Disease Acceptance, but not Perceived Control, is Uniquely Associated with Inflammatory Bowel Disease-related Disability

Background and Aims: Disability, an important aspect of disease burden in patients with inflammatory bowel disease [IBD], has been suggested as a valuable clinical endpoint. We aimed to investigate how disease acceptance and perceived control, two psychological predictors of subjective health, are associated with IBD-related disability. Methods: In this cross-sectional study, adult IBD patients from the University Hospitals Leuven received a survey with questions about clinical and demographic characteristics, disease acceptance and perceived control [Subjective Health Experience model questionnaire], and IBD-related disability [IBD Disk]. Multiple linear regressions assessed predictors of IBD-related disability in the total sample and in the subgroups of patients in clinical remission or with active disease. Results: In the total sample (N 1250, 54.2% female, median [interquartile range: IQR] age 51 [39-61] years, 61.3% Crohn's disease, 34.9% active disease), adding the psychological predictors to the model resulted in an increased explained variance in IBD-related disability of 19% compared with a model with only demographic and clinical characteristics [R²_adj 38% vs 19%, p <0.001]. The increase in explained variance was higher for patients in clinical remission [ΔR²_adj 20%, p <0.001] compared with patients with active disease [ΔR²_adj 10%, p <0.001]. Of these predictors, disease acceptance was most strongly associated with disability in the total sample [β -0.44, p <0.001], as well as in both subgroups [β -0.47, p <0.001 and β -0.31, p <0.001 respectively]. Perceived control was not significantly associated with disability when accounting for all other predictors. Conclusions: Disease acceptance is strongly associated with IBD-related disability, supporting further research into disease acceptance as a treatment target.