Abstract
Validated self-report measures of post-stroke fatigue are lacking. The Dutch Multifactor Fatigue Scale (DMFS) was translated into Danish, and response process evidence of validity was evaluated. DMFS consists of 38 Likert-rated items distributed on five subscales: Impact of fatigue (11 items), Signs and direct consequences of fatigue (9), Mental fatigue (7), Physical fatigue (6), and Coping with fatigue (5). Response processes to DMFS were investigated using a Three-Step Test-Interview (TSTI) protocol, and data were analyzed using Framework Analysis. Response processes were indexed on the following categories: (i) “congruent,” response processes were related to the subscale construct; (ii) “incongruent,” response processes were not related to the subscale construct; (iii) “ambiguous,” response processes were both congruent and incongruent or insufficient to evaluate congruency; and (iv) “confused,” participants did not understand the item. Nine adults were recruited consecutively 10–34 months post-stroke (median = 26.5) at an outpatient brain injury rehabilitation center in 2019 [five females, mean age = 55 years (SD = 6.3)]. Problematic items were defined as <50% of response processes being congruent with the intended construct. Of the 38 items, five problematic items were identified, including four items of Physical fatigue and one of Mental fatigue. In addition, seven items posed various response difficulties to some participants due to syntactic complexity, vague terms, a presupposition, and a double-barrelled statement. In conclusion, findings elucidate the interpretative processes involved in responding to DMFS post-stroke, strengthen the evidence base of validity, and guide revisions to mitigate potential problems in item performance.
Highlights
IntroductionFatigue is a common complaint following stroke (Christensen et al, 2008; Duncan et al, 2012, 2014; Cumming et al, 2016) and interferes with health-related quality of life (Naess et al, 2006; van de Port et al, 2006), participation in daily activities (Röding et al, 2003; Naess et al, 2005; White et al, 2012; Maaijwee et al, 2015), and return to work (Lock et al, 2005; Andersen et al, 2012)
Physical Fatigue Of the six items of the Physical fatigue subscale, four were classified as problematic items, i.e., less than 50% congruent response processes, namely, items 9, 5, 25, and 30
If the Dutch Multifactor Fatigue Scale (DMFS) is to be used with the intention of assessing a unitary concept of physical fatigue, the present results would suggest a substantial revision of subscale items
Summary
Fatigue is a common complaint following stroke (Christensen et al, 2008; Duncan et al, 2012, 2014; Cumming et al, 2016) and interferes with health-related quality of life (Naess et al, 2006; van de Port et al, 2006), participation in daily activities (Röding et al, 2003; Naess et al, 2005; White et al, 2012; Maaijwee et al, 2015), and return to work (Lock et al, 2005; Andersen et al, 2012). The experience of fatigue is inherently subjective (Aaronson et al, 1999; Staub and Bogousslavsky, 2001a), and stroke survivors’ perspectives reveal that fatigue is a heterogeneous condition with several characteristics (Eilertsen et al, 2013). The complexity of fatigue and the lack of a standard definition hamper efforts to develop standard assessment tools of self-reported fatigue (Aaronson et al, 1999; Kluger et al, 2013). Most scales were developed for other populations than stroke such as multiple sclerosis or cancer patients (Whitehead, 2009), and psychometric properties of fatigue scales are not well documented in neurological conditions (Tyson and Brown, 2014).
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