FATIGUE AND ASSOCIATED FACTORS IN ADULTS WITH INFLAMMATORY BOWEL DISEASE

Abstract

Inflammatory bowel disease (IBD) is an autoimmune disorder of the gastrointestinal tract and is characterized by chronic inflammation. Ulcerative colitis (UC) and Crohn's disease (CD) are the two major forms of IBD. Fatigue is one of the most common symptoms reported by those with IBD and about 22% to 77% of adults with IBD experience fatigue. The purposes of this study were to develop a parsimonious model that describes the influencing factors of fatigue in adults with IBD, adults with CD and adults with UC. The study was a secondary analysis of cross sectional data obtained from IBD partners. The conceptual framework of the study was adapted from the middle range theory of unpleasant symptoms. The variables were organized as physiological, psychological and situational factors as influencing factors with fatigue as the symptom in the framework. The Patient Reported Outcomes Measurement Information System (PROMIS) short-form scales were used to measure fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles (SSR). Additionally, physical activity, demographic and clinical variables were measured. The vast majority of the participants were White (92%) females (72%). The majority of the participants (85%) wre [less-than] 60 years of age. Majority of the participants (63%) had CD in this cohort. Three models were tested based on the conceptual framework to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD-Fatigue. The data best fit with model with situational factors (physical activity and SSR) as the mediators for all adults with IBD, as well as in the stratified evaluation of adults with CD and UC. Significant direct effects were noted from disease activity, age, sleep disturbances, pain interference, anxiety and depression to fatigue in all adults with IBD as well as in adults with CD and UC (p [less-than]. 001). An additional direct effect was noted from narcotics to fatigue in adults with UC (p [less-than]. 001). Indirect effects were noted consistently from sleep disturbances, pain interference, and depression via physical activity and SSR in all final models in adults with IBD, adults with CD and adults with UC (p [less-than]. 001).