クローン病患者への食事指導プログラムの開発と有効性の検証

Development and Effectiveness of a Dietary Education Program for Patients with Crohn's Disease

要旨

　目的：クローン病患者が症状の寛解を維持し，食事満足度が向上することを目的に食事指導プログラムを開発し，その有効性を検証した．

　方法：開発した食事指導プログラムは，試し体験行動の強化を図るために患者によるセルフモニタリング，弁別，医療者による評価のフィードバックで構成した．ランダム化比較デザインのもとベースライン，介入，フォローアップの3期，各期8週間から成る実験計画を用いた．参加者は介入群10名，対照群11名であった．両群とも4週間ごとに計7回，質問紙調査を行い，アウトカム指標としたデータを収集した．

　結果：介入群において，介入により試し体験行動が有意に増加した．ただし，フォローアップ期には減少した．疾患の増悪はなく，食事満足度に有意な変化はなかった．

　結論：本プログラムは，患者が疾患の増悪を起こすことなく，試し体験行動を増加させる上で有効であった．今後，その効果を維持させるための仕組みをプログラムに組み込む必要性が示唆された．

Abstract

　Purpose: To develop a dietary education program for patients with Crohn's disease (CD) aiming to maintain remission and improve their satisfaction with meals, and to examine the effectiveness of the program.

　Method: The core of the program consisted of self-monitoring by patients and feedback of evaluation by healthcare providers. The developed program comprised three periods such as baseline, intervention, and follow-up; each period lasted for 8 weeks (total, 24 weeks). Participants were randomly assigned to the experimental group who entered the education program (n=10) or control group (n=11). Both groups filled out questionnaires to measure outcomes every 4 weeks, in total 7 times.

　Results: In the experimental group the frequency with which patients tried food increased significantly during the intervention period but decreased significantly during follow-up (p＜0.01). The health condition of the experimental group did not become worse. There were no significant differences in participants' satisfaction with meals between the two groups and for each period.

　Conclusion: This program helped CD patients to increase the frequency with which they tried food maintaining health condition. The results suggest that the program should incorporate devices to maintain these effects.