[Measuring fatigue in patients with multiple sclerosis with standardized methods in German speaking areas]

Efficacy of supervised immersive virtual reality-based training for the treatment of chronic fatigue in post-COVID syndrome: study protocol for a double-blind randomized controlled trial (IFATICO Trial)

BACKGROUND

The treatment of persistent fatigue after COVID-19 infection is complex. On the one hand, it involves maintaining a sufficient level of physical and mental activity to counteract possible degenerative processes of the body and nervous system. On the other hand, physical and mental activities can also lead to worsening of symptoms. Therefore, the challenge in treating Post-COVID fatigue is to stimulate the body and central nervous system in a way that stimulates growth and improvement, but does not overtax individual physical and mental limits. Special training programs try to take these characteristics into account, but often reach their limits. A promising approach is offered by new fitness technologies based on immersive virtual realities that stimulate both body and brain while minimizing physical and psychological stress. The aim of this study is to investigate the efficacy of supervised immersive Virtual Reality (VR)-based activity training compared to conventional activity training for patients with Post-COVID-associated fatigue.

METHODS

In a single centre, individually randomised, prospective, double-blind two-arm exploratory superiority trial with parallel group design, N = 100 patients with persistent fatigue after COVID-19 infection will be recruited. The intervention includes a supervised immersive neuromuscular training (12 sessions of 30 min over 6 weeks) based on a novel VR-exercise device. We will systematically compare the effects of this intervention on Post-COVID-associated fatigue with a supervised conventional activation program of comparable scope without an immersive environment. The primary outcome is the difference between groups in absolute change in the mean fatigue symptom severity measured on the Fatigue Severity Scale (FSS) from baseline to posttreatment assessment. Posttreatment assessment in both groups will be conducted by blinded outcome assessors. At three and six months afterwards, patients are sent self-report questionnaires for follow up. The main analysis will be based on the intention-to-treat principle.

DISCUSSION

To the best of our knowledge, this is the first exploratory study on a supervised immersive neuromuscular training for the treatment of persistent fatigue after COVID-19 infection.

TRIAL REGISTRATION

German register for clinical studies (ID: DRKS00032059) Prospectively registered on June 16th 2023. URL of trial registration.

Itch, sleep loss, depressive symptoms, fatigue, and productivity loss in patients with moderate-to-severe atopic dermatitis: Analyses of TREATgermany registry data

BACKGROUND

TREATgermany is a multicenter registry including patients with moderate-to-severe atopic dermatitis (AD) from currently 74 study centers (university clinics, hospitals and practices) in Germany. As of August 31, 2021, 1,230 adult patients were enrolled.

METHODS

In TREATgermany, patients and physicians fill in questionnaires pertaining to symptoms, disease severity, quality of life, depressiveness, and fatigue. In particular, limitations in work performance are assessed using the Work Limitations Questionnaire (WLQ). To assess associations between occupational performance/work limitations and symptoms, correlations and regression models were calculated.

RESULTS

The examined sample of 228 employed patients reported an average of 6% at-work productivity loss within the past two weeks prior to enrolment in the registry. The WLQ productivity loss score was moderately associated with itch (r = 0.32) and sleep loss (r = 0.39) and strongly associated with depressive symptoms (r = 0.68) and fatigue (r = 0.60).

CONCLUSIONS

The analyses of the registry data show that moderate-to-severe atopic dermatitis has a negative impact on the work productivity of the patients. The analyses further point out the relevant associations between work productivity, depressive symptoms, and fatigue highlighting the disease burden caused by the psychological components of AD.

Juckreiz, Schlafstörungen, depressive Symptome, Fatigue und Einschränkungen der Arbeitsproduktivität bei Patienten mit moderater bis schwerer atopischer Dermatitis: Daten aus dem TREATgermany-Register

Hintergrund

TREATgermany ist ein multizentrisches Register, das Patienten mit moderater bis schwerer atopischer Dermatitis (AD) aus derzeit 74 Studienzentren (Universitätskliniken, Krankenhäuser und Praxen) in Deutschland umfasst. Bis zum 31. August 2021 wurden 1.230 erwachsene Patienten eingeschlossen.

Methoden

In TREATgermany füllen Patienten und Ärzte Fragebögen zu Symptomen, Krankheitsschwere, Lebensqualität, Depressivität und Fatigue aus. Die Einschränkungen der Arbeitsleistung werden insbesondere mit dem Work Limitations Questionnaire (WLQ) erfasst. Um Assoziationen zwischen beruflicher Leistung/Arbeitseinschränkungen und Symptomen zu bestimmen, wurden Korrelationen und Regressionsmodelle berechnet.

Ergebnisse

Die untersuchte Stichprobe von 228 berufstätigen Patienten beschrieb einen durchschnittlichen Produktivitätsverlust von 6% bei der Arbeit innerhalb der letzten zwei Wochen vor der Aufnahme in das Register. Der WLQ‐Wert für den Produktivitätsverlust war moderat mit Juckreiz (r = 0,32) und Schlafstörungen (r = 0,39) und stark mit depressiven Symptomen (r = 0,68) und Fatigue (r = 0,60) korreliert.

Schlussfolgerungen

Die Analysen der Registerdaten zeigen, dass eine moderate bis schwere AD einen negativen Einfluss auf die Arbeitsproduktivität der Patienten hat. Die Analysen weisen außerdem auf die relevanten Zusammenhänge zwischen Arbeitsproduktivität, depressiven Symptomen und Fatigue hin, was die durch die psychologischen Komponenten der AD verursachte Krankheitslast verdeutlicht.

NUTRISEP: Assessment of the nutritional status of patients with multiple sclerosis and link to fatigue

BACKGROUND

Fatigue is a common complaint in patients with multiple sclerosis (PwMS) and reduces quality of life. Several hypotheses for the pathogenesis of fatigue in MS are proposed ranging from neurological lesions to malnutrition, but none has been conclusively validated through clinical research.

OBJECTIVES

The goal of this study was to examine the correlation between fatigue and nutritional status and dietary habits in PwMS.

METHODS

This was a cross-sectional, multicenter study conducted at 10 French MS centers and enrolling PwMS with an Expanded Disability Status Scale (EDSS) score between 0 and 7. Plasma level of albumin, magnesium, calcium, iron, vitamin D and B12 evaluated nutritional status. A semi-structured eating behavior questionnaire has been developed to evaluate dietary habits. Evaluation of fatigue used specific questionnaire (EMIF-SEP). Quality of sleep was evaluated by visual analogue scale (VAS), depression with Beck Depression Inventory (BDI-II); dysphagia by DYsphagia in MUltiple Sclerosis questionnaire (DYMUS) and taste disorders by gustometry. Association between nutritional deficiencies and different data such as socio-demographic data, disease characteristics, swallowing and taste disorders, food intake, depression and sleep quality was investigated.

RESULTS

A total of 352 patients mean age: 48.1±10.1 years, mean duration of MS: 15.3±9.1 years and median EDSS: 4 were analyzed. Bivariate and multivariate analyses showed a statistically significant correlation between fatigue and depression and use of sleeping pills, while none of the variables related to dietary habits or nutritional status correlated significantly with fatigue.

CONCLUSIONS

Dietary habits and nutritional status have little impact on fatigue and general population nutrition recommendations remain the rule for PwMS. In cases of fatigue, specific attention should be paid to depression and use of sleeping pills.

The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study

Background

Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment.

Objective

The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability.

Methods

We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis.

Results

Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants’ reported levels of fatigue (d=0.99-1.28).

Conclusions

Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology.

Outcome measures for physical fatigue in individuals with multiple sclerosis: a systematic review

INTRODUCTION

Physical fatigue can be a common reason for early retirement or sick leave since it appears in the earliest stages of multiple sclerosis (MS). Therefore, a prompt and accurate diagnosis is essential. This systematic review aims to identify and describe the instruments used to assess physical fatigue in MS patients with consideration for the languages used to validate the instruments and their methodological qualities.

AREA COVERED

This study has been carried out through 'Medline,' 'Scopus,' 'Cinhal,' and 'Web of Science' databases for all the papers published before 24 January 2020. Three independent authors have chosen the eligible studies based upon pre-set criteria of inclusion. Data collection, data items, and assessment of the risk of bias: the data extraction approach was chosen based on the Cochrane Methods. For data collection, the authors followed the recommendations from the COSMIN initiative. Study quality and risk of bias were assessed using the COSMIN Check List.

EXPERT OPINION

119 publications have been reviewed. The 45 assessment scales can be divided into specific scales for physical fatigue and specific scales for MS. The most popular tools are the Fatigue Severity Scale and the Modified Fatigue Impact Scale.

Higher Disease and Pain Severity and Fatigue and Lower Balance Skills Are Associated with Higher Prevalence of Falling among Individuals with the Inflammatory Disease of Neuromyelitis Optica Spectrum Disorder (NMOSD)

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory and autoimmune disorder that is associated with impaired vision, sensory loss, pain, fatigue, and spasms in the upper and lower limbs. Typically, persons with this disorder are also at higher risks of falls. Given this, the aims of the study were to compare the prevalence rates of falling for NMOSD cases and healthy controls (HCs), and to predict falling in the former group based on sociodemographic, psychological, and illness-related factors. Method: A total of 95 adults with NMOSD (Mean age = 34.89 years; 70.5% females) and 100 matched HCs took part in the study. All participants completed a series of questionnaires covering sociodemographic information and falling rates. The NMOSD individuals also reported on disease duration, pain, fatigue, and fear of falling, while their balance performance was objectively assessed. Results: Compared to healthy controls, the NMOSD cases had a 2.5-fold higher risk of falling. In this latter group, higher scores for pain, fatigue, fear of falling, and higher EDSS scores were distinguished between fallers and non-fallers, and objective balance skills had no predictive value. Conclusions: Compared to healthy controls, NMOSD sufferers had a 2.5-fold higher risk of experiencing falls. In this group, disease impairments (EDSS, fatigue, pain) predicted falling. Specific interventions such as regular resistance training might reduce the risk of falling.

Better Objective Sleep Was Associated with Better Subjective Sleep and Physical Activity; Results from an Exploratory Study under Naturalistic Conditions among Persons with Multiple Sclerosis

Persons with multiple sclerosis (PwMS) often complain about sleep problems. There is less known about objective sleep-electroencephalography (EEG) dimensions within naturalistic conditions (i.e., home and/or familiar setting). The present cross-sectional study examined the associations between objective and subjective sleep, depression, physical activity scores, and MS-related information among PwMS in their familiar setting. The sample consisted of 16 PwMS (mean age: 50.3 years; median Expanded Disability Status Scale (EDSS): 5.5) who completed questionnaires covering subjective sleep (symptoms of insomnia, restless legs syndrome (RLS) and sleep-disordered breathing), as well as daytime sleepiness, subjective physical activity, depression, and MS-related information (fatigue, EDSS; disease-modifying treatments). Objective sleep was assessed with a mobile sleep-EEG device under naturalist conditions within the home. Descriptively, better objective sleep patterns were associated with lower sleep complaints (r_s = −0.51) and daytime sleepiness (r_s = −0.43), and with lower symptoms of RLS (r_s = −0.35), but not with sleep-disordered breathing (r_s = −0.17). More deep sleep was associated with higher moderate physical activity levels (r_s = 0.56). Objective sleep parameters were not associated with vigorous physical activity levels (r_s < 0.25). Descriptively, moderate and vigorous physical activity scores were associated with lower symptoms of RLS (r_s = −0.43 to −0.47). Results from this small study carried out under naturalistic conditions suggest that among PwMS, better objective sleep correlated with better subjective sleep and higher moderate physical activity levels.

The German version of the musculoskeletal pain intensity and interference questionnaire for musicians (MPIIQM-G): Translation and validation in professional orchestral musicians

Many musicians suffer from playing-related musculoskeletal disorders (PRMDs) however many of the epidemiological surveys on PRMD do not utilize evaluated self-report instruments, especially as a tool to assess musculoskeletal pain intensity and pain interference in terms of function and psychosocial constructs. The aim of this study was to translate and cross-culturally adapt the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) into German, and validate it among a population of professional orchestral musicians. The translated and cross-culturally adapted German version of the questionnaire was sent to a total of 367 professional orchestral musicians in Germany who were eligible for the study. Of this total, 124 musicians responded to the questionnaire. The psychometric evaluation showed a clear two dimensionality namely "pain intensity" and "pain interference". Internal consistency was very high for both the "pain intensity" and "pain interference" dimensions as well as for the complete scale. The values for the Intraclass Correlation Coefficient for the test-retest reliability indicated good to excellent repeatability. The subscales of MPIIQM showed strong correlation with the Brief Pain Inventory (BPI) and the shorter version of Disabilities of the Arm, Shoulder and Hand (QuickDash) and low correlation with the Fatigue Severity Scale (FSS). These results were as expected, confirming the good construct validity of the MPIIQM. The German Version of the MPIIQM (MPIIQM-G) and the original version have similarly high qualities and thus the MPIIQM-G represents a useful self-report instrument for the measurement and evaluation of musculoskeletal pain intensity and pain interference for professional orchestral musicians.

Inpatient rehabilitation for adult patients with Marfan syndrome: an observational pilot study

BACKGROUND

Advances in medical, interventional and surgical treatment have increased average life expectancy of patients with congenital heart defects. As a result a new group of adult patients with congenital cardiac defects requires medical rehabilitation. Patients with Marfan syndrome (MFS) are a relevant group among these patients. So far, no reports on the effectiveness of specialized rehabilitation programmes for MFS patients exist. We implemented an inpatient 3-week rehabilitation program for MFS patients at the Muehlenberg-Clinic for rehabilitation and assessed the medical safety as well as the impact of the program on physical fitness and psychological wellbeing of participants by means of an observational pilot study. The comprehensive multidisciplinary program included medical, physiotherapeutic, psychological and social issues. Two groups including 8 and 10 individuals with verified MFS attended the programme. Medically adverse events that occurred during the rehabilitation were registered. Adverse events were defined as: any new cardiac arrhythmias such as atrial fibrillation, ventricular tachycardia, cardiac syncope or any complications located at the aorta. Psychological assessment was performed using Short Form-36 (SF-36), hospital anxiety and depression scale and other psychometric questionnaires. Medical examinations included assessment of maximum power in bicycle ergometry. All assessments were performed at the beginning and at the end of the rehabilitation. Psychometric assessments were repeated 1 year after the end of the programme for both groups, respectively.

RESULTS

Patients were highly satisfied with the programme and improved in almost all psychological and physical fitness assessments. The pre-post-comparison resulted in significant positive changes for mental health (p < .001 for SF-36 Mental Health), fatigue (p < .05 for Fatigue Severity Scale), nociception (p < .05 for SF-36 Pain) and vitality (p < .05 for SF-36 Vitality). Physical fitness improved from admission to discharge (p < .001 for maximum power in bicycle ergometry, p < .05 for maximum nordic walking distance). Considerable improvements persisted through 1 year follow-up. Medical assessments excluded medical problems or adverse events caused by participation in the programme.

CONCLUSIONS

In our study, inpatient rehabilitation was both safe and helpful for MFS patients. They benefited in terms of physical fitness, health related quality of life and in terms of psychological wellbeing. An evaluation of the efficacy of the programme in a controlled design as well as further conceptual improvements of our current program is desirable.

Self-report fatigue questionnaires in multiple sclerosis, Parkinson's disease and stroke: a systematic review of measurement properties

PURPOSE

To critically appraise, compare and summarize the measurement properties of self-report fatigue questionnaires validated in patients with multiple sclerosis (MS), Parkinson's disease (PD) or stroke.

METHODS

MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTdiscus were searched. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of studies. A qualitative data synthesis was performed to rate the measurement properties for each questionnaire.

RESULTS

Thirty-eight studies out of 5,336 records met the inclusion criteria, evaluating 31 questionnaires. Moderate evidence was found for adequate internal consistency and structural validity of the Fatigue Scale for Motor and Cognitive functions (FSMC) and for adequate reliability and structural validity of the Unidimensional Fatigue Impact Scale (U-FIS) in MS.

CONCLUSIONS

We recommend the FSMC and U-FIS in MS. The Functional Assessment of Chronic Illness Therapy Fatigue subscale (FACIT-F) and Fatigue Severity Scale (FSS) show promise in PD, and the Profile of Mood States Fatigue subscale (POMS-F) for stroke. Future studies should focus on measurement error, responsiveness and interpretability. Studies should also put emphasis on providing input for the theoretical construct of fatigue, allowing the development of questionnaires that reflect generic and disease-specific symptoms of fatigue.

Validity of a French version of the fatigue impact scale in multiple sclerosis

Purpose Fatigue is a frequent and common symptom of multiple sclerosis (MS) that can interfere with patients' everyday activities. There is no objective scale for assessing fatigue in French MS patients. The objective of this study was to adapt an English language scale for use with French patients.

Methods The Fatigue Impact Scale was translated and culturally adapted into French by a committee of medical and linguistic specialists. The psychometric properties of this new instrument, called EMIF-SEP were assessed.

Results EMIF-SEP is composed of 40 items. Four dimensions of this scale (cognitive, physical, social role and psychological) were identified by factor analysis. Each dimension had a high internal consistency (Cronbach's alpha >0.80). The test-retest reproducibility was very satisfactory; intra-class correlation coefficients were all above 0.70.

Conclusion EMIF-SEP is the first scale for assessing MS-related fatigue which has been adapted to French-speaking patients. It is useful for clinical practice and MS-related research. Multiple Sclerosis 2007; 13: 1026—1032. http://msj.sagepub.com