gms | German Medical Science

Background/research question: High-quality standard meta-analysis of health care interventions typically requires a focused study question. A broader approach may be necessary where treatments are very variable, for example, combining various modules in varying combinations. In these situations, component network meta-analysis (CNMA) can be helpful [1]. We used this technique to examine the effects of various components and combinations of psychological therapy on quality of life (QL) in inflammatory bowel disease (IBD).

Methods: The analyses are based on a recent update of our Cochrane systematic review on psychological interventions in persons of any age with IBD and were restricted to randomized controlled trials [2]. Psychological interventions were defined as any non-pharmacological treatment targeting cognitive or emotional processing and could include psychotherapy, educational interventions and relaxation techniques, as well as any combinations of these. Cochrane standards were used to search trials, assess study quality, and extract data for analysis. Components were identified and classified independently by two psychologists (NTS, AB) and checked for correctness by an experienced psychotherapist/gastroenterologist (GM). Additive CNMA and CNMA considering potential interactions between modules were performed using R [3], based on random effects modelling. Results are presented as standardized mean differences (SMD) with 95% confidence intervals (CI), using care as usual (CAU) for comparison.

Results: 68 eligible trials were identified, of which 39 could be included in the CNMA presented in this abstract (4,249 patients). We classified ten different components, which were tested in various combinations or alone. Almost all trials used CAU as a comparison. A single-component effect (SMD=0.40, CI: 0.15–0.66) was shown for cognitive-behavioural therapy (CBT). The effect was further improved when CBT was combined with relaxation techniques (Yoga and other relaxation) (SMD=0.56, CI: 0.15–0.97). Health education had a small positive effect (SMD=0.22, CI: 0.03–0.41). We did not see relevant effects for other components, such as mindfulness-based treatment, psychoeducation, hypnotherapy, or any combinations not including CBT. However, for some treatments, this may be due to insufficient power.

Conclusion: Multimodule interventions pose specific problems for evidence synthesis. CNMA is a helpful tool to disentangle the effects of different therapy components.