Fatigue in Inflammatory Bowel Disease Reflects Mood and Symptom-Reporting Behavior Rather Than Biochemical Activity or Anemia

Ratnakumaran, Raguprakash; Warren, Lorraine; Gracie, David J.; Sagar, Rebecca; Hamlin, PJ; OʼConnor, Anthony; Ford, Alexander C

doi:10.1016/j.cgh.2017.11.030

Cited by 20 publications

(19 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of patient self-report disease activity scores may have resulted in incomplete or inaccurate data on remission status. Although self-reported disease activity scores are often utilised in research studies, it is best practice for clinicians to complete them after obtaining information from people with IBD [104] and/or use faecal calprotectin or endoscopic assessments [105]. In addition, the interviews were conducted by one of the investigators involved in recruitment of participants, which may have influenced the extent to which participants were willing to be critical.…”

Section: Discussionmentioning

confidence: 99%

Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial

Artom

Czuber‐Dochan

Sturt

et al. 2019

Pilot Feasibility Stud

View full text Add to dashboard Cite

BackgroundFatigue 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.MethodsThis 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.ResultsEighty-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.ConclusionsA 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 registrationRegistration Trial ISRCTN 17917944, Registered 2 September 2016

show abstract

Section: Discussionmentioning

confidence: 99%

Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial

Artom

Czuber‐Dochan

Sturt

et al. 2019

Pilot Feasibility Stud

View full text Add to dashboard Cite

show abstract

“…Whether fatigue represents true inflammatory activity, anaemia, mood disorder or symptom-reporting in general remains unclear. 36 , 37 The many factors leading to fatigue in IBD probably reflect the ability of both CD and UC to interfere across many domains of life ( Figure 2 ). We would therefore argue that, given the complexity of fatigue in IBD, the multidisciplinary approach piloted in this trial, encompassing gastroenterology, psychology and occupational therapy, may be more likely to provide comprehensive and durable benefits to patients with IBD.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial: a pilot study of a psychoeducational intervention for fatigue in patients with quiescent inflammatory bowel disease

OʼConnor

Ratnakumaran

Warren

et al. 2019

Therapeutic Advances in Chronic Disease

Self Cite

View full text Add to dashboard Cite

Introduction:Fatigue is a frequent, debilitating symptom of inflammatory bowel disease (IBD). Despite this, studies report dissatisfaction among IBD patients regarding how little attention is given to fatigue-related issues during consultations. We performed a pilot randomized controlled trial (RCT) to assess whether a brief, structured, multidisciplinary psychological support program improved fatigue, mood and quality of life indices in patients with quiescent IBD.Methods:The intervention consisted of three small-group psychoeducational sessions over 6 months. Primary outcomes were effect on fatigue severity and impact scores. Secondary outcomes included effect on depression, anxiety, somatization scores, generic and disease-specific quality of life.Results:Twenty-three patients were enrolled, 10 in the intervention arm and 13 controls. Mean fatigue severity and impact scores improved for patients in the intervention group (by 14.5–13.1 and 49.7–45.8, respectively), and worsened in controls (by 11.5–12.6 and 33.5–35 respectively). Mean Short Form 36 (SF-36) scores for role limitations due to physical health decreased from 44.4 to 38.9 in the intervention group, but increased from 44.2 to 51.9 among controls. Energy scores in the intervention group improved from 17.8 to 26.6, but only from 31.4 to 31.7 among controls. Short IBD questionnaire scores improved in both groups, from 46.2 to 45.2 in controls compared with 44.4–40 in the intervention group.Discussion:In this small pilot RCT, positive effects were demonstrated on fatigue, energy levels and other quality of life outcomes. Larger, adequately powered studies with longer follow up are required.ClincialTrials.gov identifier: NCT02709434.

show abstract

“…This finding is supported by evidence of a high prevalence of fatigue in patients with both inactive UC and Crohn’s disease, 13 , 19 and although an increase in both the severity and impact of fatigue has been observed in patients with IBD, this did not correlate with objective markers of disease activity, such as faecal calprotectin or haemoglobin. 34 …”

Section: Discussionmentioning

confidence: 99%

“…In terms of data on IBD-F scores in patients with UC or Crohn’s, Vestergaard and colleagues reported median fatigue scores of 9 (IQR 5–11) and 21 (IQR 4–34) for fatigue severity or impact, respectively, 31 and Ratnakumaran and colleagues reported mean fatigue severity scores of 11.5 (SD 3.0) in UC and 12.9 (3.6) in Crohn’s, and mean fatigue impact scores of 52.0 (28.7) and 53.5 (22.9) in UC and Crohn’s, respectively. 34 However, stratification of either median or mean levels of fatigue severity or impact has not been performed. Some studies in patients with classical IBD have provided data concerning the impact of fatigue on health-related quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is supported by evidence of a high prevalence of fatigue in patients with both inactive UC and Crohn's disease, 13,19 and although an increase in both the severity and impact of fatigue has been observed in patients with IBD, this did not correlate with objective markers of disease activity, such as faecal calprotectin or haemoglobin. 34 Making a direct comparison between patients with MC and classical IBD is difficult, due to the absence of a comparable biomarker for disease activity, and widely accepted clinical disease activity indices are lacking. In terms of data on IBD-F scores in patients with UC or Crohn's, Vestergaard and colleagues reported median fatigue scores of 9 (IQR 5-11) and 21 (IQR 4-34) for fatigue severity or impact, respectively, 31 and Ratnakumaran and colleagues reported mean fatigue severity scores of 11.5 (SD 3.0) in UC and 12.9 (3.6) in Crohn's, and mean fatigue impact scores of 52.0 (28.7) and 53.5 (22.9) in UC and Crohn's, respectively.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fatigue and its associated factors in microscopic colitis

Kane

Irvine

Derwa

et al. 2018

Therap Adv Gastroenterol

Self Cite

View full text Add to dashboard Cite

Background:Fatigue is a well-recognized symptom in patients with inflammatory bowel disease and irritable bowel syndrome (IBS), and has been associated with psychological comorbidity and impaired quality of life in both. However, features associated with fatigue in patients with microscopic colitis (MC) are less clear.Materials and methods:We conducted a cross-sectional survey of patients with a new diagnosis of MC including levels of anxiety, depression, somatization, quality of life, and IBS-type symptoms. Levels and impact of fatigue were assessed using the Inflammatory Bowel Disease Fatigue self-assessment scale. Mean scores were compared against various patient characteristics, and were also correlated with anxiety, depression, somatization, and quality-of-life scores.Results:In total, 129 patients with MC diagnosed between 2010 and 2015 returned completed postal questionnaires. Common histological subtypes were collagenous colitis (53.5%, n = 69) and lymphocytic colitis (38.8%, n = 50). Higher mean fatigue severity and impact scores were associated with the presence of irritable-bowel-syndrome-type symptoms, abnormal levels of anxiety and depression, and high levels of somatization (p < 0.0001 for all), but those reporting ongoing symptoms attributable to MC did not report significantly higher scores. There were significant positive correlations between total anxiety, depression, or somatization scores and fatigue severity and impact scores, and significant negative correlations with quality-of-life measures (p < 0.001 for all).Conclusions:Fatigue in MC appears to be associated with reporting IBS-type symptoms, psychological comorbidity and impaired quality of life. It may therefore represent an important target for treatment.

show abstract

Fatigue in Inflammatory Bowel Disease Reflects Mood and Symptom-Reporting Behavior Rather Than Biochemical Activity or Anemia

Cited by 20 publications

References 8 publications

Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial

Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial

Randomized controlled trial: a pilot study of a psychoeducational intervention for fatigue in patients with quiescent inflammatory bowel disease

Fatigue and its associated factors in microscopic colitis

Contact Info

Product

Resources

About