healthcare delivery, as well as pay more attention to methodological robustness. By addressing these considerations, telemedicine can emerge as a cornerstone of pediatric healthcare delivery, improving outcomes and quality of life for chronically ill children and their families.

Supplemental Material

sj-docx-1-jtt-10.1177_1357633X251334423 - Supplemental material for Telemedicine and digital health for chronic conditions in pediatrics: A systematic review

Supplemental material, sj-docx-1-jtt-10.1177_1357633X251334423 for Telemedicine and digital health for chronic conditions in pediatrics: A systematic review by Britta Exner, Isabel V Frielitz-Wagner and Fabian-S Frielitz in Journal of Telemedicine and Telecare

Footnotes

Abbreviations

Contributors statement

Britta Exner, M.Sc.: Conceptualization, Formal Analysis, Investigation, Methodology, Visualization, Writing – original draft.

Dr Isabel V. Frielitz-Wagner: Conceptualization, Methodology, Validation, Writing – review & editing.

Prof. Dr Dr Fabian-S. Frielitz, LL.M., MA, MBA, MHEd: Conceptualization, Funding acquisition, Methodology, Validation, Writing – review & editing.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the authors used ChatGPT-4/4o in order to enhance the clarity and fluency of the manuscript's language, without altering the original content or scientific integrity. After using this tool, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Bundesministerium für Bildung und Forschung (grant number 01GY2111).

Registration,data availability,and protocol

The review was not registered. A protocol was not prepared; the documentation of the review process, data extracted from studies, and analytic code can be provided by the authors upon request.

Role of funder/sponsor

The funder had no influence on the data analysis, interpretation, or publication.

ORCID iD

Britta Exner

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Supplemental material

Supplemental material for this article is available online.

References

Van Cleave

Gortmaker

Perrin

. Dynamics of obesity and chronic health conditions among children and youth. JAMA 2010; 303: 623–630. ISSN: 1538-3598.

KiGGS Study Group, Neuhauser

Poethko-Müller

. Chronische Erkrankun- gen und impfpräventable Infektionserkrankungen bei Kindern und Jugendlichen in Deutschland: Ergebnisse der KiGGS-studie – Erste Folgebefragung (KiGGS Welle 1). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2014; 57(7): 779–788. ISSN: 1436-9990, 1437-1588. URL: http://link.springer.com/10.1007/s00103-014-1976-6

Garrido-Miguel

, et al. Prevalence and trends of overweight and obesity in European children from 1999 to 2016: A systematic review and meta-analysis. JAMA Pediatr 2019; 173: e192430. ISSN: 2168-6203. DOI: 10.1001/ jamapediatrics.2019.2430. rl:

Sayal

, et al. ADHD In children and young people: Prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5: 175–186. Publisher: Elsevier, pp. 175–186. ISSN: 2215-0366, 2215-0374. DOI: 10.1016 /S2215-0366(17)30167-0. URL: https://www .thelancet.com/journals/lanpsy/article /PIIS2215-0366(17)30167-0/fulltext

Serebrisky

Wiznia

. Pediatric asthma: A global epidemic. Ann Glob Health 2019; 85: 6. ISSN: 2214-9996. DOI: 10.5334/aogh. 2416. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052318/

Dut

, et al. Psychological burden of asthma in adolescents and their parents. J Asthma: Off J Assoc for the Care of Asthma 2022; 59.: 1116–1121. ISSN: 1532-4303. DOI: 10.1080/02770903.2021.1903916.

Datz

, et al. Pediatric chronic pain and caregiver burden in a national survey. Scand J Pain 2019; 19: 109–116. ISSN: 1877-8879. DOI: 10.1515/sjpain-2018-0121

Shattnawi

, et al. Caregiver burden among parents of children with chronic diseases: A cross-sectional study. J Clin Nurs 2023; 32: 17–18 (Sept. 2023), pp. 6485–6493. ISSN: 1365-2702. DOI: 10.1111/jocn.16672.

OECD. The COVID-19 Pandemic and the Future of Telemedicine. en. OECD Health Policy Studies. OECD, 2023. isbn: 978-92-64-84041-6 978-92-64-75815-5 978-92-64-42003-8 978-92-64-48456-6. DOI: 10.1787/ac8b0a27-en. URL: https://www.oecd-ilibrary.org/social-issues-migration-health/the-covid-19-pandemic-and-the-future- of-telemedicine_ac8b0a27-en

10.

Macwilliam

Hennessey

Cleary

. Telemedicine: Improving clinical care and medical education in paediatrics. Paediatr Child Health (Oxford) 2021; 31: 388–396. ISSN: 1751-7222. DOI: 10.1016/j.paed.2021.07.004

11.

Telemedicine has clear benefits for patients in European countries, new study shows. en. URL: https://www.who.int/europe/news/item/31-10-2022-telemedicine-has- clear-benefits-for-patients-in-european-countries-- new-study-shows

12.

Hjelm

. Benefits and drawbacks of telemedicine. J Telemed Telecare 2005; 11: 60–70. ISSN: 1357-633X. DOI: 10.1258/1357633053499886.

13.

Freed

, et al. Telemedicine: Is it really worth it? A perspective from evidence and experience. J Innov Health Inform 2018; 25: 14–18. ISSN: 2058-4563. DOI: 10.14236/jhi.v25i1.957.

14.

Daragó

, et al. [Benefits and disadvantages of telemedicine]. Orv Hetil 2013; 154: 1167–1171. ISSN: 0030-6002. DOI: 10.1556/OH.2013. 29664.

15.

Shah

Badawy

. Telemedicine in pediatrics: Systematic Re- view of randomized controlled trials. JMIR Pediatr Parenting 2021; 4: e22696. ISSN: 2561-6722. DOI: 10.2196/22696. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078694/

16.

Pappalardo

, et al. Telemedicine in pediatric infectious diseases. Children (Basel, Switzerland) 2021; 8: 260. ISSN: 2227-9067. DOI: 10.3390/children8040260.

17.

Spence

, et al. Exploring the promise of telemedicine exercise inter- ventions in children and adolescents with congenital heart disease. Can J Cardiol 2023; 39: S346–S358. ISSN: 1916-7075. DOI: 10.1016/j.cjca.2023.08.015.

18.

Preminger

. Telemedicine in pediatric cardiology: Pros and cons. Curr Opin Pediatr 2022; 34: 484–490. ISSN: 1531-698X. DOI: 10.1097/MOP.0000000000001159.

19.

Umano

, et al. Telemedicine in the COVID-19 era: Taking care of children with obesity and diabetes mellitus. World J Diabetes 2021; 12: 651–657. ISSN: 1948-9358. DOI: 10.4239/wjd.v12.i5.651.

20.

Blake

. Telemedicine and adherence monitoring in children with asthma. Curr Opin Pulm Med 2021; 27: 37–44. ISSN: 1531-6971. DOI: 10.1097/MCP.0000000000000739.

21.

Ferro

, et al. Impact of telemedicine on health outcomes in children with medical complexity: An integrative review. Eur J Pediatr 2021; 180: 2389–2400. ISSN: 1432-1076. DOI: 10.1007/s00431-021-04164-2.

22.

Barker

, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. En-US. JBI Evidence Synthesis 2023; 21: 494. ISSN: 2689-8381. DOI: 10.11124/JBIES- 22- 00430. URL: https://journals.lww.com/jbisrir/Fulltext/2023/03000/The_revised_JBI_critical_appraisal_tool_for_the.5.aspx?context=FeaturedArticles&collectionId=2.

23.

Tufanaru

, et al. Chapter 3: Systematic Reviews of Effectiveness. In JBI Reviewer‘s Manual, 4th ed. JBI, 2019. DOI: 10.46658/JBIRM-17-03. URL: https://jbi-global-wiki.refined.site/space/MANUAL/4685848/Previous+versions?attachment=/rest/api/content/4685848/child/attachment/att4698146/ download&type=application/pdf&filename=JBI_Reviewers_Manual_2020March

24.

Haddaway

, et al. PRISMA2020 : An R package and shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev 2022; 18: e1230. ISSN: 1891-1803, 1891-1803. DOI: 10.1002/cl2.1230. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1002/cl2.1230

25.

Garcia

, et al. Greater telehealth use results in increased visit fre- quency and lower physician related-distress in adolescents and young adults with type 1 diabetes. J Diabetes Sci Technol 2023; 17: 878–886. ISSN: 1932-2968, 1932-2968. DOI: 10.1177/19322968221146806. URL: http: //journals-sagepub-com.web.bisu.edu.cn/doi/10 0.1177 /19322968221146806.

26.

Crossen

, et al. Home visits for children and adolescents with un-controlled type 1 diabetes. Diabetes Technol Ther 2020; 22: 34–41. ISSN: 1520-9156, 1557-8593. DOI: 10 .1089/dia.2019 .0214. URL: https://www.liebertpub.com/doi/10.1089/dia.2019.0214

27.

Von Sengbusch

, et al. Outcomes of monthly video consultations as an add-on to regular care for children with type 1 diabetes: A 6-month quasi-randomized clinical trial followed by an extension phase. Pediatr Diabetes 2020; 21: 1502–1515. ISSN: 1399-543X, 1399-5448. DOI: 10.1111/pedi.13133. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/pedi.13133

28.

Tonyushkina

, et al. Televisits to partially substitute for clinic visits are feasible and well accepted by tech-savvy patients with T1DM and their families: A prospective pilot study. J Diabetes Sci Technol 2018; 12: 1084–1085. ISSN: 1932-2968, 1932-2968. DOI: 10.1177/1932296818775438. URL: http://journals.sagepub.com/doi/10.1177/1932296818775438.

29.

Holtz

, et al. The effect of an mHealth intervention for adolescents with type 1 diabetes and their parents. J Telemed Telecare 2024; 30: 1155–1162., Publisher: SAGE Publications, pp. 1155–1162. ISSN: 1357-633X. DOI: 10.1177/1357633X221125835. URL: https://doi.org/10.1177/1357633X221125835

30.

Crossen

, et al. Remote glucose monitoring is feasible for patients and providers using a commercially available population health platform. Front Endocrinol (Lausanne) 2023; 14: 1063290. ISSN: 1664-2392. DOI: 10.3389/fendo.2023.1063290. URL: https://www.frontiersin.org/articles/10.3389/fendo.2023.1063290/full

31.

Maxwell

, et al. A randomized pilot trial using Mobile health and financial incentives to motivate heart-healthy behaviors in adolescents with type 1 diabetes. J Diabetes Sci Technol 2023; 17: 855–856. ISSN: 1932-2968, 1932-2968. DOI: 10.1177/19322968231155151. URL: http://journals.sagepub.com/doi/10.1177/19322968231155151

32.

Hannon

, et al. Advancing diabetes management in adolescents: Compar- ative effectiveness of mobile self-monitoring blood glucose technology and family- centered goal setting. Pediatr Diabetes 2018; 19: 776–781. ISSN: 1399543X. DOI: 10.1111/pedi.12648. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/pedi.12648

33.

Klee

, et al. An intervention by a patient-designed do-it-yourself Mobile device app reduces HbA1c in children and adolescents with type 1 diabetes: A randomized double-crossover study. Diabetes Technol Ther 2018; 20: 797–805. ISSN: 1520-9156, 1557-8593. DOI: 10.1089/dia.2018. 0255. URL: https://www.liebertpub.com/doi/10.1089/dia.2018.0255

34.

Holtz

, et al. An mHealth-based intervention for adolescents with type 1 di- abetes and their parents: Pilot feasibility and efficacy single-arm study. JMIR Mhealth Uhealth 2021; 9: e23916. ISSN: 2291-5222. DOI: 10.2196/ 23916. URL: https://mhealth.jmir.org/2021/9/e23916

35.

Alfonsi

, et al. Carbohydrate counting app using image recognition for youth with type 1 diabetes: Pilot randomized control trial. JMIR mHealth and UHealthm 2020; 8: e22074. ISSN: 2291-5222. DOI: 10.2196/22074. URL: http://mhealth.jmir.org/2020/10/e22074/

36.

Mulvaney

, et al. Mobile momentary assessment and biobehavioral feed- back for adolescents with type 1 diabetes: Feasibility and engagement patterns. Diabetes Technol Ther 2018; 20: 465–474. ISSN: 1520-9156, 1557-8593. DOI: 10.1089/dia.2018.0064. URL: http://www.liebertpub.com/doi/10.1089/dia.2018.0064

37.

Chatzakis

, et al. The beneficial effect of the Mobile application Euglyca in children and adolescents with type 1 diabetes Mellitus: A randomized con- trolled trial. Diabetes Technol Ther 2019; 21: 627–634. ISSN: 1520-9156, 1557-8593. DOI: 10.1089/dia.2019.0170. URL: https://www.liebertpub.com/doi/10.1089/dia.2019.0170

38.

Di Bartolo

, et al. Young patients with type 1 diabetes poorly controlled and poorly compliant with self-monitoring of blood glucose: Can technology help? Results of the i-NewTrend randomized clinical trial. Acta Diabetol 2017; 54: 393–402. ISSN: 0940-5429, 1432-5233. DOI: 10.1007/s00592-017-0963-4. URL: https://link-springer-com-443.web.bisu.edu.cn/10.1007/s00592-017-0963-4

39.

, et al. A randomized controlled trial of a mobile application-assisted nurse-led model used to improve treatment outcomes in children with asthma. J Adv Nurs 2019; 75: 3058–3067. ISSN: 0309-2402, 1365-2648. DOI: 10.1111/jan.14143. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/jan.14143

40.

Van Den Wijngaart

, et al. A virtual asthma clinic for children: Fewer routine outpatient visits, same asthma control. Eur Respir J 2017; 50: 1700471. ISSN: 0903-1936, 1399-3003. DOI: 10.1183/13993003.00471-2017. URL: http://erj.ersjournals.com/lookup/doi/10.1183/13993003.00471-2017

41.

Shdaifat

Khasawneh

Alefan

. Clinical and economic Impact of telemedicine in the management of pediatric asthma in Jordan: A pharmacist-led intervention. Journal of Asthma 2022; 59: 1452–1462. ISSN: 0277-0903, 1532-4303. DOI: 10.1080/02770903.2021.1924774. URL: https://www-tandfonline-com-s.web.bisu.edu.cn/doi/full/10.1080/02770903.2021.1924774

42.

Ljungberg

, et al. Clinical effect on uncontrolled asthma using a novel digital automated self-management solution: A physician-blinded randomised controlled crossover trial. Eneur Respir J 2019; 54: 1900983. ISSN: 0903-1936, 1399-3003. DOI: 10.1183/13993003.00983-2019. URL: http://erj.ersjournals.com/lookup/doi/10.1183/13993003.00983-2019

43.

Kosse

, et al. Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial. Respir Med 2019; 149: 45–51. ISSN: 09546111. DOI: 10.1016/j.rmed.2019.02.009. URL: https://linkinghub.elsevier.com/retrieve/pii/S0954611119300459

44.

Fedele

, et al. Using Mobile health to improve asthma self-management in early adolescence: A pilot randomized controlled trial. J of Ado- Lescent Health 2021; 69: 1032–1040. ISSN: 1054139X. DOI: 10.1016/j.jadohealth.2021.06.011. URL: https:// linkinghub.elsevier.com/retrieve/pii/S1054139X21002937.

45.

Gümüş

, et al. Virtual care for paediatric asthma: A randomized controlled trial. Int J Nurs Pract 2024; 30eprint: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/pdf/10.1111/ijn.13290. ISSN: 1440-172X. DOI: 10.1111/ijn.13290. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/abs/10.1111/ijn. 13290.

46.

Halterman

, et al. Effect of the school-based telemedicine enhanced asthma management (SB-TEAM) program on asthma morbidity: A randomized clinical trial. JAMA Pediatr 2018; 172: e174938. ISSN: 2168-6203. DOI: 10.1001/jamapediatrics.2017.4938. URL: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2017.4938

47.

Perry

, et al. Results of an asthma education program delivered via telemedicine in rural schools. Ann Allergy Asthma Immunol 2018; 120: 401–408. ISSN: 10811206. DOI: 10.1016/j.anai.2018.02.013. URL: https://linkinghub.elsevier.com/retrieve/pii/S1081120618301224

48.

Al Raimi

, et al. Effect of health education via Mobile application in promoting quality of life among asthmatic schoolchildren in urban Malaysia during the COVID-19 era: A quasi-experimental study. CIN: Computers, In- Formatics, Nursing 2022; 40: 648–657. ISSN: 1538-9774. DOI: 10.1097/CIN.0000000000000927. URL: https://journals.lww.com/10.1097/CIN.0000000000000927

49.

Stukus

, et al. Real-world evaluation of a mobile health application in children with asthma. Ann Allergy Asthma Immunol 2018; 120: 395–400.e1. ISSN: 10811206. DOI: 10.1016/j.anai.2018.02.006. URL: https://linkinghub.elsevier.com/retrieve/pii/S1081120618301157

50.

Montalbano

, et al. Targeting quality of life in asthmatic children: The MyTEP pilot randomized trial. Respir Med 2019; 153: 14–19. ISSN: 09546111. DOI: 10.1016/j.rmed.2019.05.008. URL: https://linkinghub.elsevier.com/retrieve/pii/S095461111930160X

51.

Halterman

, et al. Effect of the telemedicine enhanced asthma management through the emergency department (TEAM-ED) program on asthma morbidity: A randomized controlled trial. J Pediatr 2024; 266: 113867. ISSN: 0022-3476. DOI: 10.1016/j.jpeds.2023.113867. URL: https://www-sciencedirect-com-443.web.bisu.edu.cn/science/article/pii/S002234762300731X

52.

Vriezinga

, et al. E-Healthcare for celiac disease—A multicenter randomized controlled trial. J Pediatr 2018; 195: 154–160.e7. ISSN: 00223476. DOI: 10.1016/j.jpeds.2017.10.027. URL: https://linkinghub.elsevier.com/retrieve/pii/S0022347617313768

53.

Carlsen

, et al. Individualized infliximab treatment guided by patient-managed eHealth in children and adolescents with inflammatory bowel disease. Inflamm Bowel Dis 2017; 23: 1473–1482. ISSN: 1078-0998. DOI: 10.1097/MIB.0000000000001170. URL: https://academic.oup.com/ibdjournal/article/23/9/1473-1482/4560707

54.

Carlsen

, et al. Self-managed eHealth disease monitoring in children and adolescents with inflammatory bowel disease: A randomized controlled trial. Inflamm Bowel Dis 2017; 23: 1. ISSN: 1078-0998. DOI: 10.1097/ MIB.0000000000001026. URL: https://academic.oup.com/ibdjournal/article/23/3/357-365/4561060

55.

Hightow-Weidman

, et al. Epic allies: A gamified Mobile app to improve engagement in HIV care and antiretroviral adherence among young men who have sex with men. AIDS Behav 2021; 25: 2599–2617. ISSN: 1090-7165, 1573-3254. DOI: 10.1007/s10461-021-03222-y. URL: https://link-springer-com-443.web.bisu.edu.cn/10.1007/s10461-021-03222-y

56.

Rivet Amico

, et al. Randomized controlled trial of a remote coaching mHealth adherence intervention in youth living with HIV. AIDS Behav 2022; 26: 3897–3913. ISSN: 1090-7165, 1573-3254. DOI: 10.1007/s10461-022-03717-2. URL: https://link-springer-com-443.web.bisu.edu.cn/10.1007/s10461-022-03717-2

57.

Connelly

, et al. Multisite randomized clinical trial evaluating an online self-management program for adolescents with juvenile idiopathic arthritis. J Pediatr Psychol 2019; 44: 363–374. ISSN: 0146-8693, 1465-735X. DOI: 10.1093/jpepsy/jsy066. URL: https://academic.oup.com/jpepsy/ article/44/3/363/5094678

58.

Stinson

, et al. Teens taking charge: A randomized controlled trial of a web-based self-management program with telephone support for adolescents with juvenile idiopathic arthritis. J Med Internet Res 2020; 22: e16234. ISSN: 1438-8871. DOI: 10.2196/16234. URL: https://www.jmir.org/ 2020/7/e16234

59.

Lalloo

, et al. The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: A pilot randomized controlled trial. Rheuma- Tology 2021; 60: 196–206. ISSN: 1462-0324, 1462-0332. DOI: 10.1093 /rheumatology/keaa178. URL: https://academic.oup.com/rheumatology/article/60/ 1/196/5866174

60.

Lester

, et al. Virtual mind-body treatment for geographically diverse youth with neurofibromatosis: A pilot randomized controlled trial. Gen Hosp Psychiatry 2020; 62: 72–78. ISSN: 01638343. DOI: 10.1016/j.genhosppsych.2019.12.001. URL: https://linkinghub.elsevier.com/retrieve/pii/S0163834319302439

61.

Lester

, et al. Improvement in resiliency factors among adolescents with neurofibromatosis who participate in a virtual mind-body group program. J Neuro-Oncol 2020; 147: 451–457. ISSN: 1573-7373. DOI: 10.1007/s11060-020-03441-8.

62.

Oei

, et al. An image-recognition dietary assessment app for adolescents with obesity: Pilot randomized controlled trial. JMIR Formative Research 2024; 8: e58682. ISSN: 2561-326X. DOI: 10.2196/58682. URL: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC11650080/

63.

Zhu

, et al. The effectiveness of a 10-week family-focused e-health healthy lifestyle program for school-aged children with overweight or obesity: A randomised control trial. BMC Public Health 2025; 25: 59. ISSN: 1471-2458. DOI: 10.1186/s12889-024-21120-5. URL: https://doi.org/10.1186/s12889-024-21120-5

64.

Hagman

, et al. Effect of an interactive mobile health support system and daily weight measurements for pediatric obesity treatment, a 1-year pragmatical clinical trial. Int J Obes 2022; 46: 1527–1533. ISSN: 0307-0565, 1476-5497. DOI: 10.1038/s41366-022-01146-8. URL: https://www.nature. com/articles/s41366-022-01146-8

65.

Browne

, et al. Mobile health apps in pediatric obesity treatment: Process outcomes from a feasibility study of a multicomponent intervention. JMIR Mhealth Uhealth 2020; 8: e16925. ISSN: 2291-5222. DOI: 10.2196/16925. URL: https://mhealth.jmir.org/2020/7/e16925

66.

Naets

, et al. Adherence and barriers in e-health self-control training for enhancing childhood multidisciplinary obesity treatment. Clinical Psychol- ogy & Psychotherapy 2020; 27: 42–51. ISSN: 1063-3995, 1099-0879. DOI: 10.1002/cpp.2405. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1002/cpp.2405

67.

Vidmar

, et al. An addiction model-based mobile health weight loss intervention in adolescents with obesity. Pediatr Obes 2019; 14: e12464. ISSN: 2047-6302, 2047-6310. DOI: 10.1111/ijpo.12464. URL: https://onlinelibrary.wiley. com/doi/10.1111/ijpo.12464

68.

Vidmar

, et al. An <span style=‘font-variant:Small-caps;’>addiction-based</span> digital weight loss intervention: A <span style=‘font-variant:Small-caps;’>multi-centre</span> randomized controlled trial. Pediatr Obes 2023; 18: e12990. ISSN: 2047-6302, 2047-6310. DOI: 10.1111/ijpo.12990. URL: https://onlinelibrary. wiley.com/doi/10.1111/ijpo.12990

69.

Vidmar

, et al.

Can a behavioral weight-loss intervention change adolescents’ food addiction severity?

Childhood Obesity 2022; 18: 206–212. ISSN: 2153-2168, 2153-2176. DOI: 10.1089/chi.2021.0271. URL: https://www. liebertpub.com/doi/10.1089/chi.2021.0271

70.

Memarian

, et al.

Can sweet food-specific inhibitory control training via a mobile application improve eating behavior in children with obesity?

Br J Health Psychol 2022; 27: 645–665. ISSN: 1359-107X, 2044- 8287. DOI: 10.1111/bjhp.12566. URL: https://bpspsychub.onlinelibrary.wiley.com/ doi/10.1111/bjhp.12566

71.

Salahshoornezhad

, et al. Effect of a multi-disciplinary program on anthropomet- ric and biochemical parameters in obese and overweight elementary school girls: A randomized clinical trial. Nutr, Metab Cardiovasc Dis 2022; 32: 1982–1989. ISSN: 09394753. DOI: 10.1016/j.numecd.2022.04.014. URL: https://linkinghub.elsevier.com/retrieve/pii/S0939475322001752

72.

Stasinaki

, et al. Effects of a novel mobile health intervention compared to a multi- component behaviour changing program on body mass index, physical capacities and stress parameters in adolescents with obesity: A randomized controlled trial. BMC Pediatr 2021; 21: 308. ISSN: 1471-2431. DOI: 10.1186/s12887-021-02781-2. URL: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021- 02781-2

73.

Tugault-Lafleur

, et al. Efficacy of the Aim2Be intervention in changing lifestyle behaviors among adolescents with overweight and obesity: Randomized controlled trial. J Med Internet Res 2023; 25: e38545. ISSN: 1438-8871. DOI: 10.2196/38545. URL: https://www.jmir.org/2023/1/e38545

74.

Staiano

, et al. Home-based exergaming among children with overweight and obesity: A randomized clinical trial. Pediatr Obes 2018; 13: 724–733. ISSN: 2047-6302, 2047-6310. DOI: 10.1111/ijpo.12438. URL: https:// onlinelibrary.wiley.com/doi/10.1111/ijpo.12438

75.

W-C

, et al. Telehealth versus face-to-face fine motor and social com- munication interventions for children with autism Spectrum disorder: Efficacy, fidelity, acceptability, and feasibility. Am J Occup Ther 2023; 77: 7706205130. ISSN: 0272-9490. DOI: 10.5014/ajot.2023.050282. URL: https: //www.ncbi.nlm.nih.gov /pmc /articles /PMC10846418/.

76.

Andrén

, et al. Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric tourette’s disorder: A pilot randomised controlled trial with long-term follow-up. BMJ Open 2019; 9: e024685. ISSN: 2044-6055, 2044-6055. DOI: 10.1136/bmjopen-2018-024685. URL: https://bmjopen.bmj.com/ lookup/doi/10.1136/bmjopen-2018-024685

77.

Hollis

, et al. Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): A multicentre, parallel group, single-blind, randomised controlled trial. Lancet Psychiatry 2021; 8: 871–882. ISSN: 22150366. DOI: 10.1016/S2215-0366(21)00235-2. URL: https://linkinghub.elsevier.com/retrieve/pii/S2215036621002352

78.

Weisman

, et al. Testing the efficacy of a smartphone application in improving medication adherence, among children with ADHD. Israel J Psychiatry 2018; 55: 59–63.

79.

, et al. Comparison of compliance among patients with pediatric amblyopia undergoing virtual reality-based and traditional patching method training. Front Public Health 2022; 10: 1037412. ISSN: 2296-2565. DOI: 10.3389/fpubh.2022.1037412. URL: https://www.frontiersin.org/articles/10.3389/fpubh.2022.1037412/full

80.

Le Marne

, et al. Epapp: Development and evaluation of a smartphone/tablet app for adolescents with epilepsy. J Clin Neurosci 2018; 50: 214–220. ISSN: 09675868. DOI: 10.1016/j.jocn.2018.01.065. URL: https://linkinghub.elsevier.com/retrieve/pii/S0967586817319379

81.

Modi

, et al. Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy. Epilepsy Behav 2023; 140: 109082. ISSN: 15255050. DOI: 10.1016/j.yebeh.2022.109082. URL: https://linkinghub.elsevier.com/retrieve/pii/S1525505022005315

82.

Medina

, et al. Electrophysiological brain changes associated with cognitive improvement in a pediatric attention deficit hyperactivity disorder digital artificial intelligence-driven intervention: Randomized controlled trial. J Med Internet Res 2021; 23: e25466. ISSN: 1438-8871. DOI: 10.2196/ 25466. URL: https://www.jmir.org/2021/11/e25466

83.

Parsons

, et al. A randomised controlled trial of an information communica- tion technology delivered intervention for children with autism Spectrum disorder living in regional Australia. J Autism Dev Disord 2019; 49: 569–581. ISSN: 0162-3257, 1573-3432. DOI: 10.1007/s10803-018-3734- 3. URL: http://link.springer.com/10.1007/s10803- 018- 3734- 3.

84.

Lindgren

, et al. A randomized controlled trial of functional communication training via telehealth for young children with autism Spectrum disorder. J Autism Dev Disord 2020; 50: 4449–4462. ISSN: 0162-3257, 1573-3432. DOI: 10.1007/s10803- 020- 04451- 1. URL: https://link-springer-com-443.web.bisu.edu.cn/10.1007/s10803-020-04451-1

85.

Voss

, et al. Effect of wearable digital intervention for improving socialization in children with autism Spectrum disorder: A randomized clinical trial. JAMA Pediatr 2019; 173: 446. ISSN: 2168-6203. DOI: 10.1001/ jamapediatrics.2019.0285. URL: http://archpedi.jamanetwork.com/article.aspx?doi= 10.1001/jamapediatrics.2019.0285.

86.

Lewis

, et al. A pilot randomised controlled trial of a telehealth-delivered brief ‘sleeping sound autism’ intervention for autistic children. Sleep Med 2024; 124: 162–173. ISSN: 1389-9457. DOI: 10.1016/j.sleep.2024.09.001. URL: https://www-sciencedirect-com-443.web.bisu.edu.cn/science/article/pii/S1389945724004064

87.

Conaughton

Donovan

March

. Efficacy of an internet-based CBT program for children with comorbid high functioning autism Spectrum disorder and anxiety: A randomised controlled trial. J Affect Disord 2017; 218: 260–268. ISSN: 01650327. DOI: 10.1016/j.jad.2017.04.032. URL: https://linkinghub.elsevier.com/retrieve/pii/S0165032716315324

88.

Anderson

, et al. Recruiting adolescents with chronic fatigue syndrome/myalgic encephalomyelitis to internet-delivered therapy: Internal pilot within a randomized controlled trial. J Med Internet Res 2020; 22: e17768. ISSN: 1438-8871. DOI: 10.2196/17768. URL: https://www.jmir.org/2020/8/e17768

89.

Crawley

, et al. Comparison of cognitive behaviour therapy versus activity man- agement, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT. National Institute for Health and Care Research. 2024.

90.

Simone

, et al. Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: A pilot trial. BMC Neurol 2018; 18: 82. ISSN: 1471-2377. DOI: 10.1186 /s12883-018-1087-3. URL: https: //bmcneurol.biomedcentral.com /articles /10.1186 /s12883-018-1087-3.

91.

Ahmed

, et al. Speech-driven mobile games for speech therapy: User experiences and feasibility. Int J Speech Lang Pathol 2018; 20: 644–658. ISSN: 1754-9507, 1754-9515. DOI: 10.1080/17549507.2018.1513562.URL: https://www-tandfonline-com-s.web.bisu.edu.cn/doi/full/10.1080/17549507.2018.1513562

92.

McKechnie

, et al. The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech. J Commun Disord 2020; 87: 106026. ISSN: 00219924. DOI: 10. 1016/j.jcomdis.2020.106026. URL: https://linkinghub.elsevier.com/retrieve/pii/ S0021992420300940

93.

Corti

, et al. Feasibility of a home-based computerized cognitive training for pediatric patients with congenital or acquired brain damage: An explorative study. PLOS ONE 2018; 13: e0199001., Ed. by Jacobus P. Van Wouwe, e0199001. ISSN: 1932-6203. DOI: 10.1371/journal.pone.0199001. URL: https://dx.plos.org/10.1371/ journal.pone.0199001

94.

Piovesana

, et al. Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy. Disabil Rehabil 2017; 39: 2021–2028. ISSN: 0963-8288, 1464-5165. DOI: 10.1080/09638288.2016.1213899. URL: https://www-tandfonline-com-s.web.bisu.edu.cn/doi/full/10.1080/09638288.2016.1213899.

95.

Güven

ŞT

Dalgiç

Aİ

Duman

. Evaluation of the efficiency of the web-based epilepsy education program (WEEP) for youth with epilepsy and parents: A randomized controlled trial. Epilepsy Behav 2020; 111: 107142. ISSN: 15255050. DOI: 10.1016/j.yebeh.2020.107142. URL: https://linkinghub.elsevier.com/retrieve/pii/S1525505020303218

96.

Ramsey

, et al. A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. Cephalalgia 2018; 38: 2035–2044. ISSN: 0333-1024, 1468-2982. DOI: 10.1177/0333102418756864.URL: http:// journals-sagepub-com.web.bisu.edu.cn/doi/10.1177/0333102418756864.

97.

Hershey

, et al. Remote electrical neuromodulation for acute treatment of migraine in adolescents. Headache: The Journal of Head and Face Pain 2021; 61: 310–317. ISSN: 0017-8748, 1526-4610. DOI: 10.1111/head.14042. URL: https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14042

98.

Rachamim

, et al. Internet-based guided self-help comprehensive behavioral intervention for tics (ICBIT) for youth with tic disorders: A feasibility and effectiveness study with 6 month-follow-up. Eur Child Adolesc Psychiatry 2022; 31: 275–287. ISSN: 1018-8827, 1435-165X. DOI: 10.1007/s00787- 020-01686-2. URL: https://link-springer-com-443.web.bisu.edu.cn/10.1007/s00787-020-01686-2

99.

Lalouni

, et al. Clinical and cost effectiveness of online cognitive behavioral therapy in children with functional abdominal pain disorders. Clin Gastroenterol Hepatol 2019; 17: 2236–2244. e11. ISSN: 15423565. DOI: 10.1016/j.cgh.2018.11.043. URL: https://linkinghub.elsevier.com/retrieve/pii/ S154235651831320X

100.

Palermo

, et al. A digital health psychological intervention (WebMAP Mobile) for children and adolescents with chronic pain: Results of a hybrid effectiveness-implementation stepped-wedge cluster randomized trial. Pain 2020; 161: 2763–2774. ISSN: 0304-3959, 1872-6623. DOI:10.1097/j.pain.0000000000001994. URL: https:// journals.lww.com/10.1097/j.pain.0000000000001994.

101.

Lalloo

, et al. Capturing daily disease experiences of adolescents with chronic pain: MHealth-mediated symptom tracking. JMIR Mhealth Uhealth 2019; 7: e11838. ISSN: 2291-5222. DOI: 10.2196 /11838. URL: http://mhealth.jmir.org/2019/1/e11838/

102.

Shaygan

Jaberi

. The effect of a smartphone-based pain man- agement application on pain intensity and quality of life in adolescents with chronic pain. Sci Rep 2021; 11: 6588. ISSN: 2045-2322. DOI:10.1038/s41598-021-86156-8. URL: https://www-nature-com-s.web.bisu.edu.cn/articles/s41598-021- 86156-8

103.

De La Vega

, et al. Fibroline : A mobile app for improving the quality of life of young people with fibromyalgia. J Health Psychol 2018; 23: 67–78. ISSN: 1359-1053, 1461-7277. DOI: 10.1177/1359105316650509. URL: http:// journals-sagepub-com.web.bisu.edu.cn/doi/10.1177/1359105316650509.

104.

Kenis-Coskun

, et al. The effect of telerehabilitation on quality of life, anxiety, and depression in children with cystic fibrosis and caregivers: A single-blind ran- domized trial. Pediatr Pulmonol 2022; 57: 1262–1271. ISSN: 8755-6863, 1099-0496. DOI: 10.1002/ppul.25860. URL: https://onlinelibrary.wiley. com/doi/10.1002/ppul.25860

105.

Kilic

, et al.

Exercise intolerance, oxidative stress, and irisin in pediatric cystic fibrosis: Can telehealth-based exercise training make a difference?

Heart Lung 2024; 68: 145–153. ISSN: 0147-9563. DOI: 10.1016/j.hrtlng.2024.06.016. URL: https://www-sciencedirect-com-443.web.bisu.edu.cn/science/article/pii/S0147956324001249

106.

Kenis-Coskun

, et al. Comparison of telerehabilitation versus home-based video exercise in patients with duchenne muscular dystrophy: A single-blind randomized study. Acta Neurol Belg 2022; 122: 1269–1280. ISSN: 0300-9009, 2240-2993. DOI: 10.1007/s13760-022-01975-4. URL: https://link-springer-com-443.web.bisu.edu.cn/ 10.1007/s13760-022-01975-4

107.

Hardy

, et al. A randomized controlled trial of working memory training in pediatric sickle cell disease. J Pediatr Psychol 2021; 46: 1001–1014. ISSN: 0146-8693, 1465-735X. DOI: 10.1093/jpepsy/jsab030. URL: https://academic.oup.com/jpepsy/article/46/8/1001/6211540

108.

Boon

, et al. Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with cystic fibrosis. J Cyst Fibros 2020; 19: 562–568. ISSN: 15691993. DOI: 10.1016/j.jcf.2020.04.001. URL: https://linkinghub.elsevier.com/retrieve/pii/S1569199320301144

109.

Gagnon

, et al. Using telerehabilitation to deliver a home exercise pro- gram to youth with arthrogryposis: Single cohort pilot study. J Med Internet Res 2021; 23: e27064. ISSN: 1438-8871. DOI: 10.2196/ 27064. URL: https://www.jmir.org/2021/7/e27064

110.

Chen

, et al. Tele-Clinic visits in pediatric patients with Marfan syndrome using parentally acquired echocardiography. J Pediatr 2021; 232: 140–146. ISSN: 00223476. DOI: 10.1016/j.jpeds.2021.01.004. URL: https://linkinghub.elsevier.com/retrieve/pii/S0022347621000081

111.

Meyer

, et al. E-Health exercise intervention for pediatric patients with congenital heart disease: A randomized controlled trial. J Pediatr 2021; 233: 163–168. ISSN: 00223476. DOI: 10.1016/j.jpeds .2021.01.058. URL: https://linkinghub.elsevier.com/retrieve/pii/S0022347621000925

112.

Lin

, et al. Long-term effectiveness of an mHealth-tailored physical activity intervention in youth with congenital heart disease: A randomized controlled trial. J Adv Nurs 2021; 77: 3494–3506. ISSN: 0309-2402, 1365-2648. DOI: 10.1111/jan.14924. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/jan.14924

113.

Calvo-Lerma

, et al. Change in nutrient and dietary intake in European children with cystic fibrosis after a 6-month intervention with a self-management mHealth tool. Nutrients 2021; 13: 1801. ISSN: 2072-6643. DOI: 10.3390/nu13061801. URL: https://www.mdpi.com/2072-6643/13/6/1801

114.

Anderson

, et al. Mobile health intervention for youth with sickle cell disease: Impact on adherence, disease knowledge, and quality of life. Pediatr Blood Cancer 2018; 65: e27081. ISSN: 1545-5009, 1545-5017. DOI: 10.1002/pbc.27081. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1002/pbc.27081

115.

Kuhn

, et al. Telemedicine and spina Bifida transition: A pilot random- ized trial. World Neurosurg 2022; 167: e1455–e1460. ISSN: 18788750. DOI: 10.1016/j.wneu.2022.09.076. URL: https://linkinghub.elsevier.com/retrieve/pii/ S1878875022013535

116.

Werner-Seidler

, et al. The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: A randomised controlled trial and mediation analysis. J Child Psychol Psychiatry 2023; 64: 1324–1335. ISSN: 0021-9630, 1469-7610. DOI: 10.1111/jcpp.13795. URL: https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13795

117.

Cooper

, et al. Therapeutic alliance in family-based treatment of anorexia Nervosa: In-person versus telehealth. Clinical Psychology & Psychother- apy 2024; 31: e3017. _eprint: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/pdf/10.1002/cpp.3017, e3017. ISSN: 1099-0879. DOI: 10.1002/cpp.3017. URL: https://onlinelibrary.wiley. com/doi/abs/10.1002/cpp.3017

118.

Lindqvist

, et al. Affect-Focused psychodynamic internet-based therapy for adolescent depression: Randomized controlled trial. Journal of Medical Internet Research 2020; 22: e18047. ISSN: 1438-8871. DOI: 10.2196/18047. URL: http://www.jmir.org/2020/3/e18047/

119.

De Bruin

, et al. Improvements of adolescent psychopathology after insom- nia treatment: Results from a randomized controlled trial over 1 year. J Child Psychol Psychiatry 2018; 59: 509–522. ISSN: 0021-9630, 1469-7610. DOI: 10.1111/jcpp.12834. URL: https://acamh.onlinelibrary.wiley.com/ doi/10.1111/jcpp.12834

120.

Comer

, et al. Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial. J Consult Clin Psychol 2017; 85: 178–186. ISSN: 1939-2117, 0022-006X. DOI: 10.1037/ccp0000155. URL: https://doi.apa.org/doi/10.1037/ccp0000155

121.

Nordh

, et al. Therapist-guided internet-delivered cognitive behavioral therapy vs internet-delivered supportive therapy for children and adolescents with social anxiety disorder: A randomized clinical trial. JAMA Psychiatry 2021; 78: 705. ISSN: 2168-622X. DOI: 10.1001/jamapsychiatry.2021.0469. URL: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2779637

122.

Beidel

, et al. Treating childhood social anxiety disorder with virtual environments and serious games: A randomized trial. Behav Ther 2021; 52: 1351–1363. ISSN: 00057894. DOI: 10.1016/j.beth.2021.03.003. URL: https://linkinghub.elsevier.com/retrieve/pii/S0005789421000472

123.

Kennard

, et al. As safe as possible (ASAP): A brief app-supported inpa- tient intervention to prevent postdischarge suicidal behavior in hospitalized, suicidal adolescents. Am J Psychiatry 2018; 175: 864–872. ISSN: 0002-953X, 1535-7228. DOI: 10.1176/appi.ajp.2018.17101151. URL: http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.17101151

124.

Silk

, et al. Using a smartphone app and clinician portal to enhance brief cognitive behavioral therapy for childhood anxiety disorders. Behav Ther 2020; 51: 69–84. ISSN: 00057894. DOI: 10.1016/j.beth.2019.05.002. URL: https://linkinghub.elsevier.com/retrieve/pii/S0005789419300486

125.

Rice

, et al. Moderated online social therapy for depression relapse prevention in young people: Pilot study of a ‘next generation’ online intervention. Early Interv Psychiatry 2018; 12: 613–625. ISSN: 1751-7885, 1751-7893. DOI: 10.1111/eip.12354. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/eip.12354

126.

Pitrat

, et al. Mobile app measuring sleep and behaviors: A trial in adolescents with addiction. L’Encéphale 2024; 50: 590–596. ISSN: 0013-7006. DOI: 10.1016/j.encep.2023.11.007. URL: https://www-sciencedirect-com-443.web.bisu.edu.cn/science/ article/pii/S0013700623002142

127.

Peake

, et al. Preliminary efficacy of a digital intervention for adolescent Depression: Randomized controlled trial. J Med Internet Res 2024; 26: e48467. Company: Journal of Medical Internet Research Distributor: Journal of Medical Internet Research Institution: Journal of Medical Internet Research Label: Journal of Medical Internet Research Publisher: JMIR Publications Inc., Toronto, Canada, e48467. DOI: 10.2196/48467. URL: https://www.jmir.org/2024/1/e48467

128.

Devine

, et al. Feasibility of FitSurvivor: A technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer 2020; 67: e28530. ISSN: 1545-5009, 1545-5017. DOI: 10.1002/pbc.28530. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1002/pbc. 28530

129.

Finlay-Jones

, et al. Web-Based self-compassion training to improve the well-being of youth with chronic medical conditions: Randomized controlled trial. J Med Internet Res 2023; 25: e44016. ISSN: 1438-8871. DOI: 10.2196/44016. URL: https://www.jmir.org/2023/1/e44016

130.

Geirhos

, et al. Feasibility and potential efficacy of a guided internet- and mobile- based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): A randomized con- trolled pilot trial. BMC Pediatr 2022; 22: 69. ISSN: 1471-2431. DOI: 10.1186/s12887- 022- 03134- 3. URL: https://bmcpediatr.biomedcentral.com/ articles/10.1186/s12887-022-03134-3

131.

Semerci

Kostak

Taşkın

. The effect of using an interactive mobile application for the management of chemotherapy-induced nausea and vomiting in children: Randomized controlled study. Eur J Oncol Nurs 2022; 58: 102121. ISSN: 14623889. DOI: 10.1016/j.ejon.2022.102121. URL: https://linkinghub.elsevier.com/retrieve/pii/S1462388922000291

132.

Looman

, et al. Health-Related quality of life outcomes of a telehealth care coordination intervention for children with medical complexity: A randomized controlled trial. J Pediatr Health Care 2018; 32: 63–75. ISSN: 08915245. DOI: 10.1016/j.pedhc.2017.07.007. URL: https:// linkinghub.elsevier.com/retrieve/pii/S0891524517302316.

133.

Mosquera

, et al. Telemedicine for children with medical complexity: A randomized clinical trial. Pediatrics 2021; 148: e2021050400. ISSN: 0031-4005, 1098-4275. DOI: 10.1542/peds.2021-050400. URL: https://publications.aap.org/pediatrics/article/148/3/e2021050400/181148/Telemedicine-for-Children- With-Medical-Complexity

134.

Hunter

, et al. A pilot study of the preliminary efficacy of pain buddy: A novel intervention for the management of children’s cancer-related pain. Pediatr Blood Cancer 2020; 67: e28278. ISSN: 1545-5009, 1545-5017. DOI: 10.1002/pbc.28278. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1002/pbc.28278

135.

Korus

, et al. Assessing the acceptability and efficacy of teens taking charge: Transplant—A pilot randomized control trial. Pediatr Transplant 2020; 24: e13612. ISSN: 1397-3142, 1399-3046. DOI: 10.1111/petr.13612. URL: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/petr.13612

136.

Jibb

, et al. Implementation and preliminary effectiveness of a real-time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study. Pediatr Blood Cancer 2017; 64: e26554. ISSN: 1545-5009, 1545-5017. DOI: 10.1002/pbc.26554. URL: https://onlinelibrary.wiley. com/doi/10.1002/pbc.26554

137.

Eliasen

, et al. Smartphone app to self-monitor nausea during pediatric chemotherapy treatment: User-centered design process. JMIR Mhealth Uhealth 2020; 8: e18564. ISSN: 2291-5222. DOI: 10.2196 /18564. URL: https://mhealth.jmir.org/2020/7/e18564

138.

Chen

, et al. Healthy hearts via live videoconferencing: An exercise and diet intervention in pediatric heart transplant recipients. J Am Heart Assoc 2020; 9: e013816. ISSN: 2047-9980. DOI: 10.1161/ JAHA.119.013816. URL: https://www.ahajournals.org/doi/10.1161/JAHA.119. 013816

139.

McKissick

, et al. The impact of telehealth and care coordination on the number and type of clinical visits for children with medical complexity. J Pediatr Health Care: Off Publi Natl Assoc Pediatr Nurse Assoc Practition 2017; 31: 452–458. ISSN: 1532-656X. DOI: 10.1016/j.pedhc.2016.11.006.

140.

Notario

, et al. Home-based telemedicine for children with medical complexity. Telemed e-Health 2019; 25: 1123–1132. ISSN: 1530-5627, 1556-3669. DOI: 10.1089/tmj.2018.0186. URL: https://www.liebertpub. com/doi/10.1089/tmj.2018.0186

141.

Zelihić

, et al. Reducing social anxiety in adolescents distressed by a visible difference: Results from a randomised control trial of a web-based intervention. Body Image 2022; 40: 295–309. ISSN: 17401445. DOI: 10.1016/j.bodyim.2022.01.008. URL: https://linkinghub.elsevier.com/retrieve/pii/S1740144522000080

142.

Johnson

, et al. Gamification for health and wellbeing: A systematic review of the literature. Internet Interv 2016; 6: 89–106. ISSN: 2214-7829. DOI: 10.1016/j.invent.2016.10.002. URL: https://www-sciencedirect-com-443.web.bisu.edu.cn/science/ article/pii/S2214782916300380

143.

Damaševičius

Maskeliūnas

Blažauskas

. Serious games and gamification in healthcare: A meta-review. Information 2023; 14: 105. Number: 2 Publisher: Multidisciplinary Digital Publishing Institute, p. 105. ISSN: 2078-2489. DOI: 10.3390/info14020105. URL: https://www.mdpi.com/2078- 2489/14/2/105

144.

Mancuso

. Health literacy: A concept/dimensional analysis. Nurs Health Sci 2008; 10: 248–255, _eprint: https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/pdf/10.1111/j.1 2018.2008.00394.x, pp. 248–255. ISSN: 1442-2018. DOI: 10.1111/j.1442- 2018.2008.00394.x. URL: https:// onlinelibrary.wiley.com/doi/abs/10.1111/j.1442-2018.2008.00394.x.

145.

Olesen

, et al. Higher health literacy is associated with better glycemic control in adults with type 1 diabetes: a cohort study among 1399 Danes. BMJ Open Diabetes Res Care 2017; 5, Publisher: American Diabetes Association. ISSN: 2052-4897. DOI: 10.1136/bmjdrc- 2017- 000437. URL: https://drc.bmj.com/content/5/1/e000437

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