Systematic review and meta-analysis: assessment of factors affecting disability in inflammatory bowel disease and the reliability of the inflammatory bowel disease disability index

TY - JOUR

T1 - Systematic review and meta-analysis

T2 - assessment of factors affecting disability in inflammatory bowel disease and the reliability of the inflammatory bowel disease disability index

AU - Lo, B

AU - Prosberg, M V

AU - Gluud, L L

AU - Chan, W

AU - Leong, R W

AU - van der List, E

AU - van der Have, M

AU - Sarter, H

AU - Gower-Rousseau, C

AU - Peyrin-Biroulet, L

AU - Vind, I

AU - Burisch, J

N1 - © 2017 John Wiley & Sons Ltd.

PY - 2018/1

Y1 - 2018/1

N2 - Background: The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). Aim: To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. Method: Systematic review of cross-sectional studies. Patients included had UC or CD and were classified as active, in remission, or needing surgery, biological and/or steroid treatment. We included studies assessing disability using the IBD-DI and that were captured by electronic and manual searches (January 2017). The possibility of bias was evaluated with the Newcastle-Ottawa Scale. Results: Nine studies were included with 3167 patients. Comparatively, patients with active disease had higher disability rates than those in remission (SMD [CI95] = 1.49[1.11, 1.88], I2 = 94%, P<.01), while patients on biological treatment had lower disability rates than those receiving corticosteroid treatment (SMD [CI95] = −0.22[−0.36, −0.08], I2 = 0%, P<.01). Disease activity and unemployment were found to be associated factors. The IBD-DI scored “good” for internal consistency, “fair” to “excellent” for intra-rater reliability and “excellent” for inter-rater reliability. Construct validity was “moderately strong” to “very strong” and structural validity was found to be mainly unidimensional. The IBD-DI had excellent responsiveness, while its interpretability was only useful on a group level. Conclusions: This systematic review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability.

AB - Background: The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). Aim: To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. Method: Systematic review of cross-sectional studies. Patients included had UC or CD and were classified as active, in remission, or needing surgery, biological and/or steroid treatment. We included studies assessing disability using the IBD-DI and that were captured by electronic and manual searches (January 2017). The possibility of bias was evaluated with the Newcastle-Ottawa Scale. Results: Nine studies were included with 3167 patients. Comparatively, patients with active disease had higher disability rates than those in remission (SMD [CI95] = 1.49[1.11, 1.88], I2 = 94%, P<.01), while patients on biological treatment had lower disability rates than those receiving corticosteroid treatment (SMD [CI95] = −0.22[−0.36, −0.08], I2 = 0%, P<.01). Disease activity and unemployment were found to be associated factors. The IBD-DI scored “good” for internal consistency, “fair” to “excellent” for intra-rater reliability and “excellent” for inter-rater reliability. Construct validity was “moderately strong” to “very strong” and structural validity was found to be mainly unidimensional. The IBD-DI had excellent responsiveness, while its interpretability was only useful on a group level. Conclusions: This systematic review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability.

KW - Journal Article

KW - Review

U2 - 10.1111/apt.14373

DO - 10.1111/apt.14373

M3 - Review

C2 - 28994131

SN - 0269-2813

VL - 47

SP - 6

EP - 15

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

IS - 1

ER -