Systematic review: self‐management support interventions for irritable bowel syndrome

Abstract

Many self-management support interventions appear benefit patients with irritable bowel syndrome. However, studies were limited by methodological flaws. Furthermore, feasibility in 'real world' clinical practice is uncertain. Thus, practical self-management interventions that can be applied across various clinical settings should be developed, and then tested in well-designed clinical trials.

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

“…In contrast, Ford et al 192 appears to offer more evidence to support CBT, but the studies in their analysis are exactly the same as in the Cochrane review so this outcome may have arisen from their meta-analysing a larger group of more heterogeneous studies than Zijdenbos et al 193 Ford et al 192 identifies evidence of publication bias and in a sensitivity analysis 'when the three studies conducted in the same centre were excluded from the analysis, the beneficial effect of CBT on symptoms of IBS disappeared' but still goes on to endorse CBT as 'efficacious in the treatment of IBS in the short-term'. In Dorn's 191 review, the primary outcomes of the RCTs were also heterogeneous but nearly always involved symptom scores and nearly every study reported a positive primary outcome result favouring, or tending to favour, the intervention. In view of the heterogeneity (which included heterogeneity in study size, diagnostic criteria, setting and quality, in addition to intervention and outcome measures), Dorn 191 did not attempt a meta-analysis -instead presenting results of each individual studies narratively.…”

“…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 …”

“…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.…”

“…One review 191 examined self-management support interventions and the remaining two reviews included psychological treatments for IBS ( Table 91). 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).…”

“…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.…”