Chalder Fatigue Questionnaire Research Articles

Sijunzi decoction, a classical Chinese herbal formula, improves fatigue symptoms with changes in gut microbiota in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, multi-center clinical trial

BackgroudChronic fatigue syndrome (CFS) severely impact patients’ quality of life and lacks well-acknowledged drug therapy. Sijunzi decoction (SJZD), a classical Chinese herbal formula, has been widely used for spleen deficiency syndrome like fatigue in China. However, there is a lack of evidence on the efficacy of SJZD in treating CFS. PurposeTo evaluate the efficacy and safety of SJZD for CFS. Study designA multi-center, double-blinded, randomized controlled trial. MethodsParticipants with definite diagnoses of CFS and spleen deficiency syndrome were randomly assigned in 1:1 ratio to receive SJZD or placebo granules for 2 months. The primary outcome was the change of Chalder fatigue questionnaire (CFQ) scoring after treatment. Other outcomes included changes in short form-36 physical function (SF36-PF) score, spleen deficiency scale score, Euroqol Questionnaire-Visual Analogue Scale (ED-VAS) score, and clinical global impression (CGI) evaluating by corresponding questionnaires. Fecal metagenome sequencing was conducted to explore the potential mechanism of SJZD effect. ResultsFrom June 2020 to July 2021, 105 of 127 participants completed the study at four hospitals in China. After a 2-month treatment, intention-to-treat (ITT) analysis found participants who received SJZD had larger reduction than placebo control (mean change 6.65 [standard deviation (SD) 6.11] points vs. 5.31 [SD 5.19] points; difference 1.34, 95 % confidence interval [CI] -0.65 to 3.33). Per-protocol (PP) analysis reported confirmative results with a significant difference between SJZD and placebo groups (2.24, 95 % CI 0.10 to 4.39). SJZD also significantly improved overall health status compared with placebo in per-protocol population (p = 0.009). No significant difference was found between groups in changes of SF36-PF, spleen deficiency scale scoring, and CGI. Fecal metagenome sequencing and correlation analyses indicated that the beneficial effect of SJZD may be related to the abundance change of Pediococcus acidilactici. No serious adverse event or abnormal laboratory test was found during the whole study. ConclusionOur results indicated that SJZD can improve fatigue symptom and overall health status in patients with CFS under good medication adherence. Potential therapeutic effects may be related to the regulation of gut microbiota. Large-scale trials with longer intervention period are encouraged to further support SJZD's application. Clinical trial registration(ID, ISRCTN23930966, URL = https://www.isrctn.com/ISRCTN23930966).

Exploring the content validity of the Chalder Fatigue Scale using cognitive interviewing in an ME/CFS population

ABSTRACT Background The Chalder Fatigue Scale, also known as the Chalder Fatigue Questionnaire (CFQ) is a Patient Reported Outcome Measure (PROM) comprising 11 items designed to measure physical and cognitive fatigue. It is widely used with people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There is no published evaluation of the content validity of the CFQ. Objectives To elicit information regarding the cognitive processes undertaken by people living with ME/CFS, when completing the CFQ to allow examination of the CFQ’s content validity. Methods A qualitative study utilising semi-structured cognitive interviewing. All data were collated according to the CFQ item but some general criticisms of the content validity of the CFQ were also identified. Results The CFQ currently consists of one item clearly related to physical symptoms (1.6), four items clearly related to cognitive function (1.8, 1.9, 1.10, 1.11) and one item relating to fatigue (1.5) which could be interpreted as cognitive and/or physical fatigue. The other five items have been identified by participants as lacking clarity (1.1, 1.7), relating to behaviour not symptoms (1.2, 1.4), or relating to sleepiness not fatigue (1.3). Conclusion Participants provided a wealth of insight into the challenges related to relevance, comprehensiveness, and comprehensibility of the CFQ, indicating that revision is required. This strengthens the case for participation of people with lived experience at all stages of PROM development. There is a need for an assessment tool/PROM for clinical and research use ME/CFS which has undergone content validation involving people living with ME/CFS.

P742 The efficacy of comprehensive multivitamin and mineral supplement to treat symptoms of fatigue in patients with Inflammatory Bowel Disease in remission with immunomodulators and or biological agents

Abstract Background Patients with inflammatory bowel disease(IBD) very often report feeling tired for no reason. Malnutrition and vitamin or mineral deficiencies are also very common among patients with IBD. The aim of this study was to evaluate the efficacy of a multivitamin and mineral supplement for the treatment of fatigue in patients with IBD. Methods Single-centre, randomized placebo-controlled clinical trial to compare a comprehensive over-the-counter multivitamin and mineral supplement (supplemented group) with an identical presented placebo (placebo group) for the treatment of fatigue. Non-vitamin deficient patients with IBD in remission with immunomodulators and/or biological therapy were asked to report score their fatigue on a Visual Analog Scale (0-10) and the validated Chalder fatigue questionnaire (CFQ) at baseline, week 12 and 24. The validated CFQ has a scoring range from 0-33 and 2 subscales physical and psychological fatigue. Patients were considered to be fatigued by the CFQ with a score of 12 or above. Results A total of 214 patients reported fatigue at the start of the study. Of these patients 115 and 99 were assigned to the supplement and placebo groups, respectively. In the supplemented and placebo group, 32 (34%) and 18 (21%) patients, respectively, experienced no fatigue according to the CFQ definition at 24 weeks (Unadjusted Odds Ratio (OR): 2.0 (95% Confidence Interval (CI):1 - 3.8). In particular patients with Ulcerative Colitis (UC) and supplement use experienced less fatigue at 24 weeks (OR 5.7 (95% CI:1.3 - 24.1). Improvement of fatigue experienced between baseline and 24 weeks was not statistical different for either the supplemented and placebo group. Conclusion Although improvement in fatigue score was limited, a significant number of patients with IBD in remission with immunomodulators, and/or biological therapy using a very comprehensive vitamin and mineral supplement reported improvement of fatigue after 24 weeks of use.

The prevalence and correlates of post-infectious fatigue following dengue infection among adults admitted to two selected hospitals in Colombo District, Sri Lanka

Introduction: Dengue illness, an acute viral infection, is endemic in Sri Lanka causing a substantial public health challenge today in all dimensions of health. Post-infectious fatigue (PIF) after dengue infection had been reported in several studies as well as in textbooks of medicine.Objectives: To describe the prevalence and correlates of PIF at one-month follow-up among adults confirmed with dengue infection admitted to selected healthcare institutions in Colombo District, Sri Lanka.Methods: A longitudinal study was conducted among 480 patients from July 2018 to January 2019. Participants were recruited on discharge from the hospital. We adopted systematic sampling method and followed them up one month after day 1 of the fever. Prevalence was assessed by the culturally adapted and validated Sinhala version of the Chalder Fatigue Questionnaire. Correlates were assessed by a pre-tested interviewer-administered questionnaire. A binomial multiple logistic regression analysis was carried out via the SPSS-21 version.Results: The response rate was 84.58 (406/480). The majority were between 18-35 years (69.2%) and male (60.15%). The prevalence of PIF at one month was 35% (95% CI: 30.3, 39.8). After controlling for confounders, age ≥35 years (adjusted OR (AOR)=4.05; 95% CI: 2.04, 8.04), not being married (AOR=2.7; 95% CI: 1.38, 5.28), having experience of stress full life events (AOR=1.98; 95%CI: 1.16, 3.36), not receiving an adequate quantity of sleep (AOR=2.51; 95% CI: 1.00, 6.31), poor quality of sleep (AOR=15.34; 95% CI: 3.25, 72.49), headache post-discharge (AOR=2.69; 95% CI: 1.6, 4.53), presence of myalgia post-discharge (AOR=3.63; 95% CI: 2.16, 6.11), haemoglobin <11 g/dl at acute stage (AOR=2.01; 95% CI: 1.02, 3.98) and having a platelet count ≤30,000/mm3 (AOR=2.38; 95% CI: 1.42, 3.99) showed significant associations with having PIF.Conclusions & Recommendations: Post-infectious fatigue was present among approximately one in three patients after one month following a dengue infection. The modifiable correlates suggest the indications for screening and prevention which is more applicable to clinicians.

Impact of mother's care burden, fatigue and child's functional level on quality of life in spastic cerebral palsy.

Cerebral palsy (CP) may be considered one of the most common motor disabilities that require a lot of caregiving from mothers or caregivers; therefore, the mothers of children with CP face a lot of difficulties in their caregiving, which in turn may affect the child's quality of life (QOL). This work was conducted to evaluate the impact of the children's functional level in different types of spastic CP, mothers' care burden (CB), and fatigue on the child's QOL. One hundred thirty-eight children with different types of spastic CP (unilateral and bilateral) with different levels of the gross motor function classification system (GMFCS), with an age range of 6-12years, and their mothers with ages ranged from 25 to 45years, participated in this study. Mother CB, fatigue, and child QOL were measured and compared between different groups by using the Zarit burden Interview (ZBI), Chalder Fatigue Questionnaire (CFQ), and Pediatric Quality of Life Inventory (PedsQL) CP Module, respectively. There were significant differences in all measured variables (ZBI, CFQ, GMFCS, and PedsQL) with p-value <0.001 among the different spastic groups (unilateral and bilateral CP). However, the results revealed a positive impact of the child's GMFCS, mother's CB, and fatigue level on the quality of the child's life, with a greater effect on those with quadriplegic type. The mother's CB and fatigue should be considered in the rehabilitation of spastic CP children based on their GMFCS, as they have a negative impact on child QOL; therefore, helping the mother with her needs should not be ignored, especially in families with severely spastic CP children and low financial income.

The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue

PurposeChronic fatigue (CF) affects 25–30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention.MethodsThis feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1.ResultsSeven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance.ConclusionLymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention.Trial registrationClinicalTrials.gov, identifier: NCT04931407. Registered 16. April 2021-Retrospectively registered. https://www.clinicaltrials.gov/ct2/show/NCT04931407

Self-Reported Fatigue by the Chalder Fatigue Questionnaire and Mortality in Brazilian Hemodialysis Patients: The PROHEMO

Background: The existing data support the Chalder Fatigue Questionnaire (CFQ-11) as a valid instrument to assess fatigue in maintenance hemodialysis (MHD) patients. The objective of this work was to investigate whether self-reported fatigue can serve as an independent prognostic indicator for mortality in MHD patients. Methods: The data are from 233 adult patients enrolled in the cohort “The Prospective Study of the Prognosis of Chronic Hemodialysis Patients” (PROHEMO) developed in Salvador, BA, Brazil. The Brazilian version of the validated CFQ-11 was used to calculate self-reported fatigue. The CFQ-11 scores may range from 0 to 33; higher scores represent more fatigue. Fatigue categories were created based on proposed cut point: absence or mild degree if CFQ-11 scores Results: The mean age was 51.5 ± 2.5 years, 58% were male, and 30% were diabetic. Self-reported moderate to severe fatigue was reported by 71% of patients. The mortality rate was 8.6 cases/100 person-years. Patients with moderate to severe fatigue had a more than threefold mortality rate (HR = 3.07, 95% CI: 1.19, 7.93) compared to patients with absent or mild fatigue, after extensive adjustments for covariates. Conclusion: The study provides evidence that self-reported fatigue can help identify MHD patients at higher risk of earlier death.

Prevalence of fatigue in the general population during the pandemic: cross-sectional study in Geneva

Abstract Background Fatigue is a frequent symptom, the determinants of which are numerous and poorly understood. Fatigue also predicts ischemic heart disease, cancer, physical decline, and mortality. While the COVID-19 pandemic constituted a major stressor, no previous studies have measured the prevalence of fatigue and its determinants since the beginning of the pandemic in a general population. This study aims (1) to assess the prevalence of fatigue among the general population of the canton of Geneva, Switzerland, two years into the pandemic and (2) to analyse its determinants. Methods A cross-sectional population-based study was conducted as part of the Specchio-COVID19 cohort study. Adult participants answered an online health survey between March and May 2022. The main outcome was self-reported fatigue measured by the Chalder Fatigue Questionnaire. Other variables included general and mental health status, quality of life, and sociodemographic data. Multivariable logistic regressions were used to evaluate the determinants of fatigue. Results 4040 participants took part in the survey (participation rate 59%, respondents and non-respondents were comparable). The overall prevalence of fatigue was 31%. Significant determinants of fatigue were depression (aOR 10.49 [6.29-17.50], p &amp;lt; 0.001), diagnosis of a chronic disease in the past year (aOR 1.37 [1.12-1.68], p = 0.002), and an acute health event in the past year (aOR 1.44 [1.08-1.93], p = 0.014). 18-45-year-old people with a chronic disease were more likely to report fatigue (aOR 1.70 [1.04-2.77], p = 0.033). Male gender (aOR 0.72 [0.57-0.92], p = 0.007) or retirement (aOR 0.60 [0.43 - 0.85], p = 0.003) were protective factors. Age, level of education, and income were not significantly associated with fatigue. Conclusions Fatigue was still highly prevalent in the general population two years into the COVID19 pandemic, comparing to regional prepandemic data. The cohort Specchio will monitor the evolution of fatigue after the pandemic. Key messages • Fatigue was still highly prevalent two years into the COVID19 pandemic among the general population in Geneva, comparing to regional prepandemic data. • Longitudinal follow-up is crucial to assess how fatigue is evolving after the pandemic.

Investigating the factors associated with meaningful improvement on the SF-36-PFS and exploring the appropriateness of this measure for young people with ME/CFS accessing an NHS specialist service: a prospective cohort study

ObjectivesPaediatric myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is relatively common and disabling, but little is known about the factors associated with outcome. We aimed to describe the number and characteristics of...

Depression as a possible determinant of fatigue in patients with axial spondyloarthritis.

Fatigue is a common comorbidity in patients with axial spondyloarthritis (axSpA), often reported also by those in clinical remission or with moderate disease activity. The aim of this study is to assess the prevalence of fatigue in patients with axSPA, and to investigate possible non-disease-related determinants, with a special focus on depression. Patients with axSpA were assessed using the Chalder's Fatigue Questionnaire (CFQ) for fatigue, and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) for depression. Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) were also used to assess disease activities and disability. Univariate and multivariate linear regressions were performed to identify possible predictors of fatigue. Out of 119 patients, 53 (44.5%) had fatigue. Patients with fatigue had higher HADS-D, ASDAS, BASFI, HAQ scores. HADS-D was predictive of CFQ score in univariate and multivariate regressions for total CFQ, and for mental and physical subscales. The correlation between HADS-D and CFQ total score was statistically significant also when taking into consideration only patients in clinical remission and with moderate disease activity. Depressed patients had higher CFQ score compared to non-depressed ones, and did not show any difference in CFQ scores when stratified for disease activity or systemic inflammation. The study found correlation between fatigue and disease activity and depression in patients with axSpA. These findings suggest that depression could represent the major determinant of fatigue in patients with axSpA, independently of clinical activity.

A safe and effective micro-choice based rehabilitation for patients with long COVID: results from a quasi-experimental study

At least 65 million people suffer from long COVID. Treatment guidelines are unclear, especially pertaining to recommendations of increased activity. This longitudinal study evaluated safety, changes in functional level and sick leave following a concentrated rehabilitation program for patients with long COVID. Seventy-eight patients (19–67 years) participated in a 3-day micro-choice based rehabilitation program with 7-day and 3-month follow-up. Fatigue, functional levels, sick leave, dyspnea and exercise capacity were assessed. No adverse events were reported and 97.4% completed the rehabilitation. Fatigue measured with Chalder Fatigue Questionnaire decreased at 7-days [mean difference (MD = − 4.5, 95% CI − 5.5 to − 3.4) and 3-month (MD = − 5.5, 95% CI − 6.7 to − 4.3). Sick leave rates and dyspnea were reduced (p < 0.001) and exercise capacity and functional level increased (p < 0.001) at 3-month follow-up regardless of severity of fatigue at baseline. Micro-choice based concentrated rehabilitation for patients with long COVID was safe, highly acceptable and showed rapid improvements in fatigue and functional levels, sustaining over time. Even though this is a quasi-experimental study, the findings are of importance addressing the tremendous challenges of disability due to long COVID. Our results are also highly relevant for patients, as they provide the base for an optimistic outlook and evidence supported reason for hope.

Effects of whole-body cryotherapy and static stretching are maintained 4 weeks after treatment in most patients with chronic fatigue syndrome

In the previous study, whole-body cryotherapy (WBC)+static stretching (SS) has been shown to reduce the severity of some symptoms in Chronic Fatigue Syndrome (CFS) noted just after the therapy. Here we consider the effects of treatment and explore the sustainability of symptom improvements at four weeks (one-month) follow-up. Twenty-two CFS patients were assessed one month after WBC + SS programme. Parameters related to fatigue (Chalder Fatigue Questionnaire (CFQ), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS)), cognitive function (Trial Making test part A and B (TMT A and TMT B and its difference (TMT B-A)), Coding) hemodynamic, aortic stiffness (aortic systolic blood pressure (sBP aortic)) and autonomic nervous system functioning were measured. TMT A, TMT B, TMT B-A and Coding improved at one month after the WBC + SS programme. WBC + SS had a significant effect on the increase in sympathetic nervous system activity in rest. WBC + SS had a significant, positive chronotropic effect on the cardiac muscle. Peripheral and aortic systolic blood pressure decreased one month after WBC + SS in comparison to before. Effects of WBC + SS on reduction of fatigue, indicators of aortic stiffness and symptoms severity related to autonomic nervous system disturbance and improvement in cognitive function were maintained at one month. However, improvement in all three fatigue scales (CFQ, FIS and FSS) was noted in 17 of 22 patients. In addition, ten patients were treated initially but they were not assessed at 4 weeks, and are thus not included in the 22 patients who were examined on follow-up. The overall effects of WBC + SS noted at one month post-treatment should be interpreted with caution.

Associations between excessive fatigue and pain, sleep, mental-health and work factors in Norwegian nurses.

To investigate whether pain, sleep duration, insomnia, sleepiness, work-related factors, anxiety, and depression associate with excessive fatigue in nurses. Fatigue among nurses is a problem in the context of ongoing nursing shortages. While myriad factors are associated with fatigue not all relationships are understood. Prior studies have not examined excessive fatigue in the context of pain, sleep, mental health, and work factors in a working population to determine if associations between excessive fatigue and each of these factors remain when adjusting for each other. A cross-sectional questionnaire study among 1,335 Norwegian nurses. The questionnaire included measures for fatigue (Chalder Fatigue Questionnaire, score ≥4 categorized as excessive fatigue), pain, sleep duration, insomnia (Bergen Insomnia Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and work-related factors. Associations between the exposure variables and excessive fatigue were analyzed using chi-square tests and logistic regression analyses. In the fully adjusted model, significant associations were found between excessive fatigue and pain severity scores for arms/wrists/hands (adjusted OR (aOR) = 1.09, CI = 1.02-1.17), hips/legs/knees/feet (aOR = 1.11, CI = 1.05-1.18), and headaches/migraines (aOR = 1.16, CI = 1.07-1.27), sleep duration of <6 hours (aOR = 2.02, CI = 1.08-3.77), and total symptom scores for insomnia (aOR = 1.05, CI = 1.03-1.08), sleepiness (aOR = 1.11, CI = 1.06-1.17), anxiety (aOR = 1.09, CI = 1.03-1.16), and depression (aOR = 1.24, CI = 1.16-1.33). The musculoskeletal complaint-severity index score (aOR = 1.27, CI = 1.13-1.42) was associated with excessive fatigue in a separate model adjusted for all variables and demographics. Excessive fatigue was also associated with shift work disorder (OR = 2.25, CI = 1.76-2.89) in a model adjusted for demographics. We found no associations with shift work, number of night shifts and number of quick returns (<11 hours between shifts) in the fully adjusted model. Excessive fatigue was associated with pain, sleep- and mental health-factors in a fully adjusted model.

Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial.

Insomnia is associated with fatigue, but it is unclear whether response to cognitive behaviour therapy for insomnia is altered in individuals with co-occurring symptoms of insomnia and chronic fatigue. This is a secondary analysis using data from 1717 participants with self-reported insomnia in a community-based randomized controlled trial of digital cognitive behaviour therapy for insomnia compared with patient education. We employed baseline ratings of the Chalder Fatigue Questionnaire to identify participants with more or fewer symptoms of self-reported chronic fatigue (chronic fatigue, n=592; no chronic fatigue, n=1125). We used linear mixed models with Insomnia Severity Index, Short Form-12 mental health, Short Form-12 physical health, and the Hospital Anxiety and Depression Scale separately as outcome variables. The main covariates were main effects and interactions for time (baseline versus 9-week follow-up), intervention, and chronic fatigue. Participants with chronic fatigue reported significantly greater improvements following digital cognitive behaviour therapy for insomnia compared with patient education on the Insomnia Severity Index (Cohen's d=1.36, p < 0.001), Short Form-12 mental health (Cohen's d=0.19, p=0.029), and Hospital Anxiety and Depression Scale (Cohen's d=0.18, p=0.010). There were no significant differences in the effectiveness of digital cognitive behaviour therapy for insomnia between chronic fatigue and no chronic fatigue participants on any outcome. We conclude that in a large community-based sample of adults with insomnia, co-occurring chronic fatigue did not moderate the effectiveness of digital cognitive behaviour therapy for insomnia on any of the tested outcomes. This may further establish digital cognitive behaviour therapy for insomnia as an adjunctive intervention in individuals with physical and mental disorders.

Persian version of the Chalder Fatigue Questionnaire and Multidimensional Fatigue Symptom Inventory-Short Form: psychometric properties in Iranian chronic stroke survivors

ABSTRACT Background Post-stroke fatigue is a disturbing condition with various physical and psychological facets, which needs to be assessed by meaningful and psychometrically valid and reliable tools. The Chalder Fatigue Questionnaire (CFQ) and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) have been designed to assess diverse dimensions of fatigue. Objectives The present study aimed to investigate the psychometric properties of the CFQ and MFSI-SF in people with chronic stroke. Methods Both measures were translated according to forward-backward standard protocol. This cross-sectional study was conducted with 130 first-time stroke survivors. The multidimensional fatigue inventory, checklist individual strength, fatigue assessment scale, fatigue subscale of profiles of mood state, fatigue severity scale, visual analogue scale-fatigue, beck anxiety inventory, center for epidemiologic studies of depression scale, and 36-item short-form health survey were administered in addition to the CFQ and MFSI-SF. Reliability, precision, known-groups validity, and convergent validity were examined for the CFQ and MFSI-SF. Results The results showed an acceptable (Cronbach’s alpha = 0.81–0.97) internal consistency and test–retest reliability (intra-class correlation = 0.75–0.97). The CFQ and MFSI-SF revealed good ability (P < 0.001) to differentiate chronic stroke survivors with different disability levels. Significant high correlation (P = −0.61–0.87) was found between CFQ and MFSI-SF and other fatigue scales. Conclusions The results of this study showed that the CFQ and MFSI-SF have high reliability and validity for chronic stroke survivors.

Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients

BackgroundChronic musculoskeletal pain (CMP) is characterised by pain related to the muscles or the joints with a duration of three months or more and is associated with high symptomatic burden in patients in primary health care. CMP is commonly associated with impaired mental health, which may affect the rehabilitation process. The primary aim of this study was to compare symptoms of anxiety, depression, fatigue, and insomnia in patients in primary health care with and without CMP. The secondary aim was to assess difference in mental health symptoms related to number of pain sites and pain intensity.MethodsThis cross-sectional study was conducted in Trondheim, Norway. All patients aged 21–58 from randomly selected general practitioners (GPs) were invited to participate. Participants were classified into two groups according to presence of CMP. Symptoms of anxiety, depression, fatigue, and insomnia were assessed by the Hospital Anxiety and Depression Scale (HADS), Chalder Fatigue Questionnaire (CFQ), and Insomnia Severity Index (ISI), respectively, using an online survey system.ResultsFrom the patient lists of six GPs, we included 969 patients. Mean age 46 years (SD: 10.1), and 517 reported CMP. CMP patients reported higher mean symptom score for anxiety (5.4 vs 3.7), depression (3.4 vs 2.0), fatigue (14.2 vs 11.2), and insomnia (8.1 vs 4.4), all p < 0.01 compared to no-CMP patients. Symptoms of impaired mental health increased with increasing number of pain sites and pain intensity (p < 0.001).ConclusionsPrimary health care patients with CMP reported significantly more symptoms of anxiety, depression, fatigue, and insomnia than patients without CMP. The higher number of pain sites and pain intensity, the more mental health symptoms, especially of anxiety. Primary health care personnel have to address mental health issues when treating patients with CMP.Trial registrationClinicaltrials.gov (NCT02020772, 25/12/2013).

Cerebral gray matter volume correlates with fatigue and varies between desk workers and non-desk workers.

Chronic fatigue syndrome (CFS), a clinical entity of chronic fatigue, has been associated with a decrease in regional gray matter volume (rGMV). In this study targeting a large number of healthy middle-aged individuals without CFS, the relationship between fatigue perception and rGMV was investigated. Considering that the work setting is an environmental factor that influences fatigue perception among healthy individuals, the differences between desk workers and non-desk workers were investigated. Chalder Fatigue Questionnaire (CFQ) scores were used for perceptional evaluation of fatigue, and rGMV of 110 brain regions was adapted with Statistical Parametric Mapping (SPM) 8 on 1.5 T magnetic resonance imaging (MRI) results for the volumetric calculation of gray matter. The CFQ scores were negatively correlated with the right supplementary motor area (SMC) and positively correlated with the right superior parietal lobule (SPL) and left basal forebrain in all participants (n = 1,618). In desk workers and non-desk workers, the CFQ scores correlated with different regions and yielded different mechanisms of fatigue perception in the brain. Identifying the gray matter regions correlated with fatigue perception in healthy individuals may help understand the early stage of fatigue progression and establish future preventive measures.

Perceptions of Fatigue and Safety Climate Pertaining to Residency Duty-Hour Restrictions.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME), which sets the standards for residency training, instituted work-hour restrictions in 2003. Our purpose was to assess residents’ perceptions of fatigue and local safety climate specific to these duty-hour restrictions.Methods: All residents (N=433) at one university were emailed a link to a survey in 2019. The survey included demographic details, on-call descriptors, an 18-point climate survey (CS), and the 33-point Chalder Fatigue Questionnaire (CFQ). The CS was adapted from a commonly used safety climate scale and intended to measure the respondent’s perceptions of their program’s attitudes and practices around resident duty-hour compliance. A Pearson correlational analysis was used to determine if there were associations between the variables.Results: Mean CS score was 12.89 (95% confidence interval, CI 12.32-13.46, N=164, 48.5%). Respondents were most likely to disagree with “Residents are told when they are at risk of working beyond ACGME duty-hour restrictions,” where 57 (34.7%) disagreed or strongly disagreed. Mean CFQ score was 16.02 (95% CI 14.87-17.17, N=113, 26.1%). As the CS score improved, CFQ scores decreased indicating an inverse relationship between duty-hour climate and fatigue (r=-0.328, p<0.05). Having a protected post-call day off, and having either the Program Director, Chief Resident, or Senior Resident decide that a resident takes a post-call day off were all associated with higher CS scores. Conclusion: We found that the CS had good internal consistency and evidence of construct validity. An inverse relationship between CS score and fatigue suggests that the level of fatigue is higher among residents in programs where residents perceived that ACGME duty-hour compliance was less important.

Regional gray matter volume correlates to physical and mental fatigue in healthy middle-aged adults

Previous studies on neural/molecular mechanisms of fatigue focused on a variety of brain functions, morphological changes, and neurochemical functions such as neurotransmitter and neuroimmune dynamics. However, MRI morphological changes were adopted primarily to compare patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and healthy controls. A few studies have been done on healthy subjects with fatigue scores; one study with 63 adults (their ages of 53.2 ± 8.3) showed the gray matter volume (GMV) reduction in good correlation with a higher score of fatigue. The other one with university students (their ages of 20.7 ± 1.8) demonstrated no significant correlation between regional GMV (rGMV) and fatigue severity. To elucidate the brain structural underpinning in parallel with fatigue development, a large number of healthy middle-aged adults (n = 1873; aged 54.1 ± 5.4) without ME/CFS were recruited, and the correlation between both rGMV in the cerebrum including basal ganglia and Chalder's fatigue questionnaire (CFQ) with physical and mental categories were investigated. A higher CFQ score denotes a higher perceived fatigue level by the participant. The physical fatigue scores of CFQ showed a significantly negative correlation (i.e., smaller rGMV for higher CFQ score) with the volume of the right planum temporale and supplemental motor cortex (SMC), while the left putamen, middle temporal gyrus (MTG), parietal operculum, and right precentral gyrus showed a significantly positive correlation (i.e., bigger rGMV for higher CFQ score). In the mental fatigue scores, the right SMC and left lateral orbital gyrus (LOG) showed a significantly negative correlation, while only the left fusiform gyrus showed a significantly positive correlation. In total scores of (both physical and mental) fatigue, the right SMC and orbital part of the inferior frontal gyrus (OIFG) showed a negative correlation, while the left putamen and MTG showed a positive correlation. Therefore, the right SMC may play a critical role in fatigue progression because of the only common factor among physical, mental, and total fatigue. The left putamen may play a compensatory role with a positive correlation to physical and total fatigue. Additionally, identifying the other gray matter regions that positively or negatively correlated to CFQ of healthy adults may help deepen the understanding of early-stage fatigue progression, leading to the future establishment of preventive measures through volumetrics by using MRI.

Digital cognitive behaviour therapy for insomnia (dCBT-I): Chronotype moderation on intervention outcomes.

Using data from 1721 participants in a community-based randomized control trial of digital cognitive behavioural therapy for insomnia compared with patient education, we employed linear mixed modelling analyses to examine whether chronotype moderated the benefits of digital cognitive behavioural therapy for insomnia on self-reported levels of insomnia severity, fatigue and psychological distress. Baseline self-ratings on the reduced version of the Horne-Östberg Morningness-Eveningness Questionnaire were used to categorize the sample into three chronotypes: morning type (n=345; 20%); intermediate type (n=843; 49%); and evening type (n=524; 30%). Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale were assessed pre- and post-intervention (9 weeks). For individuals with self-reported morning or intermediate chronotypes, digital cognitive behavioural therapy for insomnia was superior to patient education on all ratings (Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale) at follow-up (p-values≤0.05). For individuals with self-reported evening chronotype, digital cognitive behavioural therapy for insomnia was superior to patient education for Insomnia Severity Index and Chalder Fatigue Questionnaire, but not on the Hospital Anxiety and Depression Scale (p=0.139). There were significant differences in the treatment effects between the three chronotypes on the Insomnia Severity Index (p=0.023) estimated difference between evening and morning type of -1.70, 95% confidence interval: -2.96 to -0.45, p=0.008, and estimated difference between evening and intermediate type -1.53, 95% confidence interval: -3.04 to -0.03, p=0.046. There were no significant differences in the treatment effects between the three chronotypes on the Chalder Fatigue Questionnaire (p=0.488) or the Hospital Anxiety and Depression Scale (p=0.536). We conclude that self-reported chronotype moderates the effects of digital cognitive behavioural therapy for insomnia on insomnia severity, but not on psychological distress or fatigue.