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Self-help information book in the management of irritable bowel syndrome in primary care: randomised controlled trial

Available to download - Managing your life with...Irritable Bowel Syndrome.  This guide will give you detailed and up-to-date information about irritable bowel syndrome. It will help you find the best way to manage your condition and show you how other people cope with irritable bowel syndrome.

This randomised controlled trial was designed to establish whether a self-help guidebook produced following a number of focus group meetings with patients with irritable bowel syndrome improved symptoms, social functioning, use of primary and secondary health-care, drug usage and is acceptable to users and health professionals. The guidebook incorporated self-care strategies used successfully by patients to manage their symptoms and provided evidence-based information in response to the needs identified by those with IBS.   The guidebook was evaluated in a randomised controlled trial with three arms: Provision of self-help guidebook; Provision of self-help guidebook plus invitation to attend one self-help group meeting which we facilitate; Treatment as usual (these patients are sent the guidebook at the end of the project ). 

Patients with established IBS who consulted their GP for problems with IBS were recruited in three Health Authorities in Greater Manchester. Patients were then randomised to one of the three study arms. In addition to the quantitative data being collected qualitative interviews were undertaken with patients at the end of the one year follow up period. A total of 420 patients have been recruited from 200 GPs. Postal questionnaires were completed at three points: baseline, 1-month and 12 months. There was a 96% response rate at 1-month and an 87% response rate at 12 months and GP records were reviewed for 96% of the patients. A total of 10 in-depth qualitative interviews have been undertaken.

The number of medical consultations during the trial was significantly lower in the intervention group. At one year, patients in the guidebook group had a 60% reduction in primary care consultations (p<0.001) and a reduction in perceived symptom severity (p<0.001) compared with controls. Allocation to the self-help group conferred no additional benefit. Whilst symptom scores for pain, diarrhoea, constipation and bloating remained similar for both groups, patient perceptions of symptoms were significantly improved in favour of the intervention.  Costs per patient were reduced by £73 (C.I. £43, £103) or 40% per year.

Introduction of a self-help guidebook results in a reduction in primary care consultations, a perceived reduction in symptoms and significant health service savings. This suggests that patients attending their primary care physician with functional abdominal symptoms should be offered self-help information as part of their management.


Project Details
Self management
Main Contact
Dr Anne Kennedy
Other NPCRDC staff participating
Dr David Reeves
Professor Anne Rogers
Professor Elspeth Guthrie
Division of Psychiatry, University of Manchester

Dr Andrew Robinson
Gastroenterology, Hope Hospital

Professor David Thompson
Gastroenterology, Hope Hospital


2009 [close]
 Published Articles
Kennedy A;
Decision aids and shared decision-making in inflammatory bowel disease
In Edwards A;Elwyn G; Shared decision-making in health care Oxford, Oxford University Press 2009; 263 -268
2008 [close]
 Published Articles
Lee V; Guthrie E; Robinson A; Kennedy A; Tomenson B; Rogers A; Thompson D;
Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation
J Psychosom Res 2008; 64 2 129 -138
2007 [close]
 Published Articles
Rogers A; Lee V; Kennedy A;
Continuity and change?: exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long term condition
Trials Biomed Central 2007; 8 6
2006 [close]
 Published Articles
Robinson A; Lee V; Kennedy A; Middleton E; Rogers A; Thompson DG; Reeves D;
A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome
Gut 2006; 55 5 643 -648
2003 [close]
 Published Articles
Kennedy A; Robinson A; Rogers A;
Incorporating patients' views and experiences of life with IBS in the development of an evidence based self-help guidebook.
Patient Education and Counseling 2003; 50 3 303 -310
2000 [close]
 Published Articles
Kennedy A; Robinson A;
What should I do? A Handy Guide to Managing Irritable Bowel Syndrome
Southampton, RTFB Publishing 2000; 1 -88
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