Multimodal stress reduction and lifestyle modification program for patients with ulcerative colitis: a qualitative study

Christoph Schlee, Christine Uecker, Nina Bauer, Anna K Koch, Jost Langhorst, Christoph Schlee, Christine Uecker, Nina Bauer, Anna K Koch, Jost Langhorst

Abstract

Background: Over 2 million people in Europe are affected by ulcerative colitis, which often severely impacts the quality of life of those concerned. Among other factors, lifestyle and psychosocial factors seem to play an important role in pathogenesis and course of the disease and can be addressed as a complement to pharmacotherapy in comprehensive lifestyle modification programs.

Methods: This qualitative study as part of a mixed methods approach was carried out in the framework of a randomized controlled trial that examined the effect of a comprehensive lifestyle-modification-program (10-week-day clinic program) on quality of life in patients with ulcerative colitis. Qualitative interviews were conducted with 20 out of 47 patients of the intervention group after the program. The aim was to deepen, supplement, and expand the quantitative results of the trial, i.e. to examine individual perceptions of the intervention, including subjective changes and the extent to which elements of the program were integrated into everyday life. Qualitative content analysis techniques utilizing the software MAXQDA were used.

Results: Patients with ulcerative colitis in our sample often experienced multiple negative effects on different levels (physical, psychological, and social) and impaired quality of life because of their disease. They reported generally positively about the program itself, and emphasized perceived positive changes regarding their psychological and physical well-being. The interviews indicated a good implementation of elements learned during the intervention in everyday life.

Conclusions: Through participation in a comprehensive lifestyle modification program in the structure of a day clinic complementary to pharmacotherapy, patients with ulcerative colitis can reduce psychosocial stress and physical symptoms and thereby actively improve their well-being and general quality of life. This patient-centered, holistic approach was rated as useful in countering the complex disease manifestation as well as meeting the individual needs of the patients regarding their disease.

Trial registration: clinicaltrials.gov NCT02721823.

Keywords: Complementary medicine; Lifestyle modification; Mind-body-medicine; Qualitative methods; Stress reduction; Ulcerative colitis.

Conflict of interest statement

JL was a speaker for Repha GmbH, Techlab Inc., Falk Foundation, Takeda, Celegene GmbH and Willmar Schwabe and received research funding from Repha GmbH, Techlab Inc., Falk Foundation and Willmar Schwabe. No conflict of interest: CS., CU., NB, AKK. The sponsors had no role in the design, execution, interpretation or writing of the study.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow-Chart of mixed methods study design

References

    1. Kucharzik T, Dignass AU, Atreya R, Bokemeyer B, Esters P, Herrlinger K, et al. Updated S3-guideline colitis ulcerosa. German Society for Digestive and Metabolic Diseases (DGVS). Z Gastroenterol. 2018;56(9):1087–169. 10.1055/a-0651-8174.
    1. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017;390(10114):2769–2778. doi: 10.1016/S0140-6736(17)32448-0.
    1. Hilsden RJ, Verhoef MJ, Rasmussen H, Porcino A, DeBruyn JC. Use of complementary and alternative medicine by patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(2):655–662. doi: 10.1002/ibd.21360.
    1. Langhorst J, Anthonisen IB, Steder-Neukamm U, Ludtke R, Spahn G, Michalsen A, et al. Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey. Inflamm Bowel Dis. 2005;11(3):287–295. doi: 10.1097/01.MIB.0000160771.71328.6c.
    1. Nedelciuc O, Pintilie I, Dranga M, Mihai C, Prelipcean CC. Quality of life in patients with ulcerative colitis. Rev Med Chir Soc Med Nat Iasi. 2012;116(3):756–760.
    1. Engler H, Elsenbruch S, Rebernik L, Kocke J, Cramer H, Schols M, et al. Stress burden and neuroendocrine regulation of cytokine production in patients with ulcerative colitis in remission. Psychoneuroendocrinology. 2018;98:101–107. doi: 10.1016/j.psyneuen.2018.08.009.
    1. Abitbol V, Lahmek P, Buisson A, Olympie A, Poupardin C, Chaussade S, et al. Impact of complementary and alternative medicine on the quality of life in inflammatory bowel disease: results from a French national survey. Eur J Gastroenterol Hepatol. 2014;26(3):288–294. doi: 10.1097/MEG.0000000000000040.
    1. Hood MM, Jedel S. Mindfulness-based interventions in inflammatory bowel disease. Gastroenterol Clin. 2017;46(4):859–874. doi: 10.1016/j.gtc.2017.08.008.
    1. Elsenbruch S, Langhorst J, Popkirowa K, Müller T, Luedtke R, Franken U, et al. Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis. Psychother Psychosom. 2005;74(5):277–287. doi: 10.1159/000086318.
    1. Langhorst J, Mueller T, Luedtke R, Franken U, Paul A, Michalsen A, et al. Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: a twelve-month follow-up. Scand J Gastroenterol. 2007;42(6):734–745. doi: 10.1080/00365520601101682.
    1. Paul A, Lauche R, Cramer H, Altner N, Langhorst J, Dobos GJ. An integrative day care clinic for chronically ill patients: concept and case presentation. Eur J Integr Med. 2012;4(4):e455–e459. doi: 10.1016/j.eujim.2012.07.980.
    1. Langhorst J, Schöls M, Cinar Z, Eilert R, Kofink K, Paul A, et al. Comprehensive lifestyle-modification in patients with ulcerative colitis - a randomized controlled trial. J Clin Med. 2020;9(10):3087. doi: 10.3390/jcm9103087.
    1. Verhoef MJ, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: adding qualitative research methods to the “gold standard”. J Altern Complement Med. 2002;8:275–281. doi: 10.1089/10755530260127961.
    1. Koch AK, Schöls M, Haller H, Anheyer D, Cinar Z, Eilert R, et al. Comprehensive lifestyle modification influences medium-term and artificially induced stress in ulcerative colitis - a sub-study within a randomized controlled trial using the Trier social stress test. J Clin Med. 2021;10(21):5070. doi: 10.3390/jcm10215070.
    1. Patton MQ. Qualitative research & evaluation methods. 3. Thousand Oaks, London: Sage; 2009.
    1. Kruse J. Qualitative Interviewforschung. Ein integrativer Ansatz. Weinheim: Beltz Juventa; 2014.
    1. Strübing J. Qualitative Sozialforschung. Eine komprimierte Einführung für Studierende. München: Oldenbourg; 2013.
    1. Lamnek S, Krell C. Qualitative Sozialforschung. 6. Weinheim: Beltz; 2016.
    1. Dresing T, Pehl T. Praxisbuch Transkription. Regelsysteme, Software und praktische Anleitungen für qualitative ForscherInnen. 4. Marburg: self-published; 2012.
    1. Kuckartz U. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. 3. Weinheim: Beltz Juventa; 2016.
    1. Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken. 12. Weinheim: Beltz; 2015.
    1. Reichertz J. Qualitative und interpretative Sozialforschung. Eine Einladung. 1. Wiesbaden: Springer; 2016.
    1. Schreier M. Qualitative content analysis in practice. Los Angeles, London, New Delhi, Singapore, Washington DC: Sage; 2012.
    1. Kurina LM, Goldacre MJ, Yeates D, Gill LE. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health. 2001;55(10):716–720. doi: 10.1136/jech.55.10.716.
    1. Petrak F, Hardt J, Clement T, Borner N, Egle UT, Hoffmann SO. Impaired health-related quality of life in inflammatory bowel diseases: psychosocial impact and coping styles in a national German sample. Scand J Gastroenterol. 2001;36:375–382. doi: 10.1080/00365520118423.
    1. Smith GD, Watson R, Roger D, McRorie E, Hurst N, Luman W, et al. Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. J Adv Nurs. 2002;3:152–160. doi: 10.1046/j.1365-2648.2002.02159.x.
    1. Janke KH, Raible A, Bauer M, Clemens P, Meisner C, Hauser W, et al. Questions on life satisfaction (FLZ(M)) in inflammatory bowel disease. Int J Color Dis. 2003;19:343–353. doi: 10.1007/s00384-003-0522-z.
    1. Langhorst J, Lauche R. It is about time - tailoring of an individualized multimodal treatment approach in ulcerative colitis. Digestion. 2014;89:139–141. doi: 10.1159/000357368.
    1. Klytta C, Wilz G. Selbstbestimmt aber professionell geleitet? Zur Effektivität und Definition von Selbsthilfegruppen. Gesundheitswesen. 2007;69(2):88–97. doi: 10.1055/s-2007-970148.
    1. Langhorst J, Anthonisen IB, Steder-Neukamm U, Luedtke R, Spahn G, Michalsen A, et al. Patterns of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease: perceived stress is a potential indicator for CAM use. Complement Ther Med. 2007;15(1):30–37. doi: 10.1016/j.ctim.2006.03.008.
    1. Joos S, Rosemann T, Szecsenyi J, Hahn EG, Willich SN, Brinkhaus B. Use of complementary and alternative medicine in Germany - a survey of patients with inflammatory bowel disease. BMC Complement Altern Med. 2006;6:19. doi: 10.1186/1472-6882-6-19.
    1. Dieterich A. Arzt-Patient-Beziehung im Wandel: Eigenverantwortlich, informiert, anspruchsvoll. Dt Ärzteblatt. 2007;104(37):2489–2491.
    1. Klusen N, Fließgarten A, Neblin T. Informiert und selbstbestimmt. Der mündige Bürger als mündiger Patient. Baden-Baden: Nomos; 2009.
    1. Targownik LE, Sexton KA, Bernstein MT, Beatie B, Sargent M, Walker JR, et al. The relationship among perceived stress, symptoms, and inflammation in persons with inflammatory bowel disease. Am J Gastroenterol. 2015;110:1001–1012. doi: 10.1038/ajg.2015.147.
    1. Cramer H, Schäfer M, Schöls M, Köcke J, Elsenbruch S, Lauche R, et al. Randomised clinical trial: yoga versus written self-care advice for ulcerative colitis. Aliment Pharm Ther. 2017;45(11):1379–1389. doi: 10.1111/apt.14062.
    1. Koch AK, Schöls M, Langhorst J, Dobos J, Cramer H. Perceived stress mediates the effect of yoga on quality of life and disease activity in ulcerative colitis. Secondary analysis of a randomized controlled trial. J Psychosom Res. 2020;130:109917. doi: 10.1016/j.jpsychores.2019.109917.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera