TY - JOUR
AU1 - BA, Manuel Y. Lam,
AU2 - PhD, Hang Lee,
AU3 - MS, Renee Bright,
AU4 - MD, Joshua R. Korzenik,
AU5 - MS, Bruce E. Sands, MD,
AB - Background The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a written, self-administered instrument measuring quality of life in IBD. We assessed the validity of an interactive voice response system (IVRS) as a new mode of administering the SIBDQ. Methods An IVRS was designed using prerecorded questions to collect data via touchtone telephone. Subjects with Crohn's disease (CD) or ulcerative colitis (UC) were randomized into 2 groups with different orders of administration: written, self-administered followed by IVRS (S-I) or IVRS followed by written, self-administered (I-S). Half of the S-I group was also randomized to receive a second IVRS. Sixty-four subjects were studied: 30 in S-I, 34 in I-S. Results The mean SIBDQ scores were not different between written and IVRS modes (P = 0.26) with r = 0.93. IVRS scores were lower in active than inactive CD (36.1 ± 9.6 versus 54.7 ± 8.6, P < 0.001) and lower in active than inactive UC (40.8 ± 9.6 versus 59.8 ± 10.0, P < 0.001). Mean scores correlated highly with disease activity indices, and were not different between first and second IVRS administrations (P = 0.85) with r = 0.92. IVRS had excellent internal consistency (Cronbach alpha = 0.90). Conclusions IVRS administration of the SIBDQ yields results similar to written self-administration, with excellent procedural validity, test–retest reliability, and internal consistency. Crohn's disease, ulcerative colitis, quality of life, health status instrument, interactive voice response system Crohn's disease (CD) and ulcerative colitis (UC), the 2 major forms of inflammatory bowel disease (IBD), are chronic conditions of the gastrointestinal tract that can cause abdominal pain, diarrhea, rectal bleeding, and a variety of systemic manifestations.1 The typical course consists of intermittent exacerbations alternating with periods of asymptomatic remission. However, the clinical course of IBD is highly variable, with some patients experiencing prolonged remission and others with unremitting symptoms and severe complications. The response to therapy is also variable. Some patients may respond readily to medical therapy, while others require increasingly potent medications with greater potential for side effects. Still others become refractory to medical treatment and require surgical intervention. As a patient's health experience broadly affects their sense of well-being, health-related quality of life (HrQoL) is an important metric in chronic diseases such as IBD.2,3 The Inflammatory Bowel Disease Questionnaire (IBDQ) was developed to encompass elements of social, systemic, and emotional symptoms as well as bowel-related symptoms, and can be used to monitor fluctuations in health status or response to treatment in clinical trials.3,4 This instrument has been shown to provide valid and reliable measurement of HrQoL that correlates highly with disease activity indices.5 The chronicity of symptoms, variable response to treatment, toxicities of medical therapy, and adverse effects of surgical intervention all may have a significant impact on HrQoL,2 yet maximizing HrQoL over the long-term course of disease is a major therapeutic goal. Short-term measurement of disease activity in randomized controlled trials may fail to account for the influence of each of these factors, and of the impact of practice variation on HrQoL as it is experienced over extended periods of time. Prospective observational cohort studies offer a unique opportunity to elucidate longitudinally the impact of these various factors on quality of life by prospectively and repeatedly recording self-reported outcomes over the long-term follow-up of patients in the course of their disease. However, this task has been logistically challenging because of the work burden of repeated administration of instruments to measure HrQoL. Several validated versions of the IBDQ have cut down on the work burden and have greatly increased the efficiency of instrument administration. First, the IBDQ was originally validated as an interviewer-administered instrument,4,–6 but was subsequently revalidated as a self-administered questionnaire.7 This lessens personnel labor time and costs of administration but may compromise completion rates by comparison to interviewer administration. Second, the IBDQ was refined into a 10-item questionnaire called the Short IBDQ (SIBDQ).8 Nevertheless, long-term large-scale studies could benefit from more streamlined and automated administration of this instrument without compromising completeness or accuracy. We propose that interactive voice response system (IVRS) technology offers the potential of harnessing the advantages of the interviewer-administered as well as written self-report formats. IVRS is a type of telephone interviewing in which prerecorded question sets prompt subjects and respondents provide answers via touchtone keypad or speech-recognition technology.9,–11 The subjects' responses are instantly uploaded into a Web-based database, which may immediately be accessed by the researcher to assess outcomes or by the primary healthcare provider to assist in decision-making to optimize therapy.12 Ultimately, if proven to be valid and accurate, IVRS-administered questionnaires could facilitate studies over wider geographical areas with higher follow-up ratings. Thus, the objectives of the present study were to validate an IVRS for the administration of the SIBDQ by comparing instrument characteristics to self-completed written administration of the SIBDQ. Materials and Methods Patient Populations Subjects ages 18 years and older with an established diagnosis of CD13 or UC14 by endoscopic, pathologic, or radiographic findings according to the criteria of Lennard-Jones15 were eligible for enrollment, provided they did not have a colostomy, ileostomy, or ileoanal anastomosis with pelvic pouch. Subjects were also excluded if they were unwilling to provide informed consent for study participation, if they could not read or write English, or if they had collagenous or lymphocytic colitis. All subjects were recruited from the Massachusetts General Hospital Crohn's & Colitis Center. The study was approved by the Institutional Review Board. Clinical Assessments Age, gender, race, and education were recorded in all subjects. At each assessment the physician evaluated disease activity by the Harvey–Bradshaw Index (HBI)16 in subjects with CD or the Simple Clinical Colitis Activity Index (SCCAI)17 in subjects with UC. For the HBI, inactive disease was defined as a score ≤3, and active disease was defined as a score ≥7.18 For the SCCAI, inactive disease was defined as a score ≤2, and active disease was defined as a score ≥5.19 Questionnaires In order to track disease stability, subjects were administered a single question to assess global disease-related health status. Subjects were asked to record an assessment of their current symptoms compared to 1 week prior on a 5-point Likert scale as “much better” (1), “somewhat better” (2), “about the same” (3), “somewhat worse” (4), or “much worse” (5). Stable disease activity was defined by a score of 3, indicating that the IBD-related symptoms and general well-being of the subject were “about the same” as 1 week ago. The SIBDQ is a self-administered questionnaire that is a shortened version of the 32-item IBDQ consisting of a subset of 10 questions from the full IBDQ.8 It accounts for 92% of variance in the IBDQ for CD and 90% for UC.8 Individual questions are graded on a 7-point Likert scale, from 1 (a very severe problem) to 7 (not a problem at all). SIBDQ scores are reported as the total score, which is obtained by summing the scores from each of the 10 questions. A maximum score of 70 indicates best possible IBD-related quality of life and a minimum of 10 indicates worst. As with the IBDQ, there are 4 domains within the SIBDQ covering issues of importance to HrQoL: social performance, emotional status, bowel function, and systemic symptoms. Administration takes less than 10 minutes on average. Interactive Voice Response System (IVRS) An IVRS application was developed over a 2-month period prior to the study. The process included system development, computer programming, call script writing, and voice recording. Supported by the service provider Voxeo (http://www.voxeo.com), the IVRS was programmed on a VoiceXML platform, which interfaced with a local Web server, consisting of an Apache HTTP Server, MySQL database, and interpreters for scripts written in the PHP programming language. The system contained functionality for the traditional dual-tone multifrequency (DTMF, i.e., touch-tones), as well as speech recognition technology. Our system used prerecorded question sets to collect data from subjects via DTMF only. A script was written for each question of the SIBDQ. A computer algorithm was programmed to control the flow of questions and prerecorded responses heard based on a subject's input. After programming the system, recording the content, and testing call flow, the IVRS went live on September 11, 2007. The system was able to receive calls from subjects who accessed the survey via telephone. A potential problem with telephone interviewing is difficulty with questions that require the person to choose among lengthy options lists. Accordingly, we provided the respondent with a card listing the response items. Subjects could enter their response after each question was presented to them by the IVRS system, or alternatively could choose a response item for each question immediately from the response item card. Study Procedures Subjects were administered the SIBDQ using both the self-administered written method and IVRS method. Subjects were randomized into 2 groups in a 1:1 ratio according to the administration procedure order: 1) self-administered questionnaire followed by IVRS-administered (S-I); 2) IVRS-administered questionnaire followed by self-administered (I-S). Subjects randomized to the I-S group were first instructed to call to take the IVRS-administered SIBDQ. The call was logged into the computer and the self-administered questionnaires were subsequently mailed to addresses designated by the subject. E-mail or telephone reminders were sent to remind subjects to fill out their questionnaires. Approximately 7 days (±3 days) after the IVRS administration, subjects were instructed to complete the written self-administered questionnaires. Completed questionnaires were either mailed back in a stamped, self-addressed envelope or faxed back. Subjects randomized to the S-I group were first mailed the self-administered written questionnaires. E-mail or telephone reminders were sent to remind subjects to fill out their questionnaires. Subjects were instructed to call in to take the IVRS-administered SIBDQ ≈7 days (±3 days) after completing the written self-administered version. In addition, half of the S-I group with stable disease was randomized to receive a second IVRS administration (S-I-I) ≈7 days (±3 days) after the first IVRS administration to assess test–retest reliability of IVRS administration. Statistical Analysis Demographic characteristics were compared between the 2 arms of the study using a chi-square test for categorical variables and unpaired Student's t-test for continuous variables. To test the procedural validity of IVRS-administration, we used paired Student's t-test to compare the mean SIBDQ and dimensional scores (reported as mean ± standard deviation) between IVRS-administration and the established method of administration (written, self-administration). The population of interest satisfied 3 criteria: 1) the subjects completed both the written, self-administered as well as IVRS questionnaires in the S-I or I-S groups; 2) the subjects completed the 2 questionnaires within 7 ± 3 days of each other; 3) the subjects described having stable global disease-related health status defined by a score of 3, indicating that the IBD-related symptoms and general well-being of the subject were “about the same” as 1 week ago. To test the effect of the order of administration on SIBDQ scores, we compared the IVRS scores in the S-I arm to IVRS scores in the I-S arm using unpaired Student's t-test with equal variance; we used the same analysis for written, self-administered scores. The total SIBDQ scores and subscores for each domain were correlated with the disease activity indices (HBI and SCCAI). The population of interest for this analysis included subjects who completed a written, self-administered or an IVRS questionnaire within 14 days of the disease activity assessment. To illustrate that the index can distinguish between groups that would be expected to have different scores (discriminant validity), unpaired Student's t-test with equal variance was used to compare the SIBDQ scores for subjects classified as having active or inactive disease. In addition, we also assessed the linear association between the 2 modes of administration as well as the relationship between the SIBDQ and disease activity indices (HBI and SCCAI) using Pearson's correlation coefficients. To assess test–retest reliability of the IVRS-administered SIBDQ, we tested whether the instrument gave similar mean scores over time when repeated under stable disease activity conditions using the paired Student's t-test and Pearson's correlation coefficient of mean scores. The population of interest satisfied 3 criteria: 1) the subjects completed 2 IVRS questionnaires (S-I-I group); 2) the subjects completed the 2 questionnaires within 7 ± 3 days of each other; 3) the subjects described having stable global disease-related health status defined by a score of 3. Finally, the internal consistency of the IVRS-administered SIBDQ was evaluated using Cronbach's alpha.20 All completed IVRS questionnaires were included in this assessment. Times to complete the self-administered versus IVRS-administered assessments were compared using paired Student's t-test. Descriptive statistics were used to compare completion rates and missing item rates between the 2 modes. Completion rate was defined as the ratio between questionnaires submitted via mail or IVRS and total questionnaires scheduled. Missing items rate was defined as the ratio of the number of answered questionnaire query items and total query items. Statistical analyses were performed using Microsoft Excel 2004 and SAS (Cary, NC) 9.1.3 software. Results Patient Demographics A total of 157 patients consented to participate (Fig. 1). Eighty-one subjects were randomized to the self-administered written followed by IVRS-administered questionnaire arm and 76 subjects constituted the IVRS-administered followed by self-administered arm. In the S-I arm, of the 51 subjects who completed both the self-administered questionnaire followed by the IVRS questionnaire, 30 completed the questionnaires approximately a week apart from each other with stable disease activity. In the I-S arm, of the 52 subjects who completed both the IVRS-administered questionnaire followed by the self-administered questionnaire, 34 completed the questionnaires approximately a week apart from each other with stable disease activity. Sociodemographic characteristics of the study population are presented in Table 1. The test–retest reliability subgroup (S-I-I) had significantly more female and slightly more educated subjects. Otherwise, demographic and baseline characteristics were generally similar between the S-I and I-S arms of the study population. Figure 1. View largeDownload slide Disposition of subjects randomized to self-administered followed by IVRS-administered (S-I) versus IVRS-administered followed by self-administered (I-S). Figure 1. View largeDownload slide Disposition of subjects randomized to self-administered followed by IVRS-administered (S-I) versus IVRS-administered followed by self-administered (I-S). Table 1. Demographic Characteristics of Participants by Groups     View Large Table 1. Demographic Characteristics of Participants by Groups     View Large Procedural Validity The mean differences between self-administered and IVRS-administered SIBDQ total scores were not significantly different (mean difference of 0.76 points, P = 0.26) (Table 2). Similarly, the mean differences between SIBDQ domain scores were not significantly different (Table 3). This is not confounded by order of administration procedure, because the IVRS scores in the S-I arm compared to IVRS scores in the I-S arm and the written self-administered scores in the S-I arm compared to scores in the I-S arm were not significantly different (P = 0.70 and P = 0.81, respectively). In addition, there was a significant linear relationship between written self-administration and IVRS-administration with r = 0.91 (P < 0.001), demonstrating excellent concordance (Fig. 2). Table 2. Mean Scores, Mean Differences, and Correlations by Groups Formed According to Administration Procedure Order and Administration Procedure     View Large Table 2. Mean Scores, Mean Differences, and Correlations by Groups Formed According to Administration Procedure Order and Administration Procedure     View Large Table 3. Mean Scores, Mean Differences, and Correlations by Groups Formed According to SIBDQ Domains     View Large Table 3. Mean Scores, Mean Differences, and Correlations by Groups Formed According to SIBDQ Domains     View Large Figure 2. View largeDownload slide Scatterplot of SIBDQ scores. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.] Figure 2. View largeDownload slide Scatterplot of SIBDQ scores. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.] Mean SIBDQ scores were statistically different between the active and inactive groups. Mean IVRS scores were lower in active CD subjects than inactive CD (36.1 ± 9.6 versus 54.7 ± 8.6, P < 0.001) and lower in active UC subjects than inactive UC (40.8 ± 9.6 versus 59.8 ± 10.0, P < 0.001). In addition, SIBDQ scores correlated highly with disease activity indices (Table 4). The Pearson correlation coefficients for the IVRS-administered SIBDQ scores were r = −0.60 and r = −0.66 (P < 0.0001) for the HBI and the SCCAI, respectively, which compared favorably to the self-administered written method (r = −0.55 and r = −0.60 for the HBI and the SCCAI, respectively). The negative correlation reflects the inverse relationship between the scoring of the SIBDQ and of the disease activity indices. Table 4. Correlation Matrix of SIBDQ and Disease Activity Indices     View Large Table 4. Correlation Matrix of SIBDQ and Disease Activity Indices     View Large Reliability SIBDQ mean and domain subscores, mean differences and correlations within the test–retest reliability group (S-I-I) are summarized in Table 5. Total scores of the first IVRS-administered and second IVRS-administered SIBDQ were not significantly different (mean difference of 0.3 points, P = 0.85), indicating good test–retest reliability. In addition, there was a significant linear relationship between the first IVRS-administration and second IVRS-administration (r = 0.92, P < 0.001). Table 5. Mean Scores, Mean Differences, and Correlations Between the First and Second IVRS Administrations     View Large Table 5. Mean Scores, Mean Differences, and Correlations Between the First and Second IVRS Administrations     View Large The internal consistency of IVRS-administered SIBDQ, as defined by Cronbach's alpha,20 was 0.90. Deletion of Question 7 (“Overall, in the last 2 weeks, how much of a problem have you had maintaining or getting to the weight you would like to be?”) slightly increased the value of the total questionnaire to 0.91. Other Outcome Measures SIBDQ mean administration times are summarized in Table 6. Regardless of the order of administration, completion of the second administered SIBDQ took less time than the first. In the S-I arm, there was a statistically significant 24-second decrease between the first (self-administered) and second (IVRS) questionnaires. In the I-S arm, there was a statistically significant 82-second difference between the first (IVRS) and second (self-administered) questionnaires. When comparing differences between the IVRS-administered and self-administered SIBDQs overall, differences emerged showing lower mean administration times for self-administered when compared with IVRS—a difference of 55.8 seconds. In addition, the second IVRS-administered SIBDQ in the S-I-I group took, on average, 10.8 seconds less than the first. Table 6. Mean Administration Times and Mean Differences Between Administrations     View Large Table 6. Mean Administration Times and Mean Differences Between Administrations     View Large The completion rate for the IVRS questionnaire was 74%, which was comparable to the self-administered written questionnaire (71%). In addition, 18/1221 items were missed with self-administered written as opposed to 0/1573 items missed with IVRS administration. There were 5 incomplete/dropped calls, but 4 of these called again to complete the IVRS administration within 24 hours. Discussion Previously, thorough psychometric testing in patients with CD and UC has demonstrated the validity, reliability, and responsiveness of the SIBDQ for both groups of patients as a measure of HrQoL,4,5,8,21,22 with good discrimination between patients in remission and various degrees of relapse. Written self-administration of the questionnaire has also been shown not to affect the validity of the SIBDQ.7 Self-administration is convenient in the office; however, self-completed questionnaires administered outside of the office setting have potential disadvantages, which may include failure to return surveys and higher frequency of missing data. Although not previously validated as an IVRS-administered instrument, we believe that administering the SIBDQ via IVRS would have potential advantages, including control of timing of administration, less missing data, and a reduction of burden on study personnel and patients. However, altering the method of administration can affect the validity and reliability of an instrument. Therefore, we have evaluated the psychometric properties of the SIBDQ administered by IVRS and compared these properties with data gathered through self-administration. We demonstrate that the administration of the SIBDQ via an interactive voice response system yields results similar to those via written self-administration, suggesting good procedural validity. The mean differences between the self- and IVRS-administered scores were not found to be significant (P = 0.26). It is possible that if a larger “n” were studied, a significant difference may have been found. However, based on a comparison with data extracted from the Canadian Crohn's Relapse Prevention Trial, the magnitudes of the mean score differences we observed between self- and IVRS-administered scores (less than 1.0 for SIBDQ and less than 0.3 for dimensional scores) were significantly less than the differences noted in the low-dose cyclosporine trial in patients who remained clinically stable (−1.8, 95% confidence interval [CI] = (−2.1,−1.3), standardized to the SIBDQ scale).7,23 Thus, we do not believe the small differences we observed to be clinically relevant. The present study demonstrates that the SIBDQ administered via IVRS is able to distinguish between active and inactive IBD, confirming discriminant validity. Mean IVRS scores are appropriately lower in patients with active IBD as compared to inactive disease, indicating a poorer quality of life perceived in patients in the active disease stratum than in the patients with inactive disease. In addition, SIBDQ scores correlated highly with disease activity indices. The IVRS-SIBDQ correlation with HBI was higher than a past study comparing SIBDQ with HBI (r = 0.44)8; its correlation with SCCAI was lower than a past study comparing SIBDQ with SCCAI (r = 0.83).21 Additionally, the test–retest reliability and the internal consistency of the IVRS-administered SIBDQ were very high, even with the small numbers of patients repeating the IVRS assessment. There is general agreement that the internal consistency of a questionnaire corresponds to a Cronbach's alpha greater than 0.85.24 In our study, the Cronbach's alpha was higher than 0.90, indicating excellent coherence of items in the questionnaire. Since deletion of Question 7 improved Cronbach's alpha slightly, this suggests that distilling the SIBDQ to 9 questions may be just as valid and reliable. Test–retest reliability was additionally confirmed with excellent reproducibility, demonstrated by the high Pearson's correlation coefficient and insignificant mean differences between repeat administrations of the IVRS. Our results show that completion time consistently decreases with each successive administration, the second administration taking less time on average than the first. This is observed in comparisons between the IVRS and self-administered written administration times as well as in comparisons within the test–retest reliability group. This “training phenomenon” is reflected in past studies, which have shown that the duration of calls decrease with the familiarity of each consecutive administration of IVRS-administered instruments.9 Our study has several potential limitations. First, previous studies had set an ≈45-minute interval between the 2 modes of administration, practically within 1 clinical visit.7 Instead, we chose the time interval to be as long as 7 ± 3 days to minimize systematic error that we were assessing patient memory (which we believe is unlikely over a 1-week period), yet short enough in duration in order to minimize random error secondary to change in clinical status. As even a few hours may be sufficient to observe a change in emotional state, a strong determinant of HrQoL,25 the longer time intervals between assessments may have confounded the ability to discriminate true psychometric variability between modes of administration and genuine changes in disease activity or quality of life. However, we believe that the 7-day interval we chose is reasonable, as the SIBDQ is designed to reflect HrQoL in the prior 2 weeks. Second, the IVRS-SIBDQ seems to be biased toward slightly lower scores than the self-administered written SIBDQ. It is possible that users may become impatient with the user interface and select lower numbers in order to hasten the IVRS call. However, we hope to have ameliorated some of this anticipation effect by allowing the user to view a card that lists all the response items for each question. In addition to the possibility that users may have become impatient during IVRS sessions, it is also possible that users were less inhibited in disclosing health information through the IVRS system and chose the lower scores, which indicate lower quality of life. Nevertheless, the demonstrated test–retest reliability and discriminant validity indicate that IVRS administration should track changes of HrQoL with precision, and the differences we observed between IVRS and written self-administered were not clinically significant. Third, the IVRS-SIBDQ appears to be biased toward longer administration call times than the self-administered written SIBDQ. It should be noted that the self-administered written questionnaire times are estimations. Subjects recorded start times before the SIBDQ and the end time after the SIBDQ. The recorded time for written questionnaires did not include time devoted to the global assessment question and questionnaire instructions. In addition, the time recorded for the written SIBDQ does not take into consideration the preparation time before taking a written questionnaire (i.e., opening the envelope, finding a pen/pencil, etc.) and the time to return the questionnaire in the mail. The IVRS program, by contrast, records the time it takes to complete the global assessment survey, questionnaire instructions, and the SIBDQ itself accurately to the millisecond. These factors may have contributed to discrepancy between the administration times. Fourth, we are aware that IVRS technology could selectively exclude participants not having a telephone or participants who cannot afford to pay long-distance telephone fees to access the interactive questionnaire. In the present-day United States, this is a very small portion of the population. The US Census reported that more than 96.3% of American households had access to a land-line or cell-line in 2004 as opposed to 55% with a Web-connected computer.26 Additional validation of the IBD questionnaire for E-mail and Website administration would increase potential response options. Fifth, the SIBDQ is currently validated to be administered in English only,8 which may result in selection biases on certain demographic characteristics. This may limit generalizability to other populations. Several studies have validated the IBDQ in alternative language versions (e.g., Dutch,27 Spanish,28 Korean,29 Chinese,30 Portuguese,31 German,32 etc.) and have further proved its validity and reliability for different cultural and linguistic contexts.33,–38 In the future, it would be possible to validate the IVRS-SIBDQ into multiple different languages and linguistic contexts. The user would be able to select their native language from a menu that is presented to them in the beginning of the call.10 Since receptive vocabulary exceeds reading vocabulary for both native speakers and second-language learners,39 IVRS may turn out to be better suited for low literacy populations who may have difficulties taking self-administered written questionnaires. IVRS may have other advantages over written self-administration. IVRS may increase response rates through automated reminders.40,41 Initial costs to set up the interactive voice response system may be high, but some vendors offer the hardware at no cost if there is technical expertise to program the front-end of the system. In the long run, IVRS reduces labor and time costs because there is no requirement to train interviewers or to staff telephone stations. The system runs automatically and continuously, 24-hours a day; thus, subjects can access the system on their own time and proceed through the interview at their own pace. A professional prerecording of the questionnaire provides interview standardization, which reduces interviewer bias9 and increases consistency and accuracy of questionnaire administration.10 It also provides anonymity and confidentiality, which may reduce response bias.42 IVRS offers wide geographical access. It has the ability to upload data from multiple sites quickly into a searchable Web-based database. IVRS provides fast scoring and instantaneous communication. Clinicians may have access to scores within a few seconds of questionnaire completion. We hope that the advantages of IVRS9 would enable larger sample sizes to be obtained and facilitate large prospective studies with more precise and detailed longitudinal assessments.43 We conclude that administration by IVRS seems to be both a valid and reliable method for the SIBDQ. This new mode of administration may be useful in long-term, large-scale observational studies, and may prove both more convenient for subjects and cost-effective for investigators. References 1 Sands BE. Inflammatory bowel disease: past, present, and future. J Gastroenterol . 2007; 42: 16– 25. Google Scholar CrossRef Search ADS PubMed  2 Irvine EJ. Quality of life—measurement in inflammatory bowel disease. Scand J Gastroenterol Suppl . 1993; 199: 36– 39. Google Scholar CrossRef Search ADS PubMed  3 Guyatt GH, Feeny DH, Patrick DL. 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TI - Validation of Interactive Voice Response System Administration of the Short Inflammatory Bowel Disease Questionnaire
JF - Inflammatory Bowel Diseases
DO - 10.1002/ibd.20803
DA - 2009-04-01
UR - https://www.deepdyve.com/lp/oxford-university-press/validation-of-interactive-voice-response-system-administration-of-the-1PFsvP80UT
SP - 599
EP - 607
VL - 15
IS - 4
DP - DeepDyve
ER -