Randomized Trial Comparing Two Methods of Increasing Dietary Calcium Intake in Children with Inflammatory Bowel Disease

Stark, Lori J.; Hommel, Kevin A.; Mackner, Laura M.; Janicke, David M.; Davis, Ann M.; Pfefferkorn, Marian; Crandall, Wallace; Heubi, James E.

doi:10.1097/01.mpg.0000157913.32465.45

Cited by 20 publications

(16 citation statements)

References 35 publications

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“…Children with JRA in the behavioral intervention group demonstrated a net gain in dietary calcium intake of more than twice that of controls, with 92% of children who received the behavioral intervention achieving their adherence goals, compared to 19% of controls 19,20 . Children with IBD in the behavioral intervention group demonstrated a net gain in dietary calcium intake of more than three times that of controls, with 81% of children who received the behavioral intervention achieving their adherence goals, compared to only 19% of controls 21 . Nevertheless, these studies have targeted either young children, as opposed to adolescents, or a different chronic condition with, consequently, different treatment regimens.…”

Section: Introductionmentioning

confidence: 96%

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

Hommel

Hente

Odell

et al. 2012

European Journal of Gastroenterology & Hepatology

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Objective To pilot test the feasibility and acceptability of a family-based group behavioral intervention to improve medication adherence in adolescents diagnosed with Inflammatory Bowel Disease (IBD). Methods Participants were 40 adolescents age 11-18 years diagnosed with IBD and their primary caregivers, who were randomized to either a 4-session Family-Based Group Behavioral Treatment or Usual Care over a 6-week period. Adherence was measured using a mutli-method, multi-informant assessment involving caregiver- and patient-report, pill count data, and electronic monitoring. Results Adherence rates ranged from 66-89% for 6-MP/azathioprine and 51-93% for mesalamine across assessment methods. The intervention was feasible, as evidenced by the 99% treatment session attendance rate, and acceptable based on patient and caregiver report. Repeated measures ANOVA tests revealed nonsignificant differences between the conditions from baseline to post-treatment assessments for pill count, electronic monitor, and primary caregiver-reported adherence (p's> .05). There was a statistically significant improvement in patient-reported mesalamine adherence represented by a significant main effect for Condition (F = 22.24, p< .01; δ = .79) and Condition X Time interaction (F = 13.32, p< .05; δ = .69). Conclusions Findings suggest potential for use of behavioral intervention to improve medication adherence in this population. This intervention may be more effective with more complex regimens (e.g., multiple doses per day) such as those prescribed with mesalamine. Further research is needed to examine this type of intervention in more diverse samples with more active disease. Use of alternative adherence measurement approaches, including electronic pill boxes and/or real-time self-report (e.g., via text messaging, electronic diaries, etc.) is also recommended.

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Section: Introductionmentioning

confidence: 96%

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

Hommel

Hente

Odell

et al. 2012

European Journal of Gastroenterology & Hepatology

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“…A total of 808 references were identified, of which eleven articles, reporting nine trials 23,[25][26][27][28][29][30]31,32 were included (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…All except one of the trials were conducted in the USA 23,[25][26][27][28][29][30]32 Seven were randomized controlled trials (RCTs) 23,[25][26][27][28][29][30] and two were non-randomized controlled trials 31,32 . Overall, 521 CA participated in the trials and in most trials parents/carers were involved except for one that included adolescents only 31 .…”

Section: Inclusion Criteriamentioning

confidence: 99%

A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease

Tran

Mulligan

2018

Inflammatory Bowel Diseases

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BackgroundSelf-management of inflammatory bowel disease is complex. Children and adolescents (CA) with inflammatory bowel disease (IBD) often have difficulty with managing aspects of their condition, resulting in treatment non-adherence and impaired psychosocial function. Self-management interventions are developed to help support patients and their parents/carers to effectively self-manage. The aim of this systematic review was to evaluate the efficacy of self-management interventions in children and adolescents with IBD. MethodsThe review was conducted in accordance with PRISMA guidelines. A systematic literature search of the following databases; Medline, Embase, Cochrane, CINAHL and PsychINFO was conducted to identify controlled trials of interventions aiming to enhance IBD self-management in CA. Two reviewers screened articles for inclusion. ResultsNine trials (eleven articles) met the inclusion criteria. Most were underpowered with seven recruiting fewer than 50 participants. The interventions aimed to enhance psychological wellbeing (n=5), medication adherence (n=3) or calcium intake (n=1). There was considerable heterogeneity in intervention content and outcomes assessment. Some benefits were reported in disease activity, adherence and psychological wellbeing but findings were inconsistent. ConclusionsSelf-management is difficult for CA with IBD, however this review identified only a small number of interventions to support self-management, most of which were under-powered and only one that was conducted outside the US. Clinical consensus is required on which self-management activities should be recommended to patients and targeted in interventions and which core outcomes should be assessed.Adequately powered trials of interventions are required to identify how best to support self-management in CA with IBD.Population: CA up to 19 years old with IBD, in line with the World Health Organization definition of adolescence 21 . As many interventions for CA include parents/carers, trials that included parents/carers of CA with IBD were also eligible for inclusion.Intervention: Self-management interventions i.e. interventions that aimed to enhance participants' ability to manage their condition and could include interventions to enhance medication adherence, lifestyle, diet, and coping with emotional and social aspects of living with IBD.Comparator: Treatment as usual, an alternative intervention or a waiting list comparator.Outcomes: Outcomes of interest included clinical, behavioural and psychosocial outcomes.Study design: Controlled trials (randomised and non-randomised). Exclusion Criteria:Studies were excluded if they were: Articles that combined adults and CA with IBD or combined CA with IBD with other chronic diseases but did not report findings for CA with IBD separately.  Observational studies. . Relevant variations of search terms in the database thesauruses and MeSH terms were used. See Supplemental file 1 for the full search strategy. Study selectionRetrieved articles were imported into Endnote ver...

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“…One study in the CD literature (27) reported that nonadherence was “corrected,” but no details were provided regarding how this was accomplished. Another study conducted a randomized clinical trial in IBD (20) and reported significant improvements in dietary adherence via multicomponent behavioral intervention compared with education only. Thus, there are limited data on interventions to improve adherence; however, treatment outcome research, particularly randomized clinical trials, remains a significant need for both IBD and CD.…”

Section: Discussionmentioning

confidence: 99%

Treatment Regimen Adherence in Pediatric Gastroenterology

Hommel

Mackner

Denson

et al. 2008

J. pediatr. gastroenterol. nutr.

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Objective To review and critically evaluate the extant research pertaining to adherence in pediatric gastroenterological diseases, particularly inflammatory bowel disease and celiac disease, and to provide recommendations for future research development. Materials and Methods A literature search with no date restriction was conducted using PubMed and PsychInfo electronic databases and bibliographies of relevant articles. Results Adherence rates in inflammatory bowel disease and celiac disease range considerably from 16% to 62% and 5% to 70%, respectively, across treatments and assessment method; nonadherence frequency was generally not reported. Measures used to assess adherence included self-report, interview, diet record, and bioassay methods, and each measure demonstrated strengths and limitations. Limited evidence suggests that adherence in both disease populations is related to patient and family behavioral factors and that nonadherence is related to poor disease outcome. Treatment outcome research for nonadherence is scant in the current literature. Conclusions Future research should focus on refining assessment method, examining adherence and concomitant behavioral factors longitudinally, testing theoretical models of adherence, and developing efficacious treatments for nonadherence.

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Randomized Trial Comparing Two Methods of Increasing Dietary Calcium Intake in Children with Inflammatory Bowel Disease

Abstract: Behavioral modification appears to be significantly more effective than nutrition education alone in modifying calcium intake in children with inflammatory bowel disease.

Cited by 20 publications

References 35 publications

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

Evaluation of a group-based behavioral intervention to promote adherence in adolescents with inflammatory bowel disease

A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease

Treatment Regimen Adherence in Pediatric Gastroenterology

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