P0850 Managing pain in people with Crohn’s Disease: feasibility testing of an Acceptance and Commitment Group Therapy intervention
Authors: Watson N , Mawdsley J , Kent A , Duff A , Norton C , Moulton C , Czuber-Dochan W 
Published: January 2025

Abstract

Background
Chronic abdominal pain in Crohn’s disease (CD) significantly impacts on quality of life (QoL) (1). Current management strategies are unsatisfactory. Acceptance and Commitment Therapy (ACT) is emerging as an approach in other areas (2). This feasibility study aimed to test an 8-week, online group ACT intervention in reducing the impact of CD pain.

Methods
A feasibility crossover RCT with the aims of: (1) 48 participants recruited; 2) 75% attend 5 of 8 sessions; (3) &lt;20% missing questionnaire data; (4) &gt;50% deem the intervention acceptable.
We planned to recruit 48 patients (≥18 years old, diagnosed with CD for ≥6 months and reported a pain-interference score of ≥4/10, Brief Pain Inventory) with 1:1 allocation ratio into intervention arm (IA) and control crossover arm (CC). The CC received treatment as usual (TAU) for 16 weeks, before beginning the online intervention. Feasibility measures included recruitment, retention, and completion rates; clinical outcomes included pain severity and interference, fatigue, distress, stress, anxiety and depression, QoL, and functional impairment. The outcome measures were collected at baseline, weeks 8-10 and 16-18 with additional measures for CC at week 24-26 and 32-34. Patients were recruited from outpatient clinics in two large NHS hospitals, and via the UK IBD BioResource. Descriptive statistics and thematic analysis (with Patient and Public involvement) were employed to analyse quantitative and qualitative data respectively.

Results
Despite invitations being sent to over 1000 patients, only 95 volunteered. The screening process revealed low reported levels of pain (&lt;4) or/and a need for medical intervention for CD. 27 out of the 48 target were recruited (28% successful recruitment rate), mean age 45 (range 19-71). Eight participants withdrew from the study before the intervention (70% retention rate), one dropped out after session 1, 18 patients completed the intervention (67% completion rate).
The feasibility aims 1,2 and 3 were not achieved. Hence, the intervention and the study are deemed not feasible. There were insufficient clinical data to analyse findings in detail.
Qualitative data indicate that patients found the group therapeutic, and the content helped to re-evaluate their relationship with pain (Figure 1). Many reported using ACT techniques after the group ended and several felt that the intervention should be offered sooner after IBD diagnosis.

Conclusion
An online group ACT intervention is not feasible in its current format. Although some reported benefits, the overall impact is unclear. The difficulty recruiting patients highlights several issues suggesting more work needs to be done to successfully reach and engage this population.

References
1.Farrokhyar F, Marshall JK, Easterbrook B, Irvine EJ. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm Bowel Dis. 2006;12(1):38-46. doi:10.1097/01.mib.0000195391.49762.89
2.Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res. 2018;11:2145-2159. Published 2018 Oct 2. doi:10.2147/JPR.S144631

Figure 1: Summary of Qualitative themes