Objectives: Fatigue is a prevalent and burdensome problem in patients with inflammatory bowel disease (IBD), even when the disease is in remission. Evidence-based psychological interventions for managing IBD-related fatigue are still lacking. This study aimed to examine the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) for reducing fatigue in patients with IBD in remission. Method: A two-arm multicenter randomized controlled trial was conducted in 113 IBD outpatients in remission with elevated levels of fatigue (i.e., Checklist Individual Strength — subjective fatigue ≥ 27). Patients were randomly assigned to an 8-week MBCT program (n = 56) or a waiting-list condition (n = 57). All participants completed questionnaires at baseline and directly post-intervention. The primary outcome was fatigue, assessed with the Checklist Individual Strength-20. Secondary outcomes included fatigue interference in daily life, depression, anxiety, and IBD-specific quality of life. Analysis of covariance (ANCOVA) was performed to examine treatment outcomes. Results: Intention-to-treat analyses showed significant reductions in the subjective experience of fatigue in patients receiving MBCT, compared to the waiting-list control condition (p = 0.03; Cohen’s d = 0.46; clinically relevant improvement in 36% vs. 10%). No significant effects were found on other fatigue aspects or secondary outcomes. Conclusions: An 8-week MBCT group program effectively reduced the subjective experience of fatigue in patients with IBD in remission. Results do not support effects for other aspects of fatigue or secondary outcomes. Preregistration: ClinicalTrials.gov Identifier: NCT03162575.

Fatigue is prevalent in patients with inflammatory bowel disease (IBD) in remission. Previously, we showed that fatigued IBD patients experienced a significant decrease in fatigue after receiving mindfulness-based cognitive therapy (MBCT). The current study examined to what extent these short-term beneficial effects of MBCT on fatigue were maintained over nine months follow-up, and whether patient characteristics were associated with clinically relevant improvement in fatigue. A randomized controlled trial, including an MBCT and waiting-list control condition, was performed in fatigued IBD patients in remission. For this study, we analysed long-term outcomes of 108 patients who received MBCT (either directly or after three months waiting). The primary outcome was fatigue, assessed with the Checklist Individual Strenght-20. Secondary outcomes included fatigue interference, depression, anxiety, and quality of life. The reduced level of fatigue post-treatment did not change significantly during follow-up (F(2,76) = 1.68, p = 0.19). In total, 29% of patients reported clinically relevant improvement from pre-treatment to nine months follow-up. We found few significant differences in baseline characteristics between those reporting clinically relevant improvement and those not, except that patients who improved were significantly more often unemployed (χ²(1, n = 73) = 4.40, p = 0.04). Secondary outcomes, which did not change significantly during MBCT, also remained stable during follow-up. Findings suggest that reductions in IBD-related fatigue after receiving MBCT are sustained over nine months follow-up, with around one-third of patients reporting clinically relevant improvement from pre-treatment to follow-up. Employment status might be related to improvements in fatigue. Future research is needed to confirm these long-term outcomes. ClinicalTrials.gov ID: NCT03162575.

Background and Aims: Fatigue is a common and burdensome problem for patients with inflammatory bowel disease (IBD). Previous studies lack insight into the individual variability in fatigue severity and course over time, and the characteristics of patients at risk of severe and persistent fatigue. This study aimed to identify distinct groups of IBD patients based on their level and course of fatigue over 5 years. Subsequently, we examined the relationship between these trajectories, patient characteristics, and trajectories of perceived stress, sleep, and physical activity. Methods: This longitudinal cohort study used prospectively collected data from the myIBDcoach telemedicine monitoring tool, including 320 IBD patients who completed 3 or more online consultations between 2016 and 2021. Latent class growth analyses were performed to identify distinct trajectories. Results: We found 5 subgroups with distinct trajectories of fatigue, differing in level and course over time, with 33% of patients experiencing chronic stable and high levels of fatigue. Few differences in patient characteristics were found between trajectories, yet the chronic high fatigue subgroup was more likely to report persistent stable sleep problems, perceived stress, and little physical activity over time compared to the other groups. Conclusions: Distinct subgroups of IBD patients can be identified based on longitudinal fatigue trajectories. The relatively stable levels of fatigue, stress, sleep, and physical activity suggest that a one-time screening of patients on these topics may be sufficient to identify those at risk. Interventions aiming to reduce fatigue should target persistent stress, sleep problems, and low levels of physical activity.

Background and aim: Lifestyle and psychosocial factors impact mucosal inflammation and well-being of Inflammatory Bowel Disease (IBD) patients. However, lifestyle assessment and interventions are not standard care. The aim of this study was to estimate the occurrence of and gather patients’ perspectives on unfavorable lifestyle and psychosocial factors in individuals with IBD. Methods: A multicenter study was conducted, enrolling IBD patients using a telemedicine platform that reports on disease activity, lifestyle, and psychosocial factors. Patients' perspectives were gathered through a nationwide online survey distributed by the Dutch IBD patient organization. Results: In the telemedicine cohort (n = 460), 16.3% followed a specific diet, and 50.7% believed diet impacted their disease or quality of life. Additionally, 67.4% did not meet exercise norms, 9.3% smoked, and 8.0% had excessive alcohol consumption (>7 units/week). About one-third experienced high stress, poor sleep regularly, and emotional distress occasionally. In the nationwide survey (n = 1126), most patients (58–91%) believed that stress, unhealthy diet, poor sleep, physical inactivity, and anxiety or depression could cause intestinal symptoms. Around 70% were motivated to change diet, stress management, and physical activity. Less than one-fifth of patients received hospital support, with the majority being satisfied. Approximately 20% of patients desired but lacked support concerning stress, physical activity, diet, and sleep. Conclusions: Patients with IBD commonly report unfavorable lifestyle and psychosocial factors, recognize their impact on intestinal symptoms, and are motivated to change, but often lack hospital support. This underscores the importance for systematic incorporation of lifestyle and psychosocial factors into patient-centered IBD care and the potential for targeted interventions.

Aims: To explore reasons why patients with inflammatory bowel disease (IBD) do (not) engage in fatigue‐related care and their care needs.Design: A qualitative interview study, using a phenomenological methodological approach.Methods: We included 16 fatigued patients with IBD in remission. Data were collected between December 2021 and March 2022, using semi‐structured interviews. Template analysis was performed.Results: We identified six themes regarding reasons why (not) to seek care for fatigue: (1) Cognitions about fatigue and coping with fatigue, (2) perceptions of fatigue‐related care and previous care experiences, (3) perceived knowledge and behaviour of healthcare professionals, (4) physical and emotional well‐being, (5) social relationships and support, and (6) practical factors. Regarding their care needs, patients reported a need for a holistic and person‐centred care approach, with healthcare professionals actively addressing fatigue and offering care. They suggested a range of options for what care to offer, including eliminating physical causes of fatigue, discussing medication options, providing information on fatigue management, lifestyle support, psychological support, peer support and practical support.Conclusion: Both patient‐ and healthcare‐related factors play a role in why IBD patients do (not) seek fatigue‐related care. Our findings emphasise the importance of active screening and discussion of fatigue, using a holistic and person‐centred approach to treat fatigue.Implications: This study contributes to the understanding of IBD patients' facilitators and barriers for seeking care for fatigue and their care needs. Moreover, results can inform nurses and physicians about ways to optimise the offer and uptake of fatigue‐related care, and the development of interventions that fit patients' needs. Results also provide implications for the treatment of fatigue in other chronic (inflammatory) conditions.Impact: The current results can inform nurses and physicians about ways to optimise the offer and uptake of fatigue‐related care, and the development of interventions that fit the needs of patients with IBD. An increase in the uptake of effective and acceptable interventions can improve patients' health and well‐being.Reporting Method: Findings were reported following the consolidated criteria for reporting qualitative research (COREQ).Patient or Public Contribution: No patients, service users or members of the public were involved in this study. The study focused on patients' experiences with fatigue‐related care and their needs.