IBD-F Assessment Scale Predicts Fatigue Level and Shows Negative QoL in IBD

Shot of a young woman suffering from stomach cramps in her bedroom
A longitudinal cohort study was conducted to validate the IBD-F scale in the assessment of clinically significant fatigue, as well as to identify the impact of fatigue on quality of life in patients with IBD.

The Inflammatory Bowel Disease-Fatigue (IBD-F) patient self-assessment scale depicts accurate fatigue levels and demonstrates the negative effect on quality of life (QoL) in patients with IBD, according to research published in Inflammatory Bowel Diseases.

The IBD-F patient self-assessment scale was developed to evaluate fatigue in individuals with IBD. The tool consists of 2 components: SCORE1 containing 5 questions that estimate the level of fatigue with values from 0 to 20, and SCORE2 containing 30 questions that estimate the negative impact of fatigue on QoL with values from 0 to 120. A longitudinal cohort study used 2 phases to validate a Greek version of the disease-specific IBD-F scale to assess the severity of fatigue and its relationship with QoL. Inpatients and outpatients with confirmed Crohn disease and ulcerative colitis who received care in the IBD department of a hospital in Athens, Greece, from October 2017 to November 2019 were included in both study cohorts.

To validate the IBD-F scale for use in the Greek IBD population, the researchers initially compared reports from 61 patients (39.3% were women and 31.1% had ulcerative colitis) in the validation group who were followed in the gastrointestinal unit; 2 questionnaires were obtained between 30 and 45 days to avoid changes in confounding factors. Another 96 patients were later added to the validation cohort for a total of 157 patients (52.2% were men, mean age was 35.8 years, and 65.6% had Crohn disease) for the main part of the study; these patients provided 474 questionnaires. Among the 157 patients, 102 (65%) completed the questionnaires during a visit to the outpatient clinic and 55 (35%) completed the questionnaires during treatment at the hospital infusion center.

Validation for the Greek IBD-F scale was achieved through testing for face and content validity, construct validity, concurrent validity, test-retest reliability, and internal consistency. Three other questionnaires were used to collect data on fatigue and QoL including the validated Greek version of the IBD-F, the generic Fatigue Severity Scale (FSS), and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ).

Results from all questionnaires showed 51 patients (32.5%) had a mean SCORE1 of 0 to 5, 59 patients (37.6%) had a mean SCORE1 of 6 to 10, 37 patients (23.6%)  had a mean SCORE1 of 11 to 15, and 10 patients (6.3%) had a mean SCORE1 of 16 to 20. The researchers identified a score >7.5 (n=81) as the ideal value for discriminating between significant and no significant fatigue and propose it as the cutoff value for SCORE1, resulting in 52% of the study population having significant fatigue with IBD. SCORE1 >7.5 was also significantly associated with female sex, a higher Harvey-Bradshaw Index, low hemoglobin level, and receiving no active treatment. The score was also marginally associated with having Crohn disease vs ulcerative colitis.

Patients were also evaluated as to whether long-term remission would lead to a decreased SCORE1 measurement over time, and results showed that patients without significant fatigue at baseline (n=70) continued to have low SCORE1 measurements with only 2.8% crossing above the 7.5 cutoff score. Patients with significant fatigue at baseline (n=48) similarly continued to have high SCORE1 measurements with only 18% crossing below the 7.5 cutoff score.

­The researchers also noted that both comparisons of SCORE1, which depicts severity of fatigue, vs FSS and SCORE2, which measures the level of fatigue and QoL, vs SIBDQ showed statistically significant results (P <.001).

“We report that patients with active disease and female patients with [Crohn disease] in long-standing remission seem to be at higher risk of experiencing severe fatigue. This prevalence is in turn associated with an adverse impact on patient QoL,” the study authors conclude.


Varbobitis I, Kokkotis G, Gizis M, et al. The IBD-F patient self-assessment scale accurately depicts the level of fatigue and predicts a negative effect on the quality of life of patients with IBD in clinical remission. Inflamm Bowel Dis. Published online August 7, 2020. doi:10.1093/ibd/izaa201