...psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in [IBD] 2024 Wileman et al

[Andy]

Full title: Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis

Full author list: Vari Wileman, Joseph Chilcot, Christine Norton, Ailsa Hart, Laura Miller, Imogen Stagg, Natasha Seaton, Richard Pollok, Qasim Aziz, Rona Moss-Morris

Abstract

Background
Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.

Methods
This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.

Results
LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.

Conclusions
Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

Open access, https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjae183/7917199

 

[rvallee]

Many participants experienced symptoms even when deemed to be in clinical remission

Uh. Oh yeah makes perfect sense.

Even with IBD, which can be very severe, they still trot out the exact same "it's not the symptoms, it's the behavioral reaction to the symptoms that cause impairment". Absolutely insane stuff.

Just straight up weird weird weird stuff:

The IBD-BOOST intervention, based on a cognitive behavioural model of symptom perpetuation, was recently developed to help people manage their IBD symptoms of fatigue, pain, and faecal urgency/incontinence [6]. There is a need for this integrated approach; 29% of the UK IBD Survey respondents wanted help for all three symptoms of fatigue, pain and faecal incontinence.

They take their traditional model, develop yet another identical intervention, which they somehow argue is needed, this one specifically, because people suffering from those problems want help. Even in high school you'd be taken aside and told that this is not valid argumentation.

And really by modifiable they just mean that it's possible to change answers on generic biased questionnaires. Which still doesn't work but whatever.

We don't appear to have a thread on the "trial". Probably not worth separating them, as this study here is a nested (I guess it's their way of saying we did an unplanned secondary analysis, which is not recommended, but frame it differently).

Somehow, this is not a research paper, it's an "oral presentation"? Whatever.

O28 IBD-BOOST, a digital cognitive behavioural self-management programme for fatigue, and/or pain, and/or faecal incontinence in IBD: randomised controlled trial
https://gut.bmj.com/content/73/Suppl_1/A16.1

Abstract

Introduction Many people with IBD experience fatigue, pain and faecal incontinence (FI), impacting quality of life (QoL). We developed an interactive digital online self-management intervention (IBD-BOOST) based on a theoretically informed logic model and cognitive behavioural techniques.

Methods We conducted a multi-centre two-arm parallel group randomised controlled trial (RCT) comparing IBD-BOOST with Care as Usual (CAU), recruiting patients from clinics and national registries who rated the impact of fatigue and/or pain and/or FI as ≥5/10. Those in the IBD-BOOST arm received 6 months access to the 12-session IBD-BOOST programme, a 30-minute telephone support call and weekly in-site email messages for 3 months. The UK Inflammatory Bowel Disease Questionnaire (UK-IBDQ) and global rating of symptom relief (GRSR) at 6 months were dual primary outcomes (alpha=0.025 was considered statistically significant with two primary outcomes). Other secondary outcomes, including individual symptoms, were measured at 6 and 12 months. Complier-averaged causal effects (CACE), sensitivity and pre-specified subgroup analyses were conducted.

Results 780 participants were randomised, 432 with Crohn’s disease; 520 (66.7%) were female, mean age 49 years. At 6 months, both UK-IBDQ and GRSR were similar between the BOOST and CAU arms, p=0.19 for IBDQ and p=0.39 for GRSR. Adverse events were similar between groups. FI score and EQ5D utility score (secondary outcomes) were in favour of IBD-BOOST at 6 months, but pain and fatigue were no different. 57% of the intervention group completed a pre-defined minimum ‘dose’ of 4 sessions (i.e. compliers). The CACE analysis suggested that compliers were more likely to report better QoL (p=0.03). Subgroup analysis of those meeting criteria for irritable bowel syndrome (IBS) at baseline, showed that IBD-BOOST was more effective in improving IBDQ and GRSR at 6 months when compared with CAU for the IBD-IBS group (pinteraction=0.015 and 0.046, respectively).

Conclusions This large RCT found that IBD-BOOST did not improve IBDQ and GRSR in patients with IBD and fatigue and/or pain and/or FI relative to CAU. Participants reported less FI at 6 and 12 months. Those with IBD-IBS improved more than those without.

Ah, well, nevertheless.

 

[rvallee]

Kind of funny that they publish this secondary analysis paper from a randomized study, which as tradition they incorrectly label as a randomized controlled trial, talking about potentially modifiable psychological factors, when the actual trial found no such modification.

Funny as in what the hell is wrong with you but still.

Decades of this ideology never working, as expected since it's based on total BS, and they still present failed trials as successful. What an insane system this is.

 

[rvallee]

Oh yeah and I never thought this joke would apply literally to a situation, but here we are:

 

[shak8]

Even if your symptoms are inherently distressing, don't be distressed by them---that's the message.

 

[Yann04]

Even if your symptoms are inherently distressing, don't be distressed by them---that's the message.

They hear severe distressing symptoms and imagine the “distressing” is the problem as opposed to the “severe symptoms”.

 

[bobbler]

Full title: Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis

Full author list: Vari Wileman, Joseph Chilcot, Christine Norton, Ailsa Hart, Laura Miller, Imogen Stagg, Natasha Seaton, Richard Pollok, Qasim Aziz, Rona Moss-Morris

Abstract

Background
Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.

Methods
This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.

Results
LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.

Conclusions
Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

Open access, https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjae183/7917199

Can you think of anything more cruel or absurd to suggest as an issue ‘ just needs some mind training ‘? So delaying both proper support and having medics mapping why these various things might occur to eventually provide real help

and how it seems to me a bit like weirdly casting back as if an uncritical sucking up of Freud and his various stages of development that I can’t imagine too many taking literally these days anymore than horoscopes

 

[bobbler]

They hear severe distressing symptoms and imagine the “distressing” is the problem as opposed to the “severe symptoms”.

Telling people to chill out about not being able to rely on their own bowels not to cause huge pain and fecal incontinence they can’t control and which can’t be easy to participate in society with


I’d like to at least sssume it’s because they’ve never thought to actually meet and sit in a room with those suffering for long enough periods of time. I worrying from a what’s missing in the human factor sude that they might know full well the suffering and reactions and life limitations they get but somehow ‘think differently ‘ to what is needed

 

[bobbler]

Uh. Oh yeah makes perfect sense.

Even with IBD, which can be very severe, they still trot out the exact same "it's not the symptoms, it's the behavioral reaction to the symptoms that cause impairment". Absolutely insane stuff.

Just straight up weird weird weird stuff:

They take their traditional model, develop yet another identical intervention, which they somehow argue is needed, this one specifically, because people suffering from those problems want help. Even in high school you'd be taken aside and told that this is not valid argumentation.

And really by modifiable they just mean that it's possible to change answers on generic biased questionnaires. Which still doesn't work but whatever.

We don't appear to have a thread on the "trial". Probably not worth separating them, as this study here is a nested (I guess it's their way of saying we did an unplanned secondary analysis, which is not recommended, but frame it differently).

Somehow, this is not a research paper, it's an "oral presentation"? Whatever.

O28 IBD-BOOST, a digital cognitive behavioural self-management programme for fatigue, and/or pain, and/or faecal incontinence in IBD: randomised controlled trial
https://gut.bmj.com/content/73/Suppl_1/A16.1

Abstract

Introduction Many people with IBD experience fatigue, pain and faecal incontinence (FI), impacting quality of life (QoL). We developed an interactive digital online self-management intervention (IBD-BOOST) based on a theoretically informed logic model and cognitive behavioural techniques.

Methods We conducted a multi-centre two-arm parallel group randomised controlled trial (RCT) comparing IBD-BOOST with Care as Usual (CAU), recruiting patients from clinics and national registries who rated the impact of fatigue and/or pain and/or FI as ≥5/10. Those in the IBD-BOOST arm received 6 months access to the 12-session IBD-BOOST programme, a 30-minute telephone support call and weekly in-site email messages for 3 months. The UK Inflammatory Bowel Disease Questionnaire (UK-IBDQ) and global rating of symptom relief (GRSR) at 6 months were dual primary outcomes (alpha=0.025 was considered statistically significant with two primary outcomes). Other secondary outcomes, including individual symptoms, were measured at 6 and 12 months. Complier-averaged causal effects (CACE), sensitivity and pre-specified subgroup analyses were conducted.

Results 780 participants were randomised, 432 with Crohn’s disease; 520 (66.7%) were female, mean age 49 years. At 6 months, both UK-IBDQ and GRSR were similar between the BOOST and CAU arms, p=0.19 for IBDQ and p=0.39 for GRSR. Adverse events were similar between groups. FI score and EQ5D utility score (secondary outcomes) were in favour of IBD-BOOST at 6 months, but pain and fatigue were no different. 57% of the intervention group completed a pre-defined minimum ‘dose’ of 4 sessions (i.e. compliers). The CACE analysis suggested that compliers were more likely to report better QoL (p=0.03). Subgroup analysis of those meeting criteria for irritable bowel syndrome (IBS) at baseline, showed that IBD-BOOST was more effective in improving IBDQ and GRSR at 6 months when compared with CAU for the IBD-IBS group (pinteraction=0.015 and 0.046, respectively).

Conclusions This large RCT found that IBD-BOOST did not improve IBDQ and GRSR in patients with IBD and fatigue and/or pain and/or FI relative to CAU. Participants reported less FI at 6 and 12 months. Those with IBD-IBS improved more than those without.

Ah, well, nevertheless.

Sounds like another classic krypton factor filter

I know a few people with severe IBDs and they can kill. Like many conditions there are treatments that work for many then you have those who find it doesn’t work and they have to try other things until they get to the end of the list getting iller and iller. That latter group would I guess have to drop out if part of a trial over 6months where the former wouldn’t - so the group post-drop out us on average having less fecal in continence than the group including the illest people

I just feel there’s a common sense test where these people need to stand back and wonder if their 4online sessions cures fecal incintinence in serious IBD is grandiose to believe

particularly when it looks like all the other measures didn’t change

 

[SNT Gatchaman]

Many participants experienced symptoms even when deemed to be in clinical remission.

Clinical remission when talking about Crohns, means symptoms are anywhere from absent to reduced to controlled. The inflammation is still present. It's just that the patient is not currently lining up for escalating immunomodulation or surgical resection for the fibrostenotic or penetrating complications.