A carregar...
Publicação
Inflammatory bowel disease and cognitive behavioural therapy : a systematic review and meta-analysis
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 822.54 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução. As doenças inflamatórias do intestino (DII) são doenças crónicas, com agudizações, multifactoriais, caracterizadas por inflamação crónica do intestino e estão associadas a perturbações psiquiátricas, como depressão e ansiedade, assim como uma pior qualidade de vida. Alguns estudos reportaram benefício com a aplicação de terapia cognitivo-comportamental (TCC) nestes doentes. Objectivo. Nesta revisão, propomo-nos inventariar e analisar as evidências da TCC nos doentes com DII relativas à actividade da doença, depressão, ansiedade e qualidade de vida (QdV).
Métodos. Foram incluídos estudos controlados e aleatorizados que compararam TCC com um grupo controlo, independentemente da idade ou data de publicação. A pesquisa foi efectuada na MEDLINE, e estudos adicionais foram selecionados da literatura cinzenta e da bibliografia de estudos seleccionados. Todos os outcomes foram considerados para a revisão sistemática, e os dados relativos a actividade da doença, depressão, ansiedade e qualidade de vida foram incluídos na meta-análise. Dados foram resumidos em médias e desvios-padrão (DP). Variância inversa genérica com modelos de efeitos aleatorizados foram feitas para obter estimativas do efeito, expressas em diferenças de médias padronizadas (DMP) com intervalos de confiança de 95% (IC).
Resultados. Identificámos 117 estudos, dos quais 11 foram incluídos na revisão sistemática, com um total de 1012 doentes. Nenhum outcome demonstrou benefício da TCC. A actividade da doença foi avaliada em 7 estudos, tendo 2 sido incluídos na nossa análise (DMP: 0.060; -0.449 0.568 IC 95%; p-values>0.818). A depressão (DMP: -0.131; -0.347, 0.084 IC 95%; p-values>0.233) foi avaliada em todos os estudos, a ansiedade (DMP: -0.029; -0.232, 0.173 IC 95%; p-values>0.777) e qualidade de vida (DMP: 0.037; -0.178, 0.252 IC 95%; p-values>0.736) em 7, com 3 incluídas na nossa análise, não tendo sido demonstrado benefício. Discussão e conclusão. Esta meta-análise falhou em provar benefícios da TCC nos doentes com DII nos 4 outcomes principais: actividade da doença, depressão, ansiedade e qualidade de vida, mas foram encontradas grandes limitações. Estudos futuros deverão incluir mais doentes e fazer análises de subgrupo, reportando dados completos.
Introduction. Inflammatory bowel diseases (IBDs) are chronic, relapsing-remitting, multifactorial disorders characterized by chronic intestinal inflammation, associated with psychiatric disorders, such as anxiety and depression, and with poorer quality of life. Some trials have reported benefit of cognitive-behavioural therapy (CBT) for these patients. Aim. In this review, we aim to summarize and analyse the evidences of CBT in IBD patients regarding disease activity, anxiety, depression and quality of life. Methods. Randomized controlled trials recruiting patients with IBD that compared CBT to a control group were included, regardless of age or date of publication. Search was performed on MEDLINE, and additional trials were selected from grey literature and references from selected articles. Any disease-related or psychological outcomes were considered for the systematic review, and data regarding disease activity, anxiety, depression and quality of life was included in the meta-analysis. We summarized the findings using descriptive statistics, including mean and standard deviation (SD) scores for outcomes of interest. Generic inverse variance with random-effects models were run to obtain effect estimates expressed as standardized mean difference (SMD) and 95% confidence intervals (CIs). Results. We identified 117 studies of which 11 studies included, with a total of 1012 participants. None of the outcomes reported benefit from CBT. Disease activity was evaluated in 7 trials, with 2 included in our analysis showing no improvement (SMD: 0.060; -0.449 0.568 CI 95%; p-values>0.818). Depression (SMD: -0.131; -0.347, 0.084 CI 95%; p-values>0.233) was evaluated in all trials, anxiety (SMD: -0.029; -0.232, 0.173 CI 95%; p-values>0.777) and quality of life (SMD: 0.037; -0.178, 0.252 CI 95%; p-values>0.736) in 7, with 3 included in our analysis showing no improvement. Discussion and conclusion. This meta-analysis failed to prove that CBT could be of benefit for IBD patients on 4 major outcomes: disease activity, depression, anxiety and quality of life, but several limitations were found. Future studies should include more patients, perform subgroups analysis, and adequately report data.
Introduction. Inflammatory bowel diseases (IBDs) are chronic, relapsing-remitting, multifactorial disorders characterized by chronic intestinal inflammation, associated with psychiatric disorders, such as anxiety and depression, and with poorer quality of life. Some trials have reported benefit of cognitive-behavioural therapy (CBT) for these patients. Aim. In this review, we aim to summarize and analyse the evidences of CBT in IBD patients regarding disease activity, anxiety, depression and quality of life. Methods. Randomized controlled trials recruiting patients with IBD that compared CBT to a control group were included, regardless of age or date of publication. Search was performed on MEDLINE, and additional trials were selected from grey literature and references from selected articles. Any disease-related or psychological outcomes were considered for the systematic review, and data regarding disease activity, anxiety, depression and quality of life was included in the meta-analysis. We summarized the findings using descriptive statistics, including mean and standard deviation (SD) scores for outcomes of interest. Generic inverse variance with random-effects models were run to obtain effect estimates expressed as standardized mean difference (SMD) and 95% confidence intervals (CIs). Results. We identified 117 studies of which 11 studies included, with a total of 1012 participants. None of the outcomes reported benefit from CBT. Disease activity was evaluated in 7 trials, with 2 included in our analysis showing no improvement (SMD: 0.060; -0.449 0.568 CI 95%; p-values>0.818). Depression (SMD: -0.131; -0.347, 0.084 CI 95%; p-values>0.233) was evaluated in all trials, anxiety (SMD: -0.029; -0.232, 0.173 CI 95%; p-values>0.777) and quality of life (SMD: 0.037; -0.178, 0.252 CI 95%; p-values>0.736) in 7, with 3 included in our analysis showing no improvement. Discussion and conclusion. This meta-analysis failed to prove that CBT could be of benefit for IBD patients on 4 major outcomes: disease activity, depression, anxiety and quality of life, but several limitations were found. Future studies should include more patients, perform subgroups analysis, and adequately report data.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Doenças inflamatórias do intestino Terapia cognitivo-comportamental Depressão Qualidade de vida Psiquiatria