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Table 1. Studies Included in the Review
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Findings
Kennedy, Nelson,
Reeves, Richardson,
Roberts, Rogers,
Sculpher, &
Thompson (2003).
RCT. UK.
Quality of Life
(EUROQoL, EQ-5D
and IBDQ),
Consultant
Satisfaction (CSQ),
Anxiety and
Depression (HADS),
health service
resource use, patient
acceptability and
satisfaction
N = 700, 77%
response rate,
22% attrition,
mean age =
45.5 years,
57.6% female
IBD (63.5% UC),
Hospital clinic lists
Incorporated into
Intervention: Trained
consultation,
physicians to deliver
Consultant, Individual. patient-centered
consultations and
negotiate written selfmanagement plan with
patient, provided openaccess clinics, gave
patients guidebook on
self-management.
Control: usual care.
To determine if using this Intervention group:
whole systems approach Fewer hospital visits,
to self-management
better coping, fewer
improved clinical outcomes symptom relapses. No
and led to cost-effective
change in quality of life
use of services.
or anxiety levels. Costeffectiveness analysis
favored intervention
group. 74% of
intervention group said
they would prefer to
continue with selfmanagement system.
McColl, LeCouturier,
Corbett, Sppe,
Vanoli, Welfare, . . .
Steen (2004). RCT.
UK.
Anxiety and
Depression (HADS),
Quality of life
(EuroQol, IBDQ),
Generic health status
(SF-36), acceptability
(assessed
quantitatively and
using in-depth
interviews), validated
measures of selfefficacy and selfmanagement
behaviors. Healthcare
resource costs.
N = 159, 61%
response rate,
38% attrition,
mean age = 54
years, 52%
female.
UC. 16 sig others
(relatives, friends) in
intervention group.
Hospital databases
and IBD clinics.
6 weekly sessions (2.5 Intervention: Provision of
hrs). GI research nurse information (patient
and health
guidebook, 'core pack' of
psychologist. Group. NACC booklets,
worksheets relating to
medical management of
UC), training in coping
strategies (stress
management, relaxation
techniques, cognitive
symptom management,
strategies for
communicating with
family, friends, and
health professionals),
sharing of experiences
and 'self-help' ideas.
Control: Provision of
information (as
intervention group but
without worksheets)
To determine if the selfNo significant effects on
management program
quality of life,
improved quality of life and depression, anxiety or
increased participants'
generic health status.
self-efficacy and selfStatistically significant
management behavior.
improvements in the
To undertake economic
intervention group were
evaluation.
found in IBD bowel
symptoms (6mths);
emotional functioning
(12mths), and total
IBDQ score (12mths).
Significant
improvements reported
for all participants
(intervention & control)
for self-management
behaviors and 3
aspects of self-efficacy
(6-months). No
differences in
healthcare resource
costs between groups.
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Robinson, Thompson, Time between
N = 203, 65%
Wilkin , & Roberts
symptom
response rate,
(2001). RCT. UK.
development and start 14% attrition,
of treatment; number median age =
of consultations in
48, 51.5%
primary and
female
secondary care; costs
to patients (temporal
and financial);
acceptability; quality
of life (IBDQ)
UC. Outpatients from Incorporated within
4 gastroenterology routine clinic appt (15departments in the 30mins).
greater Manchester Gastroenterologist.
area.
Individual.
Quan, Presen,t &
Sutherland (2003).
Single group prepost. Canada,
51%IBD patients (%
UC NK) plus
partners, friends and
family. Local TV and
radio
advertisements,
workshop brochures
circulated to local
gastroenterologists
and physicians.
Knowledge
(CCKNOW)
N = 734,
response rate =
62%, attrition =
N/A, mean age
= NK, %female
= NK
1 workshop (3hrs).
One of 9 recognized
US experts in IBD.
Group.
Intervention
Intervention:
Development of
personalized guided selfmanagement regimen.
Aim of regimen was to
ensure that patients
could recognize relapse
and patient and clinician
could agree on a
mutually acceptable
treatment protocol for
use in event of relapse.
Follow-ups made at
patients' request.
Control: Standard
treatment and routine
follow-up
Presentation covering
general knowledge about
IBD, complications, diet,
and treatment followed
by questions and
answers.
Objectives
Findings
To assess an alternative to Intervention group:
traditional outpatient care. relapses were treated
faster, fewer visits to
the hospital and to
primary care, less
money and time spent
on visiting health
professionals. 82%
preferred the new
system. No differences
in health-related quality
of life between the
groups.
To assess 1) IBD
knowledge of participants
attending educational
workshops offered to the
public, and 2) the effect of
the workshop on
participants' IBD
knowledge levels.
Increased patients’
knowledge, retained at
3-months follow-up.
Majority of participants
still lacking knowledge
on treatments, sideeffects, and
consequences of
disease.
Authors/Study
Design/Country
Larsson, Sundberg
Hjelm, Larlbom,
Nordin, Anderberg, &
Loof (2003).
Waiting list control.
Sweden.
Measures
Anxiety and
Depression (HADS),
Quality of Life (IBDQ
SF-36), participant
satisfaction
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
N = 49,
response rate =
36%, attrition =
47%, mean age
= 44, 65.3%
female
47% UC. Letters
sent to all IBD
patients in county of
Uppsala, Sweden.
8 weekly sessions (23hrs).
Gastroenterologist,
surgeon, psychiatrist,
physiotherapist,
dietician, stoma-care
nurse, medical social
worker, members of
patient organization.
Group.
Intervention
Objectives
Findings
Intervention: general
1) To determine whether Within-group analyses:
medical information
group-based education will no significant
about IBD and its
have an effect on anxiety differences over time on
pharmacological and
in patients screened for
depression, anxiety,
surgical treatment; info high anxiety 2) to
quality of life, or general
on diet, nutrition, and
investigate the effect of the health status.
stress management and intervention on quality of Intervention group
how to adapt and cope life.
reported higher levels of
with a chronic disease;
satisfaction with their
info about relevant
disease knowledge at
aspects of social security
6-months follow-up.
system and patient
organizations; practical
cookery and computer
based nutrient profiles.
Waiting List Control
group: received
intervention 6-mont.hs
later
Borgaonkar,Townson, Quality of life (IBDQ & N = 59,
39% UC.
Information booklets Intervention: Four
To assess the effect of
Quality of life (total
Donnelly & Irvine
QuICC)
response rate = Consecutive patients handed out by
booklets covering 1)
education on healthIBDQ score)
(2002). RCT.
NK, attrition = with IBD attending a physicians while
general information about related quality of life.
deteriorated in the
Canada.
10%, mean age gastroenterology
patient attending
IBD, 2) list of available
intervention group
= 39.7 years,
clinic.
routine appointment at medications, their
compared to controls by
55.9% female
gastro clinic. Individual. efficacy and rationale for
follow-up (approx. 2
choosing them, 3) role of
weeks to 1 month after
surgery in management
educational
of IBD including available
intervention).
procedures and their
Disproportionate
indications, and 4) issues
worsening of disease
of sexuality, fertility, and
severity in the
pregnancy, and how
educational group
these might be affected
compared to controls
by IBD and its treatment.
and more specifically,
Control: standard care.
only in the CD group.
This was not controlled
for.
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Smart, Mayberry,
Calcraft, Morris, &
Rhodes (1986).
Single group prepost. UK.
Self-reported anxiety,
frequency of
consultation with GP
and consultant,
requests for
information on life
assurance, disability
allowances, and
pregnancy. Used
questionnaire
developed for study.
N = 175,
CD. Booklet sent to
response rate = patients attending
NK,aAttrition = outpatient clinics in
9%, mean age = South East Wales.
NK, % female =
NK
Information booklet
developed by group of
clinicians in South
Wales, sent by post
Information booklet
To assess the effect of
entitled Living with
information booklet on
Crohn's Disease
anxiety levels and
covering symptoms,
consultation rates
attendance at clinic, and
examination,
investigations, theories of
etiology, medical and
surgical treatment, and
listing voluntary patient
organizations
Bregenzer, Lange,
Furst, Gross,
Scholmerich & Andus
(2005) . Wait-list
control. Germany.
Disease-related
knowledge,
depression (General
Depression Scale),
Gastrointestinal
Quality of Life Index,
disease activity (CDAI
& Colitis Activity
Index).
N = 145,
39% UC. Recruited
response rate = via regional
NK, attrition = hospitals, primary
NK, mean age = care physicians, and
34.9 yrs, 66% self-help groups.
female
4 sessions (2 hours).
Period of time not
specified. Some
patients accompanied
by a relative.
Gastroenterologists,
surgeons,
psychologists, social
worker and nutrition
advisor. Group.
Intervention: Education
delivered in an
interactive, participating
way: 1) pathogenesis,
diagnostic procedures
and course of the
disease; 2) medical and
surgical treatment ;3)
nutrition, social problems
and support ;4) stress
management and coping
with the disease.
Waiting-List Control:
normal care but not
described. Received
educational intervention
after the 1-year
evaluation period.
Findings
At 1-year follow-up:
82% found booklet
valuable; 90% wanted
booklet to be made
available to all CD
patients; 70% felt
awareness of medical
and social problems
associated with Crohn
disease had increased;
30% showed decrease
in anxiety levels;
significant fall in
consultation rates; less
than 20% sought further
advice on life
assurance, pregnancy,
and disability
allowances.
To determine whether a
No significant
systematic interdisciplinary differences between
patient education program groups in diseasecould affect patient
related knowledge,
knowledge, quality of life, depression, quality of
and depression for a
life, or disease activity.
prolonged period of time Both groups showed a
and thereby improve self- significant improvement
management.
in disease-related
knowledge over time.
98% of intervention
group were very
satisfied with the
educational program.
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Langhorst, Mueller, Clinical disease
Luedtke, Franken,
(CDAI), quality of life
Paul, Michalson,
(IBDQ & SF-36),
Schedlowski, Dobos, psychological distress
,& Elsenbruch (2007). (BSI), health
RCT. Germany,
behaviors (author
created)
N =60,
UC.
response rate = Recruitment through
NK, attrition = advertisement in the
7%, mean age = paper.
44.3 years, %
female = 85%
6 hours over 10 wks.
Trained individuals
with experience of
lifestyle modification.
Group.
Intervention: stress
management training,
psycho-educational
elements, and self-care
strategies. Usual care:
usual medical care
carried out by their
primary physician or
gastroenterologist.
Milne, Joachim, &
Niedhardt (1986).
RCT. Canada.
N = 80,
response rate =
NK, attrition =
14%, mean age
= 33.2 years, %
female = NK
6 classes (3 hours) period of time not
specified. Two
nurse/social workers.
Group.
Intervention: based on a To determine whether
series of stress
practicing stress
management booklets: 1) management techniques
personal planning skills would decrease disease
(e.g. time management, activity and promote
goal setting, problem
psychosocial functioning.
solving), 2)
communication skills, 3)
autogenic training
(systematic repetition of
autogenic phrases
describing a desired
body condition. These
focus on heaviness,
warmth, and breathing,
together in association
with deep relaxation.)
Waiting-List Control:
usual care.
Disease activity
(CDAI), stress (IBD
Stress Index & ISA)
UC and CD (% of
each condition not
reported).
Recruitment through
practices of 5
gastroenterologists
and Vancouver
Chapter of Canadian
Foundation for Ileitis
& Colitis.
Findings
To analyze the effects of a There was no change in
lifestyle modification
disease activity. An
program on health related improvement was
quality of life,
shown in the
psychological distress, and intervention group on
clinical parameters.
quality of life, anxiety,
and health behaviors
when compared to the
control group.
Intervention group
showed significant
improvements in
disease activity and IBD
stress Index scores that
were maintained at all
follow-ups (4, 8, and 12months). No change in
control group.
Authors/Study
Design/Country
Mussel, Bocker,
Olbrich & Singer
(2003). Single group
pre-post. Germany.
Measures
Disease activity
(CDAI), psychological
distress (SCL-90-R),
depression (CESD),
disease-specific
distress (RFIPC),
coping with the
disease (FQCI).
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
N = 36,
response rate =
NK, attrition =
11%, mean age
= 42.3 years,
57% female
50% UC. Leaflets
and posters in
outpatients' waiting
area.
12 weekly sessions (90 Intervention: Initial
To determine whether
mins.) followed by 3
sessions based on
cognitive-behavioral group
follow-up sessions at cognitive-behavioral
treatment accompanying
3-monthly intervals.
principles included: a)
standard medical care is
Clinical psychologists psycho education about effective in reducing
and gastroenterologist. IBD and the role of
psychological distress.
Group.
cognitions and emotions
in distress, b) training in
adaptive cognitive coping
strategies for diseaserelated and everyday
distress, c) progressive
muscle relaxation
training. Follow-up
sessions included open
group conversation on
topics of participants'
choice.
Findings
Disease-related
concerns decreased
significantly by 1-year
follow-up. Trend
towards a CD showing
greater concerns over
time than UC. Trend for
greater decrease in
concerns in patients
with shorter disease
duration. Women's
depressive symptom
scores and depressive
coping behavior
improved significantly
post-intervention and
this was maintained at
all follow-ups. No
changes in disease
activity or on global
measure of
psychological distress.
CD scored significantly
higher on global
measure of
psychological distress
over time than UC.
Authors/Study
Design/Country
Measures
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Krause (2003).
Quantitative: quality of N = 38,
Controlled trial. Chile. life (short IBDQ),
response rate =
knowledge of IBD
NK, attrition =
(measure not
NK, age range
validated).
approx. 25-45
Qualitative: interviews years, 75%
and observations
female
UC and CD (% of
each condition not
reported).
Participants were
members of locally
run self-help group
for IBD.
Monthly group
Intervention: included
meetings over 1 year. info about the illness and
Psychologists. Group. psychosocial processes
associated with the
disease; training in
relaxation techniques;
working on mutual social
support strategies;
promoting sharing of
experiences, emotions,
and information; training
in coping with stressful
events; supporting
participants in gaining
better contracts from
health insurance
providers.
Schwarz & Blanchard Stress (IBDSI),
(1991). RCT. USA. Hassles Scale,
depression (BDI),
anxiety (STAI),
psychosomatic
symptom checklist,
symptoms (diary
reporting)
48% UC. Letter to
members of local
chapter of National
Foundation for Ileitis
& Colitis.
12 sessions (1 hour)
twice-weekly for 4
weeks, then once per
week for 4 weeks. 4th
year clinical
psychology doctoral
student. Individual.
N, Response
(%), Attrition
(%), Mean
age, %
Female
N = 21,
response rate =
NK, attrition =
10%, mean age
= 43.9 years,
57% female
Intervention
Objectives
Findings
To promote psychosocial
processes within an IBD
self-help group and to
increase and evaluate the
impact of the group on
well-being
Qualitative:
representations of
illness became
normalized, allowing
participants to cope
better with their disease
and helping them to
better identify times
when special care was
needed.
Quantitative: No
difference between
groups in quality of life
(total score).
Intervention group
significantly increased
level of IBD knowledge
from baseline to postintervention.
Intervention: progressive To assess effectiveness of Controls showed
muscle relaxation,
multi-component treatment greater reduction in
thermal biofeedback,
intervention.
symptoms than
training in cognitive
intervention group.
coping strategies,
Once undergoing
educational component
intervention, controls
relating to IBD
showed less
symptomatology,
improvement in
monitored symptoms
symptoms than when
daily, recorded food
they had only monitored
and/or activity avoidance
symptoms. Intervention
due to IBD.
group showed
Control: monitored
significantly lower
symptoms daily.
scores on IBD Stress
Index post-treatment.
No significant changes
on any other
psychological
measures. Following
intervention, controls
significantly improved
scores on measures of
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Findings
depression and number
of hassles. Some
differences between CD
and UC groups on
malaise and abdominal
pain.
Watters, Wright,
Robinson, Krzywick,
Almond, Shelvin &
Mayberry (2001).
RCT. UK.
Anxiety and
depression (HADS),
Acceptance of Illness
Scale, Satisfaction
with Life Scale
N = 113,
response rate =
48%, attrition =
11%, mean age
= 40.7, %
female = NK
CD. Invitation letters
sent to database of
IBD patients in
Leicestershire.
Two exercise sessions Intervention: Attended
To evaluate the efficacy of
per week for 12
series of induction
a 12-month exercise
months. Background of meetings where 12 core intervention on
person delivering
floor-based, low-impact, psychological well-being.
intervention not
resistance-type exercises
reported. Patients
were demonstrated and
taught the exercises
supporting resource
initially and then
package provided.
carried them out on
Program was hometheir own.
based.
Control: usual care.
No differences between
the control and
intervention groups, on
any measures, at 12
months. Higher scores
on Acceptance of
Illness Scale at baseline
positively predicted
exercise uptake.
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
N = 30,
30% UC. Self20 weekly sessions (90 Group therapy
Adapt supportiveresponse rate = referrals after
minutes). 2
techniques to encourage expressive therapy to
NK, attrition
obtaining information experienced group
expression of thoughts patients with IBD.
20%, mean
from staff at
leaders (psychiatrists) and feelings about illness Determine concerns that
age=34.9 years, participating hospital, familiar with treatment and its impact on lifestyle need to be addressed,
80% female
through
manual for supportive- and relationships.
Investigate the potential of
advertisements with expressive therapy ran Relaxation techniques
the therapy to improve
Crohn's & Colitis
4 groups of 6-10
introduced. Therapy
quality of life and enhance
Foundation of
people.
expected to provide
coping with IBD.
Canada or via other
information, instill hope Assess feasibility and
community agencies.
and realize the
utility of a larger-scale
universality of individual RCT
concerns. Leaders
balanced 2 imperatives:
1) use of unstructured
enquiry to encourage
discussion of emotionevoking issues, and 2)
directed efforts to
facilitate discussion of
topics that may be
important but might be
withheld without direct
enquiry, e.g. self-image,
stigma.
Stress (IBDSI), quality N = 16,
CD. Recruitment via 3 sessions per week Structured walking in a To evaluate the effects of
of life (IBDQ), disease response rate = advertisements at
over 12 weeks.
group starting at 20
regular light-intensity
activity (Harvey &
NK, attrition
University IBD
Physiotherapist.
minutes per session,
exercise on sedentary
Bradshaw's Simple
25%, mean age Research Center
Preferably group.
increasing to 35 minutes. patients.
Index), Canadian
= 38.3 years, % Clinic and local
Distance and intensity of
Aerobic Fitness Test, female = NK
chapter of Crohn's &
walking increased over
BMI.
Colitis Foundation of
12-week period. Patients
Canada.
able to walk individually if
they were unable to
attend group sessions.
Findings
Maunder & Esplen
Rating Form of IBD
(2001). Single group Patient Concerns
pre-post. Canada.
(RFIPC); quality of life
(IBDQ; self-reported
disease activity;
anxiety & depression
(HADS); Ways of
Coping Inventory
No significant
differences in IBD
symptoms, quality of
life, depression or
anxiety from start to end
of trial. Scores on
maladaptive coping
sub-scale (Ways of
Coping Inventory) were
significantly reduced by
end of therapy.
Loudon, Carroll,
Butcher, Rawthorne
& Bernstein (1999).
Single group prepost. Canada.
Significant
improvements postintervention in stress
levels, quality of life,
and disease activity
although these
improvements were not
statistically significant
when patient with very
high disease activity
score at baseline was
excluded from analysis.
Authors/Study
Design/Country
Waters, Jensen, &
Fedorak (2005).
RCT. Canada.
Measures
Disease knowledge,
quality of life (IBDQ),
Rating Form of IBD
Patient Concerns,
healthcare use,
patient satisfaction
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
N = 89,
response rate =
34%, attrition =
22%, mean age
= 42.7 years,
43% female.
36% UC.
Approached during
routine clinic visits or
sent information by
mail and followed up
with telephone call.
4 weekly sessions (3
hours). Nurse
practitioner, surgeon,
dietician. Group.
Intervention: Variety of To evaluate the effects of
teaching strategies used a formalized education
to enhance learning and program.
improve critical thinking
skills. Sessions covered
general education about
basic gut and immune
system anatomy and
physiology, explored
pathophysiology,
reviewed current and
future therapies. Group
discussion tailored to
address worries and
concerns of patients.
Copies of presentations,
information booklet, and
overview of group
discussion information
given out. Opportunity for
individual dietary
counseling offered.
Control: Standard care
consisting of physician
visits, physician-directed
ad hoc teaching, and
presentation of printed
educational literature.
Findings
Intervention group had
significantly higher
knowledge scores and
levels of patient
satisfaction than control
group (post-intervention
and at 8-weeks followup). Those with UC
were significantly more
satisfied with the
education program than
CD patients. No
significant differences
between groups in
quality of life, diseaserelated concerns,
medication adherence,
or healthcare use.
Authors/Study
Design/Country
Jantschek, Zeitz,
Pritsch, Wirsching,
Klor, Studt,
Rasenack, Det er
Rieken, Feiereis &
Keller (1998);
Keller, Pritsch, VonWietersheim, Scheib,
Osborn, Balck, Dilg,
SchmelzSchumacher, Poppl,
Jantschek, & Deter
(2004);
Deter, Keller, von
Wietersheim,
Jantschek,
Duchmann, & Zeitz
(2007). RCT.
Germany.
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
Disease course and N =1 08,
CD. Consecutive
activity (CDAI, ranking response rate = patients from 4
system developed for NK, attrition
centers.
study; Beck
25%, median
Depression Inventory; age = 27 years,
anxiety (STAI); quality 66% female
of life (not cited);
psychic & sociocommunicative status
rating using interview
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Findings
At least 10 verbal
sessions of individual
or group
psychotherapy at a
minimum. Length of
psychotherapy did not
exceed 1 year. Length
of sessions not
reported. Therapists
were experienced
postgraduate
physicians or
psychologists trained
in psychodynamic
treatment.
Intervention: 1) verbal
To determine whether the No significant
sessions of individual or course of Crohn disease, differences between
group psychotherapy and within a 2-year observation groups at 12-months or
relaxation procedures
period, could be changed 24-months follow-up in
(autogenic). Aim of
by psychodynamic short- depression, trait
therapy was to provide term therapy in addition to anxiety, quality of life,
health education and
a standard drug treatment. psycho and socioenhance health
communicative status
promoting behaviors,
scores, or disease
give patients greater
course. 23% of controls
responsibility and control
and 30% of
in treatment, and improve
psychotherapy group
coping skills and
showed episode-free
adjustment to Crohn
illness course over 2
disease. Standardized
years. This was not
drug treatment using a
significant. Intervention
uniform, fixed dosage
group spent significantly
scheme of corticosteroids
less days in hospital
during acute episodes. 2)
and reported less sick
standardized drug
leave than controls.
treatment only (as
above).
Authors/Study
Design/Country
Smith, Watson,
Roger, McRorie,
Hurst, Luman &
Palmer (2002).
RCT. UK.
Measures
Quality of life (SF-36),
Crohn's disease
activity (CDDAI),
anxiety & depression
(HADS), coping
(Styles & Strategies
Q)
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
N = 100,
response rate =
NK, attrition =
0%, age range
= 17-68 years,
55% female
50% UC.
One session at
Consecutive patients randomization and
from a single
then 3-6 monthly
gastroenterology
intervals, as required.
clinic.
Duration of sessions
not specified. Nurse
counselor.
Group/Individual = NK.
Intervention
Objectives
Intervention: Provision of To examine the effects of
information in form of
psychosocial counseling.
booklets and educational
videos describing
aspects of physical
symptoms, drug therapy,
diet, and surgery, and
made aware of existence
of local support groups.
Challenge of Change
stress management
program: teaching
appropriate coping
mechanisms and use of
progressive relaxation
techniques using
audiocassette,
discussion of potentially
stressful situations, and
ways of improving
coping.
Control: routine
outpatient follow-up.
Information booklets on
request. Made aware of
existence of local support
groups.
Findings
No significant
differences in mean
disease activity scores
or HADS scores
between groups. Mental
health domain on SF-36
in Crohn disease
patients in Intervention
group showed greater
improvement than
controls at 6 months but
difference not sustained
at 12 months. No other
differences between
groups on other SF-36
domains. Mean HADS
anxiety score in Crohn
disease patients in
intervention group fell
significantly from
baseline to 12-months.
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Intervention: Progressive To assess whether
relaxation. Participants relaxation training would
given audio tapes and
reduce the perception of
instructed to practice at pain and pain-related
home with and without
behaviors in individuals
the tapes at least once suffering from chronic pain
each day.
due to UC.
Control: on waiting list for
relaxation training.
Telephoned once a week
but no direct suggestions
made about pain
alleviation.
Findings
Shaw & Erhlich
(1987). RCT. USA.
Pain (MPDI & P&DS),
intensity of present
pain, duration and
frequency of pain
episode, amount of
pain relief
experienced, use of
medication.
N = 40,
UC. Los Angeles
response rate = Colitis-Ileitis
NK, attrition = Foundation.
0%, mean age =
30.4, 50%
female
Six 75 minute, weekly
sessions. Person
delivering intervention
not reported. Group.
Intervention group rated
pain as less intense and
occurring less
frequently, used fewer
words to describe their
pain, rated pain relief as
greater, and had less
psychological distress
due to pain than
controls. Effects found
immediately postintervention and
maintained at 6-week
follow-up.
Oxelmark,
Magnusson, Lofberg
& Hilleras (2007).
RCT. Sweden.
Quality of life (IBDQ)
sense of coherence
(SOC), visual
analogue scale
(VAS)/patient
evaluation.
N = 44,
39% UC. IBD
response rate = outpatient clinic in
61%, attrition = hospital.
21%, mean age
= 37.5 years,
59% female
9 weekly sessions of Intervention: Lectures
To develop and integrate The mean IBDQ score
lectures and therapy. with education about
medical and psychological/ showed no statistically
Gastroenterologist,
diseases so that patients psychosocial group-based significant differences
specialist nurse,
could identify his/her
intervention program for
before or after the
colorectal surgeon,
likely disease course.
IBD patients and to
intervention (6 months
dietician, medical
Medical treatment,
evaluate the possible
or 12 months) or when
social worker, and
efficacy, side effects and effects on the patients’
comparing the
physiotherapist. Group. new research were
coping abilities and
intervention and
outlined and the
HRQOL by comparing
controls at month 12.
anatomy, physiology, and intervention group with a Similarly, there were no
function of the bowel and control group.
statistically significant
digestive tract were
differences in the mean
described and explained.
SOC before or after the
Group therapy:
intervention or when
consequences of the
comparing groups. The
disease, psychological
VAS and the content
reactions, receiving
analysis showed the
information of the
intervention was well
diagnosis, coping, stress
appreciated by the
management, positive
patients.
and negative stress, and
disease and self image.
Control: conventional “on
demand” medical and
psychosocial/psychologic
al treatment during the
Authors/Study
Design/Country
Measures
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Objectives
Findings
study period
Cross & Finkelstein
(2007). Pre-post.
USA.
Disease activity
(Harvey Bradshaw
Index), quality of life
(IBDQ), and
knowledge
(CCKNOW)
N = 34,
60% UC. Clinics and
response rate = IBD programs.
NK, attrition =
26%, mean age
= 43.1 years,
48% female
One initial test to learn
how to use the
computer program,
then weekly for 6
months. Delivered via
computer. Individual.
Intervention: Patients
Access the acceptance
used a telemedicine
and feasibility of home
system to help them
telemedicine system in
follow self care plans,
IBD.
help healthcare
practitioners monitor
patients selfmanagement, and to gain
ongoing education about
their disease.
There was no change in
disease activity or
quality of life. The study
did find a significant
improvement in
patients’ knowledge.
Authors/Study
Design/Country
Measures
Ng, Miljard, Lebrun, & Physical activity
Howard (2007). RCT. (IPALQ), stress
USA.
(IBDSI), disease
dysfunction (IBDQ),
and disease activity
(HBI).
N, Response
(%), Attrition
(%), Mean
age, %
Female
Disease Type
(%Ulcerative
Colitis),
Recruitment
Process
N = 32,
CD.
response rate = Gastroenterology
NK, attrition = clinics.
NK, mean age =
38.8 years, 56%
female
Key: NK = not known, RCT = randomized control trial
# & duration of
sessions,
Delivered by,
Group/Individual
Intervention
Three 30 minutes
sessions for 3 months.
Background of person
delivering intervention
not reported.
Individual.
Intervention: Carried out
low-intensity walking 3
times per week for 3
months. Each walking
session lasted for 30
minutes.
Usual care: asked to
maintain their habitual
physical activity level.
Objectives
Examine the effects of a
low intensity walking
program on the quality of
life of patients with Crohn
disease.
Findings
Intervention group
showed an increase in
post-study physical
activity level compared
to pre-study scores with
no exacerbations of
disease activity.
Results showed a
significant improvement
in quality of life and
stress between pre- and
post study scores.