Assessment of health-related quality of life for patients with inflammatory bowel diseases in Palestine

Abstract

Abstract Background: Measuring patient’s quality of life (QoL) in chronic diseases is very important to assess disease outcomes and impact of intervention. Inflammatory bowel disease (IBD) has a large impact on patient’s QoL. Disease activity has been suggested as an important indicator for QoL in patients with IBD. Limited studies regarding association between medication adherence and QoL in IBD patients are available worldwide and data was conflicting. Therefore, this study was performed to examine the association between disease activity, medication adherence and its impact on QoL among IBD in Palestine. Also, this study aimed to determine the QoL profile, medication adherence for IBD patients and stated the factors associated with QoL. Methods: A correlation cross-sectional study was conducted from July 2017 to February 2018 at An-Najah National University Hospital, Nablus, Alia Governmental Hospital, Hebron and Dr. Khalil Suleiman Hospital, Jenin, Palestine. The disease specific tool inflammatory bowel disease questionnaire (IBDQ) was used to examine QoL. Medication adherence was measured using modified Morisky adherence scale8 (MMAS-8). The results were analyzed using Statistical Package for Social Sciences (SPSS) program version 20. Multiple linear regression analysis was performed to determine the most important variables related with QoL in IBD patients.

Results: One hundred and thirty two patients were involved in this study. Of them, about 58.3% are males with a mean ± SD for age of 34 ± 13 years ranged from 18-70 years. Active disease was reported in 81 participants (61.4%) in the previous 6 months. Using MMSA-8 questionnaire, low adherence was reported in 39.4% of the participants. The reported QoL of this study was measured by using the average IBDQ scores, which was 150.72 ± 30.08 and this is indicated a low QoL among Palestinian IBD patients. Emotional and bowel domains are more disrupted than other domains. Active disease was the major significant factor associated with IBD patients QoL in its all dimensional score (P- value<0.001). No significant association was found between medication adherence and patients QoL. Diagnosis (Type of disease) didn’t affect any IBDQ dimensional score. Regression analysis revealed that: patients with remission (r2 = 0.436, p-value <0.001), with high educational status (r2 =0.035, p-value =0.009) and using Azathioprine drug (r2 =0.017, p- value= 0.034) were independently associated with high QoL. Conclusions: This study shows a low QoL among Palestinian IBD patients compared to other countries and identified a number of significant associated factors that should be considered when dealing with IBD. Results of the study may help healthcare providers to identify patients at risk of low QoL especially those in the relapse status and active symptoms. Attention should be provided by healthcare givers and strategy makers to increase knowledge about IBD, to improve IBD patient’s QoL and to identify the importance of treatment adherence.