Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook

Cognitive-behavioral treatment of irritable bowel syndrome

There is increasing evidence that supports the view that irritable bowel disorder (IBS) is a disorder of brain-gut function. Cognitive-behavioral therapy (CBT) has received increased attention in light of this recent shift in the conceptualization of IBS. This review has two main aims. The first is to provide a critical review of controlled trials on CBT for IBS. The second is to discuss ways of further developing CBT interventions that are more clinically relevant and meaningful to health care providers and individuals with a diagnosis of IBS. A theme from a CBT intervention will be presented to illustrate how CBT interventions can be incorporated within a larger social context. A review of CBT for IBS lends some limited support for improvement in some IBS symptoms and associated psychosocial distress. This conclusion needs to be expressed with some caution, however, in light of many methodological shortcomings including small sample sizes, inadequate control conditions and failure to identify primary versus secondary outcome measures. In addition, future studies will need to further develop more relevant CBT protocols that more fully integrate the patient's perspective and challenge social cognitions about this stigmatized disorder.

Patterns of intra-cluster correlation from primary care research to inform study design and analysis

OBJECTIVE

To provide information concerning the magnitude of the intraclass correlation coefficient (ICC) for cluster-based studies set in primary care.

STUDY DESIGN AND SETTING

Reanalysis of data from 31 cluster-based studies in primary care to estimate intraclass correlation coefficients from random effects models using maximum likelihood estimation.

RESULTS

ICCs were estimated for 1,039 variables. The median ICC was 0.010 (interquartile range [IQR] 0 to 0.032, range 0 to 0.840). After adjusting for individual- and cluster-level characteristics, the median ICC was 0.005 (IQR 0 to 0.021). A given measure showed widely varying ICC estimates in different datasets. In six datasets, the ICCs for SF-36 physical functioning scale ranged from 0.001 to 0.055 and for SF-36 general health from 0 to 0.072. In four datasets, the ICC for systolic blood pressure ranged from 0 to 0.052 and for diastolic blood pressure from 0 to 0.108.

CONCLUSION

The precise magnitude of between-cluster variation for a given measure can rarely be estimated in advance. Studies should be designed with reference to the overall distribution of ICCs and with attention to features that increase efficiency.

Impact of psychosocial parameters on quality of life in patients with irritable bowel syndrome

AIM: To investigate the impact of psychosocial parameters on the quality of life (QOL) in healthcare seeking patients with irritable bowel syndrome (IBS).

METHODS: QOL and psychosocial parameters in consecutive 41 patients with IBS irritable bowel syndrome (IBS) according to Rome II criteria were measured by questionnaires including IBS-QOL, Pittsburgh sleep quality index (PSQI) and symptom checklist-90 (SCL-90), coping style, social supports, respectively. In the meantime, 37 normal subjects were served as a control group. The relationship between IBS-QOL and psychosocial parameters was investigated by regression analysis.

RESULTS: Compared with normal subjects, all subscales scores of QOL were lower (P < 0.05, respectively), especially in dysphoria, interference with activity, health worry, social reaction, and overall score (P = 0.000, respectively). In addition, IBS patients had more psychiatric symptoms (40.24±4.5, t = 2.63, P = 0.047), and higher scores of depression (0.64±0.24, t = 2.53, P = 0.020) and anxiety (0.67±0.30, t = 2.16, P = 0.016). The score of negative coping (40.79±8.01, P < 0.05), fancying (4.95±2.1, P = 0.001) and withdrawal (4.81±2.1, P = 0.004), as well as subjective supporting (23.92±4.2, P = 0.046) in IBS was higher than that in normal subjects. Among IBS patients, the quality of sleep and daily functions significantly decreased, PSQI and sleep disturbances as well as soporific using was markedly increased. Multiple regression analysis showed poorer quality of life in IBS was related with sleep quality (β = 0.281), negative life event (β = -0.363)and anxiety (β = -0.175).

CONCLUSION: QOL in healthcare seeking patients with IBS is impaired significantly, which is negatively associated with the abnormalities of many of psychosocial parameters.