A number of studies have identified fatigue as a leading concern among individuals with IBD (Drossman et al. 1989; Casti et al. 2000; Casellas et al. 2001; de Rooy et al. 2001). Jelsness-Jørgensen et al. (2011) found that reduced energy levels were a consistent concern of patients over a one-year period. A number of physical, psychological and situational factors are associated with fatigue, with increased disease activity, depression, anxiety and stress found to be consistently associated with greater levels of fatigue (Czuber-Dochan et al. 2013).
Studies have demonstrated that IBD related fatigue negatively impacts on quality of life and activities of daily living in individuals with inflammatory bowel disease (Minderhoud et al. 2003; Graff et al. 2011; Czuber-Dochan et al. 2013; Opheim et al. 2014). A recent study by Czuber–Dochen et al. (2014) revealed that while healthcare professionals perceive fatigue as an important and problematic symptom in patients with IBD its impact and associated management remain poorly understood.
In recent years, there has been an increase in the number of Cochrane reviews undertaken to examine the effect of drugs (Minton et al. 2013), blood transfusions (Preston et al. 2012), exercise (Cramp and Byron-Daniel, 2012), education (Bennet et al. 2010) and psychosocial interventions (Goedendorp et al. 2009) on cancer-related fatigue. Interventions have been developed and published to address the problem of IBD related fatigue either directly (e.g. Vogelaar et al. 2013) or indirectly (e.g. Garcia-Vega & Fernandez-Rodriguez, 2004) as part of the
overall management of the disease and its symptoms. These vary between pharmacological and nonpharmacological interventions. However, to date, there is uncertainty regarding the effects of these interventions in alleviating fatigue. Unlike the case of cancer, no systematic review has previously been undertaken to assess the effects of interventions for fatigue in IBD. A Cochrane Review is therefore proposed to draw together existing evidence on the effects interventions for fatigue in individuals with IBD. This review is important and timely given
the rising incidence of IBD, the increase in healthcare service utilisation, and the economic and individual burden of fatigue in Ireland and globally.
AIM OF THE REVIEW: To assess the effect of interventions for fatigue in inflammatory bowel disease.
OVERVIEW OF METHODS: Methods will be in the accordance with the Cochrane handbook and the inclusion criteria for the review are set using the PICO format:
Criteria for Including Studies
Type of Participants: Children, adolescents and adults with Crohn’s disease or ulcerative colitis or any other form of IBD (e.g. indeterminate colitis) regardless of disease status (remission/relapse) will be included. Interventions: Pharmacological and non-pharmacological interventions designed to help alleviate fatigue in individuals with IBD will be included. Interventions for inclusion will have the alleviation of fatigue explicitly stated in their aims or content of the intervention or measures fatigue as a primary or secondary outcome.
Pharmacological interventions may include but not be limited to infliximab infusion; iron therapy, and adalimumab maintenance therapy. Non-pharmacological interventions may include but not be limited to nutritional supplements (e.g. L-carnitine); psychotherapy; solution focus therapy; stress management, and physical exercise.
Studies for inclusion will be randomised control trials, quasi-experimental and controlled trials.
