Original article—alimentary tract
Fatigue and Health-Related Quality of Life in Pediatric Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2009.01.022Get rights and content

Background & Aims

Fatigue profoundly impacts quality of life and is a common complaint among patients with chronic disease. This study examined the degree of fatigue and health-related quality of life (HRQOL) in children with inflammatory bowel disease (IBD).

Methods

Seventy children with IBD and 157 healthy controls and their parents completed age-appropriate measures of fatigue (PedsQL Multidimensional Fatigue Scale) and HRQOL (PedsQL 4.0 Generic Core Scales). Children with IBD completed the IMPACT III Quality of Life Questionnaire, and the Children's Depression Inventory: Short form was completed by children with IBD and healthy controls. Disease activity was determined according to the diagnosis with either the Pediatric Crohn's Disease Activity Index (PCDAI) or a Physician's Global Assessment.

Results

Children with Crohn's disease (N = 52) had a median PCDAI of 0, and 56% with ulcerative colitis (N = 13) or indeterminate colitis (N = 5) were in remission. Mean child self-report PedsQL Multidimensional Fatigue Total Scale scores were 73.9 ± 16.8 and 82.2 ± 12.3 for patients with IBD and controls, respectively (P < .001). Mean child self-report PedsQL 4.0 Generic Core Total Scale scores were 76.7 ± 14.2 and 85.9 ± 10.4 for patients with IBD and controls, respectively (P < .0001). Children with IBD did not self-report statistically different mean total fatigue and subscale scores compared with children with rheumatologic diseases or cancer.

Conclusions

In children with primarily inactive IBD, fatigue was significantly higher and HRQOL was significantly lower than in healthy controls. Results among children with IBD were comparable to children with rheumatologic diseases and cancer.

Section snippets

Subjects

This study was conducted at gastroenterology clinics affiliated with Children's Memorial Hospital, a large university-based urban pediatric teaching hospital. From February 2007–November 2007, subjects aged 10–17 with established IBD were consecutively recruited on arriving at their regularly scheduled clinic appointment. Disease was considered established if a histologic diagnosis of IBD preceded enrollment by at least 3 months. Control subjects comprised healthy 10- to 17-year-old children of

Subjects

Two hundred seventy children were recruited during the study period. Seventeen subjects with IBD and 3 control subjects were excluded for presence of comorbidities including recent accidental injury, diabetes, developmental delay, psychological disease, asthma, liver disease, arthritis, heart disease, and irritable bowel syndrome. Of 250 eligible subjects, 227 (90%) participated, 70 with IBD and 157 healthy controls (Table 1). Among those who completed the study, there was 100% questionnaire

Discussion

As hypothesized, we found that patients with IBD have significantly more fatigue and lower generic HRQOL than healthy controls. PedsQL Total Fatigue, General Fatigue, Sleep/Rest Fatigue, and PedsQL Total Generic Core Scale Score, Physical Health, Psychosocial Health, and School Functioning scores were all impaired in patients with IBD. The majority of effect sizes for significant differences in both the PedsQL Multidimensional Fatigue Scale and the PedsQL 4.0 were moderate to large, suggesting

References (29)

  • J.W. Varni et al.

    The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module

    Cancer

    (2002)
  • A.M. Griffiths et al.

    A review of activity indices and end points for clinical trials in children with Crohn's disease

    Inflamm Bowel Dis

    (2005)
  • M.G. Swain

    Fatigue in chronic disease

    Clin Sci (Lond)

    (2000)
  • J.W. Varni et al.

    The PedsQL Multidimensional Fatigue Scale in pediatric rheumatology: reliability and validity

    J Rheumatol

    (2004)

    • Cited by (0)

    Conflicts of interest The authors disclose the following: Dr Varni holds the copyright and the trademark for the PedsQL and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory. The remaining authors disclose no conflicts.

    View full text
    Copyright © 2009 AGA Institute. Published by Elsevier Ltd. All rights reserved.