The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures

Department of Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Journal of pain and symptom management (Impact Factor: 2.8). 02/2009; 37(1):107-28. DOI: 10.1016/j.jpainsymman.2007.08.019
Source: PubMed


Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980-2007. Criteria for judging the "ideal" measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.

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    • "The scales may be multidimensional (e.g., physical, emotional, and cognitive), unidimensional (e.g., sleep/rest), or a separate module within a larger health-related life quality instrument. Many scales assess the feelings of fatigue and the perceived effect of fatigue on life quality (for reviews see Dittner et al. 2004; Hjollund et al. 2007; Whitehead 2009). Although numerous fatigue scales exist for the adult population , there are very few, well-standardized instruments for children and adolescents (Hockenberry et al. 2003). "
    Ear and Hearing 11/2014; 35(6):592-599. · 2.84 Impact Factor
    • "This is a nine-item questionnaire developed to measure the impact of fatigue on daily functioning [Krupp et al., 1989]. The FSS is widely used and has been found valid and reliable in different patient groups [Whitehead, 2009]. Each item is scored on a seven-point Likert scale with a range from 1 (completely disagree) to 7 (completely agree). "
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    ABSTRACT: This study aims to investigate how fatigue affects adults with verified Marfan syndrome (MFS) in their daily lives, by examining fatigue levels and prevalence of severe fatigue compared to the general Norwegian population and individuals with other comparable chronic conditions. We investigated associations between socio-demographic characteristics, Marfan-related health problems, pain and fatigue. A cross-sectional study was conducted, using a postal questionnaire including the Fatigue Severity Scale (FSS) and questions on socio-demographic characteristics, Marfan-related health problems and pain. One hundred seventeen persons with MFS were invited to participate, 73 answered (62%). Participants reported significantly higher FSS scores and prevalence of severe fatigue compared to the general Norwegian population and patients with rheumatoid arthritis (RA), but lower than for other chronic conditions. Participants with chronic pain reported higher fatigue scores than those without chronic pain. Participants on disability benefits reported higher fatigue scores than participants who were working or enrolled in higher education. Marfan-related health problems like aortic dissection and use of blood pressure medication were not significantly associated with fatigue. In multivariable regression analyses chronic pain and employment status were significantly associated with fatigue. The final multivariable model explained 24% of the variance in fatigue scores. Our results show that fatigue is common in MFS patients and that it interferes with their daily lives. Chronic pain and employment status show significant associations to fatigue. This implies that fatigue is important to address when meeting MFS patients in clinical practice. There is need for more research on fatigue in Marfan syndrome. © 2014 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part A 08/2014; 164A(8). DOI:10.1002/ajmg.a.36574 · 2.16 Impact Factor
    • "A critical review of methods and instruments that have been developed to measure fatigue found good psychometric properties in only 3 comprehensive instruments: Fatigue Symptom Inventory (FSI), Multidimensional Assessment of Fatigue (MAF), and MFSI-SF.[42] MFSI-SF is a valid, reliable and least time consuming instrument in the outpatient setting.[43444546] "
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    ABSTRACT: Background:Fatigue is a common presenting complaint of patients in the primary care offices. Low levels of vitamin D have been associated with fatigue in cancer patients. Normalization of vitamin D level improves their fatigue. Whether low vitamin D plays a role in fatigue in medically stable patients is not known.Aims:This prospective non-randomized therapeutic study observed the prevalence of low vitamin D in fatigue and the effect of normalization of vitamin D on fatigue.Material and Methods:One hundred and seventy four adult patients, who presented in our primary care office with fatigue and stable chronic medical conditions,completed fatigue assessment questionnaires. Patients with low vitamin D levels received ergocalciferol therapy for 5 weeks. Scores of pre- and post-treatment fatigue assessment questionnaires were compared.Results:Prevalence of low vitamin D was 77.2% in patients who presented with fatigue. After normalization of vitamin D levels fatigue symptom scores improved significantly (P < 0.001) in all five subscale categories of fatigue assessment questionnaires.Conclusion:The prevalence of low vitamin D is high in patients who present with fatigue and stable chronic medical conditions, if any. Normalization of vitamin D levels with ergocalciferol therapy significantly improves the severity of their fatigue symptoms.
    North American Journal of Medical Sciences 08/2014; 6(8):396-402. DOI:10.4103/1947-2714.139291
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