Patient education interventions for the management of inflammatory bowel disease (Review)

Background Inflammatory bowel disease (IBD) is a life‐long condition for which currently there is no cure. Patient educational interventions deliver structured information to their recipients. Evidence suggests patient education can have positive effects in other chronic diseases. Objectives To identify the different types of educational interventions, how they are delivered, and to determine their effectiveness and safety in people with IBD. Search methods On 27 November 2022, we searched CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP with no limitations to language, date, document type, or publication status. Any type of formal or informal educational intervention, lasting for any time, that had content focused directly on knowledge about IBD or skills needed for direct management of IBD or its symptoms was included. Delivery methods included face‐to‐face or remote educational sessions, workshops, guided study via the use of printed or online materials, the use of mobile applications, or any other method that delivers information to patients. Selection criteria All published, unpublished and ongoing randomised control trials (RCTs) that compare educational interventions targeted at people with IBD to any other type of intervention or no intervention. Data collection and analysis Two review authors independently conducted data extraction and risk of bias assessment of the included studies. We analysed data using Review Manager Web. We expressed dichotomous and continuous outcomes as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE methodology. Main results We included 14 studies with a total of 2708 randomised participants, aged 11 to 75 years. Two studies examined populations who all had ulcerative colitis (UC); the remaining studies examined a mix of IBD patients (UC and Crohn's disease). Studies considered a range of disease activity states. The length of the interventions ranged from 30 minutes to 12 months. Education was provided in the form of in‐person workshops/lectures, and remotely via printed materials or multimedia, smartphones and internet learning. Thirteen studies compared patient education interventions plus standard care against standard care alone. The interventions included seminars, information booklets, text messages, e‐learning, a multi professional group‐based programme, guidebooks, a staff‐delivered programme based on an illustrated book, a standardised programme followed by group session, lectures alternating with group therapy, educational sessions based on an IBD guidebook, internet blog access and text messages, a structured education programme, and interactive videos. Risk of bias findings were concerning in all judgement areas across all studies. No single study was free of unclear or high of bias judgements. Reporting of most outcomes in a homogeneous fashion was limited, with quality of life at study end reported most commonly in six of the 14 studies which allowed for meta‐analysis, with all other outcomes reported in a more heterogeneous manner that limited wider analysis. Two studies provided data on disease activity. There was no clear difference in disease activity when patient education (n = 277) combined with standard care was compared to standard care (n = 202). Patient education combined with standard care is probably equivalent to standard care in reducing disease activity in patients with IBD (standardised mean difference (SMD) ‐0.03, 95% CI ‐0.25 to 0.20), moderate‐certainty evidence. Two studies provided continuous data on flare‐up/relapse. There was no clear difference for flare‐ups or relapse when patient education (n = 515) combined with standard care was compared to standard care (n = 507), as a continuous outcome. Patient education combined with standard care is probably equivalent to standard care in reducing flare‐ups or relapse in patients with IBD (MD ‐0.00, 95% CI ‐0.06 to 0.05; moderate‐certainty evidence). Three studies provided dichotomous data on flare‐up/relapse. The evidence is very uncertain on whether patient education combined with standard care (n = 157) is different to standard care (n = 150) in reducing flare‐ups or relapse in patients with IBD (RR 0.94, 95% CI 0.41 to 2.18; very low‐certainty evidence). Six studies provided data on quality of life. There was no clear difference in quality of life when patient education combined with standard care (n = 721) was compared to standard care (n = 643). Patient education combined with standard care is probably equivalent to standard care in improving quality of life in patients with IBD (SMD 0.08, 95% CI ‐0.03 to 0.18; moderate‐certainty evidence). The included studies did not report major differences on healthcare access. Medication adherence, patient knowledge and change in quality of life showed conflicting results that varied between no major differences and differences in favour of the educational interventions. Only five studies reported on adverse events. Four reported zero total adverse events and one reported one case of breast cancer and two cases of surgery in their interventions groups, and zero adverse events in their control group. Two studies compared delivery methods of patient education, specifically: web‐based patient education interventions versus colour‐printed books or text messages; and one study compared frequency of patient education, specifically: weekly educational text messages versus once every other week educational text messages. These did not show major differences for disease activity and quality of life. Other outcomes were not reported. Authors' conclusions The ways in which patient educational support surrounding IBD may impact on disease outcomes is complex. There is evidence that education added to standard care is probably of no benefit to disease activity or quality of life when compared with standard care, and may be of no benefit for occurrence of relapse when compared with standard care. However, as there was a paucity of specific information regarding the components of education or standard care, the utility of these findings is questionable. Further research on the impact of education on our primary outcomes of disease activity, flare‐ups/relapse and quality of life is probably not indicated. However, further research is necessary, which should focus on reporting details of the educational interventions and study outcomes that educational interventions could be directly targeted to address, such as healthcare access and medication adherence. These should be informed by direct engagement with stakeholders and people affected by Crohn's and colitis

Patients’ and health professionals’ research priorities for chronic pain associated with inflammatory bowel disease: a co-produced sequential mixed methods Delphi consensus study

Objective Chronic pain in IBD is common and detrimental for quality of life. Recent Cochrane reviews identified a multitude of RCT interventions, but the certainty in the findings is low or very low. We set out to reach a patient and professional co-produced Delphi consensus on treatment priorities, key outcomes, and propose a model for understanding our findings. Methods An online survey was co-produced with CCUK and sent to patients and healthcare professionals in two phases, for prioritisastion of treatments andoutcome measures. Phase three consisted of four online group interview, where patients and healthcare professionals discussed the rationale of their choices. Transcripts were combined with the free text data from the Delphi surveys and analysed through a three-phase qualitative technique. Results The phase 1 survey was completed by 128 participants (73 patients, 3 carers and 53 health professionals). Diet was the top priority for both patients (n=26/73, 36.1%) and health care professionals (n=29/52, 56.9%). Phase 2 was completed by 68 participants. FODMAP diet, stress management therapy, and relaxation therapy were the top 3 consensus priorities. Phase 3 group interviews were attended by 13 patients and 5 healthcare professionals. Key themes included: The patient as an individual, beliefs and experiences, disease activity influencing therapy choice, accessibility barriers, and quality of life. Conclusion Low FODMAP diet, followed by psychological therapies were the highest rated research priorities for healthcare professionals and patients. Funding bodies and researchers should consider these findings, alongside the model for understanding our findings, when making research decisions

The epidemiology of common mental disorders in Libya: a systematic review

Abstract: Introduction: There has been a global increase in the prevalence of common mental disorders (CMD), particularly in conflict hotspots. The limited amount of resources is one of the key barriers to effective treatment within Low- and Middle-income countries (LAMICs). The lack of service provision for mental health disorders in LAMICs has resulted in limited opportunities to conduct mental health research. Libya is a North African country that has suffered from ongoing conflict with the current political unrest in Libya further impacting the mental health of the population. Main text: The aim of this review is to conduct a synthesis of evidence regarding the estimated prevalence and associated risk factors of CMD in Libya. A search was completed in the academic databases; PubMed, Medline, EMBASE, PsychINFO, CINHAL, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC) from inception to March 2020. Only studies that investigated prevalence and associated risk factors of CMD in Libya were included. A total of 219 studies were identified of which 15 met the inclusion criteria for the review. There were (n = 3) papers investigated the prevalence of depression, (n = 4) studies were focused on stress-related disorders and the remaining papers looked at both anxiety and depression. Statistically, sample sizes of the included studies ranged from (n = 41–13,031) for the prevalence studies (mean = 1188.6, median = 233). Conclusion: The status of Libya as a conflict hotspot has led to a reduced level of epidemiological data on mental health, with a vital need to conduct research in CMD. Libya requires better clinical governance which can allow for more scientific research into CMD and enabling the Libyan government to develop evidence-based policy initiatives for CMD

Efficacy and safety of Bowel Preparation Strategies in Inflammatory Bowel Disease Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

Aims The ESGE guidelines recommend high or low volume PEG-based bowel preparation for inflammatory bowel disease (IBD).[1] Recently available, non-PEG sulphate-based options provide additional choices. This systematic review meta-analysed efficacy and safety of bowel preparations for IBD patients undergoing colonoscopy Methods We searched CENTRAL, ClinicalTrials.gov, Embase via Ovid, MEDLINE via Ovid, WHO ICTPR for RCTs until October 2023, covering all preparation types. Primary outcomes included bowel preparation success, tolerability, willingness to repeat, and safety. Secondary outcomes were caecal intubation rates (CIR) and abnormal serum electrolyte levels. Pooled estimates used risk ratio (RR) and 95% confidence interval (CI). GRADE assessed evidence certainty. Results Ten RCTs(1479 IBD patients) were included, which compared 4L-PEG, with/without simethicone, castor oil vs. senna, two commercial low-volume PEG-based preparations, 2L PEG vs. 4L PEG, and low-volume PEG with additives vs. non-PEG-based preparations. For 2L vs. 4L PEG, bowel prep success showed no difference (RR 0.95,95% CI:0.88-1.09;I2=33%,2 RCTs;high certainty evidence). Willingness to repeat favored 2L (RR 0.69,95% CI:0.59-0.80; I2=18%,2 RCTs;high certainty evidence). In low-volume non-PEG vs. PEG, bowel prep success probably equaled (RR 0.96,95% CI:0.90-1.01;I2=6%,3 RCTs;moderate certainty evidence). Tolerability and willingness to repeat evidence was very uncertain (RR 0.81,95% CI:0.67-0.99;I2=76%,3 RCTs; very-low certainty evidence), (RR 0.77,95% CI:0.59-0.99; I2=83%,3 RCTs;very-low certainty evidence). No difference in CIR (RR 0.98,95% CI:0.93-1.03;I2=0%,2 RCTs;high certainty evidence). No abnormal post-bowel preparation electrolyte levels were noted in either group. Sub-group analysis showed comparable effectiveness of picosulphate-based (RR 0.89,95% CI:0.78-1.01;I2=0%,1 RCT) and sulphate-based preparations (RR 0.96,95% CI: 0.90-1.05;I2=28%,2 RCTs) compared to low-volume PEG-based preparations. Similar trends were noted for tolerability (RR 0.86,95% CI: 0.73-1.01;I2=22%,1 RCT with picosulphate-based, and RR 0.76,95% CI:0.45-1.26; I2=91%,2 RCTs with sulphate-based vs. low-volume PEG-based,respectively) and willingness to repeat (RR 0.62,95% CI:0.33-1.16;I2=86%,1 RCT with picosulphate-based, and RR 0.88,95% CI:0.65-1.20;I2=86%,2 RCTs with sulphate-based vs. low-volume PEG-based, respectively). Safety data were inconsistently reported. Conclusions High-certainty evidence from two trials supports low-volume PEG with additives as comparably successful to high-volume PEG, with increased willingness to repeat. Moderate-certainty evidence from three trials indicates similar success between non-PEG-based and PEG-based preparations. Both low-volume PEG-based and non-PEG-based preparations have evidence supporting their clinical utility for IBD patients, expanding choices beyond ESGE 2019 guidelines