Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life

Background: Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on Health-Related Quality of Life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue. Aim: To investigate what impact IBD fatigue has on HRQoL in adults with IBD.Methods: Systematic searches (CINAHL, EMBASE, PsychInfo, Medline) were conducted 25.09.2018, restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’. Search terms encompassed concepts of ‘Fatigue’, ‘IBD’ and ‘HRQoL’. A 5 year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted, and quality appraised by two authors. A narrative synthesis was conducted.Results: Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial wellbeing, and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both, fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool

The effect of increasing physical activity and/or omega-3 supplementation on fatigue in inflammatory bowel disease

Objective: Fatigue is frequently reported by patients with inflammatory bowel disease (IBD), irrespective of disease activity; however, evidence regarding fatigue management is limited. This study tested the effect of individualised advice to increase physical activity and/or omega-3 fatty acids supplementation, on IBD-related fatigue. Methods: A pilot study in patients with inactive IBD, utilising a randomised controlled 2x2 factorial design (four groups) compared baseline and post-intervention fatigque scores. Study interventions: individualised exercise advice (15 minute consultation) and/or supplementation (omega-3 fatty acids, 2970mg/day) for 12 weeks. Control interventions: general health discussion and/or placebo supplement. All patients received follow-up support. Primary outcome was fatigue measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale score; secondary outcomes included change in Inflammatory Bowel Disease-Fatigue (IBD-F) scale score. Results: From n=656 screened patients, n=74 who met the selection criteria were randomised, n=60 commenced, and n=52 completed the study. Fatigue as tThe primary outcome fatigque, measured with FACIT-F, showed slight worsening in the omega-3 supplementation group (95%CI:-8.6-(-0.7);p=0.02), and no change in the exercise advice group (p=0.38). Reduced fatigue, measured by IBD-F score, was identified in the exercise group (95%CI:-3.8-(-0.2);p=0.03). One treatment-related adverse event (musculoskeletal pain) was reported with exercise. Conclusions: Advice to increase physical activity and omega-3 supplementation, singly or in combination, were shown to be safe and generally well-tolerated. There was no evidence of exercise-related adverse effects on gut-related symptoms, and some evidence of improvement in fatigue. The slight worsening of fatigue with omega-3 supplementation is unexplained. Regular moderate to -vigorous exercise may be a self-management option in IBD-related fatigue

The impact of Inflammatory Bowel Disease related fatigue on Health-Related Quality of Life: A qualitative semi-structured interview study

Background: Fatigue is a frequently reported symptom of inflammatory bowel disease (IBD), having a negative impact on Health-Related Quality of Life (HRQoL). Patients’ experiences of this have not been researched in IBD. Methods: Semi-structured interviews were conducted with adults with Crohn’s Disease from out-patient clinics in the United Kingdom. Interviews were audio-recorded and transcribed verbatim, then analysed using thematic analysis.Results: Fourteen participant interviews were conducted. Three key themes were identified: 1) ’The new normal’ established through adaptation and acceptance; 2) ’Energy as a resource’ describing attempts to better manage fatigue through planning and prioritising tasks; 3) ‘Keeping healthy’ encompasses participants beliefs that ‘good health’ allows better management of fatigue.Conclusion: Participants establish a ‘new’ normality, through maintaining the same or similar level of employment/education activities. However, this is often at the expense of social activities. Further research is required to explore patient led self-management interventions in IBD fatigue

Trends in the nature of provision in ophthalmology services and resources and barriers to education in ophthalmic nursing: 3rd national UK survey

Over the last decade in the United Kingdom (UK), the roles of nurses have become increasingly specialised to support a more efficient and effective health service. In ophthalmology, the changes are most visible in the growing number of patients being treated as day case and the greater nursing contribution to patient outcomes. To support this change there is a continuing need for educational institutions to create opportunities to meet the training needs of nurses working in both specialised areas and at the advance level of practice. This article reports on a 3rd national survey the aims of which were to investigate trends in the nature and provision of ophthalmic services and the resources and barriers to education in ophthalmic nursing. The results demonstrate that over the three surveys there has been a significant increase of pre-operative assessment units and a significant decrease of designated ophthalmic wards. Between the second and third survey, the results indicate fewer difficulties with funding but there has been an increase of respondents stating a lack of training institutions offering ophthalmic courses. The survey shows that at a time when nurses need to acquire ophthalmic nursing skills and knowledge there appear to be fewer opportunities for them to access ophthalmic courses