Inflammatory bowel disease: effects on lifestyle

Patient-Evaluated Quality of Care is Related to Better Inflammatory Bowel Disease Outcomes: The IQCARO II Project

BACKGROUND

Measuring quality of care (QoC) from a patient's perspective is becoming increasingly important in inflammatory bowel disease.

OBJECTIVE

The objective of this study was to determine whether patients' evaluations of QoC correlate with better inflammatory bowel disease outcomes.

METHODS

A survey including patients' characteristics, a decalogue of QoC indicators, and self-reported disease outcomes was completed by Spanish patients with inflammatory bowel disease. A QoC index (QoCI) was constructed with the sum of the "yes" answers in the decalogue. We evaluated the correlation of QoCI with outcomes. A sub-analysis comparing patients with high QoCI vs those with low QoCI was performed (QoCI = 10 or ≤ 7).

RESULTS

Seven hundred and eighty-eight questionnaires were analyzed. Mean age of participants was 43.4 years (63% women). Mean QoCI was 8.1 (± 2.4). The QoCI correlated significantly with activity of the disease, number of flares, emergency/unscheduled visits, and disease control. Patients scoring in the first QoCI quartile reported a decreased rate of moderate/severe disease (34.8% vs 55.3%, p < 0.001), fewer numbers of flares (p < 0.001), and fewer emergency/unscheduled visits (p < 0.001) compared with those in the lower QoCI quartile. The high QoC group also reported better disease control.

CONCLUSIONS

Patient-evaluated QoC correlates with better outcomes. Evaluation of QoC by patients may be useful to detect inadequate care and improve inflammatory bowel disease outcomes.

Improving Quality of Care in Inflammatory Bowel Disease Through Patients' Eyes: IQCARO Project

BACKGROUND

Quality improvement is a major topic in inflammatory bowel disease (IBD) care, and measuring quality of care (QoC) is necessary for QoC improvement. Most QoC projects or consensus statements are designed from the health care professional point of view. Having QoC indicators designed for and fully evaluable by patients may provide a key tool for external evaluation of QoC improvement measures. The aim of the IQCARO project was to identify indicators to measure QoC from the IBD patient's point of view.

METHODS

An extensive review of the literature to identify indicators of QoC was performed; first the identified indicators were reviewed by a steering committee including patients, nurses, IBD specialists, and methodologists. Then 2 focus groups of IBD patients analyzed the QoC indicators to determine whether they could be understood and evaluated by patients. The final QoC indicators were selected by a group of IBD patients using a Delphi consensus methodology.

RESULTS

An initial list of 54 QoC indicators was selected by the steering committee. The QoC indicators were evaluated by 16 patients who participated in 2 focus groups. They identified 21 indicators that fulfilled the understandability and evaluability requirements. The 10 most relevant QoC indicators were selected by 26 patients with IBD using a Delphi consensus. The selected items covered important aspects of QoC, including professionalism, patients' autonomy, information, accessibility, and continuity of care.

CONCLUSIONS

The present Delphi consensus identified QoC indicators that are useful for developing and measuring improvement strategies in the management of IBD.

Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review

BACKGROUND AND AIMS

Little is known about the relationship between inflammatory bowel disease (IBD) and body image. The aim of this systematic review was to summarise the evidence on body image dissatisfaction in patients with IBD across four areas: (1) body image tools, (2) prevalence, (3) factors associated with body image dissatisfaction in IBD and (4) association between IBD and quality of life.

METHODS

Two reviewers screened, selected, quality assessed and extracted data from studies in duplicate. EMBASE, MEDLINE, PsycINFO and Cochrane CENTRAL were searched to April 2018. Study design-specific critical appraisal tools were used to assess risk of bias. Narrative analysis was undertaken due to heterogeneity.

RESULTS

Fifty-seven studies using a body image tool were included; 31 for prevalence and 16 and 8 for associated factors and association with quality of life, respectively. Studies reported mainly mean or median scores. Evidence suggested female gender, age, fatigue, disease activity and steroid use were associated with increased body image dissatisfaction, which was also associated with decreased quality of life.

CONCLUSION

This is the first systematic review on body image in patients with IBD. The evidence suggests that body image dissatisfaction can negatively impact patients, and certain factors are associated with increased body image dissatisfaction. Greater body image dissatisfaction was also associated with poorer quality of life. However, the methodological and reporting quality of studies was in some cases poor with considerable heterogeneity. Future IBD research should incorporate measurement of body image dissatisfaction using validated tools.

Predictors of Impaired Mental Health and Support Seeking in Adults With Inflammatory Bowel Disease: An Online Survey

This study explored the possible factors associated with psychological distress in adults with inflammatory bowel disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort. Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details, and engagement with MHS for IBD-associated issues. Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000 per annum) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support. The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge, however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.

The burden of inflammatory bowel disease: a patient-reported qualitative analysis and development of a conceptual model

BACKGROUND

The aim of this study was to describe the impacts of inflammatory bowel disease (IBD) from the patients' perspective and to inform the development of a conceptual model.

METHODS

Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between themes, assisted by qualitative data software MaxQDA. Themes from the qualitative research were supplemented with those reported in the literature and concepts included in IBD-specific patient-reported outcome measures.

RESULTS

Twenty-seven patients participated. Key physical symptoms included pain, bowel-related symptoms such as frequency, urgency, incontinence, diarrhea, passing blood, and systemic symptoms such as weight loss and fatigue. Participants described continuing and variable symptom experiences. IBD symptoms caused immediate disruption of activities but also had ongoing impacts on daily activities, including dietary restrictions, lifestyle changes, and maintaining close proximity to a toilet. More distal impacts included interference with work, school, parenting, social and leisure activities, relationships, and psychological well-being. The inconvenience of rectal medications, refrigerated biologics, and medication refills emerged as novel burdens not identified in existing patient-reported outcome measures.

CONCLUSIONS

IBD symptoms cause immediate disruption in activities, but patients may continue to experience some symptoms on a chronic basis. The conceptual model presented here may be useful for identifying target concepts for measurement in future studies in IBD.

Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey

BACKGROUND

Over 250 000 people in the UK are affected with inflammatory bowel disease (IBD) and approximately 10 000 new cases are diagnosed every year. These chronic bowel conditions have been shown to affect both work and recreational activity. In the general population, regular exercise has numerous benefits to health and well-being and there are additional benefits for those with IBD. However, people with IBD face significant challenges in trying to take regular exercise.

OBJECTIVE

With the renewed focus on sport brought about by the recent London Olympics, Crohn's and Colitis UK surveyed its members to explore their sport and fitness habits.

METHODS

918 members participated in the survey, which is the largest survey of its kind, investigating the exercise habits of people with IBD.

RESULTS

The survey showed widespread uptake of exercise in those with IBD, with a large number feeling better for it. However, it also identified a considerable number of respondents who reported a significant negative impact of IBD on their ability to take up, enjoy and derive benefit from sporting activities.

CONCLUSION

Asking questions about sporting leisure activity in clinical consultations may identify those in need of help and support and possibly identify factors to be dealt with, in order to enable them to take part in these beneficial activities.

Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients

BACKGROUND AND AIMS

Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

METHODS

Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

CONCLUSIONS

The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling

BACKGROUND AND AIMS

This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.

METHODS

Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.

RESULTS

Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.

CONCLUSIONS

The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.

Identification of areas of functioning and disability addressed in inflammatory bowel disease-specific patient reported outcome measures

BACKGROUND AND AIMS

Patient-reported outcome measures (PROMs) make it possible to assess health-status problems from the perspective of persons suffering from a disease. The objective of the paper is to examine and compare the contents of PROMs related to IBD based on the World Health Organization's International Classification of Functioning, Disability and Health (ICF) as the frame of reference.

METHODS

A systematic literature review (1999-2009) in the databases Medline, EMBASE, PsycINFO, CINAHL and CENTRAL was performed to select IBD-specific PROMs. Abstracts and full-text articles were checked applying predefined eligibility criteria; IBD-specific PROMs were identified. The contents of the identified PROMs were examined by linking the items to ICF categories. The linked ICF categories of the PROMs were then compared.

RESULTS

The review resulted in the selection of eight IBD-specific PROMs (e.g., Cleveland Global Quality of Life, Inflammatory Bowel Disease Quality of Life Questionnaire, Inflammatory Bowel Disease Questionnaire-32, Rating Form of IBD Patient Concerns, Short Inflammatory Bowel Disease Questionnaire). In total, 129 items were identified, the majority of which (n=90; 69.8%) could be linked to specific ICF categories. None of the linked categories were contained in all PROMs. The most frequently identified categories were 'b1300 Energy level', 'b5254 Flatulence', 'd910 Community life' and 'd920 Recreation and leisure'.

CONCLUSION

The present study provides an overview of IBD-specific PROMs and their items. The results of the content comparison provide valuable information to facilitate and account for the selection of appropriate PROMs for different purposes of data collection in clinical and research settings.

Preliminary examination of the relations between disease activity, illness perceptions, coping strategies, and psychological morbidity in Crohn's disease guided by the common sense model of illness

BACKGROUND

An individual's psychological adjustment to illness is influenced by disease severity, illness perceptions, and coping strategies. A more precise understanding of the contribution of each of these factors to a patient's well-being may influence the kind of psychological support required by patients. This study therefore aimed to characterize the contributors to psychological well-being in patients with Crohn's disease (CD). The design was a cross-sectional questionnaire-based study.

METHODS

Ninety-six CD patients (34 males, 62 females, mean age 38 years) attending a tertiary hospital inflammatory bowel disease outpatient clinic were studied. Disease severity was evaluated according to the Crohn's Disease Activity Index (CDAI), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (7) = 10.42, P = 0.17, χ(2) /N = 1.49, root mean square error of approximation (RMSEA) < 0.07, comparative fit index (CFI) > 0.97, Goodness-of-fit index (GFI) > 0.97). Disease activity had a significant direct influence on illness perceptions (β = 51, P < 0.001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 41, P < 0.001, β = 0.40, P < 0.001, respectively). Use of emotional coping strategies was associated significantly (P < 0.001) with the presence of anxiety and depression.

CONCLUSIONS

There is an interrelationship between disease activity, illness perceptions, coping strategies, and depression and anxiety. These aspects of psychological processing provide a framework and direction for the psychological support that patients with CD require.

Coping strategy when patients with quiescent Crohn's disease recognize that their conditions are worsening

BACKGROUND

Although self-management is important for Crohn's disease (CD), there is no research focusing on self-management, especially in worsening conditions. The purpose of this study was to investigate how quiescent CD patients cope with their conditions worsening.

METHODS

A questionnaire containing six types of coping strategy for worsening conditions was created based on a semi-structured interview. Seventy-six quiescent CD patients participated in this study. We also analyzed the related factors of each coping strategy for worsening conditions.

RESULTS

The total percentage of subjects who adopt the strategy of "change contents of meals" 'always' or 'often' was approximately 70%. On the other hand, the strategy of "see a doctor immediately" was approximately 20% in total of 'always' or 'often'. When 'sometimes' was added, "take extra medicine" was approximately 42%. The subjects with experience of hospitalization within 3 years (Z = -2.352, P = 0.019), presence of supplemental elemental diet (Z = -5.182, P < 0.001), or 1 year or less interval since last relapse (Z = -3.352, P = 0.001) showed a significant tendency to adopt the coping strategy of "take (add to) elemental diet."

CONCLUSION

The major coping strategy was "change contents of meals," and the minor coping strategy was "see a doctor immediately." The subjects with unstable disease state adopted the coping strategy of "take (add to) elemental diet." The coping strategies for worsening conditions vary according to patients' backgrounds. The coping type should be taken into account when treating CD patients.

Young peoples' experience of living with ulcerative colitis and an ostomy

Inflammatory bowel disease is a significant illness among young people, requiring some of them to get an ostomy; however, there is minimal research that seeks to understand the meanings young people assign to their inflammatory bowel disease experiences. The purpose of this phenomenological study was to arrive at an understanding of the lived experiences of young persons with inflammatory bowel disease and an ostomy. Six young adults (19-24 years of age) diagnosed with ulcerative colitis, and who all had had an operation for a temporary ostomy, participated in individual open-ended interviews. "Concealing and Revealing the Self," which emerged as the essence of young adults' experiences, referred to how much they chose to present their "true" self to others. The concealment of their true self was, in part, due to the symptoms they experienced and the impact that the illness had on their changing bodies. It was not until they were no longer experiencing the symptoms and their bodies returned to normal that they were able to reveal themselves and have a true sense of confidence. Findings also reveal that young persons with ulcerative colitis and an ostomy experience many uneasy feelings that affect their sense of self, which nurses need to acknowledge.

Low-intensity exercise improves quality of life in patients with Crohn's disease

OBJECTIVE

This study examines the effects of a low-intensity walking program on the quality of life in patients with Crohn's disease.

DESIGN

Patients were randomized into exercise and nonexercise groups for a prospective study.

SETTING

Patients were recruited at the inflammatory bowel disease outpatient clinic at the London Health Science Center, London, Ontario.

PATIENTS

Thirty-two adult patients met the inclusion criteria of (1) mildly active disease or disease in remission, (2) habitual physical activity of less than 2 times per week of vigorous activity, (3) not anticipating change of dose or type of medication for Crohn's disease, and (4) no history of cardiovascular disease. All 32 patients who entered the study completed the 3-month study.

INTERVENTION

Patients performed low-intensity walking at an interval of 3 times per week for a duration of 3 months. Each walking session lasted for 30 minutes.

MAIN OUTCOME MEASUREMENTS

The Inflammatory Bowel Disease Questionnaire, the Inflammatory Bowel Disease Stress Index, and the Harvey-Bradshaw Simple Index were used as outcome. Survey measurements were recorded at 1-month intervals on commencement of the walking program.

RESULTS

Patients in the exercise group experienced a statistically significant (P < 0.05) improvement in quality of life in all 3 of the outcome measurement questionnaires with no detrimental effects in terms of disease activity.

CONCLUSION

A low-intensity walking program may have a beneficial effect in patients with Crohn's disease and improve their quality of life with no exacerbations in disease symptoms.

Ulcerative colitis: factors affecting difficulties of life and psychological well being of patients in remission

BACKGROUND

Ulcerative colitis is a chronic disease of unknown aetiology characterized by alternating periods of remission and relapses. The difficulties in the patients with ulcerative colitis daily life mostly arise from symptoms associated with bowel inflammation but there are many patients who have difficulties despite being in the remission phase. This study was conducted to elucidate factors that influence perception of difficulties of life and psychological well being of patients with ulcerative colitis in remission.

METHODS

A questionnaire survey was carried out in 72 outpatients with ulcerative colitis in remission. The perception of difficulties of life was assessed using the scale developed by Tanaka et al. Psychological well being was assessed using the Japanese version of the 'profile of mood states'. Physical condition, demographic attributes and psychosociological states were also investigated as related factors.

RESULTS

There was no outstanding aspect of psychological well being, but a relatively large number of patients perceived a 'decline of vitality or vigour' despite being in the remission phase. In the presence of irritable bowel syndrome-like symptoms, the scores for 'difficulties of life in society' or 'difficulties concerned with bowel movements' were high. Scores for 'decline of vitality or vigour' were high when the emotive coping scores were high, social support was lower, disease durations were short and relapses occurred more than once. When the emotive coping scores were high, psychological well being was not fine.

RELEVANCE TO CLINICAL PRACTICE

Strategies need to be developed to allow patients to recover and maintain their strength in the remission phase. Further, the strategies should take the above factors into consideration.

Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease

Information on quality of life in inflammatory bowel disease is limited. Despite the clear importance of this topic to patients, quality of life measurement is seldom undertaken in day-to-day management of patients or included in clinical trials. Although previous reviews have dealt with quality of life, the area of psychosocial functioning has not been specifically addressed. The aim of this study was to review the psychosocial factors affecting quality of life in patients with inflammatory bowel disease, using an electronic search of MEDLINE, EMBASE, CINAHL and psycINFO. Of the 751 articles identified by the search, 107 were considered relevant and included in the review. A number of psychosocial factors appear to be important, including gender, socioeconomic status, ethnicity and perceived stress. To improve the quality of life in patients with inflammatory bowel disease, clinicians' attention needs to be drawn towards this subject, with an awareness of those patient groups more vulnerable to impaired quality of life. These identified variables also represent important factors, which should be adjusted for when conducting research into quality of life in these patients.

A study of the relationships between self-evaluation of physical condition and perception of difficulties of life in ulcerative colitis patients

This study was conducted to elucidate factors that influence the self-evaluation of physical condition and perception of difficulties of life in ulcerative colitis patients. A survey and clinical examination were carried out in 171 outpatients with ulcerative colitis. Self-evaluation of physical condition was assessed according to a five-grade system. Perception of difficulties of life was assessed using a scale developed by the authors and others. Physical condition of patients was assessed according to their disease state, disease symptoms, and nutritional state. Additional related factors such as mental condition, demographic attributes, and psychosocial states were also investigated. Multiple regression analyses was used to assess the relationships among variables and showed that perception of difficulties of life and disease symptoms were the main explanatory factors for the self-evaluation of physical condition. Perception of difficulties of life was comprised of physical and mental conditions, the latter being further influenced by the patients' psychosocial state.

Young adults' perceptions of living with chronic inflammatory bowel disease

King's (1981, 1995b) Theory of Goal Attainment provided the theoretical framework for this qualitative, descriptive study exploring the perceptions of five young adults living with chronic inflammatory bowel disease (IBD). Through in-depth interviews, the participants had the opportunity to share their perceptions of what mattered most as they lived the experiences of this illness. The uniqueness and individuality of perceptions, the challenges of chronic bowel disease, recommendations for the future, and participants' expectations of healthcare professionals were explored. Persons with chronic IBD are faced with many life-disrupting challenges that profoundly affect their personal, interpersonal, and social systems. This research study supported the premise that understanding the patient's perspective and reaching perceptual accuracy through human-to-human interaction is critical to healthcare outcomes and achievement of the young adult's health goals.

The effects of physical exercise on patients with Crohn's disease

OBJECTIVE

Despite the suggested benefits of exercise training in the prevention and management of chronic diseases, few data exist regarding the safety of exercise in Crohn's disease and whether or not exercise may have beneficial effects on patients' health. We performed a pilot study to evaluate the effects of regular light-intensity exercise on sedentary patients with Crohn's disease.

METHODS

Sedentary patients with inactive or mildly active Crohn's disease were eligible for the study. A thrice-weekly, 12-wk walking program was supervised, although if subjects could not attend the group walking sessions they were allowed to walk on their own. Logbooks of performance were maintained, and individual exercise heart rate goals were established. Measures performed at baseline and at study completion included the Inflammatory Bowel Disease Stress Index, the Inflammatory Bowel Disease Quality of Life Score, the Harvey and Bradshaw Simple Index, the Canadian Aerobic Fitness Test, VO2 Max, and body mass index (BMI).

RESULTS

Twelve subjects completed the 12-wk exercise program. Subjects walked an average of 2.9 sessions/wk, at an average of 32.6 min/session, and for an average distance of 3.5 km/session. Statistically significant improvements at study end were seen by all measures, with a trend toward reduction in BMI. No patient's disease flared during the study.

CONCLUSIONS

Sedentary patients with Crohn's disease can tolerate low-intensity exercise of moderate duration without an exacerbation of symptoms. Twelve weeks of walking was adequate to elicit psychological and physical improvements and did not adversely affect disease activity.

Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status

OBJECTIVE

There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse.

METHOD

The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history.

RESULTS

We found the following: 1) 66.5% of patients experienced some type of sexual and/or physical abuse; 2) women with sexual abuse history had more pain, non-GI somatic symptoms, bed disability days, lifetime surgeries, psychological distress, and functional disability compared to those without sexual abuse; 3) women with physical abuse also had worse health outcome on most health status indicators; 4) rape (intercourse) and life-threatening physical abuse seem to have worse health effects than less serious physical violence, and sexual abuse involving attempts and touch; and 5) those with first abuse in childhood did not appear to differ on health from those whose first abuse was as adults.

CONCLUSIONS

The authors conclude that asking about abuse should be integrated into history taking within referral-based gastroenterology practices.

Sexual health issues in inflammatory bowel disease

Alterations in sexual health caused by inflammatory bowel disease (IBD) may affect quality of life and disease status. IBD usually strikes adolescents or young adults, who are also facing developmental milestones important to sexual health. Issues include growth and development, body image, intimacy and sexual functioning, fertility, and pregnancy. A review of published research regarding these issues, in addition to suggestions for nursing assessment and interventions, is included in this article. Nurses must offer sensitive support and suggestions for coping. Nurses must be aware of the issues influencing sexual health when providing total care to clients with IBD.

The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders

Although the literature on the psychological and medical sequelae of sexual and physical abuse has been growing, researchers have made few attempts to standardize the measurement of abuse history. The authors of this article report the first standardization of a screening instrument to identify sexual and physical abuse in a medical population. Reliability was assessed using test-retest methodology, and validity was supported by comparison with an interview (criterion validity). The sample included 139 female patients in a gastroenterology clinic. Data indicate acceptable test-retest reliability of the sexual abuse instrument (81%) and 81% overall agreement between the questionnaire and the interview on any sexual abuse. In comparison, the authors found 77% agreement in test-retest reliability of the physical abuse questionnaire and 70% agreement between the questionnaire and the interview on physical abuse. From their analyses, they concluded that the sexual abuse questionnaire and, to a lesser extent, the physical abuse instrument have acceptable levels of reliability and validity. As a screening tool, the abuse measures could be used to identify women in clinic settings for further study.

Evaluation of a psychological treatment for inflammatory bowel disease

Inflammatory bowel disease (IBD) encompasses two related gastrointestinal-tract diseases, ulcerative colitis (UC) and Crohn's Disease (CD). This study, a randomized controlled trial, compared the effectiveness of a multi-component behavioral treatment package (n = 11), which included IBD education, progressive muscle relaxation, thermal biofeedback, and training in use of cognitive coping strategies, to the effectiveness of symptom-monitoring (n = 10) as a control condition; 8 controls subsequently completed treatment. At posttreatment, the treatment group showed mean reductions on 5 symptoms, while the symptom monitoring controls showed mean reductions on all 8 symptoms. On a measure of Total Symptomatic change, the controls showed more improvement than the treated group; the treated controls at posttreatment, showed increases on all 8 symptoms. However, treated subjects perceived themselves as coping better with IBD, as feeling less IBD-related stress, and as experiencing less depression and anxiety. It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses.