Psychometric properties of an Arabic version of the fatigue severity scale in patients with stroke

A systematic review of post-stroke fatigue measurement scale based on COSMIN guidelines

Objective

This study aimed to evaluate the methodological quality and measurement attribute quality of the post-stroke fatigue measurement scale, so as to provide some basis for the clinical application and promotion of related scales.

Methods

The Chinese National Knowledge Infrastructure, the Wanfang Data Knowledge Service Platform, the China Science and Technology Journal Database, the Chinese Medical Journal Full-text Database, the Chinese Biology Medicine, PubMed, Embase, Medline, the Cochrane Library, the Web of Science, CINAHL, and PsycINFO databases were searched for literature on the post-stroke fatigue measurement scale up to June 2022. Literature screening and data extraction were carried out independently by two researchers, and in the case of disagreement, discussions were held with a third investigator to reach an agreement, and the COSMIN checklist and criteria were used to systematically evaluate the attributes of the measurement scale.

Results

A total of 17 studies were included, involving 10 post-stroke fatigue measurement scales. The content validity of FSS-7, FACIT-F, NRS-FRS, and MFI-20 was "not mentioned," and the remaining scales were "uncertain." In terms of construct validity, MFS was "adequate"; FSS-7, FACIT-F, and NRS-FRS were "not mentioned"; and the remaining scales were "uncertain." In terms of internal consistency, NRS-FRS was "not mentioned"; FSS and MFS were "adequate"; and the remaining scales were "uncertain." In terms of hypothesis testing, CIS and FACIT-F were "not mentioned," NRS-FRS was "adequate," and the remaining scales were "uncertain." The stability of FSS-7, CIS, FACIT-F, and MFI-20 was "not mentioned," and the remaining scales were "adequate." The cross-cultural validity of FSS-7 was "adequate," and the remaining scales were "not mentioned." All 10 scales were given a recommendation grade of "B".

Conclusion

For the time being, the FSS can be recommended to measure post-stroke fatigue, but it still needs to be tested for more relevant measurement properties in order to gain more support from high-quality evidence. For a more comprehensive assessment of post-stroke fatigue, the FIS, FAS, and NFI-stroke should perhaps be considered, as the FSS is a one-dimensional scale that can only measure physical fatigue in patients; however, these scales also need to be tested for more relevant measurement properties to verify their clinical applicability.

Validating the Fatigue Scale for Motor and Cognitive Function (FSMC) in chronic stroke

BACKGROUND

Post-stroke fatigue can manifest as both physical and mental fatigue. The Fatigue Scale for Motor and Cognitive Functions (FSMC) evaluates fatigue on the motor and cognitive domains separately, however, the psychometric properties of this measure in stroke have not been reported.

OBJECTIVE

To determine the internal consistency, test-retest reliability, and concurrent validity of the FSMC in chronic stroke.

METHODS

Thirty-four participants with chronic stroke (55.26±12.27 years of age; 59.53±89.21 months post-stroke) completed the FSMC on two separate visits. Internal consistency and reliability of the FSMC were examined using Cronbach's alpha and two-way mixed effects intraclass correlation coefficients (ICC), respectively. Correlation between the FSMC and the Fatigue Severity Scale and Visual Analog Scale-Fatigue was used to assess concurrent validity.

RESULTS

Internal consistency was excellent (Cronbach's alpha > 0.9) and reliability was moderate to good (ICC = 0.72-0.81) for all FSMC scores. The FSMC demonstrated moderate to good concurrent validity with the Fatigue Severity Scale (ρ= 0.66-0.72) but only fair concurrent validity with the Visual Analog Scale-Fatigue (ρ= 0.37-0.44).

CONCLUSION

The FSMC is a valid and reliable measure of post-stroke fatigue and may be a useful tool to examine physical fatigue and cognitive fatigue in chronic stroke.

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

Evaluating fatigue in patients recovering from COVID-19: validation of the fatigue severity scale and single item screening questions

BACKGROUND

Fatigue is a common symptom in hospitalized and non-hospitalized patients recovering from COVID-19, but no fatigue measurement scales or questions have been validated in these populations. The objective of this study was to perform validity assessments of the fatigue severity scale (FSS) and two single-item screening questions (SISQs) for fatigue in patients recovering from COVID-19.

METHODS

We examined patients ≥ 28 days after their first SARS-CoV-2 infection who were hospitalized for their acute illness, as well as non-hospitalized patients referred for persistent symptoms. Patients completed questionnaires through 1 of 4 Post COVID-19 Recovery Clinics in British Columbia, Canada. Construct validity was assessed by comparing FSS scores to quality of life and depression measures. Two SISQs were evaluated based on the ability to classify fatigue (FSS score ≥ 4).

RESULTS

Questionnaires were returned in 548 hospitalized and 546 non-hospitalized patients, with scores computable in 96.4% and 98.2% of patients respectively. Cronbach's alpha was 0.96 in both groups. The mean ± SD FSS score was 4.4 ± 1.8 in the hospitalized and 5.2 ± 1.6 in the non-hospitalized group, with 62.5% hospitalized and 78.9% non-hospitalized patients classified as fatigued. Ceiling effects were 7.6% in the hospitalized and 16.1% in non-hospitalized patients. FSS scores negatively correlated with EQ-5D scores in both groups (Spearman's rho - 0.6 in both hospitalized and non-hospitalized; p < 0.001) and were higher among patients with a positive PHQ-2 depression screen (5.4 vs. 4.0 in hospitalized and 5.9 vs. 4.9 in non-hospitalized; p < 0.001). An SISQ asking whether there was "fatigue present" had a sensitivity of 70.6% in hospitalized and 83.2% in non-hospitalized patients; the "always feeling tired" SISQ, had a sensitivity of 70.5% and 89.6% respectively.

CONCLUSIONS

Fatigue was common and severe in patients referred for post COVID-19 assessment. Overall, the FSS is suitable for measuring fatigue in these patients, as there was excellent data quality, strong internal consistency, and construct validity. However, ceiling effects may be a limitation in the non-hospitalized group. SISQs had good sensitivity for identifying clinically relevant fatigue in non-hospitalized patients but only moderate sensitivity in the hospitalized group, indicating that there were more false negatives.

Obesity and Poststroke Fatigue: A 2-Year Longitudinal Study

Introduction

Obesity is associated with fatigue in many diseases, but the correlation between obesity and poststroke fatigue (PSF) is unclear. The study aimed to investigate the relationship between body mass index (BMI) and the occurrence of and recovery from PSF.

Methods

Within 3 days of the onset of ischemic stroke, patients were consecutively recruited. We assessed PSF at admission and at 6, 12, and 24 months with the Fatigue Severity Scale (FSS). Multivariable logistic regression and restricted cubic spline function were used to explore the relationships between baseline BMI and the risk of PSF at different time points. The correlation between baseline BMI and the dynamic changes in the natural logarithm transformation of the FSS (lnFSS) score during the follow-up period was analyzed by the piecewise linear mixed-effects model.

Results

A total of 1026 stroke patients were included. Multivariable analyses indicated that obesity was associated with a decreased risk of early PSF (fatigue diagnosed at baseline) [odds ratio (OR) 0.61, 95% confidence interval (CI) 0.41–0.93] but an increased risk of late PSF (fatigue diagnosed 6 months after the index stroke) (OR 1.63, 95% CI 1.06–2.50 for 6 months; OR 1.87, 95% CI 1.18–2.96 for 12 months; OR 2.11, 95% CI 1.28–3.49 for 24 months). Longitudinal analyses indicated that in the late stage of fatigue, the higher the BMI category, the slower the rate of decrease was for the FSS score.

Conclusion

Obese patients are less likely to develop fatigue in the acute stage of ischemic stroke. However, they are more prone to late fatigue and exhibit a slower decline in the FSS score in the long term.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40120-021-00276-x.

Stressful life events can predict post-stroke fatigue in patients with ischemic stroke

OBJECTIVE

To investigate whether stressful life events (SLEs) can predict post-stroke fatigue (PSF) in patients with acute ischemic stroke (AIS).

METHODS

This prospective cohort study included data from patients with AIS who were followed up to 2-year interview. PSF was assessed at admission and at 6 (n = 916), 12 (n = 880), and 24 (n = 857) months with the fatigue severity scale (FSS). SLEs were measured with the Social Readjustment Rating Scale questionnaire at 6, 12 and 24 months' interview.

RESULTS

A significant dose-response association was found between SLEs and FSS score across all examined time-points: compared with those did not experience SLEs, FSS score was higher for those experiencing SLEs ≥3 at 6 months (β 0.53, 95% CI 0.28-0.78), 12 months (β 0.54, 95% CI 0.30-0.78) and 24 months (β 0.48, 95% CI 0.29-0.68). Longitudinal analyses indicated a significantly positive relationship between the number of SLEs and FSS score (SLEs: ≥3 vs. 0, β 0.14, 95% CI 0.09-0.19). Moreover, a distinct interaction of follow-up time and SLE numbers on FSS score was observed (p < 0.05), which means elevated exposure to SLEs during follow-up was associated with a lower rate of fatigue decline. A similar association was found in SLE load analysis.

CONCLUSION

Patients with severe fatigue were more likely to report increased number of SLEs in the previous 6 months, which could suggest that a non-specific stressful event leads to an extra burden to an already vulnerable psychological system.

Assessment of the stroke-specific quality-of-life scale in KFHU, Khobar: A prospective cross-sectional study

Objectives:

To assess the overall and domain-specific quality of life (QOL) in post-stroke patients using the stroke-specific quality of life (SS-QOL) scale and to identify variables that may affect the QOL after stroke.

Methods:

A prospective cross-sectional study, included 80 stroke patients, was conducted in the Neurology department at King Fahad Hospital of the University (KFHU), Khobar, Saudi Arabia, from December 2019 to February 2020. Stroke patients were interviewed using the Arabic version of the SS-QOL questionnaire and modified Rankin scale (mRS).

Results:

The overall quality of life in the surveyed participants was at the level of 3.72 points, which is above the average recognized in the middle of the scale that ranges from 1 to 5. The overall quality of life was not significantly correlated with sex, age, type of stroke, recurrence of stroke, and time since stroke (p>0.05). Hypertension and atrial fibrillation were the only comorbidities that were determined to be significantly associated with the overall quality of life at the level of (3.53), and (2.97) respectively (p<0.05). There was a statistically significant correlation between the mRS score and the overall quality of life (p<0.05).

Conclusion:

Performing a comprehensive assessment of the overall QOL in post-stroke patients will result in better health outcomes, particularly in terms of quality of functioning in psycho-social aspects.