N012 Nursing interventions for fatigue in IBD: A systematic literature review

Abstract

Background: Inflammatory bowel disease (IBD) can lead to severe and debilitating fatigue which may largely impair the healthrelated quality of life (HRQoL) of them. Indeed, various studies showed that more than 40% of IBD patients suffer from severe fatigue, even during disease remission. Although most patients have persistent fatigue, and psychological factors are known to be associated with fatigue, management strategies focusing on fatigue are lacking and intervention studies are scarce. The aim of this review was to identify and describe nursing interventions on IBDrelated fatigue. Methods: Scientific articles were searched in electronic database such as Medline, Cinahl and Scopus. An hand-made searching was done to assess grey literature and congress proceedings of major gastroenterology conferences. Randomised controlled trials, openlabel controlled investigations and interrupted time series studies evaluating the effect of nursing interventions on adult IBD patients with disease remission or mild disease activity with fatigue level as primary outcome were considered for inclusion. Results: A total of 234 articles were initially identified. Of which, 162 were excluded after reading the title and the abstract, and 39 were excluded after reading the full text article. Finally, 31 duplicates were also excluded. The remaining identified studies were two randomised controlled trials on solution focused therapy (SFT), a therapeutic approach born in the 80s by constructivist psychology, applied to various areas of mental health, family therapy, couples, scholastic. The first study compared the SFT and problem-solving-therapy to standard of care (SoC): 40 patients with ulcerative colitis (UC) and 87 with Crohn's disease (CD) were treated. Fatigue at the first follow-up decreased in 85.7% of the patients who performed the SFT and in 60% of PST patients, whereas the control group showed a decrease only in 45% of patients. Furthermore, 57.1% of SFT patients showed a 20% decrease in direct costs compared with the other groups. In the second study, patients were assigned to SFT or standard of care (SoC). Three months after intervention, fatigue score dropped significantly by 8.5 points for patients in SFT group and only by 3.8 points in the SoC group. Benefit was maintained at six months follow-up, but not at nine months. Conclusions: SFT was an effective nursing intervention to improve IBD-related fatigue, but its effectiveness does not seem to last over time. Further studies are necessary to evaluate whether repeated SFT interventions (i.e. at 9 to 12 months after the first administration) may favour the effectiveness of SFT. Moreover, it would also be interesting to evaluate SFT in the treatment of other IBD-related symptoms such as anxiety and depression.