Application Study Of Evidence-based Self-management Program Of Ulcerative Colitis

[Background] Ulcerative colitis (UC) is a chronic nonspecific inflammatory bowel disease, occuring in the rectum, colon mucosa and submucosa. Few attention was paid on research on UC because of low-incidence rates in China. With the progress of medicine, mortality decreased. However, as a chronic disease, UC is incurable. Patients with UC commonly experience lifelong relapsing and a remitting course which can negatively affect their health-related quality of life. Self-management is defined as "a set of planned interventions designed to improve patients’ health-related behaviors, health status, or both". Self-management is viewed as a cost-effective strategy enabling the patients to manage the chronic disease with optimal resources to support patients to live the best possible quality of life with their chronic condition and throughout the course of the disease. The self-management model has been accepted in many disciplines as a valid method of chronic disease management. However, the research on self-management of UC is still in the initial stage.[Purpose] Self-management program on UC was constructed through evidence-based nursing and Delphi method, and clinical trials were used to verify the comprehensive effects of new program.[Methods]1.The construction of self-management program(1) The literature analysis:A systematic search of six electronic databases, including Pubmed, Embase, Cochrane central register of controlled trials, Web of Science, Cumulative Index of Nursing and Allied Health Literature and Chinese Biomedical Literature Database, was conducted. Content analysis was used to categorize the components of the content and structure of effective self-management interventions for inflammatory bowel disease. Clinically important and statistically significant beneficial effects on health-related quality of life were explored, by comparing the association between effect sizes and various components of self-management interventions such as the presence or absence of specific content and different delivery methods.(2) Delphi method:Based on the literature review and the expert interview, evidence-based self-management program on UC was constructed, and 10 experts were consulted twice by using Delphi method.2.The clinical trialRandomized control trials were adopted to verify the project. One hundred and seven patients with UC who meet the inclusion were randomized to treatment group and control group. Treatment group accepted drug treatment and 12-week self-management program, while control group accepted drug treatment and usual education. Self-management program included motivational interview, construction of self-management plan, evidence-based self-management booklets,24-hour internet and telephone support. Questionnaires were used to assess the general condition, self efficacy, health-related behaviors, quality of life, anxiety and depression at baseline, week 4 and week 12. We used SPSS 17.0 for Windows to perform statistical analyses. Chi-squared test and ANOVA were used with statistical significance if P<0.05.[Results]1.The construction of self-management program(1) The literature analysis:Fifteen randomized controlled trials were included in this review. The results showed self-management interventions had positive effects on health-related quality of life in patients with inflammatory bowel disease [SMD= 0.48,95% CI (0.18,0.78), p< 0.001] and distance or remote self-management interventions demonstrated a larger effect size [regression coefficient -2.56,95% CI (-3.81,-1.30), p=0.001]. However, there is no evidence for a positive effect associated with specific content component of self-management interventions in adult patients with inflammatory bowel disease in general.(2) Delphi method:To discuss the self-management program on UC, we held 2 questionnaire consultations. The experts participating this study are of good enthusiasm, authority and the harmony of experts’ opinions are acceptable.2.The clinical trial(1) Self Efficacy:The self-efficacy score showed no statistically significant differences after 4-week treatment (P>0.05), and statistically significant differences between two groups were shown after 12-week treatment (P<0.05)(2) Health-related behavioral changes:There were statistically significant differences in diet diary record (P=0.001), but no statistically significant differences in mastering the method of measuring disease activity index, adhering to medication and exercise (P>0.05)(3) Quality of life:The quality of life score showed no statistically significant differences after treatment at week 4 or at week 12 (P>0.05), and statistically significant differences were shown in the systemic symptom and score changes (P<0.05)(4) Anxiety and depression:After 4-week treatment, the HADS (Hospital Anxiety and Depression Scale) score showed statistically significant differences (P<0.05), but no statistically significant differences were shown in the depression score (P>0.05) After 12-week treatment, there were statistically significant differences in both anxiety score and depression score (P<0.05)[Conclusions]We used the method of meta-regression to explore the components of content and structure of effective self-management interventions on UC. Construction of self-management program on UC was based on the results of systematic review and expert consulting. Randomized controlled trial was used to verify the short-term effects of the program on self efficacy, health-related behavioral changes, quality of life, anxiety and depression.