The effect of self-management online modules plus nurse-led support on pain and quality of life among young adults with irritable bowel syndrome: A randomized controlled trial
Authors: Chen Jie , Zhang Yiming , Barandouzi Zahra Amirkhanzadeh , Lee Joochul , Zhao Tingting , Xu Wanli , Chen Ming-Hui , Feng Bin , Starkweather Angela , Cong Xiaomei 
Published: February 2022

Background

Irritable bowel syndrome (IBS) is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with IBS is limited.

Objectives

This study aimed to examine the effect of a nurse-led self-management program on IBS related pain and symptoms, and quality of life (QOL) among young adults with IBS.

Theoretical framework

The Individual and Family Self-Management Theory (IFSMT).

Design

A randomized controlled trial with data collected at baseline, 6- and 12-week follow up.

Settings and participants

Eighty young adults with IBS recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a Self- Management Online education and learning Modules group (SMOM, n = 41) or a Nurse-Led SMOM group (NL + SMOM, n = 39). Twenty-one healthy controls (HCs) were also recruited from these two campuses.

Methods

All the IBS participants received the SMOM after baseline data collection. Participants in the NL + SMOM received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow up. Self-reported pain, symptoms, IBS-related QOL, self- efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12- week follow up among the IBS participants. The HCs completed data collection of pain and symptoms at baseline and 12-week follow up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions.

Results

Both the SMOM and NL + SMOM groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing IBS-QOL among young adults with IBS at the 12-week follow up (all p < 0.05). The NL + SMOM also had significant effect on reducing anxiety and greater improvement in IBS-QOL compared with the SMOM at the 12- week follow up (both p < 0.05). Increased self-efficacy mediated the intervention effect of the NL + SMOM on reducing pain interference and improving IBS-QOL, while the effect of the SMOM was mediated through decreased an inefficient coping strategy-catastrophizing.

Conclusions

Guided by the IFSMT, this study showed that both the pain self-management online education and nurse-led interventions were effective for alleviating pain and improving QOL among young adults with IBS by targeting the self-management process. The nurse-led program had a better outcome than the online education alone in improving IBS-QOL. Registration number: NCT03332537

What is already known about the topic

Irritable bowel syndrome (IBS) is a chronic condition warranting lifelong self- management.

Unrelieved abdominal pain is associated with increased healthcare expenditures and decreased quality of life (QOL) in young adults with IBS.

Self-management interventions have moderate effect on attenuating IBS related pain and symptoms.

What this paper adds

Both the IBS Self-Management Online education and learning Modules (SMOM) and Nurse-Led SMOM (NL + SMOM) developed in this study were efficient in reducing pain intensity and pain interference and ameliorating IBS-QOL among young adults with IBS.

The NL + SMOM had a greater interventional effect on improving IBS-QOL compared with the SMOM alone.

The NL + SMOM had an indirect effect on pain and QOL by increasing self-efficacy, while the indirect effect of SMOM on pain and QOL was derived by decreasing inefficient coping (e.g., catastrophizing).