Acceptance and perceived control are independently associated with quality of life in inflammatory bowel disease: Introduction of a new segmentation model.

BACKGROUND AND AIMS Segmentation of patients based on psychological determinants of subjective health may allow new ways to personalized care. The cross-disease segmentation model developed by Bloem & Stalpers discriminates patients based on disease acceptance and perceived control. We aimed to validate the segmentation model, compare segments and evaluate whether segments independently correlate with quality of life in IBD. METHODS A cross-sectional study of adult IBD patients was performed with questionnaires on quality of life (32-item IBDQ), acceptance and perceived control (6-items with 7-point Likert scale). Four segments were formed (cut-off>5): (I) high acceptance, high control; (II) high acceptance, low control (III); low acceptance, high control and; (IV) low acceptance, low control. RESULTS We included 686 patients. The acceptance and perceived control scale were unidimensional structured and internally consistent. Segments differed significantly in age, smoking behaviour, diagnosis, disease duration, extra-intestinal manifestations, IBD-medication, clinical disease activity and quality of life. High acceptance (s .25, p<0.001), high perceived control (s .12, p<0.001) or both (s .53, p<0.001), were associated with a significantly better HRQoL compared with low acceptance and low perceived control. Sociodemographic and clinical factors explained 25% of variance in quality of life. The explained variance significantly increased to 45% when the patients' segment was added to the model (ΔR 2 20%, p<0.001). CONCLUSIONS The segmentation model based on disease acceptance and perceived control is valid in IBD patients and discriminates different segments that correlate independently with quality of life. This may open new strategies for patient care.