Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn's disease. The relationship among multiple patient-reported outcomes measures for patients with ulcerative colitis receiving treatment with MMX® formulated delayed-release mesalamine Response and remission are associated with improved quality of life, employment and disability status, hours worked, and productivity of patients with ulcerative colitis A new validation of the Spanish Work Productivity and Activity Impairment Questionnaire-Crohn's disease version. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Quality‐of‐Life Measurement in Patients with Inflammatory Bowel Disease Receiving Social Support Influence of inflammatory bowel disease on different dimensions of quality of life Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: A twelve-month follow-up Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies. The importance of illness perceptions, quality of life and psychological status in patients with ulcerative colitis and Crohn’s disease Assessing disease activity in ulcerative colitis: Patients or their physicians? A new measure of health status for clinical trials in inflammatory bowel disease. Morbidity of juvenile onset inflammatory bowel disease: effects on education and employment in early adult life. A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self-help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease. Self-reported Disability in Patients with Inflammatory Bowel Disease Largely Determined by Disease Activity and Illness Perceptions Use of the noninvasive components of the mayo score to assess clinical response in Ulcerative Colitis [Ambulatory education of patient with Crohn disease/ulcerative colitis].
BACKGROUND Crohn 's disease ( CD ) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea , abdominal pain , and fever , which can interfere with a patient 's ability to work and perform daily activities . OBJECTIVE The aim of this study was to assess the validity , reliability , and responsiveness of the Work Productivity and Activity Impairment question naire in CD ( WPAI : CD ) . METHODS The WPAI : CD was tested in CD patients enrolled in a 26-week r and omized clinical trial of cer-tolizumab pegol versus placebo . Discriminative validity of WPAI : CD absenteeism , presenteeism(reduced on-the-job effectiveness ) , overall work productivity loss ( absenteeism + presenteeism ) , and activity impairment scores was assessed relative to 5 measures of disease severity and health status : CD Activity Index ( CDAI ) , Short Form-36 physical component summary ( PCS ) and mental health component summary ( MCS ) scores , Inflammatory Bowel Disease Question naire ( IBDQ ) , and the 5-dimensional EuroQoL health-related quality -of-life visual analog scale ( EQ-VAS ) . Responsiveness was assessed by comparing changes in WPAI : CD scores from baseline to week 26 for patients in remission ( CDAI < 150 points ) versus no remission . St and ardized Response Means ( SRMs ) were calculated to evaluate the magnitude of the changes . RESULTS A total of 662 patients ( mean [ range ] age , 37.4 [ 18 - 77 ] years ; male , 288 [ 43.5 % ] ; white , 629 [ 95.0 % ] ) were enrolled in the study . Patients with CD of the worst severity ( CDAI > median ) showed significantly higher impairment in work ( + 10.5 % ) and activities ( + 10.4 % ) versus patients with " best health " ( no problems ) ( both , P < or = 0.001 ) . Patients with " worst " IBDQ , PCS , MCS , and EQ-VAS scores also showed significantly higher impairments in work ( IBDQ , VAS -24.2 % ; PCS , -24.1 % ; MCS , -15.9 % ; EQ-VAS , -16.5 % ) and activities ( IBDQ , -23.3 % ; PCS , -21.8 % ; MCS , -16.5 % ; EQ-VAS , -17.2 % ) versus " best " scores ( all , P < 0.05 ) . There were significant differences between WPAI : CD impairment scores for patients in remission versus patients failing to achieve remission ( P < 0.05 ) . SRMs were small ( ie , < 0.5 ) in the nonre-mission group , and moderate to large ( ie , > 0.5 ) for patients in remission . CONCLUSIONS The discriminative validity , reliability , and responsiveness of the WPAI : CD were demonstrated . The WPAI : CD may be useful for evaluating drug impact on CD Purpose Ulcerative colitis ( UC ) is associated with impaired health-related quality of life ( HRQL ) and work-related outcomes ( WRO ) . This analysis examined correspondences among measures of HRQL and WRO in patients with UC , as well as the magnitude of each measure ’s responsiveness to disease activity and treatment . Methods An open-label , prospect i ve trial of delayed-release mesalamine tablets formulated with MMX ® technology included 8 weeks of treatment for patients with active mild-to-moderate UC ( n = 137 ) and 12 months of maintenance treatment for patients with quiescent UC ( n = 206 ) . Spearman correlations ( ρ ) measured inter-domain associations across measures of generic HRQL [ 12-item Short-Form Health Survey ( SF-12v2 ) ] , disease-specific HRQL [ Short Inflammatory Bowel Disease Question naire ( SIBDQ ) ] , and disease-specific WRO [ Work Productivity and Activity Impairment for Specific Health Problems ( WPAI : SHP ) ] . Responsiveness to disease activity and treatment was assessed for each instrument . Results Changes in scores from baseline to week 8 were moderately correlated across all instrument domains : 65 of 80 ( 81 % ) between-instrument inter-domain correlations were of moderate magnitude ( 0.30 < ρ < 0.70 ) , with an average magnitude of 0.42 [ 95 % confidence interval ( CI ) 0.38–0.46 ] . Associations between symptom measures were stronger for SIBDQ ( |average ρ| = 0.41 ; 95 % CI 0.34–0.48 ) and WPAI : SHP ( 0.40 ; 0.30–0.47 ) than SF-12v2 ( 0.30 ; 0.27–0.34 ) . SIBDQ was most sensitive to treatment [ effect size ( dz ) for change from baseline to week 8 = 0.62 ; 95 % CI 0.35–0.89 ] , followed by WPAI : SHP ( dz = 0.43 ; 0.32–0.54 ) and SF-12v2 ( dz = 0.33 ; 0.27–0.39 ) . Conclusion While the SIBDQ showed the greatest overall responsiveness to disease activity and treatment , all three patient-reported outcomes instruments provided complementary interpretive information regarding the impact of UC treatment Background : Impairment of health‐related quality of life , employment , and productivity has been documented in patients with moderate to severe ulcerative colitis . Methods : Using prospect ively collected data from the Active Ulcerative Colitis Trials 1 and 2 , we examined the impact of clinical response or remission , as defined using the Mayo score , on health‐related quality of life , employment , disability , productivity , and hours worked per week . These analyses were based on observed data and included all 728 patients , regardless of their r and omized treatment group ( i.e. ,  placebo and infliximab patients were grouped for analysis ) . Changes in Inflammatory Bowel Disease Question naire ( IBDQ ) and Medical Outcomes Study 36‐Item Short Form ( SF‐36 ) scores among nonresponders , responders , and patients in remission were compared . In addition , changes in employment , disability status , productivity , and hours worked per week of patients in clinical remission and patients not in clinical remission were compared . Results : Ulcerative colitis patients in clinical response or remission had significantly improved IBDQ and SF‐36 scores at week 30 compared with those of nonresponders ( P < 0.001 ) . Among those not employed at baseline , including those receiving disability compensation , greater percentages of patients in remission at week 30 were employed ( 20.6 % ) and not receiving disability compensation ( 58.8 % ) than were those not in remission ( 8.3 % and 20.0 % , respectively ; P < 0.05 for both comparisons ) . At week 30 , improvements from baseline in productivity and both actual and fully productive hours worked per week were greater for patients in remission compared with those not in remission ( P < 0.05 for all three comparisons ) . Conclusions : These results confirm the validity of response and remission as defined using the Mayo score OBJECTIVES The Work Productivity and Activity Impairment Question naire ( WPAI ) is an instrument that measures work impairment in the setting of different diseases . One previous study validating the WPAI in Crohn 's disease ( CD ) patients suggested that its reproducibility may be unsatisfactory . This study evaluated the validity and reproducibility of the Spain Spanish version of the WPAI question naire in CD patients . METHODS In a prospect i ve study , convergent validity was tested comparing WPAI with quality of life and CD activity indices . Known-groups validity was assessed by comparing WPAI scores in CD patients with active versus inactive disease . Reproducibility of repeated tests was evaluated by comparing two WPAI measures obtained two to four weeks apart in stable patients . RESULTS One hundred eight patients were included in the various steps of the analysis . The WPAI showed adequate known groups validity and convergent validity . The reproducibility of the test and , specifically , that of the evaluation of presenteeism ( the impairment of productivity while working ) were good . CONCLUSIONS This study confirms the validity of WPAI for measuring work impairment  in CD patients . In contrast to previous studies , the test reproducibility was adequate BACKGROUND AND AIMS Colonoscopic appearance , the primary measure of disease activity in adult ulcerative colitis , is less acceptable to children . Our aim was to develop a noninvasive activity index of pediatric ulcerative colitis . METHODS Item selection was performed judgmentally using a Delphi group of 36 experts in pediatric inflammatory bowel disease . Item weighting was performed by regression modeling using a prospect i ve cohort of 157 pediatric ulcerative colitis patients . Validation was assessed on a separate prospect i ve cohort of 48 children with ulcerative colitis undergoing complete colonoscopy .  Responsiveness was evaluated at a follow-up visit of 75 children using effect size statistics and diagnostic utility approaches . RESULTS A list of 41 items was generated and reduced to 11 by rank order . Two physicians completed the  Pediatric Ulcerative Colitis Activity Index ( PUCAI ) on each of the patients in the weighting cohort . Six clinical items were significant in the regression analysis ; the laboratory items and an endoscopic appearance item did not improve the PUCAI performance . In the validation cohort , the PUCAI was highly correlated with the Physician 's Global Assessment ( r = 0.91 , P < .001 ) , Mayo score ( r = 0.95 , P < .001 ) , and colonoscopic appearance ( r = 0.77 , P < .001 ) . Correlations were higher than 2 noninvasive adult indices calculated concurrently . Interobserver and test-retest reliability were excellent ( intraclass correlation coefficient = 0.95 ; 95 % CI : 0.93 - 0.97 ) . Cut-off points were established using receiver operator characteristic curves on the full cohort . Excellent responsiveness was found at repeated visits ( effect size = 1.9 , area under the receiver operator characteristic curve = 0.97 ) . CONCLUSIONS The rigorously developed PUCAI is a noninvasive , valid , highly reliable , and responsive index with which to assess disease activity in pediatric ulcerative colitis Background : Crohn 's disease and ulcerative colitis , referred to as inflammatory bowel diseases , affect mainly young adults and have an elevated morbidity and a negative effect on quality of life . This study aim ed to compare the health‐related quality of life between 2 r and omized groups of patients with inflammatory bowel disease : ( 1 ) the supported group ( SG ) , patients receiving social support for an 18‐month period , and ( 2 ) the control group ( CG ) , patients receiving no social support  Methods : Health‐related quality of life was assessed at 4 moments with the Portuguese versions of the Medical Outcomes Study Short Form 36 and the Inflammatory Bowel Disease Question naire ( IBDQ ) , both vali date d in Brazil . Results : In the SG , using analysis of variance for repeated measures complemented by the Bonferroni test positive variations were observed ( 1 ) in the Social Aspects domain , between the first and third evaluations ( P = 0.044 ) , and ( 2 ) in the Emotional Aspects domain , between the first and second and the third and fourth evaluations ( P = 0.029 ) . Conclusions : In the sample studied , social support , measured by use of the Inflammatory Bowel Disease Question naire , had a positive impact on the social and emotional aspects of quality of life Objective To establish the impairment of different dimensions of quality of life in inflammatory bowel disease ( IBD ) . Design Prospect i ve observational study . Participants 289 patients [ 160 with ulcerative colitis ( UC ) and 129 with Crohn 's disease ( CD ) ] . Measures Health-related quality of life was assessed by means of the  Inflammatory Bowel Disease Question naire ( IBDQ ) and the Psychological General Well Being Index ( PGWBI ) . Results In active IBD , all dimensions of the quality of life scored significantly lower than in inactive IBD , indicating a poor quality of life . Social impairment was the least impaired dimension of the IBDQ in active UC and CD , compared with digestive and systemic symptoms . In inactive IBD , the systemic symptoms domain received the lowest score ( P < 0.01 ) . In a subgroup of 22 patients studied before and after remission , emotional function was the most impaired dimension after achieving remission . The Psychological General Well Being Index was significantly impaired in active UC [ 78.5 ( range 64–89 ) ] and CD [ 76.5 ( range 69–97 ) ] relative inactive IBD [ 104 ( range 93–111 ) ] vs 106 ( 95–113 ) , respectively;P < 0.05 ] . Conclusions Quality of life is impaired in IBD . During relapse , clinicians should pay attention to digestive symptoms and psychological distress . In remission , they should be sensitive to systemic symptoms Objective . To analyze the effects of a comprehensive lifestyle modification program on health-related quality -of-life , psychological distress , and clinical parameters in patients with ulcerative colitis ( UC ) 3- and 12 months after completion of the program . Material and methods . Sixty patients with UC in clinical remission or with low disease activity were r and omly assigned to an intervention group or a usual-care control group . Comprehensive lifestyle modification consisted of a structured 60-h training program over a period of 10 weeks which included stress management training , psychoeducational elements , and self-care strategies .  Quality -of-life , psychological distress , and clinical disease activity were assessed with st and ardized question naires ( Inflammatory Bowel Disease Question naire ( IBDQ ) ; the MOS Short-Form 36 ( SF-36 ) ; the Brief Symptom Inventory ( BSI ) , and the Colitis Activity Index ( CAI ) ) at baseline , and 3 months and 12 months after comprehensive lifestyle modification . Results . Three months after comprehensive lifestyle modification , patients in the intervention group showed significantly greater improvement in the SF-36 scale physical function ( p=0.0175 ) , and a significantly greater reduction in anxiety scores , measured with the BSI ( p=0.0294 ) . Use of relaxation techniques was a significant predictor of improvement in the psychological sum score after 3 months of therapy ( p=0.034 ) . Though 80 % of patients with an initial IBDQ score < 170 in the intervention group showed an improvement of > 16 points after 3 months , no significant effects of the intervention were found on the IBDQ scales , or on clinical disease parameters , including CAI scores , self-assessed disease activity , hospitalizations , or medical consultations . Conclusions . These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality -of-life and emotional well-being , but no effects were discernable 12 months after completion of therapy . Comprehensive lifestyle modification had no effect on clinical disease variables . The generalizability of these data is limited because of the inclusion of patients with a relatively low disease activity who were interested in integrative medicine BACKGROUND & AIMS Mobile health technologies are advancing rapidly as smartphone use increases . Patients with inflammatory bowel disease ( IBD ) might be managed remotely through smartphone applications , but no tools are yet available . We tested the ability of an IBD monitoring tool , which can be used with mobile technologies , to assess disease activity in patients with Crohn 's disease ( CD ) or ulcerative colitis ( UC ) . METHODS We performed a prospect i ve observational study to develop and vali date a mobile health index for CD and UC , which monitors IBD disease activity using patient-reported outcomes . We collected data from disease-specific question naires completed by 110 patients with CD and 109 with UC who visited the University of California , Los Angeles , Center for IBD from May 2013 through January 2014 .  Patient-reported outcomes were compared with clinical disease activity index scores to identify factors associated with disease activity . Index scores were vali date d in 301 patients with CD and 265 with UC who visited 3 tertiary IBD referral centers ( in California or Europe ) from April 2014 through March 2015 . RESULTS We assessed activity of CD based on liquid stool frequency , abdominal pain , patient well-being , and patient-assessed disease control , and activity of UC based on stool frequency , abdominal pain , rectal bleeding , and patient-assessed disease control . The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.90 in patients with CD and 0.91 in patients with UC . They identified endoscopic activity with area under the receiver operating characteristic values of 0.63 in patients with CD and 0.82 in patients with UC . Both scoring systems responded to changes in disease activity ( P < .003 ) . The intraclass correlation coefficient for test-retest reliability was 0.94 for CD and for UC . CONCLUSIONS We developed and vali date d a scoring system to monitor disease activity in patients with CD and UC that can be used with mobile technologies . The indices identified clinical disease activity with area under the receiver operating characteristic curve values of 0.9 or higher in patients with CD or UC , and endoscopic activity in patients with UC but not CD The present study investigates illness perceptions of inflammatory bowel disease patients in an outpatient population , examining whether these illness perceptions are related to disease severity , quality of life and psychological adjustment . A cohort of 102 inflammatory bowel disease out patients was prospect ively enrolled on the study . The participants completed a question naire assessing illness perceptions , anxiety , depression and disease-specific symptoms . The study has identified specific illness perceptions of inflammatory bowel disease sufferers that are strongly associated with patients ’ quality of life . By raising and addressing these issues , clinicians may be able to allay these significant and often unexpressed concerns , and improve quality of life for patients with inflammatory bowel disease Background : We aim ed to determine the optimal approach to assess disease activity ( i.e. , biological inflammation ) in ulcerative colitis ( UC ) by comparing patients ' and physicians ' rating of the disease . Methods : This was a prospect i ve , multicenter , double‐cohort study . The first cohort was composed of 94 children with UC ( parent proxy when required ) and their physicians who provided independent clinical report and global assessment of disease , rated on a 100 mm visual analog scale . Constructs of disease activity ( including mucosal inflammation , laboratory tests , Mayo score , and the Pediatric UC Activity Index ) , were scored by an independent blinded physician and used to compare validity of the assessment . Of the 94 children , 43 were seen at a follow‐up visit and provided a global rating of change in disease activity . To ascertain whether age influences assessment accuracy , a second cohort of 86 adult UC patients were analyzed in a similar way . Results : In both cohorts the physician global assessment had higher correlations with all constructs of disease activity than did the patient ' global assessment ( for colonoscopic score r = 0.76 vs. r = 0.29 , P = 0.002 ) . Even with abdominal pain , a subjective item , the physician 's rating had higher correlation than the patient 's rating . Similarly , the physician rating of change better reflected change in disease activity than that of the patient rating . Conclusions : For indirect measurement of biological activity on the basis of symptoms and signs , clinician assessment s are superior to those of patients . Patient assessment s , physician assessment s , and direct measurement of disease activity provide complementary information in clinical research . ( Inflamm Bowel Dis 2009 We have developed a measure of subjective health status ( quality of life ) for patients with inflammatory bowel disease ( IBD ) . Ninety-seven patients with IBD described problems they had experienced as a result of the disease ; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Question naire ( IBDQ ) . Sixty-one IBD patients were evaluated twice . One month separated the evaluations , at which disease activity indices , the IBDQ , and a number of other question naires were administered . Reproducibility studies in 19 stable patients showed improvement in scores , but also a small within-person st and ard deviation . Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure . Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn 's disease . Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar . We conclude that although further testing is required , particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn 's disease , the IBDQ shows promise as a measure of health status for clinical trials in IBD Seventy young adults ( 50 with Crohn 's disease ( CD ) and 20 with ulcerative colitis ( UC ) ( from a geographically derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 ( range 5.2 - 29.5 ) years after diagnosis .  Details of  education and employment  were collected as part of a structured clinical interview . Although 57 % had had periods of absence from school of two months or more , their school examination pass rates were similar to those of the healthy population . The achievements of CD patients were consistently better than those of the UC group . In 15 patients , relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations . Extra tuition in hospital had been provided for only four patients , and three others had had privately arranged tuition at home . Fifty per cent proceeded to full time higher education . At the time of review , seven patients were full time students , one was a university research fellow , 47 were in full time and three in part time employment , one was self employed , four were housewives , and only six were involuntarily unemployed . All four unemployed CD patients attributed this to inflammatory bowel disease , but other factors were relevant in the unemployed UC patients . Few had direct evidence of rejection by employers on health grounds , though some did not declare their illness to prospect i ve employers OBJECTIVES To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services . DESIGN Nineteen hospitals were r and omised to 10 control sites and nine intervention sites . Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients . Patients at the control sites were recruited and went on to have an ordinary consultation . Qualitative interviews were undertaken to obtain an in-depth underst and ing of patients ' and consultants ' experience of the intervention . SETTING Follow-up outpatient clinics at 19 hospitals in the north-west of Engl and . PARTICIPANTS Seven hundred patients ( 297 at intervention sites and 403 at control sites ) with established ulcerative colitis or Crohn 's disease , aged 16 years and over , and able to write in English .  INTERVENTIONS Consultants were trained to provide a patient-centred approach to care . Guidebooks on ulcerative colitis and Crohn 's disease were developed with patients prior to the study . Patients prepared a written self-management plan and self-referred to services based on a self-evaluation of their need for advice . MAIN OUTCOME MEASURES Rates of hospital outpatient consultation , quality of life ( QoL ) and acceptability to patients . Health service re source use and assessed cost effectiveness using the EQ-5D . RESULTS After 1 year , the intervention result ed in fewer hospital visits , without change in the number of primary care visits . Patients felt more able to cope with their condition . The intervention produced no reduction in QoL and did not raise anxiety . The intervention group reported fewer symptom relapses ; 74 % of patients in the intervention group indicated a preference to continue the system . Qualitative results showed the guidebook was effective but organisational limitations constrained patient-centred aspects of the intervention for some . Cost-effectiveness analyses favoured self-management over st and ard care . CONCLUSIONS Further use of this method in chronic disease management seems likely to improve overall patient satisfaction and reduce health expenditure without evidence of adverse effect on disease control . Further attention needs to be given to self-referral and access arrangements and a re-distribution of control to patients through increased adherence to patient-centred norms on the part of consultants . Future research is recommended to evaluate the operating systems within secondary and primary care that would allow self-managers to self-refer and to keep them informed of new treatments , also to explore models for training health professionals in self-care methods , to study long-term effects of self-management in chronic disease and to transfer this approach to other chronic conditions Background : The inflammatory bowel disease ( IBD ) disability index has recently been introduced to measure patients ' physical , psychological , familial , and social limitations associated with IBD . We assessed factors related to self-reported disability and the relationship between disability and direct health care costs . Methods : A large cohort of patients with Crohn 's disease ( CD ) and ulcerative colitis ( UC ) was prospect ively followed for 2 years by 3 monthly web-based question naires . At 2 years , patients completed the IBD disability index , with lower score indicating more disability . Linear regression analysis was used to examine the impact of demographics , clinical characteristics , and illness perceptions on self-reported disability . Trends in direct health care costs across the disability severity groups minimal , mild , moderate , and severe , were tested . Results : A total of 554 patients with CD and 424 patients with UC completed the IBD disability index ( response rate , 45 % ) . Both clinical characteristics and illness perceptions significantly contributed to self-reported disability ( 45%–47 % , P = 0.000 and 8%–12 % , P = 0.000 , respectively ) . Patients with CD scored lower on the self-reported IBD disability index than patients with UC ( 0.255 versus 3.890 , P < 0.000 ) , indicating more disability in patients with CD . Factors independently associated with higher self-reported disability rates were increased disease activity , illness identity ( higher number of symptoms attributed to IBD ) , and stronger emotional response . Disease duration and disease phenotype were not associated with self-reported disability . Direct health care costs increased with the worsening of self-reported disability ( P = 0.000 ) . Conclusions : More disability was reported by patients with CD than by UC . Self-reported disability in IBD was mainly determined by clinical disease activity and illness perceptions but not by disease duration or disease phenotype Background : The Mayo score and a noninvasive 9‐point partial Mayo score are used as outcome measures for clinical trials assessing therapy for ulcerative colitis ( UC ) . There are limited data assessing what defines a clinical ly relevant change in these indices . We sought to assess what constitutes a clinical ly meaningful change in these indices using data from a recently completed placebo‐controlled clinical trial . Methods : In all , 105 patients were enrolled in a 12‐week r and omized , placebo‐controlled trial assessing rosiglitazone for treatment of mild to moderate UC . We compared the change in  the Mayo score , the partial Mayo score , and a 6‐point score composed just of the stool frequency and bleeding components of the Mayo score to the patient 's perception of disease activity at week 0 and week 12 . Optimal cutpoints were calculated as the maximal product of sensitivity and specificity . Results : Each index was strongly correlated with the patient 's rating of disease activity at week 12 ( Spearman correlations 0.61–0.71 , P < 0.0001 for all correlations ) . The maximal product of sensitivity and specificity to identify patient reported improvement of disease activity was achieved using cutpoints for change of 2.5 for the Mayo score ( sensitivity 88 % , specificity 80 % ) , 2.5 for the partial Mayo score ( sensitivity 88 % , specificity 87 % ) , and 1.5 for the 6‐point score ( sensitivity 88 % , specificity 80 % ) . Conclusions : The partial Mayo score and the 6‐point score composed solely of the stool frequency and bleeding components performed as well as the full Mayo score to identify patient perceived clinical response BACKGROUND Patient education has been accepted widely over the past years as a valid component of disease management in patients with chronic diseases . The aim of our study was to evaluate the effects of patient education in patients with inflammatory bowel disease . Participation in a patient education program should increase the patient 's disease-related knowledge and positively influence the patient 's quality of life , depression , beliefs of internal control and social activity . METHODS We studied 36 patients with Crohn 's disease and ulcerative colitis : 18 were educated in four sessions , 18 were not educated ( control-group ) . The following topics were presented : diagnosis , causes and course of disease ; medication and surgery ; nutrition and social benefits and stress management and coping with the disease . RESULTS The effects of the program were evaluated before , immediately and three months after the intervention using question naires . Participants in the program showed a significant increase in knowledge after three months compared with the non- participants . There were positive , although not significant effects on psychosocial variables . CONCLUSION Patient education is a valuable means to increase knowledge of disease and treatment in patient 's with Crohn 's disease and ulcerative colitis . Effects on psychosocial variables need to be examined on a long term basis in larger patient groups
The evidence supports the WPAI as having test-retest reliability ( reproducibility ) over time ; convergent validity , as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity ; known-groups validity , as indicated by differences in WPAI scores between patients with active and inactive disease ; ability ( sensitivity ) to detect change , as indicated by substantial improvement in scores for patients who achieve remission , accompanied by substantial worsening of scores for patients who relapse ; and , responsiveness to treatment , with improvements in scores following treatments that reduce disease activity .
Patients with ulcerative colitis , a type of inflammatory bowel disease , report negative impacts of disease symptoms on work-related outcomes , including absenteeism and presenteeism .
As a way to better underst and the impact of this disease and its treatment on work-related outcomes , the current review examines the use of the Work Productivity and Activity Impairment Question naire ( WPAI ) , a patient-reported outcomes measure of absenteeism , presenteeism , and impairment in other activities , in studies of patients with ulcerative colitis .
This review assesses the measurement properties of the WPAI in this patient population : its reliability , construct validity , ability to detect change , and responsiveness to effective treatments .