Use of community resources before inflammatory bowel disease surgery is associated with postsurgical quality of life

BACKGROUND: Research in chronic illness shows that community resources can have a lasting influence on the course of the illness; however, little rese arch has been done to evaluate the community agencies that specifically add ress the needs of inflammatory bowel disease (IBD) patients. OBJECTIVES: To survey awareness of community agency resources among patient s who have surgery for IBD, and to analyze the association between using th ese resources and qualitative postsurgical outcomes. SUBJECTS AND METHODS: Ninety-two subjects who had surgery over a 12-month p eriod completed, in full, the Inflammatory Bowel Disease Questionnaire (IBD Q), and a self-report instrument used to probe awareness and use of local c ommunity resources. Community resources were divided into two groups: those involving primarily social and educational participation ('social/educatio nal') and those involving some individualized attention, usually from a pro fessional or trained lay facilitator ('professional/individual'). The contr ibution of presurgical participation in each type of resource to postsurgic al quality of life was tested using ANOVA, with IBDQ score as the dependent variable. The ANOVA was repeated with postsurgical disease activity as a c ovariable. IBDQ subscale scores were compared between groups that: were fou nd to differ in the ANOVA. RESULTS: Almost all subjects were aware of at least one avail able resource . Participation in resources before surgery was variable, but 50% of the sa mple participated in at least one social/educational resource, and 46.9% pa rticipated in at least one professional/individual support. For the 92 subj ects who completed both the IBDQ and the survey of resources, ANOVA reveale d a main effect of professional/individual resource use on postsurgical qua lity of life but no main effect of social/educational resources and no inte raction. DISCUSSION: The association between presurgical participation in profession al or individualized community resources and better subjective outcome of I BD surgery may be explained by a positive contribution of participation to coping with surgery for IBD. The data do not support the alternative explan ation that subjects with less severe disease (and thus better outcome) have greater ability to participate, although further research is required.