title: Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome.
abstract: BACKGROUND
  Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome (IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway.
  
  
  METHODS
  Patients with IBS (n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model.
  
  
  RESULTS
  The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up (P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up (P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36.
  
  
  CONCLUSIONS
  The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care.
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.|Department of Nutrition and Dietetics, Imperial College NHS Healthcare Trust, London, UK.
authors: L
authors: L
authors: Whigham
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.|Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: T
authors: T
authors: Joyce
authors: Matrix, London, UK.
authors: G
authors: G
authors: Harper
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.|Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: P M
authors: PM
authors: Irving
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.|Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: H M
authors: HM
authors: Staudacher
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.
authors: K
authors: K
authors: Whelan
authors: Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.|Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.|Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: M C E
authors: MC
authors: Lomer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050528:Diet, Carbohydrate-Restricted / Q000191:economics / Q000379:methods*; D005247:Feeding Behavior; D005260:Female; D005285:Fermentation; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: FODMAP; cost-effective; diet; group education; irritable bowel syndrome