Abstract
ObjectiveThe Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) is commonly used to assess fatigue in rheumatic diseases, and has shown to discriminate better across levels of the fatigue spectrum than other commonly used measures. The aim of this study was to assess the cross-language measurement equivalence of the English, French, and Dutch versions of the FACIT-F in systemic sclerosis (SSc) patients.MethodsThe FACIT-F was completed by 871 English-speaking Canadian, 238 French-speaking Canadian and 230 Dutch SSc patients. Confirmatory factor analysis was used to assess the factor structure in the three samples. The Multiple-Indicator Multiple-Cause (MIMIC) model was utilized to assess differential item functioning (DIF), comparing English versus French and versus Dutch patient responses separately.ResultsA unidimensional factor model showed good fit in all samples. Comparing French versus English patients, statistically significant, but small-magnitude DIF was found for 3 of 13 items. French patients had 0.04 of a standard deviation (SD) lower latent fatigue scores than English patients and there was an increase of only 0.03 SD after accounting for DIF. For the Dutch versus English comparison, 4 items showed small, but statistically significant, DIF. Dutch patients had 0.20 SD lower latent fatigue scores than English patients. After correcting for DIF, there was a reduction of 0.16 SD in this difference.ConclusionsThere was statistically significant DIF in several items, but the overall effect on fatigue scores was minimal. English, French and Dutch versions of the FACIT-F can be reasonably treated as having equivalent scoring metrics.
Highlights
Chronic fatigue from medical illness can be characterized as persistent exhaustion that is disproportionate to exertion and not relieved by rest
Patients with systemic sclerosis (SSc, or scleroderma), a chronic, multi-system connective tissue disorder characterized by thickening and fibrosis of the skin, involvement of internal organs, substantially reduced health-related quality of life (HRQL), and significant morbidity and mortality [3,4,5] report that fatigue impacts HRQL as much or more than any other symptom [6,7,8]
Fatigue was reported to be present in 89% of 464 Canadian SSc patients who responded to a national survey, with an impact on the ability to carry out daily activities in 72% [9]
Summary
Chronic fatigue from medical illness can be characterized as persistent exhaustion that is disproportionate to exertion and not relieved by rest. Patients with systemic sclerosis (SSc, or scleroderma), a chronic, multi-system connective tissue disorder characterized by thickening and fibrosis of the skin, involvement of internal organs, substantially reduced HRQL, and significant morbidity and mortality [3,4,5] report that fatigue impacts HRQL as much or more than any other symptom [6,7,8]. Fatigue was reported to be present in 89% of 464 Canadian SSc patients who responded to a national survey, with an impact on the ability to carry out daily activities in 72% [9]. Fatigue in SSc is independently associated with reduced capacity to carry out daily activities, work disability and impaired physical function [10,11,12,13]. Fatigue ratings by SSc patients are similar to those of patients with other rheumatic diseases and cancer patients currently undergoing treatment, and substantially worse than in the general population or among cancer patients in remission [14]
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