ACTIB trial (Assessing Cognitive behavioural Therapy in Irritable Bowel): a multicentre randomised controlled trial, 2015, Chalder et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
From 2015 but to be presented in a talk in July at the Society for Academic Primary Care conference:
https://sapc.ac.uk/conference/2018

Approach
ACTIB is a National institute for Health Research (NIHR) multicentre randomised controlled trial. Participants: Adults (≥18 yrs) with refractory IBS who had been offered first-line therapies (eg, antispasmodics, antidepressants or fibre-based medications) and had continuing IBS symptoms ≥12 months, were recruited over 23 months from primary and secondary care in the south of England and London. The interventions were therapist telephone delivered CBT (TCBT) (8 hours therapist time) with a patient CBT manual and homework tasks, or Web-based CBT self-management with minimal therapist support (WCBT) (2 ½ hours therapist time) versus treatment as usual (TAU). Main outcome measures: IBS Symptom Severity Score (IBS SSS) and Work and Social Adjustment Scale (WSAS). Baseline and follow up data was patient reported and collected on-line at 3, 6 and 12 months. Analysis was Intention-to-treat with multiple imputation at 12 months.

Consequences
Both CBT arms showed significant improvements in IBS outcomes compared to TAU, which were sustained at 12 months. TCBT had larger effects than WCBT. We believe this is the largest trial of CBT for IBS worldwide. The results suggest that CBT for IBS could be effectively delivered to a broad range of NHS patients with refractory IBS.
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https://sapc.ac.uk/conference/2018/...cognitive-behavioural-therapy-irritable-bowel

one of the co-authors is Susan Windgassen (!):giggle:
 
IBS - yet another medical condition that the medical profession can't (be bothered to) find real reasons for, so blame the patients' mental health. It is also a really good diagnosis for any doctor with any patient with a pain vaguely in the gut region. I'm sure it reduces the work load substantially.
 
Think this is might be a 'spin off' :
Patients’ perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

Alice Sibelli, Rona Moss-Morris, Trudie Chalder, Felicity L Bishop, Sula Windgassen and Hazel Everitt

Abstract
Background Previous studies have identified issues with the doctor–patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms.

Aim To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU).

Design and setting This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fifty-two participants took part in semi-structured interviews post-treatment in UK primary and secondary care.

Method Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data.
Results Two key themes were identified: perceived paucity of GPs’ IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: reaching a ‘last-resort diagnosis’; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.

Conclusion In this refractory IBS group, specific doctor–patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.
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https://bjgp.org/content/68/674/e654

CBT, the solution to the staff shortage in the NHS(?)

"Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour."
 
Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.
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Does this mean what it seems to mean. My translation: Only CBT participants had started blaming themselves if they didn't improve, and reported they would give up bothering the doctor and trying to get better.

Is this supposed to be a good outcome?

:banghead::banghead::banghead::banghead::banghead:
 
Trish said:
Does this mean what it seems to mean. My translation: Only CBT participants had started blaming themselves if they didn't improve, and reported they would give up bothering the doctor and trying to get better.

Is this supposed to be a good outcome?

:banghead::banghead::banghead::banghead::banghead:
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When this whole IAPT project is understood as a cost-cutting measure by providing cheap alternative to medical care, it is definitely a good outcome according to them and everything they say and do starts to make sense.

There ain't no cheaper patients for a health care system than those who have stopped seeking care. Massively more expensive overall for society, but on the single balance sheet of medical services, it definitely gives the illusion that it is a bargain.
 
Cost effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome: the ACTIB randomised trial
Abstract
Background Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions.
Methods Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU.
Results TCBT cost £956 more than TAU (95% CI, £601 to £1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, -£11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, -£1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, -£448 to £2580).
Conclusions TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective
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https://kclpure.kcl.ac.uk/portal/en...al(9326c129-3d3f-4d89-a74a-f06d666e007c).html

@dave30th
 
Working with completely fictitious numbers, perfectly normal. Triple floating point precision on feelings and rainbows. This is what peak lying with statistics looks like.

In hindsight setting up a system where they are always right no matter what will look foolish, but to be fair it looks no more foolish than it obviously looked from the start. The damn scientific method was invented exactly to stop this, and back we are to pre-science ways. But now there are decades of sunk cost and careers and egos on the line so the lies go on and on because these people aren't so smart and things got out of hand.

Some primitive societies used to sacrifice people to imaginary gods. Modern medicine does the same but for imaginary savings. "Savings" which obviously cost far more down the line. Even if it was just for money it would be insulting enough, but the savings are entirely fictitious. What a dystopian nightmare they created, exchanging lives for mediocre careers.
 
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