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P605 Development and validation of an objective disability index for Inflammatory Bowel Disease patients (ODIBD)

Melcarne, L.(1);Vergara Gómez, M.(1);Villoria Ferrer, A.(1);Brunet Mas, E.(1);Garcìa Iglesias, P.(1);Llovet Soto, L.(1);Dosal Galguera, A.(1);Monllor Nunell, T.(1);Alforcea Alcaraz, S.(1);Calvet Calvo, X.(1);

(1)Hospital Universitari Parc Taulì, Digestive Disease, Sabadell Barcelona, Spain

Background

Inflammatory Bowel Disease (IBD) can be a cause of disability. To date, the scores that evaluate disability in IBD patient use mainly subjective criteria. The aim of this study was to develop and validate an index of disability in IBD based on objective, measurable criteria.

Methods

IBD patients from the Catalan and Spanish Crohn and Colitis Associations volunteered to fulfill an online self-administered survey. Demographic, clinical, and therapeutic variables were collected. They also informed on whether they have a recognized disability and whether they receive a work disability pension.
Patients were divided into a training and validation set. In the training set, different multivariate analyses were carried out to evaluate objective variables related to having a recognized work disability, a general disability or a moderate or severe degree of disability.
The score was elaborated with the statistically or clinically significant variables present in the multivariate analyses.
The ROC curves for predicting general and work disability were calculated.

Results

981 valid surveys were included. Sixty six percent of the patients were women, mean age was 40.9 years and 59.3% had Crohn's disease. Of these patients, 85 (9.1%) had a recognized work disability and 429 (45.9%) had a degree of recognized general disability. The results of the multivariate analyses are shown in table 1.
Eight variables were selected to develop the inflammatory bowel disease objective work disability index (ODIBD) (table 2). Each variable was scored one point to calculate the final index.
The AUROC of the index in the training group was 0.76 for work disability and 0.71 for general disability. The AUROC of the index in the validation group was 0.83 for work disability and 0.67 for general disability (fig1).

Table1: Multivariate analyses

Work disabilityGeneral disability Severity of disability
OR p-value OR p-value OR p-value
Age 1.04(1.01-1.08) 0.01
Disease’s evolution time 6.3(3.7-10.9) <0.001 3.7(1.8-7.2) <0.001
Immunosuppressant therapy 2.1(1.4-3.4) 0.001
Faecal incontinence 0.7 0.6 0.2
Bowel movements3.4(1.4-8.4) 0.008
Surgeries 4.7(2-10.8) 0.001 5.5(2.6-11.5) <0.001 4.1(2.1-7.8) <0.001
Psychiatric comorbidity 2.6(1.6-4.3) <0.001 1.7(1.1-2.9) 0.02
Ostomy 3.3(1.1 – 10.3) 0.03  
Arthropathy 1.5(1.1-2.3) 0.03 1.6(1.1-2.6) 0.04
BMI<18.53.5(1.3-9.5)
Medical examinations in the last year 2.4(1.1-5.4)

Table 2: IBD-OWDI

Age >50 years
Disease’s evolution time >5 years
Liquid fecal incontinence YES
Bowel movement per day > 6
Psychiatric comorbidity YES
Surgeries >2
Ostomy YES
Arthropathy YES



Figure 1: 
AUC of IBD-OWDI in validation set


Conclusion

The ODIBD may be useful score to objectively assess of work disability in patients with IBD.

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