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Original research
Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life
  1. Shellie Jean Radford1,2,
  2. Jordan McGing2,
  3. Wladyslawa Czuber-Dochan3,
  4. Gordon Moran1,2
  1. 1 Nottingham Digestive Diseases Centre, University of Nottingham, University Park Campus, Nottingham, UK
  2. 2 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 Florence Nightingale school of Nursing, Midwifery and Pallative care, King's College London, London, UK
  1. Correspondence to Shellie Jean Radford, Nottingham Digestive Diseases Centre, University of Nottingham University Park Campus, Nottingham NG7 2RD, UK; shelliejean{at}


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 on 25 September 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 well-being 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 were some of the methodological shortcomings.

Conclusion Psychosocial factors, symptom management and acceptance and physical activity levels have significant impact on HRQoL. Results support application of psychosocial or exercise interventions for fatigue management. Further exploration of HRQoL factors in IBD fatigue is required, using validated fatigue and HRQoL measures.

PROSPERO registration number CRD42018110005.

  • inflammatory bowel disease
  • Crohn’s disease
  • ulcerative colitis
  • fatigue
  • health related quality of life

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  • Contributors SJR: whole manuscript preparation, literature searching, data appraisal and extraction, analysis and write up. JMcG: literature searching, data appraisal and extraction and analysis. WC-D: review of manuscript and supervision of data extraction and analysis. GM: whole manuscript review, supervision of data extraction and analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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