Introduction
Disease acceptance and perceived control have been proposed as general predictors of subjective health. Acceptance refers to the feeling that a disease and its resulting constraints are acceptable, whereas perceived control is the belief that one’s health condition can be influenced by oneself or by others. The current study sought to investigate to what extent disease acceptance and perceived control are associated with the valuable clinical endpoint of IBD-related disability.
Aims & Methods
In this cross-sectional study, adult IBD patients at a Belgian tertiary referral center received a survey with questions about clinical and demographic characteristics, the Subjective Health Experience (SHE) model questionnaire1, and the shortened version of the IBD Disability Index (IBD Disk)2. Analyses consisted of multiple linear regressions with IBD-related disability as dependent variable. The first model contained nine predictors: age, sex, IBD type, smoking, education, disease duration, current medication, number of IBD-medication types ever used, and previous bowel surgery. In the second model, disease acceptance and perceived control were added. This was tested in the total sample and in subgroups consisting only of patients with active disease and patients in remission, according to the two-component patient-reported outcome (PRO-2)3,4.
Results
Out of 5091 patients who received the survey either digitally or on paper, 1458 patients responded (28.6% participation rate). Of those, 208 were excluded because of missing data. The remaining 1250 were included for the main analysis (54.2% female, median [IQR] age 51 [39-61] years, 61.3% Crohn’s disease). Across the total sample, model 2 explained significantly more variance in IBD-related disability compared to model 1 (R2adj 37% vs. 19%, p<.001). Female sex, Crohn’s disease, current smoking, current steroids use, a higher number of medication types ever used and previous bowel surgery were positively correlated with disability, whereas a middle or high level of education and higher disease acceptance were negatively correlated with disability. Of all included factors, disease acceptance was most strongly associated with disability (β=-.43, p<.001). In subgroup analyses, the increase in explained variance from model 1 to model 2 was higher in the remission group (n=693) compared to the active disease group (n=378), respectively R2adj 12% vs. 32%, p<.001 and R2adj 13% vs. 22%, p<.001. Female sex, high level of education, number of medication types ever used and disease acceptance remained significantly associated with disability in both subgroups, and current smoking only in the active disease group. Acceptance remained the strongest variable associated with disability in both subgroups, β=-.46, p<.001 in the remission group and β=-.28, p<.001 in the active disease group. Perceived control was not a significant predictor in any of the analyses.
Conclusion
Disease acceptance is an important psychological factor that is more strongly associated with IBD-related disability than demographic and clinical characteristics. The association is stronger for IBD patients in remission compared to patients with active IBD. Perceived control had no added value on top of disease acceptance. These findings support future research into disease acceptance as a potential treatment target to improve IBD-related disability.
References
1. van Erp, L. W., van Gerven, J., Bloem, S., Groenen, M. J., & Wahab, P. J. (2021). Acceptance and perceived control are independently associated with quality of life in inflammatory bowel disease: Introduction of a new segmentation model. Journal of Crohn's and Colitis, 15(11), 1837-1845. https://doi.org/10.1093/ecco-jcc/jjab082
2. Ghosh, S., Louis, E., Beaugerie, L., Bossuyt, P., Bouguen, G., et al. (2017). Development of the IBD disk: A visual self-administered tool for assessing disability in inflammatory bowel diseases. Inflammatory Bowel Diseases, 23(3), 333-340. https://doi.org/10.1097/MIB.0000000000001033
3. Khanna, R., Zou, G., D'haens, G., Feagan, B. G., Sandborn, W. J., et al. (2015). A retrospective analysis: The development of patient reported outcome measures for the assessment of Crohn's disease activity. Alimentary Pharmacology & Therapeutics, 41(1), 77-86. https://doi.org/10.1111/apt.13001
4. Jairath, V., Khanna, R., Zou, G. Y., Stitt, L., Mosli, M., et al. (2015). Development of interim patient‐reported outcome measures for the assessment of ulcerative colitis disease activity in clinical trials. Alimentary Pharmacology & Therapeutics, 42(10), 1200-1210. https://doi.org/10.1111/apt.13408
Disclosure
Séverine Vermeire receives financial support for research from AbbVie, J&J, Pfizer, Takeda and Galapagos; receives speakers’ and consultancy fees from AbbVie, AbolerIS Pharma, AgomAb, Alimentiv, Arena Pharmaceuticals, AstraZeneca, Avaxia, BMS, Boehringer Ingelheim, Celgene, CVasThera, Cytoki Pharma, Dr Falk Pharma, Ferring, Galapagos, Genentech-Roche, Gilead, GSK, Hospira, Imidomics, Janssen, J&J, Lilly, Materia Prima, MiroBio, Morphic, MrMHealth, Mundipharma, MSD, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Second Genome, Shire, Surrozen, Takeda, Theravance, Tillots Pharma AG, Zealand Pharma.
João Sabino receives financial support for research from Galapagos and Viatris; receives speakers’ fees from Abbvie, Falk, Ferring, Fresenius, Galapagos, Janssen, Pfizer and Takeda; and does consultancy for Abbvie, Celltrion, Ferring, Fresenius, Galapagos, Janssen, Pharmacosomos and Pharmanovia.
Bram Verstockt receives financial support for research from AbbVie, Biora Therapeutics, Landos, Pfizer, Sossei Heptares and Takeda; receives speakers’ fees from Abbvie, Biogen, Bristol Myers Squibb, Celltrion, Chiesi, Falk, Ferring, Galapagos, Janssen, MSD, Pfizer, R-Biopharm, Takeda, Truvion and Viatris; and does consultancy for Abbvie, Alimentiv, Applied Strategic, Atheneum, Biora Therapeutics, Bristol Myers Squibb, Galapagos, Guidepont, Landos, Mylan, Inotrem, Ipsos, Janssen, Progenity, Sandoz, Sosei Heptares, Takeda, Tillots Pharma and Viatris.
Marc Ferrante receives financial support for research from AbbVie, Amgen, Biogen, EG, Janssen, Pfizer, Takeda and Viatris; receive speakers’ fees from AbbVie, Amgen, Biogen, Boehringer Ingelheim, Falk, Ferring, Janssen-Cilag, Lamepro, MSD, Pfizer, Sandoz, Takeda, Truvion Healthcare and Viatris; and does consultancy for AbbVie, Agomab Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, Medtronic, MSD, Pfizer, Regeneron, Samsung Bioepis, Sandoz, Takeda and ThermoFisher.