Background: Fatigue is a frequently reported and predominant symptom experienced by patients with inflammatory bowel disease (IBD) and its impact has been associated with poorer quality of life (QoL). The complex interplay between disease-related variables and potentially modifiable psychosocial factors in IBD-fatigue has yet to be unravelled. Aim to evaluate the contribution of clinical, sociodemographic and psychosocial factors to the severity and impact of IBD-fatigue and QoL.
Methods: In a cross-sectional study, 182 patients with IBD were recruited from three tertiary referral hospitals' outpatient clinics in London. Fatigue was assessed utilising the Inflammatory Bowel Disease-Fatigue Scale (IBD-F), the Multidimensional Fatigue Inventory (MFI); and QoL by the Inflammatory Bowel Disease Questionnaire (IBDQ). Patients completed self-report questionnaires evaluating emotional, cognitive and behavioural factors potentially correlated with fatigue. Sociodemographic data were collected. Disease-related and laboratory data were retrieved from patients' hospital electronic medical records.
Results: In hierarchical regression models, disease activity was the only disease-related factor consistently associated with severity and impact of fatigue and QoL (p=0.01). More negative fatigue perceptions were significantly associated with greater IBD-F1 scores (p=0.01). When controlling for clinical factors (disease activity and anti-TNF therapy), negative perceptions of fatigue, and all-or-nothing and avoidance behaviours explained an additional 41% of the variance in fatigue impact (Table 1).
Disease activity (p<0.001) and currently taking steroids (p=0.01) were significantly associated with worse QoL. The addition of emotional, cognitive and behavioural variables significantly increased the validity of the model, with the fully adjusted model explaining 64% of the variance in QoL. Higher levels of IBD-related distress (p=0.01) was significantly associated with diminished QoL (Table 2).
Conclusions: Apart from disease activity, emotional and behavioural factors and patients' negative fatigue perceptions may be key factors to be addressed. Further exploration of these factors in longitudinal and intervention studies may help to develop effective models of fatigue management.