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Truyens M, Lernout H, De Vos M, Laukens D, Lobaton T. Unraveling the fatigue puzzle: insights into the pathogenesis and management of IBD-related fatigue including the role of the gut-brain axis. Front Med (Lausanne) 2024; 11:1424926. [PMID: 39021817 PMCID: PMC11252009 DOI: 10.3389/fmed.2024.1424926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
A significant percentage of patients with an inflammatory bowel disease (IBD) encounter fatigue which can profoundly diminish patients' quality of life, particularly during periods of disease remission when gastrointestinal symptoms have receded. Various contributing risk factors have been identified including active inflammation, anemia, psychological, lifestyle and drug-related factors. While addressing these risk factors has been suggested as the initial approach to managing fatigue, a considerable number of patients still experience persisting symptoms, the primary causes of which remain incompletely understood. Recent insights suggest that dysfunction of the gut-brain axis may play a pathogenic role. This review provides an overview of established risk factors for fatigue, alongside emerging perspectives on the role of the gut-brain axis, and potential treatment strategies.
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Affiliation(s)
- Marie Truyens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Hannah Lernout
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium
| | - Martine De Vos
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Debby Laukens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research (IRC), Ghent University, Ghent, Belgium
- Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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2
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Sands I, Picariello F, Maple H, Chilcot J. Psychosocial and Clinical Associations of Fatigue Severity and Fatigue-Related Impairment in Kidney Transplant Recipients. Behav Med 2024; 50:153-163. [PMID: 36803685 DOI: 10.1080/08964289.2022.2159311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023]
Abstract
Debilitating fatigue is common in people living with kidney disease and often persists after a kidney transplant. Current understanding of fatigue is centered around pathophysiological processes. Little is known about the role of cognitive and behavioral factors. The aim of this study was to evaluate the contribution of these factors to fatigue among kidney transplant recipients (KTRs). A cross-sectional study of 174 adult KTRs who completed online measures of fatigue, distress, illness perceptions, and cognitive and behavioral responses to fatigue. Sociodemographic and illness-related information was also collected. 63.2% of KTRs experienced clinically significant fatigue. Sociodemographic and clinical factors explained 16.1% and 31.2% of the variance in the fatigue severity and fatigue impairment, respectively, increasing by 28% and 26.8% after adding distress. In adjusted models, all the cognitive and behavioral factors except for illness perceptions were positively associated with increased fatigue-related impairment, but not severity. Embarrassment avoidance emerged as a key cognition. In conclusion, fatigue is common following kidney transplantation and associated with distress and cognitive and behavioral responses to symptoms, particularly embarrassment avoidance. Given the commonality and impact of fatigue in KTRs, treatment is a clinical need. Psychological interventions targeting distress and specific beliefs and behaviors related to fatigue may be beneficial.
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Affiliation(s)
- Imogen Sands
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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3
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Maetzler W, Correia Guedes L, Emmert KN, Kudelka J, Hildesheim HL, Paulides E, Connolly H, Davies K, Dilda V, Ahmaniemi T, Avedano L, Bouça-Machado R, Chambers M, Chatterjee M, Gallagher P, Graeber J, Maetzler C, Kaduszkiewicz H, Kennedy N, Macrae V, Carrasco Marin L, Moses A, Padovani A, Pilotto A, Ratcliffe N, Reilmann R, Rosario M, Schreiber S, De Sousa D, Van Gassen G, Warring LA, Seppi K, van der Woude CJ, Ferreira JJ, Ng WF. Fatigue-Related Changes of Daily Function: Most Promising Measures for the Digital Age. Digit Biomark 2024; 8:30-39. [PMID: 38510264 PMCID: PMC10954320 DOI: 10.1159/000536568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024] Open
Abstract
Background Fatigue is a prominent symptom in many diseases and is strongly associated with impaired daily function. The measurement of daily function is currently almost always done with questionnaires, which are subjective and imprecise. With the recent advances of digital wearable technologies, novel approaches to evaluate daily function quantitatively and objectively in real-life conditions are increasingly possible. This also creates new possibilities to measure fatigue-related changes of daily function using such technologies. Summary This review examines which digitally assessable parameters in immune-mediated inflammatory and neurodegenerative diseases may have the greatest potential to reflect fatigue-related changes of daily function. Key Messages Results of a standardized analysis of the literature reporting about perception-, capacity-, and performance-evaluating assessment tools indicate that changes of the following parameters: physical activity, independence of daily living, social participation, working life, mental status, cognitive and aerobic capacity, and supervised and unsupervised mobility performance have the highest potential to reflect fatigue-related changes of daily function. These parameters thus hold the greatest potential for quantitatively measuring fatigue in representative diseases in real-life conditions, e.g., with digital wearable technologies. Furthermore, to the best of our knowledge, this is a new approach to analysing evidence for the design of performance-based digital assessment protocols in human research, which may stimulate further systematic research in this area.
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Affiliation(s)
- Walter Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Leonor Correia Guedes
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Kirsten Nele Emmert
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Luise Hildesheim
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Emma Paulides
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hayley Connolly
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kristen Davies
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | | | - Luisa Avedano
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | | | | | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Johanna Graeber
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Victoria Macrae
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | - Anusha Moses
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Ralf Reilmann
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Madalena Rosario
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Dina De Sousa
- European Huntington’s Association, Moerbeke, Belgium
| | | | | | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - C. Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - on behalf of the IDEA-FAST project consortium
- Department of Neurology, University Medical Centre Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
- Instituto de Medicina Molecular João Lobo Antunes and Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
- Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- CHDI Management, CHDI Foundation, Princeton, NJ, USA
- Teknologian tutkimuskeskus VTT Oy, Espoo, Finland
- European Federation of Crohn’s and Ulcerative Colitis, Brussels, Belgium
- MC Healthcare Evaluation, London, UK
- Janssen Research and Development, Cambridge, MA, USA
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Institute of General Medicine, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- Asociación Parkinson Madrid, Madrid, Spain
- University of Twente, Department of Medical Cell Biophysics, TechMed Centre, Enschede, The Netherlands
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Parkinson’s UK, London, UK
- George-Huntington-Institute, R&D-Campus/Technology-Park Münster, Münster, Germany
- Institute of Clinical Radiology, University of Münster, Münster, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein, Kiel University, Kiel, Germany
- European Huntington’s Association, Moerbeke, Belgium
- Medical Department, Takeda, Brussels, Belgium
- Janssen LLC, GCSO Immunology, Horsham, PA, USA
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Moulton CD, Jordan C, Hayee B, Chalder T. All-or-Nothing Behavior and Catastrophic Thinking Predict Fatigue in Inflammatory Bowel Disease: A Prospective Cohort Study. Inflamm Bowel Dis 2023:izad193. [PMID: 37619243 DOI: 10.1093/ibd/izad193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Indexed: 08/26/2023]
Abstract
Lay Summary
Patients with inflammatory bowel disease (IBD) often report fatigue. However, the reasons for this are poorly understood. In this study of people with IBD, we demonstrate that all-or-nothing behavior (being very active then needing to resting a while) and catastrophic thinking (making very negative assumptions about outcomes) both predict worsening in fatigue over time.
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Affiliation(s)
- Calum D Moulton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Psychological Medicine Unit, St Mark's Hospital, London, United Kingdom
| | - Cheryl Jordan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Uhlir V, Stallmach A, Grunert PC. Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study. BMC Gastroenterol 2023; 23:288. [PMID: 37608313 PMCID: PMC10463723 DOI: 10.1186/s12876-023-02906-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Fatigue is a debilitating and highly relevant symptom in patients with inflammatory bowel disease (IBD). However, awareness of fatigue and treatment options remains limited. This study was aimed at elucidating the influence of disease activity and common complications (pain, anemia, depression, anxiety and quality of life) on fatigue in patients with IBD to identify potential interventional targets for treating physicians. METHODS A cross-sectional survey including five questionnaires (HADS, Fatigue Assessment Scale, McGill Pain Questionnaire, IBDQ and general well-being) was performed on patients with IBD (n = 250) at a university IBD clinic. Additionally, demographic data, laboratory data, IBD history, treatment and current disease activity (Harvey-Bradshaw Index, partial Mayo Score, calprotectin and CRP) were recorded. RESULTS A total of 189 patients were analyzed (59.8% with Crohn's disease (CD) and 40.2% with ulcerative colitis (UC)). A total of 51.3% were fatigued, and 12.2% were extremely fatigued. Multiple factors showed significant correlations in univariate analysis. Multivariate analysis revealed that fatigue was correlated with depression (CD, p = 0.002; UC, p = 0.02), diminished quality of life (CD, p = 0.015), female sex (CD, p = 0.015) and younger age (UC, p = 0.024), whereas the influence of anemia or disease activity was non-significant. CONCLUSIONS Fatigue is burdensome and highly prevalent in patients with active and inactive IBD. Considerations for fatigue treatment, beyond targeting inflammation and anemia, should include investigation of underlying sub-clinical depression.
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Affiliation(s)
- Victoria Uhlir
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Philip Christian Grunert
- Department of Internal Medicine IV, Jena University Hospital, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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Hatamnejad MR, Shirvani M, Pourhoseingholi MA, Balaii H, Shahrokh S, Asadzadeh Aghdaei H, Koolaeian A, Cheraghpour M. Translation and cross-cultural adaptation of the Persian version of inflammatory bowel disease-fatigue (IBD-F) self-assessment questionnaire. PLoS One 2023; 18:e0288592. [PMID: 37478140 PMCID: PMC10361485 DOI: 10.1371/journal.pone.0288592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND This study appraises the psychometrics properties of the Inflammatory bowel disease-fatigue (IBD-F) Persian version questionnaire. METHODS The original IBD-F questionnaire was translated into the Persian version in a standard forward-back manner. The validation was performed through the face, content, and construct validity. Fifteen experts scored each item's necessity on an ordinal Likert scale of three; then, the content validity ratio was calculated using the Lawshe formula. Eight judges from pre-defined panel rated each item on an ordinal 4-point Likert scale concerning its relevancy, clarity, and simplicity for individual-CVI calculation. The mean individual-CVI was considered as the Scale-CVI for each domain. Twenty lay experts (selected from the target population) were asked to express their opinion on each item's importance by scoring on a 5-point Likert scale; subsequently, face validity was determined by the impact score formula. The questions that had minimum values of CVR, CVI, and impact score were retained in the final version of the questionnaire for reliability evaluation. Construct validity was evaluated via Confirmatory Factor Analysis. Internal consistency and test-retest reliability were checked using Cronbach's α and intraclass correlation coefficients (ICC). Fifty-four patients recruited based on inclusion and exclusion criteria to participate in the reliability analysis. RESULTS All the questions received the qualified values of CVR (exceeding 0.49 points) and impact score (more than 1.5 points) and were retained in the questionnaire; however, revisions were made for questions with a CVI 0.7-0.9 for clarity and simplicity. The result demonstrated relative goodness CFA and proper internal consistency, as Cronbach's α coefficient was 0.964 for the test (0.845 and 0.963 for the first and second part of the questionnaire, respectively (and 0.888 for the re-test (0.793 and 0.876 for the first and second section of the questionnaire, respectively). The ICC values between test and re-test for the first and second part and the whole questionnaire were obtained as 0.904, 0.922, and 0.921, respectively. CONCLUSION The Persian version of the IBD-F questionnaire was valid and reliable; thus, an appropriate scale was deemed to measure fatigue (severity, frequency, and impact on daily activities).
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Shirvani
- Student of Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedieh Balaii
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahrokh
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhosein Koolaeian
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Makan Cheraghpour
- Research Institute for Gastroenterology and Liver Diseases, Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lee HH, Gweon TG, Kang SG, Jung SH, Lee KM, Kang SB. Assessment of Fatigue and Associated Factors in Patients with Inflammatory Bowel Disease: A Questionnaire-Based Study. J Clin Med 2023; 12:jcm12093116. [PMID: 37176558 PMCID: PMC10179196 DOI: 10.3390/jcm12093116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Although fatigue is common in patients with inflammatory bowel disease (IBD), it often goes unrecognized and untreated. We investigated the degree of fatigue and associated factors in patients with IBD. A multicenter study involving 147 IBD patients was conducted at five academic hospitals from August 2019 to December 2021. Fatigue was evaluated using the validated Korean version of the Multidimensional Fatigue Inventory (MFI-K). Among 97 ulcerative colitis patients and 50 Crohn's disease patients, the mean total MFI-K score was 59.0 ± 5.5, which corresponded to a moderate-to-severe level of fatigue. Moderate-to-severe disease activity was found to be significantly associated with a higher general and physical fatigue subscale MFI-K score compared to remission-to-mild disease activity (17.6 ± 1.7 vs. 16.7 ± 2.0, p = 0.009), while the use of biologics was associated with a lower total MFI-K score (57.3 ± 5.0 vs. 59.5 ± 5.5, p = 0.031). In multiple linear regression, the total MFI-K score was positively correlated with a history of surgery for IBD, while it was negatively correlated with the use of biologics. Depression was positively correlated with the reduced motivation subscale score. The degree of fatigue in patients with IBD was high. Disease activity, the use of biologics, a history of surgery for IBD, and depression were associated with fatigue.
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Affiliation(s)
- Han Hee Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Tae-Geun Gweon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sung-Goo Kang
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Sung Hoon Jung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kang-Moon Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang-Bum Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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8
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Regev S, Schwartz D, Sarid O, Goren G, Slonim-Nevo V, Friger M, Sergienko R, Greenberg D, Monsonego A, Nemirovsky A, Odes S. Randomised clinical trial: Psychological intervention improves work productivity and daily activity by reducing abdominal pain and fatigue in Crohn's disease. Aliment Pharmacol Ther 2023; 57:861-871. [PMID: 36734040 DOI: 10.1111/apt.17399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/13/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic abdominal pain and fatigue are characteristics of Crohn's disease (CD) and contribute to functional impairments. AIMS To examine whether CD-tailored cognitive-behavioural and mindfulness intervention (COBMINDEX) is effective in reducing abdominal pain and fatigue in patients with CD and whether changes in abdominal pain and fatigue mediate any beneficial effects of COBMINDEX on impairments in work productivity and daily activities. METHODS This is a secondary analysis of a parallel-group multicentre randomised controlled trial. Patients with mild-to-moderate CD (n = 142) were randomised into either intervention group receiving COBMINDEX, or control group receiving treatment-as-usual for 3 months followed by COBMINDEX. Complete data were collected from 120 patients (34.0 ± 10.7 years, 62.5% female, intervention = 60, control = 60). Analysis of covariance assessed group differences in 3-month follow-up scores, controlling for baseline scores. Multiple parallel mediation analysis assessed the proposed mechanisms for the entire sample. RESULTS The intervention group demonstrated significantly lower levels of abdominal pain (F = 17.46, p < 0.001, η2 p = 0.13), fatigue (F = 7.26, p = 0.008, η2 p = 0.06) and impairments at work (F = 4.82, p = 0.032, η2 p = 0.07) and daily activities (F = 6.26, p = 0.014, η2 p = 0.05), compared with treatment-as-usual. Moreover, changes in abdominal pain and fatigue significantly mediated the beneficial effects of COBMINDEX on patients' work productivity (b = -9.90, SE = 2.86, 95% CI: -16.11 to -4.94) and daily activities (b = -9.65, SE = 1.91, 95% CI: -13.77 to 6.35), independent of changes in disease activity. CONCLUSIONS COBMINDEX is effective at reducing abdominal pain and fatigue in patients with CD, which in turn leads to improvement in functioning. Clinicians should incorporate screening for severe abdominal pain and fatigue and consider offering cognitive-behavioural and mindfulness training. CLINICALTRIALS gov, Number: NCT05085925. Ministry of Health in Israel (https://my.health.gov.il/CliniTrials/Pages/MOH_2020-02-24_008721.aspx).
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Affiliation(s)
- Shirley Regev
- Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Orly Sarid
- Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ganit Goren
- Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vered Slonim-Nevo
- Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Monsonego
- Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Nemirovsky
- Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shmuel Odes
- Division of Clinical Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Picariello F, Chilcot J, Chalder T, Herdman D, Moss-Morris R. The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions. Br J Health Psychol 2023; 28:619-638. [PMID: 36690909 DOI: 10.1111/bjhp.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs). Although the Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, its original development and psychometric properties as a transdiagnostic measure have not been reported. Our aim was to evaluate the psychometric properties of the CBRQ and a recently proposed short version, across different LTCs. DESIGN Psychometric validation study. METHODS Confirmatory factor analysis (CFA) tested the factor structure of the CBRQ in two datasets from the CBRQ's original development; (chronic fatigue syndrome, N = 230; and multiple sclerosis, N = 221) and in additional groups: haemodialysis (N = 174), inflammatory bowel disease (N = 182) and chronic dizziness (N = 185). Scale reliability and construct validity were assessed. The factor structure of the shortened CBRQ (CBRQ-SF) was also assessed. RESULTS CFA revealed that a 7-or 8-factor structure had generally appropriate fit supporting the originally proposed 7 factors (Fear avoidance, Damage beliefs, Catastrophising, Embarrassment avoidance, Symptom focusing, All-or-nothing behaviour and Avoidance/Resting behaviour). Omega coefficients indicated satisfactory internal reliability. Correlations with related constructs suggested construct validity. The scale appeared sensitive to change. The CBRQ-SF also displayed good psychometric quality, with a better model fit than the CBRQ. CONCLUSIONS The CBRQ and the shortened version were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of this questionnaire. Further research is necessary to determine the test-retest reliability and sensitivity to change of the CBRQ and CBRQ-SF and a thorough evaluation of the content validity of the items.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Trudie Chalder
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - David Herdman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
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10
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Radford SJ. The impact of Inflammatory Bowel Disease related fatigue on Health-Related Quality of Life: a qualitative semi-structured interview study. J Res Nurs 2022; 27:685-702. [PMID: 36530749 PMCID: PMC9755563 DOI: 10.1177/17449871211061048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background Fatigue is a frequently reported symptom of Inflammatory Bowel Disease (IBD), having a negative impact on Health-Related Quality of Life (HRQoL). Patients' experiences of this have not been researched in IBD. Methods Semi-structured interviews were conducted with adults with Crohn's Disease from out-patient clinics in the United Kingdom. Interviews were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results Fourteen participant interviews were conducted. Three key themes were identified: 1) 'The new normal' established through adaptation and acceptance; 2) 'Energy as a resource' describing attempts to better manage fatigue through planning and prioritising tasks; 3) 'Keeping healthy' encompasses participants' beliefs that 'good health' allows better management of fatigue. Conclusion Participants establish a 'new' normality, through maintaining the same or similar level of employment/education activities. However, this is often at the expense of social activities. Further research is required to explore patient led self-management interventions in IBD fatigue.
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Affiliation(s)
- Shellie J Radford
- Senior Research Nurse, Nottingham Digestive Diseases Centre, School of Medicine, The University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, GI and Liver Theme, University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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11
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Raman M, Rajagopalan V, Kaur S, Reimer RA, Ma C, Ghosh S, Vallance J. Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review. Inflamm Bowel Dis 2022; 28:1100-1111. [PMID: 34605548 DOI: 10.1093/ibd/izab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advancement in the treatment of inflammatory bowel disease (IBD), induction and maintenance of remission remain challenging to achieve in many patients and a significant proportion of patients with IBD experience mental health conditions, including anxiety, depression, and fatigue, which impair their quality of life (QoL). We aim to describe the available evidence regarding the effects of physical activity (PA) on the onset of IBD, its disease course, and important patient-reported outcome measures (PROMs), such as QoL, fatigue, and mental health. METHODS A literature search was performed using electronic databases to identify original articles that assessed the effects of PA in patients with IBD using PROMs. RESULTS Prospective cohort and case-control studies demonstrate inverse relationships between PA and new-onset IBD in Crohn's disease but not in ulcerative colitis; however, they have small sample sizes and caution must be taken in considering associations versus causation. Small randomized controlled trials suggest promise for PA and beneficial outcomes, such as maintenance of clinical remission and improvement in QoL, fatigue, depression, and anxiety. However, these studies were small and underpowered, and limited by outcome measurements and durations of follow-up. CONCLUSIONS Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered.
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Affiliation(s)
- Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Vidya Rajagopalan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Sandeep Kaur
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | | | - Christopher Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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12
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Sweeney L, Windgassen S, Artom M, Norton C, Fawson S, Moss-Morris R. A Novel Digital Self-management Intervention for Symptoms of Fatigue, Pain, and Urgency in Inflammatory Bowel Disease: Describing the Process of Development. JMIR Form Res 2022; 6:e33001. [PMID: 35583924 PMCID: PMC9161057 DOI: 10.2196/33001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Empirical studies and systematic reviews have demonstrated the role of biological, cognitive, behavioral, and emotional factors in fatigue, pain, and urgency in inflammatory bowel disease (IBD). Behavioral management that addresses the cognitive, behavioral, and emotional factors offered alongside medical treatment is seldom available to people with IBD. Digital interventions provide a potentially scalable and cost-effective way of providing behavioral support to patients. Objective This paper aimed to describe the process of developing a supported digital self-management intervention for fatigue, pain, and urgency in IBD using theory and evidence-based approaches and stakeholder input. Methods The Medical Research Council framework for complex health interventions and a person-based approach were used to guide intervention development, consulting with 87 patients with IBD and 60 nurses. These frameworks informed the selection and use of a theoretical model that subsequently guided cognitive behaviorally based intervention content. They also guided the design of tailored digital intervention pathways for individuals with IBD that matched the predominant symptoms. Results A transsymptomatic cognitive behavioral framework of symptom perpetuation was developed for the symptoms of fatigue, pain, and urgency in IBD. A logic model was used to define the intervention techniques. Patient feedback and qualitative interviews refined the website content and functionalities, including the use of visual aids, email reminders, and graphical tracking of symptoms. Nurse focus groups informed the volume and delivery model of the therapist facilitator support. Ratings of acceptability out of 10 following feasibility testing (31/87, 36%) demonstrated accessibility (scoring 9.43, SD 1.040), ease (scoring 8.07, SD 3.205), clarity, and the relevant tone of the intervention. The final intervention comprised 12 web-based sessions (8 core and 4 symptom-specific), with one 30-minute facilitator phone call following session 1 and subsequent on-site messaging. Conclusions The use of theory and integration of stakeholders’ views throughout informed the development of an evidence-based digital intervention for fatigue, pain, and urgency in IBD. This is the first web-based self-management intervention designed to address these multiple symptoms with the aim of improving the quality of life and reducing the symptom burden of IBD. The intervention is being tested in a large multicenter randomized controlled trial. Trial Registration ISRCTN Registry ISRCTN71618461; https://www.isrctn.com/ISRCTN71618461
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Affiliation(s)
- Louise Sweeney
- Health Psychology Section, King's College London, London, United Kingdom
| | - Sula Windgassen
- Health Psychology Section, King's College London, London, United Kingdom
| | | | - Christine Norton
- Health Psychology Section, King's College London, London, United Kingdom
| | - Sophie Fawson
- Health Psychology Section, King's College London, London, United Kingdom
| | - Rona Moss-Morris
- Health Psychology Section, King's College London, London, United Kingdom
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13
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Walentynowicz M, van de Pavert I, Fierens L, Coenen S, Vlaeyen JWS, von Leupoldt A, Van Oudenhove L, Vermeire S, Van Assche G, Ferrante M, Van Diest I. Inflammatory Bowel Disease-related Behaviours [IBD-Bx] Questionnaire: Development, Validation and Prospective Associations with Fatigue. J Crohns Colitis 2022; 16:581-590. [PMID: 34622275 DOI: 10.1093/ecco-jcc/jjab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Disease-related behaviours that may maintain or worsen symptom burden remain largely unexplored in inflammatory bowel disease [IBD]. In this study, we developed and validated an instrument assessing IBD-related, modifiable behaviours and explored which behaviours prospectively correlate with fatigue, a debilitating and common symptom in IBD. METHODS Initially, 72 items reflecting IBD-related behaviours were generated based on literature review and input from clinicians and people diagnosed with IBD. During wave 1, 495 IBD patients rated to what extent each behaviour was applicable to them. Additionally, disease activity, fatigue, IBD-related concerns and psychological variables were assessed. During a follow-up visit 4-12 weeks later [wave 2], a random selection of 92 patients from wave 1 completed the measures assessing the IBD-related behaviours, disease activity and fatigue once more. RESULTS A principal component analysis with oblique rotation revealed seven components in the 72 IBD behaviours, which could be interpreted as: [1] Avoiding food and activities, [2] Access to toilets, [3] Avoidance of sex, [4] Cognitive avoidance, [5] Not sharing with others, [6] Alternative treatments and [7] Disease management. Each component was reduced to three to five representative items, resulting in a final, 25-item IBD-Bx questionnaire showing good concurrent validity [alphas > 0.63] and reliability. Almost all components were cross-sectionally related to levels of fatigue. Avoiding food and activities and Access to toilets significantly predicted fatigue at wave 2 when controlling for baseline fatigue. CONCLUSIONS The IBD-Bx is a valid and reliable questionnaire of IBD-related behaviours, some of which predict future fatigue burden.
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Affiliation(s)
- Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.,Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Liselotte Fierens
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Sofie Coenen
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Johan W S Vlaeyen
- Health Psychology Research Group, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Department of Clinical Psychological Science, Maastricht University, Netherlands
| | | | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Séverine Vermeire
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, KU Leuven, Leuven, Belgium
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14
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Keefer L, Bedell A, Norton C, Hart AL. How Should Pain, Fatigue, and Emotional Wellness Be Incorporated Into Treatment Goals for Optimal Management of Inflammatory Bowel Disease? Gastroenterology 2022; 162:1439-1451. [PMID: 34995528 DOI: 10.1053/j.gastro.2021.08.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022]
Abstract
Early diagnosis and the optimal control of inflammation, with a continuous cycle of assessment, treatment, monitoring, and adjustment of therapy, is best practice for the management of inflammatory bowel disease. However, patients express frustration with ongoing challenging symptoms, often discordant with inflammation, including abdominal pain, fatigue, depression, anxiety, and emotional wellness; these are often not optimally addressed by inflammatory bowel disease clinicians due to lack of time or resources. This review will highlight the burden of these symptoms and issues, suggest ways of assessing these in clinical practice, highlight the importance of acknowledging and validating the symptoms and issues with patients, reassuring them that they are being heard, and discuss different possible models of service delivery for psychosocial support, from fully integrated gastropsychology models to referral pathways that optimize community support. We suggest the importance of the treat-to-target concept, where the target is not only control of inflammation but also emotional wellness.
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Affiliation(s)
- Laurie Keefer
- Department of Medicine-Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Alyse Bedell
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Christine Norton
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Ailsa L Hart
- IBD Unit, St Mark's, The National Bowel Hospital, London, United Kingdom
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15
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Kamp KJ, Clark-Snustad K, Barahimi M, Lee S. Relationship Between Endoscopic and Clinical Disease Activity With Fatigue in Inflammatory Bowel Disease. Gastroenterol Nurs 2022; 45:21-28. [PMID: 35020629 PMCID: PMC8820259 DOI: 10.1097/sga.0000000000000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Fatigue is a prevalent symptom among individuals with inflammatory bowel disease. Yet, few studies have examined the relationship between fatigue and endoscopic disease activity. A retrospective chart review was conducted to determine the prevalence of fatigue based on endoscopic inflammation and clinical disease activity and describe the factors associated with fatigue among adults with inflammatory bowel disease. One hundred sixty patients were included. The majority had Crohn disease (72.5%), with an average age of 40.5 years. Sixty-one percent reported fatigue. Both endoscopic (p = .03) and clinical disease activities (p = .001) were significantly associated with fatigue. Among participants reporting fatigue, 52% had inactive disease and 48% had active disease based on endoscopy whereas 63% reported clinically active disease and 37% reported clinically inactive disease. In the multivariate regression model, clinical disease activity (odds ratio [OR] = 8.5; 95% CI [3.9, 18.6]) and anxiety (OR = 2.8; 95% CI [1.0, 7.6]) were significantly associated with fatigue. The prevalence of fatigue is high among individuals with active and inactive disease. Clinical disease activity and anxiety, but not endoscopic disease activity, were associated with fatigue.
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Affiliation(s)
- Kendra J Kamp
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Kindra Clark-Snustad
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Mitra Barahimi
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
| | - Scott Lee
- Kendra J. Kamp, PhD, RN, is a post-doctoral fellow at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad, DNP, ARNP, is a teaching associate at Division of Gastroenterology, University of Washington, Seattle, WA
- Mitra Barahimi, MD, is a clinical assistant professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Scott Lee, MD, is an associate professor at Division of Gastroenterology, University of Washington, Seattle, WA
- Kindra Clark-Snustad has served as a consultant for Pfizer. Scott D. Lee has received grant support from AbbVie, UCB Pharma, Janssen, Salix, Takeda, Calgene, Arena, and AbGenomics and has served as a consultant for UCB Pharma, Cornerstones Health, Janssen, Eli Lilly and Company, Celgene, KCRN Research, LLC, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Applied Molecular Transport, Arena, Celltrion Healthcare, Samsung Bioepis Co, and Bridge Biotherapeutics. The other authors have no conflicts of interest to disclose
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16
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Influencing Factors of Inflammatory Bowel Disease-Fatigue: A Path Analysis Model. Nurs Res 2021; 70:256-265. [PMID: 33935213 PMCID: PMC8231668 DOI: 10.1097/nnr.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatigue is a common symptom in adults with inflammatory bowel disease (IBD) and is influenced by many physiological, psychological, and situational factors. However, the influencing factors of fatigue associated with IBD have not been evaluated. OBJECTIVE This study aims to examine factors associated with fatigue during IBD and develop a parsimonious model that describes the influencing factors of fatigue. METHODS The study was a secondary analysis of cross-sectional data obtained from IBD Partners, an online cohort of adults with the disease, including 12,053 eligible participants. Data were collected using the Patient-Reported Outcomes Measurement Information System short-form scales measuring fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles. Physical activity was measured using a single question. Demographic and clinical variables were collected. Path analysis was computed to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD-fatigue based on the middle range theory of unpleasant symptoms' conceptual framework. RESULTS Most of the participants were White females. The data best fit a model with situational factors (physical activity and satisfaction with social roles as the mediators). The direct effect of IBD activity, age, sleep disturbances, pain interference, anxiety, and depression on IBD-fatigue was significant. Significant indirect effects were noted on IBD-fatigue from sleep disturbances, pain interference, and depression via physical activity and satisfaction with social roles. DISCUSSION The study identified two important intervening variables from the tested model. In addition, other symptoms such as sleep, pain, anxiety, and depression are essential and also influence IBD-fatigue.
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17
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Tasson L, Zingone F, Barberio B, Valentini R, Ballotta P, Ford AC, Scarpa M, Angriman I, Fassan M, Savarino E. Sarcopenia, severe anxiety and increased C-reactive protein are associated with severe fatigue in patients with inflammatory bowel diseases. Sci Rep 2021; 11:15251. [PMID: 34315951 PMCID: PMC8316564 DOI: 10.1038/s41598-021-94685-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) report fatigue more frequently than healthy population, but the precise mechanisms underlying its presence are unknown. This study aimed to evaluate the prevalence of fatigue in IBD and its relation with potential causative factors. A survey on fatigue, depression, anxiety, sleep disorders, and the presence of sarcopenia and malnutrition, was sent by email to 244 IBD outpatients of the Gastroenterology Unit of Academic Hospital of Padua. Demographics and clinical data, including the levels of fecal calprotectin (FC) and C-reactive protein (CRP), and current pharmacological treatments were obtained from patients' medical records. Ninety-nine (40.5%) subjects answered the survey. Ninety-two (92.9%) patients reported fatigue, with sixty-six having mild to moderate fatigue and twenty-six severe fatigue. Multivariate analysis showed that abnormal values of CRP (OR 5.1), severe anxiety (OR 3.7) and sarcopenia (OR 4.4) were the factors independently associated with severe fatigue. Fatigue has a high prevalence in subject affected by IBD. Subjects with altered CRP, sarcopenia and severe anxiety appear more at risk of severe fatigue.
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Affiliation(s)
- Laura Tasson
- Clinical Nutrition Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Romina Valentini
- Clinical Nutrition Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Pamela Ballotta
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Marco Scarpa
- Clinica Chirurgica 1, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Imerio Angriman
- Clinica Chirurgica 1, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, Via Giustiniani 2, 35121, Padova, Italy.
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18
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Gong SS, Fan YH, Lv B, Zhang MQ, Xu Y, Zhao J. Fatigue in patients with inflammatory bowel disease in Eastern China. World J Gastroenterol 2021; 27:1076-1089. [PMID: 33776374 PMCID: PMC7985735 DOI: 10.3748/wjg.v27.i11.1076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/14/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fatigue is a very common but relatively neglected problem in patients with inflammatory bowel disease (IBD). The prevalence rate of IBD in China is the highest in Asia, but there is little research on fatigue in patients with IBD. Neither the relationship between fatigue and quality of life (QoL) nor the relationship between fatigue and work productivity (WP) in Chinese IBD patients has been reported.
AIM To investigate the prevalence of fatigue related to IBD in Eastern China, to identify the risk factors associated with fatigue, to assess the impact of fatigue on QoL, and to evaluate the relationship between fatigue and WP.
METHODS A cross-sectional study was conducted in a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China. Clinical data of patients were collected, and disease activity was evaluated. Blood samples were analyzed to assess anemia, albumin, and inflammation. Fatigue was assessed using the multidimensional fatigue inventory. QoL and WP were measured using the short inflammatory bowel disease questionnaire and the work productivity and activity impairment general health questionnaire, respectively. The patients also completed assessments of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder 7-item Scale).
RESULTS A total of 311 IBD patients, comprising 168 Crohn's disease patients and 143 ulcerative colitis patients, were enrolled. The prevalence of fatigue in patients with IBD was 60.77%. In a univariate logistic regression analysis, factors such as disease activity, depression, anxiety, anemia, and IBD-related surgery were individually related to a significantly increased risk of fatigue in IBD patients. Multivariate logistic regression analysis indicated that depression [odds ratio (OR) = 8.078, 95% confidence interval (CI): 4.113-15.865], anxiety (OR = 2.373, 95%CI: 1.100-5.119), anemia (OR = 2.498, 95%CI: 1.290-4.834), and IBD-related surgery (OR = 2.035, 95%CI: 1.084-3.819) were related to fatigue in IBD patients. There was a negative correlation between fatigue and QoL (r = -0.831; P < 0.0001) but a positive correlation between fatigue and WP loss.
CONCLUSION The prevalence of fatigue in IBD patients in Eastern China is remarkably high even in clinical remission. Factors such as depression, anxiety, anemia, and IBD-related surgery are major risk factors for fatigue in IBD patients. In addition, fatigue has a negative impact on QoL and is positively correlated with WP loss.
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Affiliation(s)
- Shan-Shan Gong
- Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Yi-Hong Fan
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Mie-Qing Zhang
- Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Yi Xu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Jing Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res 2021; 20:43-52. [PMID: 33472342 PMCID: PMC8831770 DOI: 10.5217/ir.2020.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/12/2020] [Indexed: 11/17/2022] Open
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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Hayes B, Moller S, Wilding H, Burgell R, Apputhurai P, Knowles SR. Application of the common sense model in inflammatory bowel disease: A systematic review. J Psychosom Res 2020; 139:110283. [PMID: 33161175 DOI: 10.1016/j.jpsychores.2020.110283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The aim of this paper was to undertake a systematic review of the research utilizing the Common Sense Model (CSM) involving IBD cohorts to explain the psychosocial processes, including illness perceptions and coping styles, that underpin patient reported outcomes (PROs) - psychological distress (PD) and quality of life (QoL). METHODS Adult studies were identified through systematic searches of 8 bibliographic databases run in August 2020 including Medline, Embase, and PsychINFO. No language or year limits were applied. RESULTS Of 848 records identified, 516 were selected with seven studies evaluating the CSM mediating pathways for final review (n = 918 adult participants). Consistent with the CSM, illness perceptions were associated with PD and QoL in six and five studies respectively. Illness perceptions acted as mediators, at least partially, on the relationship between IBD disease activity and PD and/or QoL in all seven studies. Coping styles, predominantly maladaptive-based coping styles, were found to act as mediators between illness perceptions and PD and/or QoL in five studies. Perceived stress was identified in one study as an additional psychosocial process that partially explained the positive influence of illness perceptions on PD, and a negative impact on QoL. Five studies were classified as high quality and two as moderate. CONCLUSIONS The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs. Future research should explore additional psychosocial processes within the CSM and evaluate the efficacy of targeting CSM processes to promote psychological well-being and QoL in IBD cohorts.
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Affiliation(s)
- Bree Hayes
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Stephan Moller
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Helen Wilding
- St Vincent's Hospital Library Service, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Rebecca Burgell
- Department of Gastroenterology, Alfred Health, PO Box 315, Prahran, Victoria 3181, Australia
| | - Pragalathan Apputhurai
- Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia; Department of Gastroenterology, Alfred Health, PO Box 315, Prahran, Victoria 3181, Australia; Department of Mental Health, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Vic, 3010, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, RMH, Victoria 3050, Australia.
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Davis SP, Bolin LP, Crane PB, Wei H, Crandell J. Non-pharmacological interventions to manage fatigue in adults with inflammatory bowel disease: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 41:101229. [PMID: 32836107 DOI: 10.1016/j.ctcp.2020.101229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of fatigue is higher in adults with inflammatory bowel disease (IBD). There is limited information on the effectiveness of non-pharmacological interventions to manage fatigue. The purposes of this review is to evaluate the effectiveness of these interventions to manage fatigue in adults with IBD. MATERIALS AND METHODS A systematic review was conducted based on the PRISMA guidelines. Comprehensive Meta-Analysis software was used to compute metaanalysis. RESULTS Eleven studies were included in the review. The interventions to manage fatigue included problem-solving therapy, solution-focused therapy, cognitive behavioral therapy, psychoeducational intervention, exercise advice with omega-3 supplements, electro-acupuncture, and AndoSan. The pooled evidence from the metaanalysis demonstrated that non-pharmacological interventions could decrease IBDFatigue (SMD = 0.33, 95% CI [0.10, 0.55], p = 0.005). CONCLUSION The pooled data indicate that non-pharmacological interventions are helpful in managing IBD-Fatigue. Additionally, the non-pharmacological interventions reviewed could be utilized to promote self-management in IBD.
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Affiliation(s)
- Suja P Davis
- School of Nursing, UNC-CH, CB#7460, Chapel Hill, NC, 27599, USA.
| | - Linda P Bolin
- Department of Nursing Science, College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Patricia B Crane
- Carol Grotnes Belk Endowed Chair, 9201, University City Blvd, Charlotte, NC, USA.
| | - Holly Wei
- College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Jamie Crandell
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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22
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Banovic I, Montreuil L, Derrey-Bunel M, Scrima F, Savoye G, Beaugerie L, Gay MC. Toward Further Understanding of Crohn's Disease-Related Fatigue: The Role of Depression and Emotional Processing. Front Psychol 2020; 11:703. [PMID: 32425848 PMCID: PMC7204397 DOI: 10.3389/fpsyg.2020.00703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/23/2020] [Indexed: 01/19/2023] Open
Abstract
Because the relationship between Crohn’s Disease (CD) activity and CD-related fatigue remains poorly understood, this study investigated the role of underlying psychological processes (depression, anxiety, and emotional processing). It was expected that the relationship between CD activity and CD-related fatigue would be mediated by depression and anxiety and also by a deficit in emotional processing. This prediction was tested in 110 CD patients who completed self-reported questionnaires assessing fatigue (FSS), clinical activity of Crohn’s Disease (HBAI), psychological suffering (HADS), and emotional processing (EPS-25). A path analysis showed both direct and indirect effects in the relationship between CD activity and CD-related fatigue, accounting for 33% of the variance. One indirect effect on the experience of fatigue was depression, but there was no effect of anxiety. These preliminary results confirmed that disease activity induces an increase in depressive symptoms, which in turn leads to an increase in the level of fatigue. The most novel result of the present study is that emotional processing had an indirect effect on the relationship between CD and CD-related fatigue: when the disease was more active, patients exhibited greater disruption of emotional processing, which in turn led to greater fatigue. These results did not reveal any association between depression and emotional processing. In conclusion, this work highlights the role of emotional processing in CD-related fatigue and the importance of taking this factor into account in order to manage this condition better.
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Affiliation(s)
- Ingrid Banovic
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
| | - Louise Montreuil
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
| | - Marie Derrey-Bunel
- CRFDP (EA7475), Rouen Normandy University, Hôpital Jacques Monod, Montivilliers, France
| | - Fabrizio Scrima
- CRFDP (EA7475), Rouen Normandy University, UFR SHS, Mont-Saint-Aignan, France
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Fatigue, Physical Activity, and Mental Health in People Living With Inflammatory Bowel Disease, Fibromyalgia, and in Healthy Controls: A Comparative Cross-Sectional Survey. Gastroenterol Nurs 2020; 43:172-185. [PMID: 32251219 DOI: 10.1097/sga.0000000000000415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This study aimed to identify biopsychosocial factors associated with fatigue, physical activity, and perceived benefits of and barriers to exercise in adults with inflammatory bowel disease and to compare them with those with fibromyalgia and healthy controls. A cross-sectional online survey was conducted. Hierarchical linear regressions were used to examine correlates of fatigue and physical activity. Analysis of variance and Kruskal-Wallis tests were used to compare levels of fatigue and physical activity between the groups. Overall, 387 participants completed the study (inflammatory bowel disease: n = 232; fibromyalgia: n = 102; healthy controls: n = 53). Significant correlates of fatigue included pain catastrophizing (p = .006), sleep quality (p = .003), and depressive symptoms (p < .001). Perceived barriers to exercise were associated with depressive symptoms (p = .003). Correlates of perceived benefits of exercise included anxiety (p = .036), depressive symptoms (p = .014), coping (positive reframing) (p = .018), and social support (from family) (p = .033). The fibromyalgia group had the greatest fatigue interference and the lowest score for physical activity, followed by the inflammatory bowel disease group and healthy controls (p < .05). Given the interplay between depressive symptoms, fatigue, and benefits/barriers to exercise, there is a need for more psychological interventions to be developed and tested in order to reduce fatigue and increase physical activity to better manage disease-related outcomes.
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Sweeney L, Moss-Morris R, Czuber-Dochan W, Murrells T, Norton C. Developing a better biopsychosocial understanding of pain in inflammatory bowel disease: a cross-sectional study. Eur J Gastroenterol Hepatol 2020; 32:335-344. [PMID: 31851083 DOI: 10.1097/meg.0000000000001615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pain is frequently reported by patients with inflammatory bowel disease (IBD). Pain in IBD is not fully explained by disease activity or other clinical findings, and a recent systematic review suggested that psychosocial factors have an important role in IBD-pain. The aim of this study was to investigate psychosocial factors associated with pain in IBD. METHODS 297 adults (>16 years) with IBD were recruited from outpatient clinics (n = 114) and online (n = 183). Participants completed validated questionnaires assessing pain and potential emotional, cognitive and behavioural correlates. Socio-demographic and clinical factors including disease activity were also recorded. RESULTS 243 (81.8%) of participants reported pain. Of these 243, mean age was 36 years; 153 (63%) had Crohn's disease, 90 (37%) had ulcerative colitis, and 165 (67.9%) were female. 62.6% reported mild, 31.6% moderate and 5.8% severe pain. 40.3% of participants with pain met established criteria for chronic pain and 18.5% reported opioid use. Female gender, smoking, surgery and steroid use were associated with greater pain severity. Psychosocial factors associated with pain-related interference included depression, catastrophising, fear avoidance, lower self-efficacy and worse mental well-being. Regression models explained 45.6% of the variance in pain severity and 49.7% of pain interference. Psychosocial factors explained 9.5% and 24% of this variance respectively when controlling for demographic and clinical variables. CONCLUSIONS Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood. This study contributes to a biopsychosocial understanding of pain in IBD and identifies important targets for future interventions.
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Affiliation(s)
- Louise Sweeney
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
| | | | | | - Trevor Murrells
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
| | - Christine Norton
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care
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25
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Horta D, Lira A, Sanchez-Lloansi M, Villoria A, Teggiachi M, García-Rojo D, García-Molina S, Figuerola A, Esteve M, Calvet X. A Prospective Pilot Randomized Study: Electroacupuncture vs. Sham Procedure for the Treatment of Fatigue in Patients With Quiescent Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:484-492. [PMID: 31091322 DOI: 10.1093/ibd/izz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is a common symptom in patients with inflammatory bowel disease (IBD), and it often persists despite clinical remission. Acupuncture has been shown to be effective for treating fatigue in patients with many chronic diseases. The main objective of the study was to assess the efficacy of electroacupuncture (EAc), compared with sham EAc (ShEAc) or being on a waitlist (WL), for treating fatigue in patients with quiescent IBD in a single-blind randomized trial. METHODS Fifty-two patients with IBD in clinical remission and fatigue were randomly assigned to 1 of 3 groups: EAc, ShEAc, or WL. Patients in the EAc and ShEAc groups received 9 sessions over 8 weeks. Fatigue was evaluated with the IBD-validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-FS). RESULTS Baseline characteristics were similar in the 3 groups. Both EAc and ShEAc presented improved Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores compared with baseline: the respective improvements were 9.53 (95% confidence intervals, 6.75-12.3, P < 0.001) and 5.46 points (95% confidence intervals, 2.7-9.7, P = 0.015), respectively. No significant changes were observed in the WL group. In the comparison of treatment groups, EAc was nonsignificantly better than ShEAc (EAc, 33.27 and ShEAc, 28.13, P = 0.168); both EAc and ShEAc improved fatigue scores significantly compared to WL (24.5; P = 0.01 and 0.04, respectively). CONCLUSIONS Both EAc and ShEAc reduced fatigue scores in IBD patients when compared to WL. No differences were observed between EAc and ShEAc, although the study was not powered to rule out a difference. Acupuncture may offer improvements to patients with few other treatment alternatives. Clinical Trials Org Id: NCT02733276.
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Affiliation(s)
- Diana Horta
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Alba Lira
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Albert Villoria
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Dario García-Rojo
- Medical Acupuncturist. Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Ariadna Figuerola
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Maria Esteve
- Digestive Diseases Unit, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Xavier Calvet
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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LAGE AC, OLIVEIRA CC, BATALHA APDB, ARAÚJO AF, CZUBER-DOCHAN W, CHEBLI JMF, CABRAL LA, MALAGUTI C. THE INFLAMMATORY BOWEL DISEASE-FATIGUE PATIENT SELF-ASSESSMENT SCALE: TRANSLATION, CROSS-CULTURAL ADAPTATION AND PSYCHOMETRIC PROPERTIES OF THE BRAZILIAN VERSION (IBD-F BRAZIL). ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:50-63. [PMID: 32294736 DOI: 10.1590/s0004-2803.202000000-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
Abstract
ABSTRACT BACKGROUND: Fatigue is a common symptom in patients with inflammatory bowel diseases (IBD). A translated and culturally adapted, instrument with robust psychometric for measuring fatigue in Brazilian patients with IBD is needed. OBJECTIVE: To translate and cross-culturally adapt the inflammatory Bowel Disease Fatigue Scale (IBD-F) into Brazilian-Portuguese and to test its measurement properties in Brazilian patients with IBD. METHODS: Data from 123 patients with IBD were collected. In addition to IBD-F, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) was used. The measurement properties tested were: internal consistency, reproducibility (reliability and agreement), construct validity, internal and external responsiveness, and ceiling and floor effects. RESULTS: The Brazilian-Portuguese version of the IBD-F showed excellent internal consistency (Cronbach’s alpha of 0.95), excellent reproducibility (ICC=0.97) and a minimal detectable change of 6.0 points. The construct validity was demonstrated with a good correlation between the IBD-F and FACIT-F (r=- 0.46). Effect sizes used for measuring internal responsiveness were moderate among those with Crohn’s (0.66) disease and low in patients with ulcerative colitis (0.24). The Brazilian-Portuguese version of the IBD-F presented with high external responsiveness for Crohn’s disease (0.84) and with low external responsiveness for ulcerative colitis (0.33). The area under the curve considered for responsiveness was 0.84. Twenty-five percent of floor effects and no ceiling effect were recorded. CONCLUSION: The Brazilian-Portuguese version of IBD-F has adequate measurement properties and its use can be recommended in clinical practice and research.
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Radford SJ, McGing J, Czuber-Dochan W, Moran G. Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life. Frontline Gastroenterol 2020; 12:11-21. [PMID: 33489066 PMCID: PMC7802486 DOI: 10.1136/flgastro-2019-101355] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on health-related quality of life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue. AIM To investigate what impact IBD fatigue has on HRQoL in adults with IBD. METHODS Systematic searches (CINAHL, EMBASE, PsychINFO, Medline) were conducted on 25 September 2018, restricted to 'human', 'adult', 'primary research' and 'English language'. Search terms encompassed concepts of 'fatigue', 'IBD' and 'HRQoL'. A 5-year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted and quality appraised by two authors. A narrative synthesis was conducted. RESULTS Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial well-being and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably, use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool were some of the methodological shortcomings. CONCLUSION Psychosocial factors, symptom management and acceptance and physical activity levels have significant impact on HRQoL. Results support application of psychosocial or exercise interventions for fatigue management. Further exploration of HRQoL factors in IBD fatigue is required, using validated fatigue and HRQoL measures. PROSPERO REGISTRATION NUMBER CRD42018110005.
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Affiliation(s)
- Shellie Jean Radford
- Nottingham Digestive Diseases Centre, University of Nottingham, University Park Campus, Nottingham, UK,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jordan McGing
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale school of Nursing, Midwifery and Pallative care, King's College London, London, UK
| | - Gordon Moran
- Nottingham Digestive Diseases Centre, University of Nottingham, University Park Campus, Nottingham, UK,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Artom M, Czuber-Dochan W, Sturt J, Proudfoot H, Roberts D, Norton C. Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial. Pilot Feasibility Stud 2019; 5:145. [PMID: 31890258 PMCID: PMC6905023 DOI: 10.1186/s40814-019-0538-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background Fatigue is the third most prevalent symptom for patients with inflammatory bowel disease (IBD), yet optimal strategies for its management are unclear. Treatment protocols for fatigue in other conditions have been based on cognitive-behavioural models. Targeting cognitions, emotions and behaviour related to fatigue through cognitive-behavioural therapy (CBT) may be a viable option to improve fatigue and quality of life (QoL) in IBD. Methods This single centre, two-arm, feasibility randomised controlled trial (RCT) aimed to assess the feasibility and initial estimates of potential efficacy of a CBT intervention for the management of IBD-fatigue. Feasibility, acceptability and initial estimates of potential efficacy outcomes were collected through self-report measures and semi-structured interviews. Participants were recruited from one tertiary referral centre. Intervention Group 1 received a CBT manual for fatigue, one 60-min and seven 30-min telephone sessions with a therapist over 8-weeks. Control Group 2 received a fatigue information sheet without therapist support. A nested qualitative study evaluated patients’ and therapists’ experiences, and IBD-healthcare professionals’ (HCPs) perceptions of the intervention. Results Eighty-nine participants were assessed for eligibility. Of these, 31 of the 70 eligible participants consented to participate (recruitment rate of 44%). Of the 15 participants randomised to the intervention group, 13 (87%) started it and 10 (77% of those who started) completed all 8 sessions. Follow-up questionnaires were completed by 22 (71%) participants at 3 months, 14 (45%) at 6 months and 12 (39%) at 12 months’ follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. HCPs reported that the intervention would be applicable, but time, finance and training constraints limit its implementation. Initial estimates of potential efficacy with complete case analysis showed a reduction in fatigue and an increase in QoL at 3, 6 and 12 months post-randomisation. Conclusions A full-scale effectiveness RCT testing CBT for IBD-fatigue is feasible and is potentially worthwhile with some changes to the protocol. However, given the small numbers, further pilot work is warranted before a full-scale RCT. Trial registration Registration Trial ISRCTN 17917944, Registered 2 September 2016
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Affiliation(s)
- Micol Artom
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Wladyslawa Czuber-Dochan
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Hannah Proudfoot
- 2Tobacco & Alcohol Research Group, University College London, London, UK
| | - Danniella Roberts
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Christine Norton
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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Bager P, Vestergaard C, Juul T, Dahlerup JF. Population-based normative data for the inflammatory bowel disease fatigue scale - IBD-F. Scand J Gastroenterol 2019; 53:1274-1279. [PMID: 30351212 DOI: 10.1080/00365521.2018.1521868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Fatigue is a common concern among patients with inflammatory bowel disease (IBD). The Inflammatory Bowel Disease Fatigue (IBD-F) scale was developed in 2014 together with patients with IBD. The IBD-F comprises five questions about the frequency and severity of fatigue followed by 30 questions about the experience and impact of fatigue. All questions have generic character. Normative values are needed if the IBD-F scale is to be used extensively. This study aims to generate normative values for the IBD-F scale in a Danish background population. MATERIALS AND METHODS An age- and gender-stratified random sample of 3460 Danes was drawn from the total population. The IBD-F and a few socio-demographic questions were administered electronically. RESULTS Of the 3460 drawn individuals, 2952 citizens with electronic access were invited to participate, 1925 (65.2%) citizens accepted the invitation, and 1761 (59.7%) completed the IBD-F questionnaire. Overall, women had more fatigue than men (the frequency and severity, 7.2 vs. 6.6; p < .001) (the experience and impact, 17.0 vs. 13.5; p < .001). Fatigue was most marked for citizens <50 and ≥80 years old. Having no education, working part time, and morbidity were factors associated with more fatigue. Co-habitation was associated with less fatigue. The internal consistency in this population revealed Cronbach's alpha values >0.85. CONCLUSIONS The IBD-F scale can be used in the background population and this study provides normative data for fatigue. Fatigue was higher for women and specific age groups. Several socio-demographic and morbidity variables were associated with fatigue.
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Affiliation(s)
- Palle Bager
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Charlotte Vestergaard
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Therese Juul
- b Department of Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Jens F Dahlerup
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
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Tsai SY, Chen HJ, Lio CF, Kuo CF, Kao AC, Wang WS, Yao WC, Chen C, Yang TY. Increased risk of chronic fatigue syndrome in patients with inflammatory bowel disease: a population-based retrospective cohort study. J Transl Med 2019; 17:55. [PMID: 30795765 PMCID: PMC6387539 DOI: 10.1186/s12967-019-1797-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Similarities in the symptoms of chronic fatigue syndrome (CFS) and inflammatory bowel disease (IBD) have been observed as follows: severe disease activity in IBD correlates with severe fatigue, major psychiatric signs, the common use of medication, and bacterial translocation. One of several hypotheses for explaining the mechanisms underlying CFS suggests a similarity to the impaired intestinal mucosa of IBD. “This study investigated the risk of incident CFS among patients with IBD”. Methods We conducted a population-based retrospective cohort study by using Taiwan’s National Health Insurance Research Database to evaluate the subsequent risk of CFS in patients with IBD, according to demographic characteristics and comorbidities. The exposure cohort comprised 2163 patients with new diagnoses of IBD. Each patient was randomly selected and frequency matching according to gender and age with four participants from the general population who had no history of CFS at the index date (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between IBD and the subsequent risk of CFS. Results The exposure cohort had a significantly higher overall risk of subsequent CFS than that of the control group [adjusted hazard ratio (Christophi in Inflamm Bowel Dis 18(12):2342–2356, 2012) = 2.25, 95%, confidence interval (Aaron and Buchwald in Ann Intern Med 134(9 Pt 2):868–881, 2001; Farraye et al. in Am J Gastroenterol 112:241, 2017) 1.70–2.99]. Further analysis indicated a significantly higher risk of CFS in patients who were male (HR = 3.23, 95% CI 2.12–4.91), were older than 35 years, and had IBD but without comorbidity status, e.g. Cancers, diabetes, obesity, depression, anxiety, sleep disorder, renal disease (HR = 2.50, 95% CI 1.63–3.84) after adjustment. Conclusion The findings from this population-based retrospective cohort study suggest that IBD, especially Crohn’s disease, is associated with an increased risk of subsequent CFS. Electronic supplementary material The online version of this article (10.1186/s12967-019-1797-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shin-Yi Tsai
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan. .,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. .,Graduate Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan. .,Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Fu Lio
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chien-Feng Kuo
- Institute of Infectious Disease, MacKay Memorial Hospital, Taipei, Taiwan
| | - An-Chun Kao
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Shieng Wang
- Institute of Infectious Disease, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wei-Cheng Yao
- Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Tao-Yuan, 330, Taiwan
| | - Chi Chen
- Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tse-Yen Yang
- College of Medicine, China Medical University, Taichung, Taiwan. .,Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
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Abstract
Fatigue is a highly prevalent but relatively ignored problem in IBD patients. It is one of the most burdensome symptoms to the patient with an important impact on the quality of life. Therefore, fatigue is a highly relevant patient-reported outcome that should be included not only in disease activity measurement but also in the endpoints of clinical trials in IBD. However, most of the currently available scoring systems to quantify fatigue are not specifically designed for patients with IBD and none of them has undergone a complete validation process for IBD-related fatigue. Fatigue is more prevalent in patients with active disease and may improve or disappear when remission is reached. Far more complex is the persistence or onset of fatigue in quiescent IBD which presents in up to 40% of the patients. In this subgroup of patients, fatigue can be related to smoldering systemic inflammation, a poor sleep quality, anemia, nutritional deficiencies, or comorbidities. In most cases, however, no direct cause can be identified. The lack of knowledge on the mechanisms that drive fatigue in IBD hamper the development of specific drugs to treat the condition and only psychological support can be offered to the patient. Rodent models are indispensable to increase our understanding of the molecular pathways that lead to fatigue in chronic intestinal inflammation, and to develop novel therapies.
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Ballou S, Alhassan E, Hon E, Lembo C, Rangan V, Singh P, Hirsch W, Sommers T, Iturrino J, Nee J, Lembo A. Sleep Disturbances Are Commonly Reported Among Patients Presenting to a Gastroenterology Clinic. Dig Dis Sci 2018; 63:2983-2991. [PMID: 30094624 DOI: 10.1007/s10620-018-5237-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poor sleep quality is common among patients with gastrointestinal (GI) disorders. However, few studies have assessed the presence of insomnia or reported circadian preferences and none have directly compared sleep between common GI conditions. AIMS To compare clinical sleep characteristics in patients presenting to a tertiary care GI clinic for irritable bowel syndrome (IBS), functional dyspepsia (FD), inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and celiac disease (CD). METHODS Validated sleep measures were administered to consecutive patients if they were diagnosed with IBS, IBD in clinical remission, CD, FD, or GERD. Healthy Controls (HCs) with no reported GI diagnoses or symptoms were also recruited. RESULTS A total of 212 eligible respondents completed this survey, 161 GI clinic patients (IBS (n = 48), GERD (n = 29), IBD in clinical remission (n = 44), CD (n = 40)), and 41 HCs. Only, 10 respondents had a diagnosis of FD, and these were excluded. The IBS group had the highest frequency of poor sleep (72%) followed by CD (61%), GERD (60%), IBD (54%), and HC (39%). IBS patients also had the highest frequency of clinical insomnia (51%), followed by GERD (37%), CD (35%), IBD (27%), and HC (18%). 40% of IBS patients reported taking sleep medications at least once per week, compared to 32% of GERD, 23% IBD, 13% CD, and 15% HC. CONCLUSIONS Patients presenting to a tertiary care GI clinic report poorer sleep than healthy controls. In general, patients with IBS report the highest rates of sleep difficulties compared to patients with other diagnoses.
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Affiliation(s)
- Sarah Ballou
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Eaman Alhassan
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Elise Hon
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Cara Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Vikram Rangan
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Prashant Singh
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - William Hirsch
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Thomas Sommers
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Johanna Iturrino
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Judy Nee
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Anthony Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA.
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Ratnakumaran R, Warren L, Gracie DJ, Sagar RC, Hamlin PJ, O'Connor A, Ford AC. Fatigue in Inflammatory Bowel Disease Reflects Mood and Symptom-Reporting Behavior Rather Than Biochemical Activity or Anemia. Clin Gastroenterol Hepatol 2018; 16:1165-1167. [PMID: 29174713 DOI: 10.1016/j.cgh.2017.11.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Raguprakash Ratnakumaran
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - Lisa Warren
- Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - David J Gracie
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - Rebecca C Sagar
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - P John Hamlin
- Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - Anthony O'Connor
- Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom; Leeds Gastroenterology Institute, St. James' University Hospital, Leeds, United Kingdom.
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Artom M, Czuber-Dochan W, Sturt J, Norton C. Cognitive behavioural therapy for the management of inflammatory bowel disease-fatigue with a nested qualitative element: study protocol for a randomised controlled trial. Trials 2017; 18:213. [PMID: 28490349 PMCID: PMC5425996 DOI: 10.1186/s13063-017-1926-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fatigue is one of the most prevalent and burdensome symptoms for patients with inflammatory bowel disease (IBD). Although fatigue increases during periods of inflammation, for some patients it persists when disease is in remission. Compared to other long-term conditions where fatigue has been extensively researched, optimal management of fatigue in patients with IBD is unknown and fatigue has rarely been the primary outcome in intervention studies. To date, interventions for the management of IBD-fatigue are sparse, have short-term effects and have not been implemented within the existing health system. There is a need to integrate current best evidence across different conditions, patient experience and clinical expertise in order to develop interventions for IBD-fatigue management that are feasible and effective. Modifying an existing intervention for patients with multiple sclerosis, this study aims to assess the feasibility and initial estimates of efficacy of a cognitive behavioural therapy (CBT) intervention for the management of fatigue in patients with IBD. METHODS The study will be a two-arm pilot randomised controlled trial. Patients will be recruited from one outpatient IBD clinic and randomised individually to either: Group 1 (CBT manual for the management of fatigue, one 60-min session and seven 30-min telephone/Skype sessions with a therapist over an eight-week period); or Group 2 (fatigue information sheet to use without therapist help). Self-reported IBD-fatigue (Inflammatory Bowel Disease-Fatigue Scale) and IBD-quality of life (United Kingdom Inflammatory Bowel Disease Questionnaire) and self-reported disease activity will be collected at baseline, three, six and 12 months post randomisation. Illness perceptions, daytime sleepiness, anxiety and depression explanatory variables will be collected only at three months post randomisation. Clinical and sociodemographic data will be retrieved from the patients' medical notes. A nested qualitative study will evaluate patient and therapist experience, and healthcare professionals' perceptions of the intervention. DISCUSSION The study will provide evidence of the feasibility and initial estimates of efficacy of a CBT intervention for the management of fatigue in patients with IBD. Quantitative and qualitative findings from the study will contribute to the development and implementation of a large-scale randomised controlled trial assessing the efficacy of CBT interventions for IBD-fatigue. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17917944 . Registered on 2 September 2016.
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Affiliation(s)
- Micol Artom
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Wladyslawa Czuber-Dochan
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Christine Norton
- King’s College London, Florence Nightingale Faculty of Nursing & Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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35
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Artom M, Czuber-Dochan W, Norton C. Letter: causes of fatigue in inflammatory bowel disease remain uncertain - authors' reply. Aliment Pharmacol Ther 2017; 45:763-764. [PMID: 28150457 DOI: 10.1111/apt.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- M Artom
- Faculty of Nursing and Midwifery, King's College London, London, UK
| | - W Czuber-Dochan
- Faculty of Nursing and Midwifery, King's College London, London, UK
| | - C Norton
- Faculty of Nursing and Midwifery, King's College London, London, UK
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36
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Gracie DJ, Ford AC. Letter: causes of fatigue in inflammatory bowel disease remain uncertain. Aliment Pharmacol Ther 2017; 45:762-763. [PMID: 28150449 DOI: 10.1111/apt.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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