Fatigue Is Associated with Anxiety and Lower Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Remission

Psychometric evaluation of the Functional Assessment of chronic illness therapy-fatigue (FACIT-Fatigue) in adults with moderately to severely active Crohn's disease

PURPOSE

To provide further evidence on the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in moderately to severely active Crohn's disease (CD), and to determine thresholds for meaningful improvement in fatigue.

METHODS

The FACIT-Fatigue is a 13-item patient-reported outcome measure (range, 0-52) assessing fatigue over the previous week. Using pooled data from the Phase 3 VIVID-1 study of moderately to severely active CD, psychometric properties of FACIT-Fatigue were evaluated up to Week 52. The Patient Global Rating of Severity (PGRS) and Patient Global Impression of Change (PGIC) were used as primary anchors to estimate the FACIT-Fatigue score change representing meaningful improvement.

RESULTS

Psychometric analyses included 1065 adults. The FACIT-Fatigue demonstrated good internal consistency, and correlations between individual items and the total score were moderate to strong. The FACIT-Fatigue score showed moderate to strong correlations with other patient-reported assessments and weak correlations with endoscopic/laboratory assessments. The FACIT-Fatigue differentiated between distinct groups of participants varying in disease severity, quality of life, and fatigue based on PGRS and other assessments. FACIT-Fatigue improvements during the study differed significantly between most PGRS change and PGIC categories. Anchor-based estimates suggested a 6-9-point increase in the FACIT-Fatigue total score as meaningful improvement.

CONCLUSIONS

The FACIT-Fatigue demonstrated strong psychometric properties in the VIVID-1 population of adults with moderately to severely active CD and determined a FACIT-Fatigue score change threshold representing meaningful improvement.

TRIAL REGISTRATION

NCT03926130. Registered 23 April 2019, https://clinicaltrials.gov/study/NCT03926130 .

Health-related quality of life associated with fatigue, physical activity and activity pacing in adults with chronic conditions

BACKGROUND

Fatigue and inactivity are linked to decreased health-related quality of life (HRQoL) in chronic conditions. A multidimensional approach to activity pacing may improve HRQoL by promoting physical activity (PA) and alleviating fatigue. Addressing fatigue across chronic conditions is crucial, especially when underlying causes are unknown. This study aimed to (1) examine associations between HRQoL, fatigue, pacing, risk of overactivity, PA, and self-regulation of PA in adults with chronic conditions and (2) examine if these associations differ across HRQoL domains: physical, social, emotional, and functional well-being.

METHODS

Sixty-six adults with chronic conditions were recruited from UK fatigue clinics and the community. HRQoL, pacing, risk of overactivity, PA, and self-regulation of PA were assessed with standardised questionnaires and Actigraph monitor. Associations were analysed with linear mixed models, correcting for confounders.

RESULTS

HRQoL was significantly associated with fatigue (B=-7.82), pacing (B=-0.23), and self-regulation of PA (B = 0.11). Interaction effects revealed fatigue's impact on HRQoL varied significantly in physical (β=-13.49), social (β=-6.81), and emotional (β=-4.10) domains. Pacing showed significant differences in physical (β=-0.49), social (β=-7.12), and emotional (β=-7.45) domains. Perceived overactivity differed in social domain (β=-6.27), while device-based PA differed in physical (β = 0.35) and social (β = 5.73).

CONCLUSION

The negative association between fatigue and HRQoL underscores the importance of effective fatigue management. Higher pacing engagement and lower HRQoL may indicate higher fatigue. Positive associations between self-regulation and PA with HRQoL emphasise benefits of appropriate PA behaviours. The stronger impact of decreased fatigue, increased pacing, and PA on physical well-being suggests a multidimensional fatigue management approach.

Avolition Characterizes the Chronic Fatigue Experienced in Quiescent Inflammatory Bowel Disease

Background and Aims: Avolition is a symptom responsible for a high burden in patients suffering from psychiatric diseases. It refers to a motivation loss for initiating and maintaining goal-directed activities, often called fatigue by patients. Fatigue is a widespread complaint of patients suffering from inflammatory bowel disease (IBD), significantly impacting patients' well-being, even during the quiescent stage of the disease. We here address the hypothesis that fatigue experienced by IBD patients is associated with motivational impairment. Methods: Patients presenting IBD (n = 110) in a quiescent stage of Crohn's disease (CD) (n = 60) and ulcerative colitis (UC) (n = 50) were enrolled and classified following their declared experience of fatigue (n = 58) or not (n = 52). Patients were phenotyped using self-administered scales for fatigue experience, bowel disease disability, quality of life and mental health symptoms. Results: The self-administered negative symptoms scale scores identified avolition as a specific feature of fatigue experience: fatigued vs. no-fatigue in the CD group (3.806 vs. 2.103; p = 0.003) and in the UC group (2.815 vs. 1.174; p = 0.003). This difference is independent of current depressive disorder and previous history of depressive disorder. Avolition associates and correlates with the experience of fatigue (r = 0.49) in multivariate analysis. Conclusions: To tackle the question of fatigue in IBD, research should consider investigating the biological mechanisms implicating intestinal physiopathology of IBD in the impairment of brain structure involved in motivation. This may open new fields for treatment in targeting structures of the brain reward system.

Fatigue in pediatric inflammatory bowel diseases: A systematic review and a single center experience

OBJECTIVES

We aimed to review the literature on fatigue in pediatric inflammatory bowel diseases (PIBD), to explore how it is measured, and approximate its rate in an inception pediatric cohort.

METHODS

Studies on fatigue were systematically reviewed and selected by two authors. Next, we retrieved the two fatigue-related questions of the IMPACT-III questionnaire at 4 and 12 months after diagnosis from a prospectively maintained cohort of PIBD patients, each scoring 0-100 (lower scores imply more fatigue), and 44 healthy controls.

RESULTS

The systematic review identified 14 studies reporting fatigue in children, of which nine had fatigue as the primary outcome and only two provided rates of fatigue. No standalone index was identified for measuring fatigue specifically for PIBD. Of 80 children included in the inception cohort, 62 (78%) scored an average of ≤75 on the two IMPACT-III questions (approximating at least mild fatigue), 26 (33%) scored ≤50 (at least moderate fatigue) and nine (11%) scored ≤25 (severe fatigue). In comparison, only four (9%) healthy children scored at least moderate fatigue (p = 0.007). Fatigue rates at 12 months were only slightly and nonsignificantly lower. Fatigue of any severity was reported in 92% children with active disease versus 63% of those in clinical remission (p = 0.01).

CONCLUSION

Literature reporting on fatigue in PIBD is scarce, and no PIBD-specific tool is available to measure fatigue. In our cohort, fatigue-related questions were frequently scored low in children with IBD, mainly among children with active disease but also during clinical remission.