Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment.
OBJECTIVE
Assessing health related quality of life (HRQOL) is becoming more important in research and clinical 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.
Drossman
Douglas
D
The UNC Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
Morris
Carolyn B
CB
Hu
Yuming
Y
Toner
Brenda B
BB
Diamant
Nicholas
N
Whitehead
William E
WE
Dalton
Christine B
CB
Leserman
Jane
J
Patrick
Donald L
DL
Bangdiwala
Shrikant I
SI
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003109:Colonic Diseases, Functional / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003891:Desipramine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010353:Patient Education as Topic; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D003891:Desipramine