A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease

Abstract

BackgroundSelf-management of inflammatory bowel disease is complex. Children and adolescents (CA) with inflammatory bowel disease (IBD) often have difficulty with managing aspects of their condition, resulting in treatment non-adherence and impaired psychosocial function. Self-management interventions are developed to help support patients and their parents/carers to effectively self-manage. The aim of this systematic review was to evaluate the efficacy of self-management interventions in children and adolescents with IBD. MethodsThe review was conducted in accordance with PRISMA guidelines. A systematic literature search of the following databases; Medline, Embase, Cochrane, CINAHL and PsychINFO was conducted to identify controlled trials of interventions aiming to enhance IBD self-management in CA. Two reviewers screened articles for inclusion. ResultsNine trials (eleven articles) met the inclusion criteria. Most were underpowered with seven recruiting fewer than 50 participants. The interventions aimed to enhance psychological wellbeing (n=5), medication adherence (n=3) or calcium intake (n=1). There was considerable heterogeneity in intervention content and outcomes assessment. Some benefits were reported in disease activity, adherence and psychological wellbeing but findings were inconsistent. ConclusionsSelf-management is difficult for CA with IBD, however this review identified only a small number of interventions to support self-management, most of which were under-powered and only one that was conducted outside the US. Clinical consensus is required on which self-management activities should be recommended to patients and targeted in interventions and which core outcomes should be assessed.Adequately powered trials of interventions are required to identify how best to support self-management in CA with IBD.Population: CA up to 19 years old with IBD, in line with the World Health Organization definition of adolescence 21 . As many interventions for CA include parents/carers, trials that included parents/carers of CA with IBD were also eligible for inclusion.Intervention: Self-management interventions i.e. interventions that aimed to enhance participants' ability to manage their condition and could include interventions to enhance medication adherence, lifestyle, diet, and coping with emotional and social aspects of living with IBD.Comparator: Treatment as usual, an alternative intervention or a waiting list comparator.Outcomes: Outcomes of interest included clinical, behavioural and psychosocial outcomes.Study design: Controlled trials (randomised and non-randomised). Exclusion Criteria:Studies were excluded if they were: Articles that combined adults and CA with IBD or combined CA with IBD with other chronic diseases but did not report findings for CA with IBD separately.  Observational studies. . Relevant variations of search terms in the database thesauruses and MeSH terms were used. See Supplemental file 1 for the full search strategy. Study selectionRetrieved articles were imported into Endnote ver...

Psychosocial Adaptation Among Inflammatory Bowel Disease Patients and Associated Factors: A Cross-Sectional Study

“… 39 There is evidence that promoting patients’ disease management can improve their treatment compliance, thereby contributing to improved disease outcomes and disease adaptation levels. 40 For this reason, healthcare professionals including nurses could focus on improving patients’ disease management ability (e.g., in aspects of diet and medication) as a part of the intervention strategies to enhance patients’ psychosocial adaptation.…”

Psychological interventions for inflammatory bowel disease: a systematic review and component network meta-analysis protocol

“…13 14 Previous reviews do not formally address heterogeneity and complexity among psychological interventions-either only one type of therapy is evaluated, or narrative or qualitative analyses are performed. [15][16][17][18][19][20][21][22][23][24][25][26] Since there have been substantial advances in both the analysis methods and reporting of clinical trials, we will, in our meta-analysis, deal with heterogeneity by applying meta-regression, NMA and component NMA (CNMA) complementing the standard pairwise approach. [27][28][29] Meta-regression is used as a means to identify clinical sources of heterogeneity in study results, emerging from differences in populations studied and the type of index and control interventions.…”

“…Clinical guidelines typically recommend psychological treatment as a supportive measure, although they disagree concerning the level of evidence regarding its effectiveness 13 14. Previous reviews do not formally address heterogeneity and complexity among psychological interventions—either only one type of therapy is evaluated, or narrative or qualitative analyses are performed 15–26. Since there have been substantial advances in both the analysis methods and reporting of clinical trials, we will, in our meta-analysis, deal with heterogeneity by applying meta-regression, NMA and component NMA (CNMA) complementing the standard pairwise approach 27–29.…”

Reconstruction of individual, social, and professional life

“…Emotional management may include adjusting with stress arising from having IBD. [ 10 ] Several studies have been conducted to identify disease-related behaviors used by patients suffering chronic diseases. For example, Corbin and Strauss found that management-related behaviors in chronic patients are divided into three areas: medical management, adopting new behaviors or roles in life, and dealing with related emotions.…”