The Development of a Clinical Practice Guideline for the Management of Increased Intestinal Permeability
- Publication Type:
- Thesis
- Issue Date:
- 2022
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Background: Increased intestinal permeability (IP) may play an important role in health and disease. Clinicians treating people with IP use a combination of therapeutic interventions, with many interventions having little evidence. This thesis aims to improve the management of IP by clinicians in Australia by developing an evidence-based clinical practice guideline that considers the views and preferences of people with IP in the developed recommendations.
Methods: A cross-sectional survey design was employed to explore the views and preferences of Australian adults with suspected IP (Phase One n=589). A clinical practice guideline was developed based on the National Health and Medical Research Council (NHMRC) guidelines for guidelines (Phase Two). The level of evidence for each recommendation was determined based on the NHMRC grades for recommendations and the NHMRC Evaluation of Evidence process. Eight stakeholders participated in a cross-sectional survey to explore each recommendation’s understanding, agreement, importance, and appropriateness.
Results: Phase One found that most Australian adults with suspected IP (56.2%) are self-diagnosing their condition, with many of these individuals (56.7%) preferring to be assessed using an accurate method by a general practitioner or naturopath. Regarding the treatment of IP, participants reported using dietary products (87.9%), dietary supplements (72.9%) and lifestyle therapies (54.6%) for managing IP. The out-of-pocket cost associated with managing IP suggests a financial burden; participants that struggle financially spend significantly more (mean=$2963) on dietary supplements compared to participants who find it easy to live on their available income ($1918) (p=0.015). Participants had worse subjective well-being (SWB) compared to the Australian population (p < 0.001). Self-reported improvement in IP was a significant predictor of SWB and health-related quality of life (HRQoL) (β=10.70, p < 0.001). Furthermore, the number of days IP affects daily living correlated with SWB and HRQoL (p < 0.001). Phase Two produced a total of 38 recommendations consisting of 27 evidence-based recommendations, seven practice points and four consensus-based recommendations. These recommendations provide clinicians with beneficial dietary choices and dietary supplements while suggesting interventions that are ineffective and should be avoided.
Conclusion: The research findings presented in this thesis may optimise patient care, improve health outcomes, and reduce variation in care by clinicians in primary care settings in Australia. The recommendations align with consumer and stakeholder views and values, enabling clinicians to follow confidently. This thesis provides a comprehensive insight into the needs of this under-investigated population group while laying the foundations for multiple research opportunities.
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