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P266 Assessing fatigue in Inflammatory Bowel Disease comparison and validation of three fatigue scales: IBD-F, MFI and MAF scales

W. Czuber-Dochan*1, C. Norton1, P. Bassett2, S. Berliner3, F. Bredin4, M. Darvell3, A. Forbes5, M. Gay3, E. Ream1, H. Terry3

1King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, United Kingdom, 2Statsconsultancy, Medical Statistician, Amersham, United Kingdom, 3Crohn's and Colitis UK, Fatigue Steering Group, St Albans, United Kingdom, 4The Queen Elizabeth Hospital NHS Trust & Addenbrookes Hospital, Gastroenterology, King's Lynn & Cambridge, United Kingdom, 5University of East Anglia, Gastroenterology & Nutrition, Norwich, United Kingdom

Background

Patients with inflammatory bowel disease (IBD) report fatigue in both quiescent (41%) and active disease (86%). Fatigue is an unpleasant, multifactorial and multifaceted symptom that affects quality of life; however, due to its subjective nature it is difficult to assess. Many different fatigue scales have been developed to assess fatigue, although most have not been tested with IBD populations and only one scale has been developed specifically for people with IBD. We aimed to assess validity and reliability of three fatigue assessment scales in an IBD adult population and to determine factors correlated with fatigue.

Methods

A cross-sectional study with postal self-completed questionnaires with one reminder was undertaken. Participants (n=605) were randomly selected from Crohn's and Colitis UK members' database and completed questionnaires assessing fatigue, anxiety, depression, quality of life and IBD activity. A sub-group of responders (n=70) were sent the same mailing 6 weeks later for test-retest. Three fatigue assessment scales were used: the Inflammatory Bowel Disease Fatigue Self-Assessment Scale (IBD-F), the Multidimensional Fatigue Inventory (MFI) and the Multidimensional Assessment Fatigue (MAF). Internal consistency was measured by Cronbach's alpha and test-retest reliability by the intra-class correlation coefficient (ICC).

Results

465 (77%) questionnaires were completed for the test and 69% for retest. Results suggest all three scales are highly correlated (p<0.001). Test-retest suggests good agreement for all scales' total scores with ICC values of 0.74 and 0.83 (IBD-F Section 1 and 2 respectively), 0.74 (MAF) and 0.65-0.84 (MFI all five sections). Age, gender, bowel condition, anxiety, depression and all parts of the IBDQ (IBD quality of life questionnaire) score were significantly associated with level of fatigue (p<0.001) for all three fatigue scales. Older patients had lower fatigue scores and females had higher scores than males. Colitis patients had significantly lower scores than Crohn's patients, and patients with a higher level of anxiety and depression had higher fatigue scores. Better IDBQ was associated with lower fatigue scores.

Conclusion

All three tested fatigue scales were found to be valid and reliable measures of IBD fatigue. Factors such as age, gender, bowel condition, quality of life, anxiety and depression are significantly associated with fatigue and should all be taken into account in the process of care delivery to people with IBD and fatigue.