Clinical Trials Logo

Clinical Trial Summary

Inflammatory Bowel Disease (IBD) affects 250,000 adults in the United Kingdom (UK) and causes bouts of diarrhoea which are hard to control. Over a quarter of patients experience extremely distressing faecal incontinence (FI). Even when the disease is in remission, the majority of patients live in fear of not finding a toilet in time. This curtails their activities and quality of life. The National Institute for Clinical Excellence (NICE 2007) has issued national guidance on actively asking patients about FI and a step-wise care plan for managing FI. However, this has not been evaluated in people with IBD, the vast majority of whom do not ask for help, even when they have frequent FI.

Across six expert centres in the UK, the investigators will perform 3 linked studies: [1] The investigators will screen people with IBD, offering the opportunity to obtain help with bowel control. The investigators will compare uptake of a postal approach versus response to a proactive face-to-face asking approach at a physical or telephone clinical appointment. [2] The investigators will conduct a randomised controlled trial (RCT) comparing two different approaches (IBD nurse specialist plus self-help booklet versus self-help booklet alone) to see which one produces the best results in terms of reductions in FI, other symptoms, costs and quality of life at 6 months after intervention. Booklet group participants may access the nurse intervention at 6 months if they wish, when the RCT is finished. [3] Interviews will be performed at the end of the intervention, gathering patient views and preferences and staff perspectives via Qualitative interviews and free text questionnaire comments, to enable a rich understanding and interpretation of our results.

The investigators will disseminate the results widely to people with IBD and health professionals and take active steps to embed successful interventions in NHS services, having gained sound evidence on how many people want help, whether intervention is effective in improving FI, and patient and staff views on interventions.


Clinical Trial Description

Inflammatory bowel disease (IBD) affects approximately 250,000 UK adults. It causes symptoms including diarrhoea and extreme faecal urgency and has an unpredictable relapsing-remitting course. A quarter of people with IBD report faecal incontinence (FI) and two-thirds have urgency, even when IBD is in remission. Although this limits peoples' lives, most do not seek professional help. No study has determined whether nationally recommended approaches to FI would help people with IBD.

Research question Does implementation of the nationally (NICE)-recommended approach to active case-finding and step-wise management of FI improve bowel control and quality of life in people with IBD.

The investigators will address 3 objectives:

1. To implement 'active case finding' for FI and life-restricting faecal urgency in people with IBD, monitoring uptake of the offer of help and investigating barriers to accessing care.

2. To determine the effectiveness of implementing the algorithm of care proposed by NICE for people with FI in a randomised controlled trial compared to provision of the same information in a self-management booklet. The trial will measure the effects of each intervention at 6 months after completion of the intervention.

3. To obtain detailed qualitative feedback from patients and staff on the best way of enabling health-seeking, the experience of the intervention and suggestions for future service developments.

Plan of investigation We will conduct research in 6 UK specialist IBD services, in two phases with an integral qualitative element.

Phase 1: active case finding: will (a) Compare active case finding rates of disclosure for FI as recommended by NICE by using a postal, telephone or face to face approach; and (b) Determine currently unmet need for intervention for FI. All hospitals will conduct postal case-finding (1000 people) and all will conduct face to face or telephone questioning (1000 people) to compare numbers reporting FI and uptake of offer of intervention.

Phase 2: randomised controlled trial 186 patients with IBD and FI will be recruited (from people wanting help in Phase 1) to a parallel multicentre RCT comparing 2 interventions: (a) CONSULT + BOOKLET: 3-4 face to face or telephone consultations with an IBD specialist nurse who has received extra training on FI plus provision of a booklet developed with IBD patients on self-help for FI; (b) BOOKLET: intervention is booklet alone. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT02355834
Study type Interventional
Source London North West Healthcare NHS Trust
Contact
Status Completed
Phase N/A
Start date May 2015
Completion date August 2017

See also
  Status Clinical Trial Phase
Recruiting NCT03825575 - Sacral Neuromodulation as Treatment for Fecal Incontinence N/A
Completed NCT00605826 - A Randomized, Blinded, Multicenter Study to Evaluate NASHA/Dx for the Treatment of Fecal Incontinence N/A
Withdrawn NCT02208258 - Efficacy, Safety, and Performance Study of a Novel Device Designed to Manage Fecal Incontinence in Hospitalized Bedridden Patients With Liquid to Semi-formed Stool. N/A
Completed NCT01957969 - French Post-Inscription Study on Sacral Neuromodulation in the Treatment of Fecal Incontinence N/A
Completed NCT01939821 - A Pilot Study to Evaluate Educational Programs to Improve Fecal Incontinence Care in Nursing Homes N/A
Completed NCT01710579 - Normal Values in Ano-rectal 3D High Resolution Manometry N/A
Recruiting NCT00530933 - Tibial Nerve Stimulation for Faecal Incontinence N/A
Withdrawn NCT00522691 - Efficacy of Sacral Nerve Stimulation Before Definitive Implantation N/A
Completed NCT00565136 - Evaluation of Outcomes of Restoring Pelvic Floor Support With TOPAS in Women With Moderate Fecal Incontinence Symptoms Phase 1/Phase 2
Completed NCT00677508 - Development of an Instrument to Measure Quality of Life in Children With Chronic Constipation and Soiling
Completed NCT05032534 - Examination of a New Irrigation System for Transanal Irrigation in Children With Fecal Incontinence N/A
Completed NCT05058326 - Severity of Fecal Incontinence and Manometric Values Using the Anopress® Device in Women
Completed NCT03746834 - NASHA/Dx as a Perianal Implant for the Treatment of Persistent Fecal Incontience After Anorectal Malformation Phase 4
Completed NCT00124904 - Biofeedback for Fecal Incontinence N/A
Completed NCT03028636 - LIBERATE - PRO: Eclipseâ„¢ System Registry
Completed NCT04097288 - Effects of Single Dose Citalopram and Reboxetine on Urethral and Anal Closure Function on Healthy Female Subjects Phase 1
Completed NCT05621629 - Management of FI After Surgery of ARM
Withdrawn NCT04138602 - BTL Emsella Chair Versus Sham for the Treatment of Fecal Incontinence N/A
Completed NCT04478799 - Transcutaneous Posterior Nerve Stimulation inTreatment of Fecal Incontience N/A
Completed NCT03252951 - Physical Therapy for Anal Incontinence N/A