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Stavrou NAM, Debevec T, Eiken O, Mekjavic IB. Hypoxia Worsens Affective Responses and Feeling of Fatigue During Prolonged Bed Rest. Front Psychol 2018; 9:362. [PMID: 29628903 PMCID: PMC5876302 DOI: 10.3389/fpsyg.2018.00362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/05/2018] [Indexed: 12/14/2022] Open
Abstract
Previous research, although limited, suggests that both hypoxia and bed rest influence psychological responses by exaggerating negative psychological responses and attenuating positive emotions. The present study investigated the effect of a 21-day prolonged exposure to normobaric hypoxia and bed rest on affective responses and fatigue. Eleven healthy participants underwent three 21-day interventions using a cross-over design: (1) normobaric hypoxic ambulatory confinement (HAMB), (2) normobaric hypoxic bed rest (HBR) and (3) normoxic bed rest (NBR). Affective and fatigue responses were investigated using the Activation Deactivation Adjective Check List, and the Multidimensional Fatigue Inventory, which were completed before (Pre), during (Day 7, Day 14, and Day 21) and after (Post) the interventions. The most negative psychological profile appeared during the HBR intervention. Specifically, tiredness, tension, general and physical fatigue significantly increased on days 7, 14, and 21, as well as at Post. After the HBR intervention, general and physical fatigue remained higher compared to Pre values. Additionally, a deterioration of psychological responses was also noted following HAMB and NBR. In particular, both hypoxia and BR per se induced subjective fatigue and negative affective responses. BR seems to exert a moderate negative effect on the sensation of fatigue, whereas exercise attenuates the negative effects of hypoxia as noted during the HAMB condition. In conclusion, our data suggest that the addition of hypoxia to bed rest-induced inactivity significantly worsens affective responses and feeling of fatigue.
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Affiliation(s)
- Nektarios A M Stavrou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.,Department of Sport Psychology, Hellenic Sports Research Institute, Olympic Athletic Center of Athens "Spiros Louis", Athens, Greece
| | - Tadej Debevec
- Department for Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department for Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Factors affecting health-related quality of life and physical activity after liver transplantation for autoimmune and nonautoimmune liver diseases: a prospective, single centre study. J Immunol Res 2014; 2014:738297. [PMID: 24741621 PMCID: PMC3987938 DOI: 10.1155/2014/738297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/11/2014] [Indexed: 01/11/2023] Open
Abstract
Background/Aim. With the improvement of the outcomes after liver transplantation (LTx), health-related quality of life (HRQoL) and physical activity are becoming significant outcome parameters. We prospectively assessed these parameters in patients with autoimmune and nonautoimmune liver disorders undergoing LTx. Materials and Methods. Patients (n = 107) were subdivided into 3 groups depending on the time after LTx: group-A (n = 21): 6–12 months; group-B (n = 48): 13–36 months; and group-C (n = 38): >37 months. SF-36 and IPAQ were applied in HRQoL and physical activity assessment. Results. Females had impaired HRQoL in most SF-36 domains. Younger patients showed higher scores at SF-36 physical functioning domain but IPAQ was not influenced by age. Group-B had higher general health and physical component summary than group-A (P = 0.037, P = 0.04, resp.) and total IPAQ than group-C (P = 0.047). The sitting time domain was longer in group-A than in group-B and group-C (P = 0.0157; P = 0.042, resp.). Employed patients had better HRQoL and higher physical activity than those not working. SF-36 and IPAQ were unrelated to the autoimmune etiology of liver disease. Conclusions. These findings show that female and unemployed patients have worse HRQoL, while gender and age at LTx time do not affect IPAQ's physical activity. The autoimmune etiology of liver disease does not influence HRQoL and physical activity after LTx.
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Quality of life and physical activity in liver transplantation patients: results of a case-control study in Italy. Transplant Proc 2012; 44:1346-50. [PMID: 22664013 DOI: 10.1016/j.transproceed.2012.01.123] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/21/2012] [Indexed: 12/20/2022]
Abstract
The aim of the study was to assess the quality of life (QOL) and the physical activity of liver transplant recipients compared with the general population. The case-controlled pilot study was accomplished through the administration of 2 questionnaires: 36-item Medical Outcomes Study, Short-Form General Health Survey (SF-36) for quality of life (10 scores) and International Physical Activity Questionnaire (IPAQ) to estimate the physical activity (metabolic equivalent score). Fifty-four patients who underwent liver transplantation using the piggyback technique and 108 controls from the general population at the orthopedic ambulatories were enrolled between 2002 and 2009. Participants had a mean age of 55 years (range, 41-73). The multivariate analysis showed significant differences for some scales of the SF-36: liver transplant recipients displayed lower values for "Mental Composite Score" (P = .043), "physical activity" (P = .001), "role limitations due to physical health" (P = .006), "role limitations due to the emotional state" (P = .006), and "mental health" (P = .010). The metabolic equivalent positively associated with all examined SF-36 scales. The present study focused on the QOL and physical activity of liver transplant recipients, demonstrating that transplant recipients scored lower than the general population. Liver transplantation may allow full recovery of health status, but the physical and social problems persist in some patients. Interventions aimed at improving rehabilitation programs, regular psychosocial support, and follow-up in all phases of treatment may give patients a more satisfying lifestyle after transplantation.
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Leone SS, Wessely S, Huibers MJ, Knottnerus JA, Kant IJ. Two sides of the same coin? On the history and phenomenology of chronic fatigue and burnout. Psychol Health 2011; 26:449-64. [DOI: 10.1080/08870440903494191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sallinen M, Kukkurainen ML, Peltokallio L, Mikkelsson M. “I'm tired of being tired” – Fatigue as experienced by women with fibromyalgia. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14038196.2010.546880] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Den Oudsten BL, Van Heck GL, Van der Steeg AFW, Roukema JA, De Vries J. Second operation is not related to psychological outcome in breast cancer patients. Int J Cancer 2010; 126:1487-93. [PMID: 19816944 DOI: 10.1002/ijc.24937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To examine the effect of multiple surgical treatments on psychological outcomes in women with early stage breast cancer (BC) in a prospective follow-up study. Questionnaires for depressive symptoms (CES-D), fatigue (FAS), anxiety (STAI-State), physical health (WHOQOL-100), psychological health (WHOQOL-100) and overall quality of life and general health (WHOQOL-100) were completed before diagnosis (Time-1) and 1 (Time-2), 3 (Time-3), 6 (Time-4) and 12 (Time-5) months after the last surgical treatment. From the 217 participating women with early stage BC, 78 (35.9%) needed an additional surgical treatment. Using general linear model (repeated measures), psychosocial outcomes over time were investigated for the breast conserving therapy and mastectomy group, accounting for type of surgery, disease stage and hormonal therapy. Psychological outcomes did not significantly change over time, with the exception of anxiety [Wilks' Lambda = 0.72, F (4,86) = 8.55, p < 0.0001, partial eta squared = 0.29]. On average, women with 1 and women with 2 surgical treatments did not differ on any outcome measure. No interaction effects were found, indicating that changes in outcomes over time were the same for both groups. Women who had a repeat surgical treatment did not score differently on psychological outcome measures compared with women who were treated "efficiently."
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Affiliation(s)
- Brenda L Den Oudsten
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, LE Tilburg 5000, The Netherlands
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Peters VP, de Rijk AE, Boumans NP. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. J Adv Nurs 2009; 65:2689-700. [DOI: 10.1111/j.1365-2648.2009.05123.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Den Oudsten BL, Van Heck GL, Van der Steeg AFW, Roukema JA, De Vries J. Predictors of depressive symptoms 12 months after surgical treatment of early-stage breast cancer. Psychooncology 2009; 18:1230-7. [PMID: 19142843 DOI: 10.1002/pon.1518] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Brenda L Den Oudsten
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, 5000 LE Tilburg, The Netherlands
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Den Oudsten BL, Van Heck GL, Van der Steeg AFW, Roukema JA, De Vries J. Clinical factors are not the best predictors of quality of sexual life and sexual functioning in women with early stage breast cancer. Psychooncology 2009; 19:646-56. [DOI: 10.1002/pon.1610] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Personality predicts perceived availability of social support and satisfaction with social support in women with early stage breast cancer. Support Care Cancer 2009; 18:499-508. [DOI: 10.1007/s00520-009-0714-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 07/27/2009] [Indexed: 11/27/2022]
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Dritsa M, Dupuis G, Lowensteyn I, Da Costa D. Effects of home-based exercise on fatigue in postpartum depressed women: who is more likely to benefit and why? J Psychosom Res 2009; 67:159-63. [PMID: 19616143 DOI: 10.1016/j.jpsychores.2009.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 12/01/2008] [Accepted: 01/20/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES (1) To explore moderators of the effects of home-based exercise on reductions in physical and mental fatigue scores in postpartum depressed women and (2) to explore mediators of the intervention on changes in physical fatigue. METHOD Eighty-eight women in the postpartum period (4-38 weeks) obtaining a score >or=10 on the Edinburgh Postnatal Depression Scale were randomly assigned to a 12-week individualized home-based exercise intervention (n=46) or a no-treatment control group (n=42). The present analyses include the 35 women who adhered to the intervention and the no-treatment control group. Participants completed a cardiovascular fitness test, and a battery of questionnaires assessing the outcomes (Physical and Mental Fatigue) as well as potential moderators and mediators at baseline and posttreatment. RESULTS Hierarchical linear regressions evaluating moderators of changes in mental fatigue with exercise showed that the intervention was effective for women entering the study later in the postpartum period (P=.001) and women with higher depression scores (P=.014). Reductions in physical fatigue with exercise were partially mediated by reductions in perceived stress and increased exercise-related energy expenditure. CONCLUSION Identification of moderators allows for the tailoring of exercise interventions to particular subgroups of women that are most likely to benefit. The identified mediators may be enhanced and directly tested in future trials.
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Affiliation(s)
- Maria Dritsa
- Division of Clinical Epidemiology, McGill University Health Centre, Quebec, Canada.
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12
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The WHOQOL-100 has good psychometric properties in breast cancer patients. J Clin Epidemiol 2009; 62:195-205. [DOI: 10.1016/j.jclinepi.2008.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 03/19/2008] [Accepted: 03/26/2008] [Indexed: 11/20/2022]
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Thombs BD, Bassel M, McGuire L, Smith MT, Hudson M, Haythornthwaite JA. A systematic comparison of fatigue levels in systemic sclerosis with general population, cancer and rheumatic disease samples. Rheumatology (Oxford) 2008; 47:1559-63. [PMID: 18701538 DOI: 10.1093/rheumatology/ken331] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES There are no studies of fatigue levels in patients with SSc. The objective of this study was to compare fatigue in SSc to general population samples and patients with rheumatic diseases and cancer, where fatigue has been researched extensively. METHODS SSc patients completed the General Fatigue Index (GFI) of the Multidimensional Fatigue Inventory. A systematic review was conducted to select comparison samples. Mean GFI scores from SSc patients were compared with mean scores from comparison samples with t-tests and Bonferroni corrections (family-wise P < 0.05). RESULTS A total of 106 SSc patients were sampled (97 females; 28 diffuse SSc; 11.9 +/- 7.9 yrs since diagnosis). Based on comparisons from the systematic review, mean GFI scores in SSc (13.3 +/- 4.6) were significantly higher (greater fatigue; P < 0.05) than in two large population samples (8.7 and 9.6) and than in two samples of cancer patients in remission (9.4 and 10.0). Scores for the SSc sample were significantly lower (less fatigue) compared with two samples of cancer patients in palliative care (16.8 and 17.0). SSc GFI scores were similar to scores from patients with RA (13.4), AS (13.0) and SLE (13.1) and to scores from six studies of cancer patients in active treatment (11.1-13.5). CONCLUSIONS The high levels of fatigue reported in SSc were similar to patients with varying types and treatment stages of cancer and patients with other rheumatic diseases when assessed with the GFI, demonstrating that fatigue warrants greater attention in SSc.
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Affiliation(s)
- B D Thombs
- Department of Psychiatry, McGill University and Sir Mortimer B. Davis - Jewish General Hospital, Montreal, Quebec, Canada.
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The experience of fatigue in the first 2 years after moderate-to-severe traumatic brain injury: a preliminary report. J Head Trauma Rehabil 2008; 23:17-24. [PMID: 18219231 DOI: 10.1097/01.htr.0000308717.80590.22] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fatigue is a well-recognized issue for individuals with traumatic brain injury (TBI). This prospective study examined the rate and types of fatigue that are experienced by a cohort of individuals with TBI within the first 2 years, using a multidimensional fatigue scale. The impact of factors such as demographics, injury severity indices, and concomitant psychosocial variables was also examined. Using 2 measures of overall fatigue, 16%-32% at Year 1 and 21%-34% at Year 2 reported significant levels of fatigue. Fatigue did not appear to change between 1 and 2 years post-TBI. Sleep quality was the most prevalent concomitant disturbance followed by depression and pain.
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Bushnik T, Englander J, Katznelson L. Fatigue after TBI: association with neuroendocrine abnormalities. Brain Inj 2008; 21:559-66. [PMID: 17577706 DOI: 10.1080/02699050701426915] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evaluate the association between neuroendocrine findings and fatigue after traumatic brain injury (TBI) Research design: Prospective, observational. METHODS AND PROCEDURES Sixty-four individuals at least 1 year post-TBI underwent neuroendocrine testing including thyroid, adrenal, gonadal axes and growth hormone (GH) after glucagon stimulation with assessment of fatigue using the Global Fatigue Index (GFI) and the Fatigue Severity Scale (FSS). MAIN OUTCOMES AND RESULTS GFI and FSS scores were significantly higher within this sample compared to published control data. At least one pituitary axis was abnormal in 90% of participants. Higher GH levels were significantly associated with higher FSS scores. There was a noted trend between lower basal cortisol and higher scores on both the FSS and GFI. CONCLUSIONS The association between higher GH levels and greater fatigue contradicted the prevailing hypothesis that post-acute TBI fatigue is associated with GH deficiency. The association between lower basal cortisol and greater fatigue was in the expected direction. While no other trends were noted, the fatigue derived from neuroendocrine abnormalities alone may be masked by fatigue induced by other factors commonly experienced following TBI. Given the high prevalence of pituitary abnormalities, screening for hypopituitarism after TBI is a reasonable recommendation. The contribution of GH deficiency to diminished quality of life post-TBI remains unclear.
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Affiliation(s)
- Tamara Bushnik
- Rehabilitation Research Center, San Jose, CA 95128, USA.
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Lee YC, Chien KL, Chen HH. Lifestyle risk factors associated with fatigue in graduate students. J Formos Med Assoc 2007; 106:565-72. [PMID: 17660146 DOI: 10.1016/s0929-6646(07)60007-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Fatigue is not only common in clinical patients but is also prevalent in the healthy population. This study aimed to estimate the prevalence rate of fatigue and identify significant risk factors among graduate students. METHODS Health check-ups were carried out on graduate students who were newly admitted to the National Taiwan University in this cross-sectional study. A total of 1806 attendees (response rate, 84%) agreed to participate in the fatigue survey, which used the Checklist Individual Strength questionnaire (CIS-20). The modified Baecke's questionnaire was used to quantify the intensity of physical activity. RESULTS The prevalence rates of fatigue were 45.8% for males and 48.9% for females. Regular meal (odds ratio [OR], 0.69) and exercise habits (OR, 0.68), insomnia (OR, 2.23), greater amount of sleeping time (OR, 0.7), identity (doctorate vs. master students; OR, 0.61), and chronic disease history (OR, 1.61) were statistically significant predictors for fatigue. Intensity of physical activity was a protective factor (ORs, 0.72, 0.50 and 0.36 in the 2nd, 3rd and top quartiles vs. 1st quartile; p < 0.001). CONCLUSION A high prevalence rate of fatigue among the graduate students was demonstrated. The risk factors among young adults are not only related to current chronic disease and insomnia but are also attributed to the lack of physical activity.
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Affiliation(s)
- Yi-Chin Lee
- Student Health Center, College of Public Health, National Taiwan University, Taipei, Taiwan
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Thomée S, Eklöf M, Gustafsson E, Nilsson R, Hagberg M. Prevalence of perceived stress, symptoms of depression and sleep disturbances in relation to information and communication technology (ICT) use among young adults – an explorative prospective study. COMPUTERS IN HUMAN BEHAVIOR 2007. [DOI: 10.1016/j.chb.2004.12.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kos D, Kerckhofs E, Nagels G, D'hooghe MB, Ilsbroukx S. Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil Neural Repair 2007; 22:91-100. [PMID: 17409388 DOI: 10.1177/1545968306298934] [Citation(s) in RCA: 267] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is one of the most common and most disabling symptoms of multiple sclerosis (MS). Although numerous studies have tried to reveal it, no definite pathogenesis factor behind this fatigue has been identified. Fatigue may be directly related to the disease mechanisms (primary fatigue) or may be secondary to non-disease-specific factors. Primary fatigue may be the result of inflammation, demyelination, or axonal loss. A suggested functional cortical reorganization may result in a higher energy demand in certain brain areas, culminating in an increase of fatigue perception. Higher levels of some immune markers were found in patients with MS-related fatigue, whereas other studies rejected this hypothesis. There may be a disturbance in the neuroendocrine system related to fatigue, but it is not clear whether this is either the result of the interaction with immune activation or the trigger of this process. Fatigue may be secondary to sleep problems, which are frequently present in MS and in their turn result from urinary problems, spasms, pain, or anxiety. Pharmacologic treatment of MS (symptoms) may also provoke fatigue. The evidence for reduced activity as a cause of secondary fatigue in MS is inconsistent. Psychological functioning may at least play a role in the persistence of fatigue. Research did not reach consensus about the association of fatigue with clinical or demographic variables, such as age, gender, disability, type of MS, education level, and disease duration. In conclusion, it is more likely to explain fatigue from a multifactor perspective than to ascribe it to one mechanism. The current evidence on the pathogenesis of primary and secondary fatigue in MS is limited by inconsistency in defining specific aspects of the concept fatigue, by the lack of appropriate assessment tools, and by the use of heterogeneous samples. Future research should overcome these limitations and also include longitudinal designs.
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Affiliation(s)
- D Kos
- Vrije Universiteit Brussel, Department of Rehabilitation Research, Brussels, Belgium.
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Abstract
AIM The aim of this paper is to add a qualitative dimension to the body of knowledge about fatigue by revealing the meaning given by women living with chronic illness to the experience of fatigue. BACKGROUND Fatigue is a common symptom experienced by people who live with chronic illness. It pervades every aspect of life and may be experienced in physical, psychological, emotional or social dimensions. Management of fatigue relies heavily on the individual's ability to employ self-care actions. The invisibility of fatigue is recognized as one of the most frustrating aspects, which can lead to lack of understanding and misunderstanding by others. METHOD We report the findings of data from research in progress (2003-2005). Data were generated via email group conversations between us and 30 women who live with long-term illness. FINDINGS A recurring conversational thread has been women's experiences of fatigue when living with long-term illness. Although fatigue has been reported to be a major obstacle to maintaining usual daily activities and quality of life, few studies have explored this common symptom from the perspective of people themselves. Common themes found in the experience of fatigue as described by women are the meaning of fatigue, awareness as self-care, fatigue as invisible to others, seeking medical validation and accountability for self-care. CONCLUSION It is vital for healthcare workers to give opportunities for women to talk about fatigue, validate their experiences and provide support with self-care. Healthcare workers are encouraged to challenge their own meanings and expectations surrounding a person's report of fatigue so that opportunities for therapeutic intervention can be facilitated.
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Affiliation(s)
- Debbie Kralik
- School of Nursing and Midwifery, University of South Australia, Royal District Nursing Service of SA Inc Foundation (RDNS), RDNS Research Unit, Glenside, Australia.
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Kos D, Kerckhofs E, Ketelaer P, Duportail M, Nagels G, D'Hooghe M, Nuyens G. Self-report assessment of fatigue in multiple sclerosis: a critical evaluation. Occup Ther Health Care 2004; 17:45-62. [PMID: 23941221 DOI: 10.1080/j003v17n03_04] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.
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Affiliation(s)
- Daphne Kos
- Vrije Universiteit Brussel, Rehabilitation Research, Department Physical Therapy, Laarbeeklaan 103, B-1090, Brussels, Belgium
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De Vries J, Michielsen HJ, Van Heck GL. Assessment of fatigue among working people: a comparison of six questionnaires. Occup Environ Med 2003; 60 Suppl 1:i10-5. [PMID: 12782741 PMCID: PMC1765720 DOI: 10.1136/oem.60.suppl_1.i10] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To compare the psychometric qualities of six fatigue questionnaires in a sample of working persons. METHODS Internal consistency and test-retest reliability, content validity, convergent validity, and the dimensionality of the fatigue instruments were explored. RESULTS All scales had a satisfactory internal consistency. Furthermore, based on factor analyses and Mokken scale analyses, all scales were unidimensional and appeared to measure an identical construct. The Fatigue Assessment Scale (FAS) had the highest factor loading on the one factor solution obtained in a factor analysis of the total scores of all scales. CONCLUSIONS All the questionnaires were unidimensional and had good reliability and validity. The FAS was the most promising fatigue measure.
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Affiliation(s)
- J De Vries
- Department of Psychology and Health, Tilburg University, and Research Institute for Psychology and Health, Netherlands.
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Michielsen HJ, De Vries J, Van Heck GL. Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale. J Psychosom Res 2003; 54:345-52. [PMID: 12670612 DOI: 10.1016/s0022-3999(02)00392-6] [Citation(s) in RCA: 401] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The main aim of this study was to examine the dimensionality and psychometric qualities of a new 10-item fatigue measure, the Fatigue Assessment Scale (FAS). METHODS As part of a longitudinal study, the respondents, all workers with at least 20 working hours per week, completed the FAS, four related fatigue measures, a depression questionnaire, and an emotional stability scale. RESULTS The FAS had a high internal consistency. The pattern of correlations and factor analysis showed good convergent and divergent validity. The FAS correlated strongly with the other fatigue scales. In a factor analysis of the five fatigue questionnaires, the FAS had the highest factor loading on a clear one-factor solution. Moreover, factor analyses revealed that fatigue, on the one hand, and depression and emotional stability, on the other hand, are separate constructs. Finally, it was shown that 8 out of the 10 FAS items were unbiased concerning gender; two had a uniform bias. CONCLUSIONS The FAS represents a potentially valuable assessment instrument with promising internal consistency reliability and validity. Gender bias in the FAS does not have consequences for use of the FAS.
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Affiliation(s)
- Helen J Michielsen
- Department of Clinical Health Psychology, Tilburg University, PO Box 90153, The Netherlands.
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Holzner B, Kemmler G, Meraner V, Maislinger A, Kopp M, Bodner T, Nguyen-Van-Tam D, Zeimet AG, Fleischhacker WW, Sperner-Unterweger B. Fatigue in ovarian carcinoma patients: a neglected issue? Cancer 2003; 97:1564-72. [PMID: 12627522 DOI: 10.1002/cncr.11253] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although fatigue is a commonly reported symptom in cancer patients it is rarely investigated, especially in patients with ovarian carcinoma. The main focus of the current study was to assess fatigue in these patients and to investigate the impact of fatigue and other clinical and psychosocial variables on their quality of life (QOL). METHODS Ninety-eight ovarian carcinoma survivors (average age of 57.4 +/- 12.5 years) were included in the study. All women had received cancer therapy but had not been treated for at least 6 months. The average time elapsed since first diagnosis was 5.7 +/- 5.5 years. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) and QOL was measured with the Functional Assessment of Cancer Therapy (FACT)-ovarian carcinoma part and the European Organization for Research and Treatment of Cancer Care Questionnaire, including the ovarian carcinoma module. RESULTS Thirty-two of 98 ovarian carcinoma patients (32.7%, 95% confidence interval, 23.5-42.9%) reported MFI-20 General Fatigue scores >/= 12.0 and therefore could be characterized as suffering from fatigue. This group of patients had a significantly lower QOL, had higher scores of anxiety and depression, and perceived that they had less social support. In a multiple regression model, mental adjustment, social support, anxiety, and depression as well as fatigue were significant predictors of QOL (FACT-generic part total score) whereas clinical and sociodemographic variables were not. CONCLUSION A remarkably high proportion of ovarian carcinoma survivors suffered from fatigue. Because this symptom is a key predictor of QOL, it should be given more attention in aftercare programs.
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Affiliation(s)
- Bernhard Holzner
- Department of Biological Psychiatry, Innsbruck University Hospital, Innsbruck, Austria.
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Mohren DC, Swaen GM, Kant IJ, Borm PJ, Galama JM. Associations between infections and fatigue in a Dutch working population: results of the Maastricht Cohort Study on Fatigue at Work. Eur J Epidemiol 2003; 17:1081-7. [PMID: 12530766 DOI: 10.1023/a:1021270924291] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The relationship between fatigue and common infections was further explored, as part of a 3 year prospective cohort study on Fatigue at Work. The current study is based on seven successive questionnaires, covering the first 2 years of follow-up. The overall response at baseline was 45% (n = 12,140). On T1 10,592 (87.2% compared to baseline response) employees returned the questionnaire. For T2, T3, T4, T5 and T6, 10,270 (84.6%), 9655 (79.5%), 8956 (73.8%), 8692 (71.6%) and 8070 (66.5%) employees respectively returned the questionnaire. Self-administered questionnaires were used to determine the level of fatigue with the Checklist Individual Strength (CIS) and the occurrence of common cold, flu-like illness and gastroenteritis. Regression analysis using generalized estimated equations (GEE) were used for data analysis. We found a cross-sectional relationship between fatigue and the infections flu-like illness and gastroenteritis, and a longitudinal relationship between an infection as a predictor of fatigue. For fatigue as a predictor of an infection, we found odds ratios (ORs) of 1.35 (confidence interval (CI) 1.28-1.42) for flu-like illness and 1.33 (CI: 1.25-1.42) for gastroenteritis. The highest incidence of infections was found among employees who reported high fatigue levels on two successive occasions. The increased incidence of infections, is regarded as a substantial effect of fatigue because it is associated with significant absenteeism from work and leads to discomfort.
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Affiliation(s)
- D C Mohren
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
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Shapiro CM, Flanigan M, Fleming JAE, Morehouse R, Moscovitch A, Plamondon J, Reinish L, Devins GM. Development of an adjective checklist to measure five FACES of fatigue and sleepiness. Data from a national survey of insomniacs. J Psychosom Res 2002; 52:467-73. [PMID: 12069871 DOI: 10.1016/s0022-3999(02)00407-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Development and initial validation of the FACES of fatigue and sleepiness adjective checklist. An initial item pool of 65 adjectives, descriptive of fatigue, sleepiness and related deprivation states, was developed and administered to 372 individuals referred by their family physicians for psychiatric investigation and treatment of severe insomnia. Participants attended one of six Canadian university-affiliated sleep clinics where they completed a psychiatric assessment and a 766-item questionnaire, including a number of standard indices of sleep-related behavior and symptoms, medical history, sleep hygiene, psychosocial well-being and psychopathology. Principal-components and item analyses were undertaken to refine the initial 65-item pool to a smaller 50-item set, consisting of five subscales: Fatigue, Anergy, Consciousness, Energized and Sleepiness. Coefficient alpha was calculated and indicated high internal consistency reliability for all subscales. Convergent and discriminant validity were also evaluated by calculating correlations between FACES subscales and a number of independent indices. The resulting five-scale FACES questionnaire appears to offer a promising self-report instrument for the measurement of fatigue and related subjective experiences.
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Affiliation(s)
- Colin M Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada.
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Holzner B, Kemmler G, Greil R, Kopp M, Zeimet A, Raderer M, Hejna M, Zöchbauer S, Krajnik G, Huber H, Fleischhacker WW, Sperner-Unterweger B. The impact of hemoglobin levels on fatigue and quality of life in cancer patients. Ann Oncol 2002; 13:965-73. [PMID: 12123343 DOI: 10.1093/annonc/mdf122] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy. PATIENTS AND METHODS Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life with The European Organization for Research and Treatment of Cancer QLQ-C30. In order to provide normative data for fatigue levels, the MFI-20 was also completed by a sex- and age-matched sample of 120 healthy controls. RESULTS Compared with healthy subjects, cancer patients experienced significantly higher levels of subjective fatigue. Correlations between Hb values and subscales of the MFI-20 were moderate with a tendency to increase during chemotherapy. Hb values alone, however, do not fully account for the observed fatigue. Other symptoms, especially pain, dyspnea and sleep disturbances, also showed an association with perceived fatigue. CONCLUSIONS Despite significant correlations, these results indicate that Hb values only partially explain subjectively experienced fatigue and quality of life in cancer patients. It is suggested therefore that the treatment of fatigue must be multidimensional and involve all areas which contribute to the syndrome.
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Affiliation(s)
- B Holzner
- Department of Biological Psychiatry, Innsbruck University Hospital, Austria.
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Aadahl M, Hansen BA, Kirkegaard P, Groenvold M. Fatigue and physical function after orthotopic liver transplantation. Liver Transpl 2002; 8:251-9. [PMID: 11910570 DOI: 10.1053/jlts.2002.31743] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the last two decades, orthotopic liver transplantation (OLT) has become an established treatment for acute and chronic liver failure. OLT impacts not only on survival, but also on health-related quality of life. This study was undertaken to describe the self-rated health of Danish liver transplant recipients, compare their self-rated health against that of the general population, and to investigate associations between sex, age, diagnosis, time after OLT, and postoperative physical function and fatigue. All adult surviving liver transplant recipients who underwent OLT in Copenhagen, Denmark, from 1990 to 1998 (n = 154) were contacted by mail and asked to complete a self-administered questionnaire. The questionnaire contained the 36-Item Short Form Health Survey, the Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale, and questions on marital status, education, and work. The response rate was 84.4% (n = 130). Liver transplant recipients reported poorer self-rated health than the general population in physical, but not in mental, health areas. One health aspect, fatigue, was investigated in great detail. This study found that liver transplant recipients experienced physical, rather than mental, fatigue. Diagnosis was found to be a predictor of postoperative physical function and fatigue because patients with an alcoholic or cryptogenic cirrhosis background had significantly poorer physical function and experienced more physical fatigue than liver transplant recipients with other diagnoses. Work status and survival time after OLT had significant effects on postoperative physical function and fatigue. Working and having undergone transplantation 4 to 5 years previously were associated with significantly better physical function and less physical fatigue than not working and having undergone transplantation 1 to 3 years previously. This study suggests that liver transplant recipients experience physical, rather than mental, impairment and fatigue and that diagnosis, work status, and survival time after OLT are associated with physical function and fatigue.
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Affiliation(s)
- Mette Aadahl
- Department of Medical Orthopedics and Rehabilitation, University of Copenhagen, Denmark.
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