Introduction Fatigue is a complex, multifactorial and multidimensional phenomenon. Recognition of modifiable correlates of fatigue can provide a further understanding of this phenomenon in patients with inflammatory bowel disease (IBD) and aid in the development of interventions tailored towards fatigue. The aim of the present review was to systematically search and synthesise available evidence on potentially modifiable factors contributing to IBD-fatigue and what advances in the management of fatigue in individuals with IBD have been made.
Methods The review was comprised of a systematic search and a selective review. The process of selection of the retrieved citations was undertaken in two phases: i) systematic search for new studies published since the search of the previous review by Czuber-Dochan and colleagues in August 2012 (n = 21); ii) reselection of papers (n = 28) included in Czuber-Dochan and colleagues according to the aims of the current review. Seven databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, the Cochrane Library and the British Nursing Index. The search included quantitative observational designs and experimental studies.
Results Forty-three studies met the inclusion criteria, 27 cross-sectional studies, 7 longitudinal studies, 1 quantitative secondary data analysis, 7 RCTs and 1 open label pilot study. Studies were conducted in out-patient settings and with population-based cohorts. The quality of included papers was assessed using the Critical Appraisal Skills Programme. The studies were classified as high (n = 15), medium (n = 19) and low quality (n = 9), no studies were excluded on the basis of quality. IBD-fatigue was consistently associated with disease activity, depression, anxiety and sleep difficulties. However, most studies were cross-sectional thus the direction of causation remains unknown. The relationship between biochemical factors, such as anaemia and inflammation, and fatigue was inconsistent. Adding to the existing 5 interventions since the last review in 2013 only 3 interventions were tested to address IBD-fatigue. One assessed the effects of thiamine, one compared exercise advice, omega-3 oil fish oil, a dietary consultation and placebo and the last comparing solution focused therapy and care as usual. Findings from psychosocial and exercise interventions were promising. Nonetheless, interventions continue to be sparse, with methodological limitations and only short-term effects.
Conclusion The review identified a number of psychosocial and physical factors, which could potentially be modified through targeted health interventions to improve fatigue in IBD. Research utilising prospective observational studies and RCT design is required to develop and test interventions to reduce fatigue, most likely within a biopsychosocial model of care.
Disclosure of Interest None Declared
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