title: Targets for Health Interventions for Inflammatory Bowel Disease-fatigue.
abstract: OBJECTIVE
  Fatigue is a complex, multifactorial, and multidimensional phenomenon. Recognition of modifiable correlates of fatigue can provide a further understanding of this phenomenon in patients with inflammatory bowel disease [IBD] and aid in the development of interventions tailored towards fatigue with potential for efficacy. Our aims were to systematically search and synthesise available evidence on potentially modifiable factors contributing to IBD-fatigue and what advances in the management of fatigue in individuals with IBD have been made.
  
  
  METHODS
  The process of selection of citations was based on an earlier review by Czuber-Dochan et al. [2013] and was undertaken in two phases: i] searching for new studies published since August 2012, using seven electronic databases; ii] re-selection of papers included in previous review according to the aims of the current review.
  
  
  RESULTS
  A total of 43 studies met the inclusion criteria. IBD-fatigue was consistently associated with disease activity, depression, anxiety, and sleep difficulties. However, most studies were cross-sectional; thus the direction of causation remains unknown. The relationship between biochemical factors, such as anaemia and inflammation, and fatigue was inconsistent. Solution-focused therapy, thiamine, and exercise showed promising effects on IBD-fatigue. Interventions continue to be sparse, with methodological limitations and only short-term effects reported.
  
  
  CONCLUSIONS
  The review identified a number of psychosocial and physical factors which could potentially be modified through targeted health interventions and improve fatigue in IBD. Research utilising prospective observational studies and randomized control trial [RCT] design is required to develop and test interventions to reduce fatigue, most likely within a biopsychosocial model of care.
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK micol.artom@kcl.ac.uk.
authors.forename: Micol
authors.initials: M
authors.lastname: Artom
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK.
authors.forename: Wladyslawa
authors.initials: W
authors.lastname: Czuber-Dochan
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Sturt
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
mesh_terms: D003131:Combined Modality Therapy; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D012307:Risk Factors
keywords: Fatigue; inflammatory bowel disease; management