Highlights
- •Most patients with multiple sclerosis experience high levels of fatigue throughout the day, or low levels of fatigue in the morning and high levels of fatigue in the afternoon; a minority of patients show high levels of fatigue in the morning and low levels of fatigue in the afternoon, or low levels of fatigue throughout the day.
- •There is a poor agreement between the level of fatigue assessed in real time and fatigue assessed using conventional recall fatigue questionnaires.
- •An important factor that may explain the poor agreement is the feeling of sleepiness; this may indicate that in real time, the level of fatigue is associated with the feeling of sleepiness, and not captured within the conventional recall fatigue questionnaires.
Abstract
Objectives
(1) To assess real-time patterns of fatigue; (2) to assess the association between
a real-time fatigue score and 3 commonly used questionnaires (Checklist Individual
Strength [CIS] fatigue subscale, Modified Fatigue Impact Scale (MFIS), and Fatigue
Severity Scale [FSS]); and (3) to establish factors that confound the association
between the real-time fatigue score and the conventional fatigue questionnaires in
patients with multiple sclerosis (MS).
Design
Cross-sectional study.
Setting
MS-specialized outpatient facility.
Participants
Ambulant patients with MS (N=165) experiencing severe self-reported fatigue.
Interventions
Not applicable.
Main Outcome Measures
A real-time fatigue score was assessed by sending participants 4 text messages on
a particular day (How fatigued do you feel at this moment?; score range, 0–10). Latent
class growth mixed modeling was used to determine diurnal patterns of fatigue. Regression
analyses were used to assess the association between the mean real-time fatigue score
and the CIS fatigue subscale, MFIS, and FSS. Significant associations were tested
for candidate confounders (eg, disease severity, work status, sleepiness).
Results
Four significantly different fatigue profiles were identified by the real-time fatigue
score, namely a stable high (n=79), increasing (n=57), stable low (n=16), and decreasing
(n=13). The conventional questionnaires correlated poorly (r<.300) with the real-time fatigue score. The Epworth Sleepiness Scale significantly
reduced the regression coefficient between the real-time fatigue score and conventional
questionnaires, ranging from 15.4% to 35%.
Conclusions
Perceived fatigue showed 4 different diurnal patterns in patients with MS. Severity
of sleepiness is an important confounder to take into account in the assessment of
fatigue.
Keywords
List of abbreviations:
CIS (Checklist Individual Strength), ESS (Epworth Sleepiness Scale), FSS (Fatigue Severity Scale), MFIS (Modified Fatigue Impact Scale), MS (multiple sclerosis), TREFAMS-ACE (Treating Fatigue in Multiple Sclerosis – Aerobic training, Cognitive behavioral therapy, Energy conservation management)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 24, 2016
Footnotes
The TREFAMS-ACE study is supported by the Fonds NutsOhra (ZonMw grant no. 89000005).
The participants in the present study were a convenience sample of participants of the following Clinical Trial Registration Nos.: ISRCTN69520623, ISRCTN58583714, and ISRCTN82353628.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
