S515 App-Delivered Gut-Directed Hypnotherapy Program Nerva Improves Symptoms in Patients With Irritable Bowel Syndrome but How Can We Ensure Users Are Compliant?

Abstract

Introduction: App-delivered gut-directed hypnotherapy (GDH) is an efficacious treatment for irritable bowel syndrome (IBS), reducing overall and individual gastrointestinal symptoms at similar rates to face-to-face delivery.1 However, program adherence is poor. This study aimed to retrospectively assess symptoms of patients with IBS undergoing the app-delivered GDH program Nerva and to assess whether healthcare provider (HCP) referral aids program adherence. Methods: 15,552 patients with self-reported IBS downloaded a 42-session mobile app-delivered GDH program ‘Nerva’. The first 7 sessions were free. Overall and individual gastrointestinal symptoms were assessed at baseline and 6 weeks after starting the program, using a 100-mm visual analogue scale (VAS). Psychological outcomes were measured using the PHQ4, which is validated to categorise likelihood psychological distress into normal (0-2), mild (3-5), moderate (6-8) and severe (9-12). Data were parametric and presented per protocol. Results: Out of 15,552 users, 3101 completed the program. Of those who completed the program, overall gastrointestinal symptoms improved by 28 mm, to a level that would be considered meaningful clinically (mean 67 mm to 39 mm; p< 0.001 t-test). In the those who did not complete the program, overall gastrointestinal symptoms still significantly improved, but to a smaller magnitude (68 mm to 58 mm). Similar results were seen with individual symptoms. Linear regression analysis indicated that users who completed the program were more likely to respond (p< 0.001). Total adherence rate was generally low, with only 20% of users completing the program. However, users who were referred to Nerva by a HCP were statistically more likely to complete the program (24%) compared with those self-referred (19%) (OR 1.3; p< 0.001 logistic regression). HCP referral did not alter gastrointestinal symptom response (p=0.024). Users who completed the program were more likely to improve psychologically (mean ∆3, shifting from moderate to mild distress, vs 1, p< .001). Conclusion: App-delivered GDH improves overall and individual gastrointestinal symptoms. Users who complete the program report greater improvement in psychological outcomes. HCP referral is a positive predictor of program completion, but does not alter rates of efficacy.