Psychological treatments for the management of irritable bowel syndrome

Zijdenbos, Ingeborg; Wit, Niek J. de; Heijden, Geert J. van der; Rubin, Gregory; Quartero, A. Otto

doi:10.1002/14651858.cd006442.pub2

Cited by 138 publications

(130 citation statements)

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“…Seven of the nine RCTS in Dorn 191 took place in the USA and studies in the Ford et al 192 review came for a variety of countries, including India (one study) and the Islamic Republic of Iran (two studies). Zijdenbos et al 193 did not supply these data.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 97%

“…Following the title and abstract screening, 13 articles were screened for eligibility, three of which were included into the IBS quantitative meta-review [191][192][193] ( Figure 38). The reviews were all recent (published 2009-10) and their included RCTs were published between 1991 and 2010.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…Both reviews of psychological interventions 192,193 included some monocomponent interventions not considered self-management support for the purposes of this review, but both also separately presented results for CBT or multicomponent psychological support interventions separately and it is these 11 RCTS 192 and 17 RCTS 193 that are considered here. There is huge overlap between Ford et al 192 and Zijdenbos et al, 193 with only two papers in Ford et al 192 not included in Zijdenbos et al, 193 but the more broadly self-management focused Dorn 191 has only one RCT in common with Ford et al 192 and two with Zijdenbos et al …”

Section: Dornmentioning

confidence: 99%

“…Interventions in Ford et al 192 were between 6 weeks and 6 months duration, and fell somewhere between 6 weeks and 12 months in Zijdenbos et al 193 In Dorn's 191 review the interventions were heterogeneous in their nature, but were grouped into the following five categories: patient education; self-help guidebooks; self-administered CBT; self-management programmes; and support groups. Among these RCTs, intervention duration varied from the provision of a guide book (duration of this intervention not given) to 12 weeks, but the majority lasted 10-12 weeks.…”

mentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 97%

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Dornmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

View full text Add to dashboard Cite

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“…The subsequent RCTs generally support the findings of the systematic reviews. [ The remaining arm assessed stress management [54] RCT [52] There are several possible explanations as to why the systematic reviews reached different conclusions regarding the effectiveness of CBT in IBS. Both included a variety of psychological interventions in addition to CBT, and differed in their selection criteria and definitions for interventions and outcomes.…”

Section: Cbt Versus Usual Care Waiting List Control or Placebomentioning

confidence: 99%

Irritable Bowel Syndrome

Ford

Martin

Talley

2010

Evidence‐Based Gastroenterology and Hepatology

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INTRODUCTION: The prevalence of irritable bowel syndrome (IBS) varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%. IBS is associated with abnormal gastrointestinal motor function and enhanced visceral perception, as well as psychosocial and genetic factors. People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with IBS? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5HT 3 receptor antagonists (alosetron and ramosetron), 5HT 4 receptor agonists (tegaserod), antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors [SSRIs]), antispasmodics (including peppermint oil), cognitive behavioural therapy (CBT), hypnotherapy, loperamide, and soluble and insoluble fibre supplementation. QUESTIONS To be covered in future updates Probiotics Key points• The key features of irritable bowel syndrome (IBS) are chronic, recurrent abdominal pain or discomfort, associated with disturbed bowel habit, in the absence of any structural abnormality to account for these symptoms.The prevalence of IBS varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%.IBS is associated with abnormal GI motor function, enhanced visceral perception, abnormalities in central pain processing, and altered gut flora, as well as psychosocial and genetic factors.People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS.A positive symptom-based diagnosis and a graded general treatment approach are cornerstones in the management of people with IBS.• Antidepressants (tricyclic antidepressants and SSRIs) may reduce global symptoms of IBS and abdominal pain compared with placebo.• Antispasmodics (including peppermint oil) may reduce global symptoms of IBS and abdominal pain compared with placebo.• We don't know whether soluble fibre supplementation (ispaghula) is more effective than placebo at improving global symptoms or abdominal pain in IBS as the data are contradictory.• Insoluble fibre supplementation does not reduce global symptoms o...

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