This study follows the guidelines published in Preferred Reporting Items for Systematic reviews and Meta-Analyses [27] and the Cochrane Handbook of Systematic Reviews [28]. The priori protocol for the review is published in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023471223).

The research was conducted with the guidance and support of institutional librarians. A subject-specific librarian, along with researchers ZR and YC, developed a search strategy without language restrictions, which was used to conduct a comprehensive search in PubMed, Embase, Cochrane Library, Ovid, and Medline [29], covering records from the earliest available to the latest date. The search used Boolean operators in combination with Medical Subject Headings terms and free-text keywords to identify studies on the impact of digital interventions on JIA. The following search string was used as an example: (“Juvenile Idiopathic Arthritis” OR “Pediatric Rheumatic Diseases” OR “Juvenile Chronic Arthritis”) AND (“mHealth” OR “Digital Health” OR “Mobile Health”) AND (“Randomized Controlled Trial” OR “RCT” OR “Clinical Trial”). The full search strategy is provided in Multimedia Appendix 1, the specific keywords used for the search are provided in Multimedia Appendix 2.

The studies identified through this strategy were managed through the literature management software, Zotero (Corporation for Digital Scholarship). The 2 authors, ZR and YC, screened the identified studies, in line with predefined inclusion and exclusion criteria. Any discrepancies during this process were resolved through discussion between the researchers. Multimedia Appendix 1 shows the detailed search formulas. RCTs of any design, including crossover, multicenter, and cross-over trials, that were published in English are included in this review.

Episodes of JIA typically manifest in individuals before the age of 16 years [30]. However, considering the chronic nature of the condition and the need for ongoing treatment, the minimum age for inclusion in international pediatric treatment reference populations has risen to an average of 18.7 (SD 2.6) years.

Hence, for the purpose of this review, the term “children and adolescents” refers to individuals between the ages of 1 and 19 years [31]. The study population comprises children and adolescents diagnosed with JIA by a rheumatologist, ranging from 1 to 19 years old. Infants and neonates under the age of 1 year were excluded from the study population.

In assessing the effectiveness of interventions for JIA recovery, the study focused on digital platforms such as somatic gaming, smart applications, teleconferencing, televideo, and health websites.

All types of control groups were considered in this study, including waitlists, physical therapy or minimal intervention groups, alternative treatments, and standard care delivered through web-based health care websites and apps. For example, the control group may use platforms like jong-en-reuma.nl, which provides information on medical issues and emotional support [32].

Risk of bias was assessed using the risk of bias tool of the Cochrane Handbook for Systematic Reviews [28]. Quality of evidence for outcomes was assessed according to the 5 Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) domains, including study limitation (risk of bias), inconsistency, indirectness, imprecision, and publication bias [33]. The bias was assessed by the 2 independent authors, ZR and YL. Any discrepancies were resolved through discussion and reexamination within the research group.

In order to identify and present common statistical descriptions of methodological heterogeneity, a descriptive integrated methodology was used. All findings were interpreted within the context of each study, considering the total number of studies and the assessed risk of bias. Using Review Manager (RevMan) software (version 5.4; Cochrane), this study conducted a random-effect meta-analysis to compare the standardized mean difference (SMD) for parameters across at least 3 studies between patients receiving general care and those using internet-based interventions. SMD and 95% CI were calculated using baseline and study end scores inputted into RevMan 5.4. Forest plots were generated using random-effect models for continuous data, presenting a summary of the effect distribution. Cohen’s general rule of experience was applied, where an SMD of 0.2 signifies a “small” effect, 0.5 denotes a “moderate” effect, and 0.8 indicates a “large” effect. Furthermore, subgroup analysis was conducted to assess the impact of professional caregivers and intervention tools on the efficacy of e-medical intervention outcomes. Heterogeneity within the compiled studies was evaluated using I² statistics, and the carat test was used to assess significance. Heterogeneity levels were classified as low (I²<25%; P>.1), moderate (I²=25%‐49%), or high (I²>50%).

We initially identified 1155 studies. After excluding duplicate studies (n=296) and irrelevant studies (n=694), 165 studies remained for abstract evaluation. A total of 154 studies were excluded for the following reasons: conference proceedings (n=47), not trials (n=28), and not RCTs for JIA (n=79). Ultimately, 11 RCTs were included in the meta-analysis. The screening process is illustrated in Figure 1.

Table 1 shows the population characteristics, interventions, outcomes and study types of the 11 studies. Of these studies, 3 were from the Netherlands [32,34,35], 5 from Canada [36-40], and 1 each in the United States, Switzerland, and Turkey [38,40,41]. These studies included 289 individuals, predominantly female children and adolescents (663/885, 74.9%). A variety of juvenile arthritis subtypes were observed, with oligoarthritis being the most prevalent subtype (259/885, 29.3%). Almost all studies, with the exception of one [42], accounted for disease activity. The duration of the disease since diagnosis was documented in the majority of studies (7/11) [32,35-37,39,40,42].

One study in this review did not specify the care received by the control group [34]. A total of 5 studies compared the intervention group to a control group that received standard or offline care (without internet and eHealth interventions) [35,37,38,42,43]. One study solely used telephone coaching communication [36]. A total of 4 studies compared a control group using a public website or eHealth with limited functionality to an intervention group receiving a specific digital design program [32,39-41]. The control groups in all trials assessed patients’ results at pretest and posttest.

The results of the risk of bias assessment indicate that the criteria most commonly unmet were the blinding of outcome assessment and the adequacy of outcome data (Figure 2). Half of the studies (5/11 and 6/11) were deemed to have a high risk of bias in these 2 categories. In contrast, studies concerning randomized sequence generation were predominantly evaluated as having a low risk (9/11). Furthermore, 7 studies exhibited a medium risk of bias, while 4 studies were categorized as having a high risk of bias.

Table 4 presents the key comparative results with GRADE ratings. A total of 3 primary outcomes are rated as moderate quality, while 2 primary outcomes are rated as low quality.

This systematic review comprehensively assessed studies on the effectiveness of digital interventions in aiding children and adolescents with JIA from physical and psychologically perspectives. According to the findings, patients who received digital medical technology interventions had significantly better physical activity outcomes (SMD 0.37, 95% CI 0.06-0.69) and experienced a reduction in pain outcomes (SMD −0.19, 95% CI −0.35 to −0.04) in comparison with those who received standard care. However, our research did not identify significant enhancements in disease-related issues (SMD 0.09, 95% CI −0.11 to 0.29), health-related quality of life (SMD −0.02, 95% CI −0.17 to 0.13), or self-efficacy (SMD 0.05, 95% CI −0.11 to 0.20).

The secondary outcomes such as self-efficacy, health-related quality of life, and perception of disease-related issues did not show statistical significance. The previous research shows similar results. Lancaster et al [57] and Newby et al [58] did not find positive impacts of digital interventions on self-efficacy and quality of life. This discrepancy may be attributed to the measurement of self-efficacy which may not be adequately tailored to the conceptual, linguistic, and objective needs of children [32]. However, it is anticipated that improvements in quality of life may require more time to manifest [59], and changes might not be evident during shorter intervention periods. The Medical Issues, Exercise, Pain, and Social Support questionnaire, encompassing inquiries regarding medical matters, physical activity, psychological well-being, and social support [60], may experience compromised efficacy if a patient is insensitive to one of its components, indicating a limited awareness of disease-related concerns.

It is worth noting that not all psychological interventions are ineffective. The subgroup findings show that when physicians are involved in intervention implementation, children and adolescents show improved understanding of disease-related issues. Previous research shows that online health communities involving both patients and health care providers can improve mental health in chronic conditions by allowing patients to consult and interact with physicians [61,62]. Physicians provide essential health knowledge, emotional support, and guidelines for the use of medical supplies, which is crucial for improving the health status of individuals with chronic conditions [63]. To improve intervention outcomes, digital interventions should incorporate features for real-time interaction with healthcare providers, enabling physicians to offer clinical insights and socioemotional support, thereby strengthening the doctor-patient relationship and improving health outcomes.

Furthermore, video-based mindfulness interventions have shown benefits for populations with chronic illnesses and other conditions [64,65]. A study comparing the efficacy of online mindfulness interventions and in-person interventions in enhancing the mental well-being of patients with JIA observed a notable decrease in anxiety and depression [38]. This reduction may be attributed to adolescents experiencing greater ease and relaxation in the familiar setting of their homes [66]. Furthermore, Voerman et al [67] found that digital interventions incorporating cognitive behavioral therapy led to significant improvements in the psychological and social outcomes of patients. Specifically, relaxation exercises and cognitive behavioral therapy effectively reduced pain frequency in children and adolescents, alleviating depressive symptoms and functional disorders [68]. Future investigations should aim to integrate a theoretical framework that addresses the psychological dimensions of the condition, ensuring a more comprehensive approach to intervention design.

Half of the studies (5/11) used digital tools that have been developed for over a decade, they may thus fail to represent the latest advancements in communication technologies and platforms. However, our findings indeed show their continued relevance and effectiveness. Second, the results of this review demonstrate that, from a statistical perspective, digital interventions are effective for certain patient outcomes. However, considering factors such as individual differences and variability in clinical environments, their clinical significance remains to be further validated. Future research should provide stronger evidence from a clinical perspective. Furthermore, the included studies are predominantly conducted in North American and European nations. As such, the findings of this analysis may not be universally applicable and may only offer insights into the integration of digital interventions within this specific population.

This systematic review analyzes self-reported outcomes in patients with JIA, including pain, physical activity, quality of life, self-efficacy, and disease-related issues. The findings from 11 RCTs demonstrate that digital interventions significantly alleviate pain and improve physical activity. These results highlight the potential of digital tools to enhance JIA management and patient outcomes, providing a strong case for their integration into clinical practice. Future studies should consider the inclusion of physicians in digital interventions to better understand their impact on outcomes.