Micol Artom

Fatigue in advanced kidney disease.

Fatigue is commonly experienced in patients with advanced kidney disease and associated with poor outcomes. The prevalence of fatigue ranges from 42% to as high as 89% according to treatment modality and the measurement instruments used. This paper reviews studies examining sociodemographic, biological, and psychological factors associated with fatigue in advanced kidney disease. The association between fatigue and psychological factors, such as depression and anxiety, behavioral factors, such as sleep and nutrition, and cytokines, such as IL-6 and CRP corroborates the view of fatigue as a multidimensional and multifactorial problem. Although depression and fatigue are related, the relationship is typically moderate in size, thus fatigue should not simply be seen as a symptom of distress. Accordingly, it is important for treatment plans to address the complex etiology of fatigue through pharmacological and nonpharmacological interventions. To date, results of nonpharmacological interventions are promising, with physical exercise and cognitive-behavioral therapy showing beneficial results. Work conducted in other patient populations highlights the importance of cognitions and behaviors in the prediction and maintenance of fatigue. Such work could be applied to advanced kidney disease allowing a model of fatigue to be developed from which to base suitable interventions in this setting.

Targets for Health Interventions for Inflammatory Bowel Disease-fatigue

BACKGROUND AND AIMS 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 with potential for efficacy. Our aims were 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 process of selection of citations was based on an earlier review by Czuber-Dochan et al. [2013] and was undertaken in two phases: i] searching for new studies published since August 2012, using seven electronic databases; ii] re-selection of papers included in previous review according to the aims of the current review. RESULTS A total of 43 studies met the inclusion criteria. 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. Solution-focused therapy, thiamine, and exercise showed promising effects on IBD-fatigue. Interventions continue to be sparse, with methodological limitations and only short-term effects reported. CONCLUSIONS The review identified a number of psychosocial and physical factors which could potentially be modified through targeted health interventions and improve fatigue in IBD. Research utilising prospective observational studies and randomized control trial [RCT] design is required to develop and test interventions to reduce fatigue, most likely within a biopsychosocial model of care.

The contribution of clinical and psychosocial factors to fatigue in 182 patients with inflammatory bowel disease: a cross‐sectional study

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.

Systematic review: interventions for abdominal pain management in inflammatory bowel disease

Abdominal pain is frequently reported by people with inflammatory bowel disease (IBD), including in remission. Pain is an under‐treated symptom.

PTH-111 Clinical and psychosocial predictors of abdominal pain frequency in patients with inflammatory bowel disease

Introduction Pain is a commonly experienced and burdensome symptom in patients with Inflammatory Bowel Disease (IBD). A substantial number of patients continue to experience pain while the disease is in remission. Research exploring factors in IBD-pain is sparse. This study aimed to explore sociodemographic, clinical and psychosocial factors associated with pain frequency in patients with IBD. Method Patients recruited from outpatient IBD services completed the United Kingdom Inflammatory Bowel Disease Questionnaire (UK IBDQ) and a number of sociodemographic, clinical and psychosocial measures. In the secondary analysis of these data, item 13 from the UK IBDQ measuring pain frequency, “On how many days over the last two weeks have you felt pain in your abdomen?”, was utilised as the primary outcome. Sociodemographic, disease-related and laboratory data were retrieved from patients’ hospital electronic medical records. Patients completed a number of self-report measures including: IBD-Fatigue Scale (IBD-F) and Multidimensional Fatigue Inventory (MFI), Hospital Anxiety and Depression Scale (HADS), IBD-Distress Scale (IBD-DS), Cohen Perceived Stress Scale (PSS), Brief Illness Perceptions Questionnaire (BIPQ) and Cognitive and Behavioural Responses to Symptoms Questionnaire (CBSQ). Univariate and multivariate analyses were conducted to test the relationship between pain frequency and sociodemographic, clinical and psychosocial variables. Results 182 patients with IBD took part in the study (57% female, 64% Crohn’s Disease, mean age 37.0 years). In univariate analyses, greater pain frequency was significantly associated with disease activity and fatigue. Female patients, those with active disease and taking steroids reported significantly more pain frequency. All emotional, cognitive and behavioural factors in psychosocial measures had significant positive correlations with pain frequency. In multivariate analyses, disease activity (p=0.01) and fatigue measured by the MFI (p=0.04), were significant predictors of pain frequency and explained 26% of the variance. Emotional, cognitive and behavioural factors were not found to predict pain frequency. Conclusion Fatigue and disease activity were independent predictors of pain frequency in patients with IBD. Utilising a single pain item from the IBDQ, none of the psychosocial factors were found to predict pain frequency. Further research, using more comprehensive pain measures, capturing pain severity and frequency is required to explore the relationship between pain and psychosocial factors in IBD. This knowledge may help in the development of pain management interventions. Disclosure of Interest None Declared

PWE-031a Exploring Fatigue in Inflammatory Bowel Disease – A Descriptive Phenomenological Study

Introduction Fatigue is frequently reported by people with active (86%) and quiescent (41%) inflammatory bowel disease (IBD).1 It is considered a complex and multifaceted symptom; it affects many aspects of individuals’ lives. To date, limited research has investigated IBD-fatigue;2 little is known about specific areas of life affected by it or how people with IBD manage it. Methods Descriptive phenomenology with unstructured, in-depth interviews.3 Twenty participants with IBD and reporting fatigue were purposively selected and interviewed face-to-face. Interviews were audio-recorded, transcribed verbatim and analysed using Moustakas’ method. Data were analysed at individual and composite (group) level, and provided a description (texture) and an explanation (structure) of the studied phenomenon. Results A wide range of terminology, including metaphors and similes, were used to describe fatigue reflecting its complex nature. Fatigue was presented as invisible, unpredictable, with constantly fluctuating daily patterns and severity. This made reporting fatigue difficult and at times lead to participants being challenged about its authenticity. The array of physical, psychological, cognitive and situational factors were perceived to contribute to fatigue, and different methods (e.g. sleep and rest, pacing, energy preservation, exercise, stress reduction, asking for help) were attempted by participants to manage fatigue. Most methods were not used systematically, possibly resulting in their apparently limited effectiveness. Impact of fatigue was perceived as negative, with participants constantly comparing their life and themselves as they were before fatigue and how much they have lost. They felt that fatigue is in control of their life and each day they had to fight another battle to defeat fatigue. Participants felt imprisoned in their fatigued unreliable body leaving them frustrated, isolated and lacking self-confidence. They reported loss of self and self-identity, resisting to accept the ‘new fatigued me’. Conclusion Fatigue is a major and debilitating symptom for individuals diagnosed with IBD, reducing their quality of life. The complex, invisible and fluctuating nature of fatigue makes difficult for patients to describe it to others. Patients need to be informed that fatigue is part of IBD and they should be encouragement to report and to seek help from health professionals. References 1 Czuber-Dochan W, Ream E, Norton C. Review article: description and management of fatigue in inflammatory bowel disease. APT 2013;37:505–16. 2 Czuber-Dochan W, Dibley L, Terry H, Ream E, Norton C. The experience of fatigue in people with inflammatory bowel disease: an exploratory study. JAN 2013;69:1987–99. 3 Van Manen M. Researching lived experience. 1997. The Althouse Press, London. Disclosure of Interest None Declared