Cognitive Behavioral Therapy-Based Comprehensive Self-Management Program Improves Presenteeism in Persons with Irritable Bowel Syndrome: A Secondary Data Analysis

Int J Environ Res Public Health. 2022 Mar 4;19(5):3003. doi: 10.3390/ijerph19053003.


Pei-Lin Yang 1Sarah W Matthews 2Robert L Burr 3Kevin C Cain 4 5Pamela G Barney 3Jasmine K Zia 6Margaret H Heitkemper 3Kendra J Kamp 3


Author information

1School of Nursing, National Defense Medical Center, Taipei 114, Taiwan.

2Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA 98195, USA.

3Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA 98195, USA.

4Office of Nursing Research, School of Nursing, University of Washington, Seattle, WA 98195, USA.

5Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.

6Department of Gastroenterology, Swedish Medical Center, Seattle, WA 98104, USA.


Individuals with irritable bowel syndrome (IBS) are more likely to miss work (absenteeism), have reduced work effectiveness (presenteeism) and experience activity impairment. This study compared the effect of a comprehensive self-management (CSM) intervention program (incorporating cognitive behavioral therapy, diet education and relaxation) versus usual care on work- and activity-impairments in adults with IBS. This secondary data analysis used daily diaries and Work Productivity and Activity Impairment in Irritable Bowel Syndrome (WPAI-IBS) questionnaire data collected at baseline, 3, 6 and 12 months post-randomization from 160 adults with IBS. Mixed-effects modeling was used to compare the effect of CSM versus usual care on work- and activity-related outcomes. The effect of CSM was shown to be superior to usual care in improving WPAI-IBS and diary-measured presenteeism, overall work productivity loss and activity impairment with sustained effects up to 12 months post-randomization (all p < 0.05). Moreover, the CSM intervention was found to be particularly beneficial for IBS patients with greater baseline work and activity impairments (all p < 0.05). The CSM intervention may bring benefits to individuals and society through improving symptoms and reducing presenteeism associated with IBS.



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