O61 Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis
Bibliographic record
Abstract
Introduction National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. Methods We searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane central register of controlled trials through January 2020 to identify randomised controlled trials (RCTs) assessing the efficacy of psychological therapies for adults with IBS. Trials included in the analysis reported a dichotomous assessment of symptom status after completion of therapy (≥4 weeks), and data were pooled using a random effects model. We examined 6 and 12-month outcomes, where reported. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% confidence interval (CI) to summarise efficacy of each comparison tested. Treatments were ranked by therapy according to P-score. Results We identified 41 eligible RCTs, containing 4072 participants. At the first point of follow-up, after completion of therapy, contingency management was ranked first, but 95% CIs were wide (RR of remaining symptomatic = 0.39; 95% CI 0.19 to 0.84, P-score 0.89), and this was based on only one small RCT (figure 1). The psychological interventions with the largest numbers of trials, and patients recruited, included self-administered or minimal contact CBT (RR = 0.61; 95% CI 0.45 to 0.83, P-score 0.66), face-to-face CBT (RR = 0.62; 95% CI 0.48 to 0.80, P score 0.65), and gut-directed hypnotherapy (RR = 0.67; 95% CI 0.49 to 0.91, P-score 0.57). CBT-based interventions and gut-directed hypnotherapy were the most efficacious long-term. Risk of bias of individual trials was high, meaning that the efficacy of all psychological therapies studied is likely to have been overestimated. Conclusions Several psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base. Future RCTs should examine the effect of psychological therapy earlier in the disease course, before patients are refractory to medical management.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.068 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.037 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".