Fatigue in children and adolescents with inflammatory bowel disease

Table 1 General characteristics of the included studies

First author (year of publication)	Study objectives	Age (yr)	Patient population	Percentage of patients with active disease	Main findings related to fatigue
Marcus et al (2009)[6]	To evaluate the degree of fatigue and health-related quality-of-life in children with IBD	10-17	52 CD; 13 UC; 5 IBD-U; 157 healthy controls	Remission 56%; Mild 22%; Moderate 17%; Severe 5%	Adolescents with IBD have significantly more fatigue than healthy controls; PedsQL total fatigue, general fatigue, and sleep/rest fatigue were all impaired in patients with IBD; Adolescents with IBD are fatigued even when clinical remission is reached
Nicholas et al (2007)[13]	To understand the lived experience and elements of quality-of-life in adolescents and adolescents with IBD	7-19	61 CD; 19 UC	Not reported	Young patients with IBD commonly feel “sick and tired” and have “no energy”
Pirinen et al (2010)[16]	To evaluate the effect of disease severity on (the frequency of) sleep problems and daytime-tiredness among adolescents with IBD	10-18	53 CD; 83 UC; 24 IBDU; 236 healthy controls	Not reported	Adolescents with IBD do not report more sleeping problems or overtiredness than their healthy peers Adolescents with active disease have significantly more trouble sleeping, more daytime sleepiness and are overtired compared to adolescents with mild IBD symptoms; Adolescents with severe IBD symptoms have worse quality of sleep and more sleep disturbances than those with less severe IBD
Werkstetteret al (2012)[8]	To evaluate whether physical activity is reduced in patients with IBD compared to control subjects	6-20	27 CD; 12 UC; 39 healthy controls	Remission 66%; Mild 34%	Patients with IBD show a trend toward less physical activity, especially among girls and those with mild disease activity; There is no relation between inflammatory markers (CRP) and physical activity
Rogler et al (2013)[7]	To examine the determinants of health- related quality-of-life in adolescents and adolescents with IBD	11-15	64 CD; 46 UC	PCDAI > 15 36%; PUCAI ≥ 10 28%	Patients with IBD (in particular boys) have moderate impairments in physical well-being; Impairment in physical well-being is associated with active inflammation; And its symptoms
Loonen et al (2002)[12]	To evaluate the impact of IBD on health- related quality of life	8-18	41 CD; 40 UC; 2 IBD-U	Mild 60%; Moderate 23%; Severe 15%; Missing 2%	Adolescents with IBD have impairments in motor functioning (running, walking, playing) and complain more of tiredness, especially those with Crohn’s disease.
Tojek et al (2002)[14]	To examine family dysfunction, maternal physical symptoms and maternal positive affect as correlates of health status in adolescents with IBD	11-18	36 CD; 26 UC	Not reported	Family dysfunction is related to an increased frequency of fatigue in adolescents; Maternal positive affect is inversely related to fatigue (not significant); Fatigue is independent of maternal negative affect
Ondersma et al (1996)[15]	To examine how psychological factors relate to disease severity among adolescents with IBD	11-17	34 CD; 22 UC	Not reported	There is a relationship between negative affect and physical symptoms of fatigue

CD: Crohn’s disease; IBD: Inflammatory bowel disease; IBD-U: Inflammatory bowel disease-unclassified; PCDAI: Pediatric Crohn’s Disease Activity; PedsQL: Pediatric Quality of Life; PUCAI: Pediatric Ulcerative Colitis Activity Index; UC: Ulcerative colitis.