A multiprofessional education programme for patients with inflammatory bowel disease: A randomized controlled trial Employment problems and prospects for patients with inflammatory bowel disease. Unemployment and Disability in Patients With Moderately to Severely Active Crohn's Disease Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn's disease. Patient education in inflammatory bowel disease does not influence patients knowledge and long-term psychosocial well-being. Quality‐of‐Life Measurement in Patients with Inflammatory Bowel Disease Receiving Social Support Group‐based intervention program in inflammatory bowel disease patients: Effects on quality of life Influence of inflammatory bowel disease on different dimensions of quality of life Work disability in inflammatory bowel disease patients 10 years after disease onset: results from the IBSEN Study Response and remission are associated with improved quality of life, employment and disability status, hours worked, and productivity of patients with ulcerative colitis Disease-related worries and concerns: a study on out-patients with inflammatory bowel disease. Morbidity of juvenile onset inflammatory bowel disease: effects on education and employment in early adult life. Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. Effects of intensified work-related multidisciplinary rehabilitation on occupational participation: a randomized-controlled trial in patients with chronic musculoskeletal disorders Costs of Inflammatory Bowel Disease in Germany Adalimumab improves patient-reported outcomes and reduces indirect costs in patients with moderate to severe Crohn's disease: results from the CARE trial. Occupational disorders and return to work: a randomized controlled study.
Objective . Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation . The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease , and to investigate whether the programme could improve their health-related quality of life . Material and methods . Ninety-three patients with inflammatory bowel disease in remission were included and r and omized to an intervention group or a control group . The intervention group attended a multiprofessional education programme while the control group received regular information . Four question naires were used for measuring health-related quality of life . Both groups completed the question naires at baseline and after 6 months . The intervention group also completed the question naires after 1 month . Results . No significant differences were found when comparing the two groups at 6 months . However , the multiprofessional education programme was highly appreciated by the patients . Conclusions . In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group . This might be due to the fact that the question naires were not sensitive enough or that some patients were not in clinical remission . The patients ’ enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic A r and om sample of 170 patients ( 88 men ) with chronic inflammatory bowel disease ( 75 ulcerative colitis ) were first interviewed in 1978 about their employment status , problems at work , and influence of surgery .  Surgery had been carried out on 120 and 53 had an ileostomy . After six years 144 ( 92 % ) of the 156 survivors replied to a follow up postal question naire . Of the initial sample , 122 ( 72 % ) were working and there were only three ( 1 % ) registered unemployed . After six years a similar proportion were working and only seven ( 5 % ) were unemployed . Continuity of employment was good with 57 % in the same job . Changes in work because of health had been made by 72 patients mainly caused by bowel disease . After surgery 10 % completely changed and 22 % modified their work while a few had to retrain or retire . Panproctocolectomy and ileostomy result ed in more changes and longer time off work after surgery than colectomy and ileorectal anastomosis , with 35 % and 17 % respectively off work after one year . Problems at work , in particular general malaise and arthritis were experienced by 34 ( 28 % ) patients . Fewer problems were experienced by patients with a stoma who also had less sickness absence than those without a stoma . Colleagues and employers were usually supportive although some patients encountered discrimination especially those with a stoma or working in the food industry . Few patients had been counselled on their work . In general employment prospect s and time off work were good and employers should be encouraged to take an optimistic and supportive role . Doctors should consider that convalescence after surgery may be longer than they perceive and must provide better counselling for patients Goals : Unemployment and disability rates in Crohn 's disease patients from the ACCENT I trial were assessed . Factors associated with employment and disability status were explored . Background : Limited data regarding unemployment and disability status in patients with active Crohn 's disease are available . Study : Baseline data were used to assess unemployment and disability rates . Logistic regression analysis examined factors that were associated with employment and disability status . Analysis of variance was used to compare quality of life . Results : The baseline full- and part-time employment rates were 48 % and 13 % , respectively , with 39 % of patients unemployed and 25 % receiving disability compensation . Only 14 % of 225 unemployed patients felt well enough to work if a job were available . Younger age , female gender , shorter disease duration , and prior bowel resection predicted a higher likelihood of unemployment . Younger age and female gender also predicted a higher likelihood of not being employed full-time . Prior bowel resection predicted a higher likelihood of receiving disability compensation . Quality of life ( Inflammatory Bowel Disease Question naire , Short Form-36 ) scores were significantly higher in employed patients . Conclusions : Patients with moderately to severely active Crohn 's disease had low employment and high disability rates . Given their economic importance , assessment of these outcomes should be integrated into future evaluations of therapy , including clinical trials 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 BACKGROUND AND AIMS Patient education is accepted in many disciplines as a valid component of disease management in chronic diseases . The aim of this prospect i ve study was to analyze the effects of an education program in patients with inflammatory bowel disease . METHODS 145 patients with inflammatory bowel disease were prospect ively included : 73 were  educated in four sessions  , 72 were  educated after the one year evaluation period ( control group ) . The following topics were presented : pathogenesis , diagnostic procedures , course of disease , medical and surgical treatment , nutrition , social problems and support , stress management , and coping with the disease . RESULTS The repeated measurement two-way analysis of variances showed no effects of the patient education program on disease-related knowledge , depression and quality of life . CONCLUSION This patient education program was not able to increase disease-related knowledge or psychosocial variables in patients with IBD . However , most of the patients were very satisfied with the education program , since as judged by their own assessment it helped them to act responsibly for themselves and their disease 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 Background Inflammatory bowel diseases ( IBD ) such as ulcerative colitis ( UC ) and Crohn 's disease ( CD ) have great impact on patients ' health‐related quality of life ( HRQOL ) . The aim of this study was to develop an integrated medical and psychological/psychosocial group‐based intervention program for IBD patients and to evaluate if such a program could influence the patients ' HRQOL and coping abilities . Methods IBD patients in remission or with low disease activity were r and omized to intervention or control groups . The intervention comprised nine weekly sessions , alternating lectures , and group therapy sessions .  The Inflammatory Bowel Disease Question naire ( IBDQ ) and the Sense of Coherence scale ( SOC ) were used to measure HRQOL and coping ability at 0 , 6 , and 12 months . The intervention was evaluated by a  visual analog scale (  VAS ) and written comments  by a content analysis . Results In all , 24 patients were included in the intervention group and 20 in the control group .  The mean IBDQ score showed no statistically significant differences before ( 173.9 ) or after the intervention at month 6 ( 175.7 ) or at month 12 ( 171.8 ) , or when comparing intervention and controls at month 12 . Similarly , there were no statistically significant differences in mean SOC before or after intervention or when comparing groups . The VAS and the content analysis showed that the intervention was well appreciated by the patients . Conclusions The group‐based intervention program was feasible and highly appreciated . There were no statistically significant differences in average IBDQ or SOC over time or in comparison with controls , although a significant increase was seen in patients with short disease duration . ( Inflamm Bowel Dis 2007 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 compare the work disability ( WD ) rate in inflammatory bowel disease ( IBD ) patients 10 years after disease onset , with the WD rate in the background population , and to assess whether clinical or demographic factors in the early disease course could predict WD after 10 years disease . Design A large , population -based inception cohort ( the Inflammatory Bowel in South Eastern Norway cohort ) was prospect ively followed up at 1 , 5 and 10 years after diagnosis . At the 10-year follow-up data on WD were collected . Data on  disability pension ( DP )  in the background population were retrieved from public data bases . We calculated overall and age-st and ardised relative risks ( RR ) for  DP .  Logistic regression analysis was used to examine predictive factors . Results A total of 518 patients completed the 10-year follow-up ( response rate 83.5 % ) . The overall disability rate in the IBD population was 18.8 % , and the RR was 1.8 ( 95 % CI 1.4 to 2.3 ) for ulcerative colitis ( UC ) and 2.0 ( 95 % CI 1.4 to 2.7 ) for Crohn 's disease ( CD ) . The RR for DP was highest in patients aged below 40 years while patients aged over 60 years had no increased RR . Steroid treatment at the 1-year follow-up predicted WD after 10 years disease in both CD and UC . In UC , increased C-reactive protein ( CRP ) or erythrocyte sedimentation rate ( ESR ) at diagnosis , early colectomy , and more than two relapses during the first year of the disease also predicted WD . Conclusion Ten years after disease onset IBD patients had an increased RR for DP as compared with the background population . The youngest patients had the highest RR . Markers of severe disease course predicted WD 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 OBJECTIVE To investigate the relationship between inflammatory bowel disease ( IBD ) patients ' disease-related worries and concerns and their disease-related data , sociodemographic variables and perceived information level with respect to IBD . STUDY DESIGN Prospect i ve evaluation of disease-related concerns . SETTING Out-patient IBD clinic of a university hospital . STUDY POPULATION The study included 105 patients with IBD ( 72 with Crohn 's disease and 33 with ulcerative colitis ) . MEASUREMENTS Worries and concerns were measured using the st and ardized 25-item rating form of IBD patient concerns ; actual disease activity was assessed by physicians using the Crohn 's disease and clinical activity indices . Sociodemographic and other disease-related data were collected using a structured question naire . Patients '  perceived information level was measured using a visual analogue scale . RESULTS The issues of greatest concern to our patients were , in descending order of importance , having an ostomy bag ( mean score + /- SD 63.6 + /- 38 ) , the effects of medication ( 53.1 + /- 34 ) , having surgery ( 51.6 + /- 36 ) , the uncertain nature of the disease ( 46.5 + /- 32 ) and energy level ( 41.5 + /- 34 ) . Patients with ulcerative colitis scored higher with respect to concern about loss of bowel control ( P < 0.03 ) . Disease-related worries and concerns correlated poorly with disease-related data ( actual disease activity , severity of the course of IBD , diagnosis , disease duration or location , medication ) but showed a significant negative correlation with patients ' perceived information level about IBD ( t = 0.2 , P < 0.004 ) . Lower information-level scores were associated with greater concerns . CONCLUSION We conclude that the patients ' information level about IBD and disease-related concerns have to be considered in clinical practice . Better information about IBD and psychosomatic counselling for patients who show high levels of concern may improve their quality of life and clinical care 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 AIM Health related quality of life is impaired in patients suffering from inflammatory bowel disease . Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life , this has never been demonstrated . METHODS Physical and psychological well-being were assessed using question naires administered to 100 out- patients in the United Kingdom suffering from inflammatory bowel disease , 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis . A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline , 6 and 12 months . RESULTS Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity , although none were severely ill during the course of the study . Medical therapy was similar in both groups throughout the duration of the trial . The mean Short Form 36 ( SF-36 ) scores for mental health were low in inflammatory bowel disease patients ; 62.9 + /- 9.1 ( SD ) in ulcerative colitis , 60 + /- 9.8 ( SD ) in Crohn 's disease , compared with 72.4 + /- 7.2 ( SD ) in healthy controls ( P < 0.05 ) . Mean SF-36 scores for social function were also reduced in Crohn 's disease patients ; 68.4 + /- 10.1 ( SD ) in Crohn 's disease , compared with 87 + /- 10.1 ( SD ) in healthy controls ( P < 0.05 ) . As expected , the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 + /- 1.5 ( SD ) compared with 82.4 + /- 14 ( SD ) in healthy controls ( P < 0.05 ) . Crohn 's disease patients were significantly more anxious than the other groups , mean HAD score was 10 + /- 3.7 ( SD ) in Crohn 's disease patients and 6.86 + /- 3.5 ( SD ) in healthy volunteers ( P < 0.05 ) , although mean HAD scores for depression were similar in all groups . Maladaptive coping mechanisms were present in a significant proportion of Crohn 's disease patients . At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn 's disease patients without significant change in the mean physical disease index . CONCLUSION Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months This study examined the effects of work-related multidisciplinary rehabilitation ( MR ) on occupational participation in patients with chronic musculoskeletal disorders . A r and omized-controlled trial was carried out . The sample included patients with chronic musculoskeletal disorders and severe restrictions of work ability ( n=222 ) . Participants in the intervention group received a work-related rehabilitation programme following a comprehensive functional capacity evaluation ( FCE MR ) . Controls completed a conventional MR . The analysis was based on 1-year follow-up data . The primary outcome was stable occupational participation ( SOP ) , defined as employment with at most 6 months of sick leave after rehabilitation . The secondary outcomes were the duration of sick leave , employment status and the Pain Disability Index .  We included 102 patients in our analysis ( intervention : n=55 ,  control : n=47 ) . Despite r and omization there were group differences . Adjusting these differences , patients of the FCE MR had 3.5 times higher odds of SOP [ 95 % confidence interval ( CI ) : 1.2–9.8 , P=0.018 ] . However , there was neither a significant difference in the duration of sick leave between both groups ( b=−8.0 weeks , 95 % CI : −17.4 to 1.4 , P=0.095 ) nor higher odds of employment in favour of the FCE MR after 1 year ( odds ratio=2.3 , 95 % CI : 0.9–5.8 , P=0.088 ) . Participants in the FCE MR reported less pain-related disabilities ( b=−6.5 , 95 % CI : −12.6 to −0.4 , P=0.038 ) . The study had a limitation in terms of group balance . However , the findings indicate that the work-related FCE MR was more effective for SOP , but did not significantly affect employment rate and sick leave duration Abstract Introduction : Inflammatory bowel disease ( IBD ) is a chronic condition that afflicts young adults in their economically productive years . The goal of this study was to determine the costs of IBD in Germany from a societal perspective , using cost diaries . Methods : Members of the German Crohn ’s Disease and Ulcerative Colitis Association who had IBD were recruited by post , and those who agreed to participate documented their IBD-associated costs prospect ively in a diary over 4 weeks . They documented their use of healthcare facilities , medications , sick leave and out-of-pocket expenditures , as well as general demographic information , the status and history of their IBD , and long-term disability . Item costs were calculated according to national sources . Cost data were calculated using non-parametric bootstrapping and presented as mean costs ( year 2004 ) over 4 weeks . Results : The cost diaries were returned by 483 subjects ( Crohn ’s disease : n = 241 , ulcerative colitis : n = 242 ) with a mean age of 42 years and an average disease duration of 13 years ( SD ± 8.09 ) . The cost diaries were regarded as ‘ easy to complete ’ by 89 % of participants . The mean 4-week costs per subject were € 1425 ( 95 % CI 1201 , 1689 ) for Crohn ’s disease and € 1015 ( 95 % CI 832 , 1258 ) for ulcerative colitis . Of the total costs for Crohn ’s disease , 64 % were due to indirect costs such as early retirement or sick leave and 32 % were due to direct medical costs . In contrast , of the total costs for ulcerative colitis , 41 % were due to direct medical costs and 54 % to indirect costs . Conclusions : This is the first comprehensive cost study for Crohn ’s disease and ulcerative colitis in Germany . The most important economic factors that influenced the cost profiles of both diseases were the long-term productivity losses due to an ongoing inability to work and the cost of medications . Results indicate significant cost differences between Crohn ’s disease and ulcerative colitis . This data provides initial cost estimates that can be analysed further with respect to cost determinants and disease-specific costs in the future BACKGROUND AND AIMS Crohn 's disease negatively affects patients '  quality of life and ability to work . We investigated the impact of adalimumab on work productivity , daily activities , and quality of life in an open-label trial ( N=945 ) . The population comprised both infliximab-naïve and -exposed patients , including infliximab primary non-responders . METHODS Patients received adalimumab induction therapy ( 160 mg/80 mg at Weeks 0/2 ) , followed by adalimumab 40 mg every other week for up to 20 weeks ( patients with flares/non-response could receive 40 mg weekly at/after Week 12 ) . The Work Productivity and Activity Impairment Question naire and Short Inflammatory Bowel Disease Question naire were assessed . Indirect cost savings were estimated based on the average work productivity improvements at Week 20 . RESULTS Mean baseline scores indicated severe productivity impairment and poor quality of life . At Week 20 , 60 % of infliximab-naïve and 47 % of infliximab primary non-responders achieved clinical ly important improvements ( ≥9 points ) on the Short Inflammatory Bowel Disease Question naire , and 51 % and 43 % , respectively , achieved the minimum clinical ly important difference ( improvement ≥7 percentage points ) for total work productivity impairment ( non-responder imputation ) . At Week 20 , 64 % of infliximab-naïve and 55 % of infliximab primary non-responders achieved clinical ly important improvements in total activity impairment . Estimated 20-week total indirect productivity-related cost savings were € 3070 per infliximab-naïve patient and € 2059 per infliximab-exposed patient . CONCLUSIONS Adalimumab therapy significantly improved work productivity and disease-specific quality of life for patients with moderate to severe Crohn 's disease . Patients who failed prior infliximab therapy and patients naïve to infliximab benefited from adalimumab , with potentially greater benefits for  infliximab-naïve patients ( NCT00409617 ) OBJECTIVE Goal setting and motivational factors are strongly associated with maintaining a job and return to work after sick leave , but research into the effects of interventions targeting these factors is limited . We conducted a r and omized controlled study to examine the vocational effect of intervention focusing on motivation , goal setting and planning for return to work . DESIGN AND METHODS Of 243 patients at risk of long-term sick leave or job dropout , 184 ( 76 % ) provided complete baseline information for the study . After r and omization to an intervention group ( n=92 ) and a reference group ( n=92 ) , occupational physicians examined the participants in accordance with st and ard guidelines . The intervention group received additional support from a social worker in order to enhance goal setting , motivation and planning for return to work . After 1 year 163 participants ( 89 % ) provided data on general health and employment status . The risk of not being gainfully employed was analysed by logistic regression analysis with adjustment for several covariates . RESULTS The intervention did not increase the likelihood of gainful employment after 1 year or reduce the average number of days of sick leave . CONCLUSION A low-cost counselling program addressing motivation , goal setting and planning for return to work did not improve vocational outcomes or reduce sick leave among patients with work-related disorders
The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used .
Inflammatory bowel disease patients experience a high burden in work-related outcomes .
BACKGROUND & AIMS Inflammatory bowel disease has considerable effects on work-related outcomes and leads to high societal costs due to sick leave and disability pension .
The aims of this study were to systematic ally review evidence on work-related outcomes that are relevant to productivity losses and to evaluate whether medical or surgical interventions have a positive impact on patients ' work ability .