Administering cognitive behavioral therapy over the telephone and on the internet were both better than traditional care for patients with refractory irritable bowel syndrome, according to research published in Gut.
Hazel Anne Everitt, MBChB, BSc, MSc, PhD, of Southampton University in the United Kingdom, and colleagues wrote that many patients with IBS respond to cognitive behavioral therapy (CBT), but access is still very limited, and questions remain about the optimal delivery method.
“Within resource-constrained health services, telephone-delivered CBT [TCBT] and web-based CBT [WCBT] are likely to provide an important way of improving access and have the advantage of access at a time and place convenient to the participant, at a pace that suits individual’s circumstances, without additional travel time and costs,” they wrote.
Researchers conducted a three-arm, randomized trial to compare TCBT and WCBT with treatment as usual in patients with refractory IBS, defined as clinically significant symptoms for at least 12 months despite first-line therapy.
They used the IBS Symptom Severity Score (IBS-SSS) and the Work and Social Adjustment Scale (WSAS) at 12 months as the co-primary outcomes of the trial.
Of 558 patients initially enrolled in the trial, 391 completed 12 months of follow-up and were included in the analysis.
After 12 months, the IBS-SSS among patients who underwent TCBT was 61.6 points lower than patients who had treatment as usual (95% CI, 33.8–89.50, while scores among patients who underwent WCBT were 35.2 points lower (95% CI, 12.6–57.8).
Researchers found that the WSAS scores among patients who underwent TCBT were 3.5 points lower than patients who received treatment as usual (95% CI, 1.9–5.1), and scores in patients who underwent WCBT were 3 points lower (95% CI, 1.3–4.6).
Everitt and colleagues wrote that both CBT methods were superior to treatment as usual for patients with refractory IBS, who currently have few options for therapy.
“We are undertaking a process evaluation to explore which form of CBT is most appropriate for which patients with IBS,” the wrote. “Future publications are planned on the cost-effectiveness, a nested qualitative study of participant’s perceptions, investigation of moderators and mediators of CBT effects and longer-term follow-up. Further research is needed to assess whether TCBT and WCBT can be widely disseminated in non-trial clinical settings.” – by Alex Young
Disclosures: Everitt reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.