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P503. Fatigue in IBD patients decreases with psychotherapy: results of a randomized controlled trial

L. Vogelaar1, A. van 't Spijker2, R. Timman2, A. van Tilburg3, D. Bac4, E.J. Kuipers5, J.J. van Busschbach2, C.J. van der Woude5, 1Erasmus Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands, 2ErasmusMC, Department of Psychology and Psychotherapy, Rotterdam, Netherlands, 3Sint Franciscus Gasthuis, Department of Gastroenterology and Hepatology, Rotterdam, Netherlands, 4Gelderse Vallei, Department of Gastroenterology and Hepatology, Ede, Netherlands, 5ErasmusMC, Gastroenterology and Hepatology, Rotterdam, Netherlands

Background

Inflammatory bowel disease (IBD) is associated with severe fatigue and subsequently decreased Quality of Life (QoL). Little is known about the fatigue management in IBD patients. Earlier we showed the feasibility of psychotherapy in IBD patients. With this randomized controlled trial we aimed to assess the effectiveness of Solution Solution Focused Therapy (SFT) on the severity of fatigue.

Methods

Patients with quiescent IBD measured by activity disease indexes and calprotectin and a high fatigue score according to the Checklist Individual Strength (above 35 on CIS-fatigue subscale) were randomized to SFT or to a control group. They completed questionnaires including the Hospital Anxiety and Depression Scale (HADS), the Crohn's Disease Index (CDAI) or the Clinical Activity Index (CAI), the Inflammatory Bowel Disease Questionnaire (IBDQ), the Short Form-36 (SF-36), the EuroQol (EQ-5D), the Pittsburgh Sleep Quality Index (PSQI) and a questionnaire focusing on current medication use and side-effects. The Montreal classification and sociodemographics were obtained from medical records. Follow-up was 6 months.

Results

Ninety-eight patients were included (58.8% CD patients and 41.2% UC patients) of these 63% were female, mean age was 40.1 years. At baseline the treatment group showed a mean CIS-fatigue of 46.6 compared with a mean of 46.3 in the control group (p = 0.759). At baseline no differences were observed between the treatment group and the control group according to the baseline characteristics, the QoL questionnaires, the HADS and the PSQI, medication, side-effects, disease phenotype, surgery and laboratory parameters.

At 3 months the treatment group showed significant improvement on the CIS-fatigue (treatment: 37.8, control: 42.6; p ≤ 0.001), CIS-total (treatment: 83.5, control: 93.4; p = 0.001), IBDQ (treatment: 173.3, control: 166.7; p = 0.020) and SF-36 physical (treatment: 43.8, control: 41.2; p = 0.049) compared with the control group. The effect size was medium for CIS-fatigue and for CIS-total at 3 months (p ≤ 0.001). For IBDQ and SF-36 physical the effect size was small (p = 0.02 and p = 0.049, respectively). At 6 months this positive effects sustained for the CIS-fatigue and CIS-total. Gender nor IBD subtype had a significant influence on the results.

Conclusion

SFT decreased significant fatigue and increased QoL of IBD patients. This effect did not sustained during follow-up. Therefore, psychological treatment is effective in reducing fatigue in IBD patients, but repeating courses are warranted for long-term fatigue control.