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P034 The IBD-Cope: A new instrument for measuring coping in Inflammatory Bowel Disease patients

A. McCombie*1, A. Swaminathan2, R. Mulder1, R. Gearry3

1University of Otago, Medicine, Christchurch, New Zealand, 2University of Otago, Christchurch Hospital, Department of Medicine and Gastroenterology, Christchurch, New Zealand, 3University of Otago, Christchurch Hospital, Medicine and Gastroenterology, Christchurch, New Zealand

Background

Inflammatory bowel disease (IBD) has a major impact on psychological wellbeing. Coping is the cognitive and behavioral efforts to mitigate the burden of a stressor, such as a chronic illness [1] . Coping has often been associated with disease activity and health related quality of life (HRQOL) [2] . There is no IBD specific coping instrument. A disease specific approach is likely to improve the predictive power [3] . We aimed to develop a brief, IBD-specific questionnaire (IBD-Cope) to assess coping strategies and to determine whether it has test-retest reliability and validity.

Methods

Twenty items were initially selected for the questionnaire. Participants were recruited from a database. Test-rest reliability was performed on these questions and intraclass correlation coefficients (ICC) determined the most pertinent items (ICC>0.65). Exploratory factor analysis (EFA) led to subscale determination. Sum scores of IBD-Cope subscales were tested against Brief Cope subscales and the IBD questionnaire (IBDQ). Re-validation of the IBD-Cope was performed on participants from the general outpatient setting.

Table 1 Demographics of study samples.

Test-rest reliability sample (n=58)Initial validation sample (n=199)Re-validation sample (n=179)
Age44.3 (16.5)38.8 (12.3)38.3 (13.0)
Male sex15 (25.9%)71 (35.7%)82 (45.8%)
Diagnosis Crohn’s disease40 (69.0%)137 (68.8%)124 (69.3%)

Table 2 Good and bad coping strategies

Good copingBad coping
Have you used relaxation techniques (e.g. meditation, progressive muscle relaxation, yoga) to help you deal with your stress?Have you laid awake worrying about your IBD or other things in your life?
Have you altered your diet in an attempt to improve your IBD?Have you NOT taken your medication?
Have you tried to take positives out of your IBD? (e.g., it makes me a stronger person”)Have you blamed yourself for making your IBD worse?

Results

Table 1 shows the demographics of the recruited participants.

Test-retest reliability revealed 8/20 questions with ICC>0.65. EFA produced two components that explained 42% of the variance, and reflected “good” and “bad” coping. Good and bad coping on IBD-Cope was positively associated with adaptive (r=0.57, p<0.01) and maladaptive coping (r=0.55, p< 0.01) on Brief Cope, respectively. Re-validation of the IBD-Cope showed three items consistently grouping into both good and bad subscales (Table 2).

Bad coping in IBD-Cope is negatively correlated with IBDQ scores (r=-0.51, P< 0.01). Good coping is not significantly associated with IBDQ scores (r=-0.12, P >0.05).

Conclusion

The IBD-Cope is a concise, reliable, valid and IBD-specific questionnaire. IBD-Cope subscales are moderately correlated with adaptive and maladaptive subscales on the Brief Cope. Higher scores of bad coping on IBD-Cope are associated with lower HRQOL as measured by IBDQ. Further longitudinal studies utilizing the IBD-Cope are required to determine its accuracy for identifying IBD patients who may benefit

from interventions to improve coping strategies.

References:

[1] Penley, J. A., Tomaka, J., & Wiebe, J. S., (2002), The association of coping to physical and psychological health outcomes: a meta-analytic review., Journal of Behavioral Medicine, 551-603

[2] Dorrian, A., Dempster, M., & Adair, P., (2009), Adjustment to inflammatory bowel disease: The relative influence of illness perceptions and coping. , Inflammatory Bowel Diseases, 47-55

[3] McCombie, A. M., Mulder, R. T., & Gearry, R. B., (2013), How IBD patients cope with IBD: a systematic review. , Journal of Crohn's & colitis