Comparison: psychotherapy+medical vs medical

OutcomeMeta-analysis detailsSummary Statisticsp (hetero) and I2Comments:Study qualityDirectnessImprecisionInconsistencyReporting GRADEBias CommentsGRADE Evidence Rating
Global improvement of IBS symptoms (no. patients)1 trial; 102 patients; from RCT; (parallel design);RR=3.08 (95%CI 1.74, 5.47)Statistically significant, favours psychotherapy + medical care. NNT 3, control group rate 23%GoodIndirect setting-minor, secondary care OPDFairly wide CIconsistent---Rated by assessor (not patients) at 12 weeks. Refractory IBS, secondary care (tertiary referral). 48% psychological problems.Moderate/low
Global improvement of IBS symptoms (no. patients)1 trial; 101 patients; from RCT; (parallel design);RR=1.68 (95%CI 1.14, 2.49)Statistically significant, favours psychotherapy + medical care. NNT 4, control group rate 40%.GoodIndirect setting-minor, secondary care OPDPreciseconsistent---Patients’ assessment at 15 months. Long term IBS, but unclear if refractory. Patients had to commit to long\term trial. Secondary care. 70% had previous psychological comorbidities.Moderate
Global IBS symptom score1 trial; 101 patients; from RCT; (parallel design);MD=−4.56 (95%CI −8.77, −0.35)Statistically significant, favours psychotherapy + medical care. Scale may be 114 max. Control group score 37.5.GoodIndirect setting-minor, secondary care OPDPreciseconsistent---Patients’ assessment at 12 weeks. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate
Global IBS symptom score1 trial; 101 patients; from RCT; (parallel design);MD=−8.1 (95%CI −12.31, − 3.89)Statistically significant, favours psychotherapy + medical care. Scale may be 114 max. Control group score 38.0.GoodIndirect setting-minor, secondary care OPDPreciseconsistent---Patients’ assessment at 15 months. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate
pain score1 trial; 101 patients; from RCT; (parallel design);MD=−1.01 (95%CI −1.95, −0.07)Statistically significant, favours psychotherapy + medical care. Scale unclear. Control group score 7.8.GoodIndirect setting-minor, secondary care OPDPreciseconsistent---Patients’ assessment at 12 weeks. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate
pain score1 trial; 101 patients; from RCT; (parallel design);MD=−2.3 (95%CI −3.43, −1.17)Statistically significant, favours psychotherapy + medical care. Scale unclear. Control group score 7.8.GoodIndirect setting-minor, secondary care OPDPreciseconsistent---Patients’ assessment at 15 months. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate
mental health1 trial; 101 patients; from RCT; (parallel design);RR=7.33 (95%CI 2.34, 22.95)Statistically significant, favours psychotherapy + medical careGoodIndirect setting-minor, secondary care OPDWide CIconsistent---Raters’ assessment at 12 weeks. Mental improvement. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate/low
mental health1 trial; 101 patients; from RCT; (parallel design);RR=4.9 (95%CI 2.03, 11.8)Statistically significant, favours psychotherapy + medical careGoodIndirect setting-minor, secondary care OPDFairly wide CIconsistent---Raters’ assessment at 15 months. Mental improvement. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate/low
mental health1 trial; 101 patients; from RCT; (parallel design);RR=0.94 (95%CI 0.48, 1.86)Not statistically significantGoodIndirect setting-minor, secondary care OPDFairly wide CIconsistent---Patients’ assessment at 15 months. Mental improvement. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychological comorbidities.Moderate/low
mental health1 trial; 101 patients; from RCT; (parallel design);RR=1.44 (95%CI 0.86, 2.4)Not statistically significantGoodIndirect setting-minor, secondary care OPDFairly wide CIconsistent---Patients’ assessment at 15 months. Psychological subgroup. Mental improvement. Long term IBS, but unclear if refractory. Patients had to commit to longterm trial. Secondary care. 70% had previous psychologicalModerate/low

From: Appendix F, Grading the evidence

Cover of Irritable Bowel Syndrome in Adults
Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet].
NICE Clinical Guidelines, No. 61.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2008, Royal College of Nursing.

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