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P580 Improvement in disease activity is associated with less disability in a prospective study of paediatric transition patients with IBD

S. Picardo*1, R. Panaccione1, G. Kaplan1,2, C. Seow1,2, J. deBruyn3, Y. Leung1,4

1Univeristy of Calgary, Inflammatory Bowel Disease Unit, Calgary, Canada, 2University of Calgary, Community Health Sciences, Calgary, Canada, 3University of Calgary, Pediatric Gastroenterology, Calgary, Canada, 4University of British Columbia, Inflammatory Bowel Disease Unit, Vancouver, Canada

Background

The transition from paediatric to adult healthcare in patients with inflammatory bowel disease (IBD) occurs at an important time in a child’s psychosocial development and can impact education, employment, social integration and result in significant disability. A structured transition may limit disability and reduce the impact of disability over time. Our aims were to assess the change in disability over time in paediatric transition patients, who underwent a structured transition, using the validated Inflammatory Bowel Disease Disability Index (IBD-DI) and to assess the responsiveness of this index to change.

Methods

59 patients (aged 18–25) that had recently transitioned to adult care at the University of Calgary, were identified from a cohort of 200 patients recruited to undertake the IBD-DI. A research coordinator administered the IBD-DI with a repeat assessment at 12 months. Demographic and clinical data including measures of disease activity were collected from participants as well as medical chart and database review. Baseline IBD-DI scores were compared using the Mann–Whitney-U test. The Wilcoxon signed rank test with calculation of an effect size and standardised response mean were used to analyse change in IBD-DI scores over time, in groups based on change in disease activity.

Results

Baseline mean IBD-DI scores for the 59 transition patients was 20.69 ± 13.19 (range 0 to 54.41) and did not differ significantly from 141 adult patients (mean age 41.39) with mean scores of 24.90 ± 14.18 (range 1.47 to 70.59) (p = 0.08.) 50 out of 59 participants completed the follow-up assessment at 12 months. Disease activity over time improved in 5 patients, worsened in 5 and were stable in 39 patients. One patient had missing disease index measures and clinical status could not be classified. There was a significant reduction in IBD-DI scores for those with clinical improvement (−17.94, ES >−1, p = 0.04) and a significant increase in IBD-DI scores in those that with clinical deterioration (+23.53, ES >1, p = 0.04). There was a reduction in the IBD-DI scores over the 12-month time period, in patients with stable disease activity, (−2.68, ES=0.20, p = 0.15), however, this was not statistically significant.

Table 1. Mean change in IBD-DI and effect size based on whether disease improved, was stable or worsened.

Disease ActivityImproved (n = 5)Stable (n = 39)Worsened (n = 5)Overall (n = 50)
IBD-DI- Baseline36.647(10.926)19.042(13.201)23.824(13.851)20.625(13.511)
IBD-DI- 12 months14.706(10.757)16.365(12.624)47.353(10.263)19.382(15.198)
Change in IBD-DI−17.941 (11.737)−2.677(11.470)23.530(11.532)−1.242(14.893)
ES>−1.0−0.203>1.0−0.060
SRM13.094.64−40.782.15
p value0.0430.1470.0420.390

Conclusion

Transition patients have similar disability scores as compared with an adult cohort. There was a significant reduction in IBD-DI scores for those with clinical improvement. The IBD-DI demonstrates significant responsiveness to changes in disease activity over time, a factor that was not evaluated in the initial validation study of the index.