Real-time assessment of fatigue in patients with multiple sclerosis: How does it relate to commonly used self-report fatigue questionnaires?

Publication date: Available online 24 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Martin Heine, Lizanne Eva van den Akker, Lyan Blikman, Trynke Hoekstra, Erik van Munster, Olaf Verschuren, Anne Visser-Meily, Gert Kwakkel
Objectivesto (1) assess real-time patterns of fatigue; (2) assess the association between a real-time fatigue score (RTFS) and three commonly used questionnaires (Checklist Individual Strength[CIS], fatigue subscale; Modified Fatigue Impact Scale[MFIS]; and Fatigue Severity Scale[FSS]); and (3) establish factors that confound the association between RTFS and conventional fatigue questionnaires in patients with Multiple Sclerosis [MS].Designcross-sectional studySettingDutch MS-specialized outpatient facilityParticipantsAmbulant patients with MS (N = 165) experiencing severe self-reported fatigue.InterventionsNot applicable.Main outcome measuresA real-time fatigue score (RTFS) was assessed by sending participants four text messages on a particular day ('How fatigued do you feel at this moment?'; 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 RTFS and the CIS fatigue subscale, MFIS, and FSS. Significant associations were tested for candidate confounders such as disease severity, work status, and sleepiness.ResultsFour significantly different fatigue profiles were identified by RTFS, 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 RTFS. The Epworth Sleepiness Scale significantly reduced the regression coefficient between the RTFS and conventional questionnaires, ranging from 15.4 to 35%.ConclusionsPerceived fatigue showed four different diurnal patterns in patients with MS. Severity of sleepiness is an important confounder to take into account in the assessment of fatigue.



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