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CC BY-NC-ND 4.0 · TH Open 2022; 06(04): e387-e395
DOI: 10.1055/s-0042-1758546
Original Article

Possible Targets to Reduce Fatigue in Chronic Immune Thrombocytopenia Patients – An Explorative Study

Wobke E.M. van Dijk 
1   Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Merel M. Nap-van der Vlist
2   Department of Social Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Hans Knoop
3   Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, The Netherlands
,
Roger E.G. Schutgens 
1   Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
› Author Affiliations Funding R.E.G.S received a grant from Novartis.
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Abstract

Background Fatigue in immune thrombocytopenia (ITP) is frequent and burdensome, but we lack the knowledge to help these patients.

Aim The aim of the study is to explore the role of disease activity and other potentially modifiable factors in fatigue.

Method This cross-sectional study included adult chronic ITP patients (n = 59). Univariable linear regression (corrected for confounders) was used to determine the relationship between disease activity (platelet count <30 × 109/L or treatment), disease-specific factors (bleeding symptoms, ferritin), and transdiagnostic factors (FACT-G physical/functional/emotional/social well-being subscales, physical activity level, and vitamin D) and fatigue (Checklist Individual Strength fatigue subscale). Several multivariable models with clustered sets of variables were used to compare the proportion of explained variance of fatigue (adjusted R 2).

Results Significant relations with moderate effect sizes (>0.50) were found for physical and functional well-being and fatigue, and physical activity and fatigue. Other significant relations with fatigue (effect size 0.30–0.47) included skin and organ bleeding, emotional and social well-being, vitamin D, and disease activity. Notably, the models with disease activity and disease-specific factors explained <20% of the variance in fatigue, while the models with transdiagnostic factors (functioning and physical activity) explained >50%. Vitamin D alone explained 12% of the variance in fatigue.

Conclusion Transdiagnostic (non-disease-specific) rather than disease-specific factors explained a large part of the variance in ITP-related fatigue. Many factors related to fatigue are potentially modifiable and should be investigated as targets for interventions.

Keywords

fatigue - immune thrombocytopenia - modifiable factors - disease activity - transdiagnostic

Supporting Information

Additional supporting information can be found online in the Supporting Information section at the end of the article.


Supplementary Tables


• [Supplementary Table S1]. All models assessing the relation between complete (without removal of questions) physical and functional well-being subscale and fatigue


• [Supplementary Table S2]. Immune thrombocytopenia Bleeding Assessment Tool (ITP-BAT) scores per domain and item in all patients


• [Supplementary Table S3]. Multivariable models assessing the relative contribution of the questions within the respective subscales of the Functional Assessment of Cancer Therapy-General (FACT-G)


• [Supplementary Table S4]. Full model with all significant predictors (p <0.20)


Authors' Contributions

The research was designed and performed by W.E.M.v.D. and REGS. The analyses were performed by W.E.M.v.D. W.E.M.v.D. wrote the manuscript, which was critically revised by M.M.N.V., H.K., and R.E.G.S..


Supplementary Material



Publication History

Received: 28 March 2022

Accepted: 04 July 2022

Article published online:
18 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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