Objective: The purpose of this study was to test the effectiveness of a nurse-administered comprehensive self-management program in improving quality of life among women with Irritable Bowel Syndrome.
Design: A randomized clinical trial was used to compare three groups: a nurse-administered eight week comprehensive self-management (CSM) program, a one-time brief self-management session (BSM), and usual care (UC).
Population, Sample, Setting, Years: A sample of women with irritable bowel syndrome, ages 20-45, were recruited through newspaper advertisements, flyers, and directed mailing from the Seattle metropolitan area between 1996 and 2001.
Outcome Variables: Health related quality of life was measured by the Disease Specific Questionnaire - Irritable Bowel Syndrome and Cognitive Scale for Functional Bowel Disorders. The subscales include sleep, emotional, mental health beliefs, energy, physical functioning, diet, social role, physical role, and sexual relations. Items are rated on Likert scales then are transformed to 100 point scale. Cognitive Scale for Functional Bowel Disorders describes 25 negative cognitive beliefs related to functional bowel disorders. The items are rated form 1 (strongly disagree) to 7 (strongly agree), with 4 being neutral. The scale items were originally extracted from written self-statements abstracted from daily diaries of patients diagnosed with a functional bowel disorder.
Methods: Women were randomly assigned to one of the 3 groups. All subjects completed an in-person interview and questionnaires during the screening phase and at nine weeks, 6 months and 12 months post-intervention. Women in the CSM group received 8 standardized sessions with a masters prepared nurse therapist, covering the topics of diet, relaxation, and cognitive restructuring. Components of self-management include: setting specific goals, self-monitoring, and evaluation of these goals. The goals focused on self-monitoring behavior, were short range, positively stated, realistic and publicly acknowledged. Women in the BSM group received a booklet and had 1 session with the nurse therapist, in which the topics were briefly discussed and examples given.
Findings. Relative to women in the UC group (n=37), women in the IBS-CSM (n=32) group demonstrated a significant increase on the quality of life subscales of physical functioning, emotional, mental, fatigue, and social. Women who received the brief version of the intervention (IBS-BSM, n=34) improved as well, but not as much as the women who received the full CSM program. Similar changes were seen for the Cognitive Scale for Functional Bowel Disorders. Those in the IBS-CSM group (mean change score -0.95 ± 1.12) significantly improved their cognitive self-statements compared to IBS-BSM (-0.46 ± 0.64, p=.009) and UC (-0.29 ± 0.86, p=.001) at 6 months follow-up.
Conclusions: The CSM program delivered by a nurse therapist as 8 weekly sessions results in a number of substantial improvements in overall quality of life that are sustained at least until 12 months post treatment.
Implications: Young women suffering from Irritable Bowel Syndrome can improve their quality of life by working with a nurse therapist over a two-month period. However this type of program needs to be tested in older women and men of all ages to determine how generalizable the findings are.
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