Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment
Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment
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DOI：
10.1111/j.1572-0241.2007.01283.x
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发表时间：
2007-07-01
影响因子：
9.8
通讯作者：
Bangdiwala, Shrikant I.
中科院分区：
文献类型：
--
作者：
Drossman, Douglas;Morris, Carolyn B.;Bangdiwala, Shrikant I.
评估健康相关生活质量（HRQOL）在研究和临床护理中变得越来越重要。然而，关于功能性肠病（FBD）的HRQOL问卷的表现的信息很少。本研究的目的是(a)了解疾病影响谱（SIP）和IBS-QOL在治疗基线和治疗后对功能性肠病的表现，(b)确定治疗后哪些HRQOL亚量表改善最好，(c)确定临床有意义的改善，(d)确定基线和治疗后HRQOL的预测因子。方法：使用医学（地西帕明vs安慰剂）和心理（认知行为治疗vs教育）治疗对中度至重度FBD女性进行评估。临床和社会心理问卷以及SIP和IBS- QOL在基线和治疗12周后进行。结果：(a) FBD患者在社会交往、家庭管理和娱乐活动方面存在功能限制，对疼痛有情绪反应，感到无助、失控、抑郁和易怒，并感知到与厕所无障碍和饮食有关的生活方式限制；(b) FBD诊断和IBS亚组之间HRQOL无差异；(c) IBS-QOL比SIP对治疗更有反应；(d) SIP有意义的临床改善为2.8分，IBS- QOL为14分；(e)改善主要表现在心理社会领域，而不是身体领域。此外，我们发现服用药物的预期收益高于心理干预，滥用史和疼痛对结果的预测作用是由心理社会因素介导的。结论：这些数据支持IBS-QOL优于SIP的价值，并为FBD损伤的特征以及医学和心理治疗改善HRQOL的方式提供了新的信息。
BACKGROUND Assessing health related quality of life (HRQOL) is becoming more important in research and clinical AND AIMS: care. However, little information is available on the performance of HRQOL questionnaires for the functional bowel disorders (FBD). The aims of this study were to (a) understand the performance of the Sickness Impact Profile (SIP) and IBS-QOL for the functional bowel disorders at baseline and after treatment, (b) determine which HRQOL subscales best improve with treatment, (c) determine clinically meaningful improvement, and (d) determine the predictors of HRQOL at baseline and in response to treatment.METHODS: Women with moderate to severe FBD were evaluated using both medical (desipramine vs placebo) and psychological (cognitive- behavioral therapy vs education) treatments. Clinical and psychosocial questionnaires along with the SIP and IBS- QOL were given at baseline and after 12- wk treatment.RESULTS: (a) Patients with FBD experience functional limitations in social interactions, home management, and recreational activities, respond emotionally to the pain, feel helpless, out of control, depressed, and irritable, and perceive restrictions in lifestyle relating to toilet accessibility, and eating; (b) HRQOL is not different among the FBD diagnoses or IBS subgroups; (c) the IBS-QOL is more responsive to treatment than the SIP; (d) meaningful clinical improvement is 2.8 points for SIP and 14 for IBS- QOL; and ( e) improvement is demonstrated primarily in psychosocial rather than physical domains. In addition, we found that expectation of benefit is greater for taking a pill over a psychological intervention, and the predictive effects of abuse history and pain on outcome is mediated by psychosocial factors.CONCLUSIONS: The data support the value of the IBS-QOL over the SIP, and provide new information on the profile of impairment in FBD, and the ways in which medical and psychological treatments produce improvement in HRQOL.