Fatigue Rating Scale Research Articles

Muscle function, exercise capacity, physical activity level and cardiovascular disease risk factor knowledge in patients with prolactinoma.

Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls. Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36). Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls (p < 0.05). Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score (p > 0.05). Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation. This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).

Reduced TMS-evoked EEG oscillatory activity in cortical motor regions in patients with post-COVID fatigue

ObjectivePersistent fatigue is a major symptom of the so-called ’long-COVID syndrome’, but the pathophysiological processes that cause it remain unclear.We hypothesized that fatigue after COVID-19 would be associated with altered cortical activity in premotor and motor regions. MethodsWe used transcranial magnetic stimulation combined with EEG (TMS-EEG) to explore the neural oscillatory activity of the left primary motor area (l-M1) and supplementary motor area (SMA) in a group of sixteen post-COVID patients complaining of lingering fatigue as compared to a sample of age-matched healthy controls. Perceived fatigue was assessed with the Fatigue Severity Scale (FSS) and Fatigue Rating Scale (FRS). ResultsPost-COVID patients showed a remarkable reduction of beta frequency in both areas. Correlation analysis exploring linear relation between neurophysiological and clinical measures revealed a significant inverse correlation between the individual level of beta oscillations evoked by TMS of SMA with the individual scores in the FRS (r(15) = -0.596; p = 0.012). ConclusionsPost-COVID fatigue is associated with a reduction of TMS-evoked beta oscillatory activity in SMA. SignificanceTMS-EEG could be used to identify early alterations of cortical oscillatory activity that could be related to the COVID impact in central fatigue.

In Schizophrenia, Chronic Fatigue Syndrome- and Fibromyalgia-Like Symptoms are Driven by Breakdown of the Paracellular Pathway with Increased Zonulin and Immune Activation-Associated Neurotoxicity.

A meaningful part of schizophrenia patients suffer from physiosomatic symptoms (formerly named psychosomatic), which are reminiscent of chronic fatigue syndrome and fibromyalgia (FF) and are associated with signs of immune activation and increased levels of tryptophan catabolites (TRYCATs). The study aims to examine whether FF symptoms in schizophrenia are associated with the breakdown of the paracellular pathway, zonulin, lowered natural IgM responses to oxidative specific epitopes (OSEs); and whether FF symptoms belong to the behavioral-cognitive-physical-psychosocial- (BCPS)-worsening index consisting of indices of a general cognitive decline (G-CoDe), symptomatome of schizophrenia, and quality of life (QoL)-phenomenome. FF symptoms were assessed using the Fibromyalgia and Chronic Fatigue Rating scale in 80 schizophrenia patients and 40 healthy controls and serum cytokines/chemokines, IgA levels to TRYCATs, IgM to OSEs, zonulin and transcellular/paracellular (TRANS/PARA) molecules were assayed using ELISA methods. A large part (42.3%) of the variance in the total FF score was explained by the regression on the PARA/TRANS ratio, pro-inflammatory cytokines, IgM to zonulin, IgA to TRYCATs (all positively), and IgM to OSEs (inversely). There were highly significant correlations between the total FF score and G-CoDe, symtopmatome, QoL phenomenome, and BCPS-worsening score. FF symptoms belong to a common core shared by G-CoDe, symtopmatome, and QoL phenomenome. The physio-somatic symptoms of schizophrenia are driven by various pathways, including increased zonulin, breakdown of the paracellular tight-junctions pathway, immune activation with induction of the TRYCAT pathway, and consequent neurotoxicity. It is concluded that FF symptoms are part of the phenome of schizophrenia and BCPS-worsening as well.

P683 Risk factors for fatigue in IBD patients.

Abstract Background Fatigue is a common symptom, in IBD patients, ranging from 40% to 86% in patients with active disease, and 20% to 48% in those in remission. The aim was to determine the degree of fatigue and to identify possible factors associated to its presence in our patients. Methods Consecutive patients presented at our outpatient IBD clinic from 2021 to 2022 were included. Demographic data, disease activity scores, endoscopic scores, disease duration, localization, hospitalization, laboratory data, were collected for each patient. Working status was determined on the patient’s actual ability to work. Total Mayo score (TMS) and Crohn’s disease activity index (CDAI) were used to assess disease activity in patients with ulcerative colitis (UC) and Crohn’s disease (CD) respectively. Clinical remission was defined as TMS ≤ 2 points, or CDAI &amp;lt; 150 points. Presence of inflammation was defined C-reactive protein ≥ 5.1 mg/L. Presence of anxiety and depression was evaluated using Hospital Anxiety and Depression Scale HADS and fatigue was assessed with self-administered questionnaire IBD Fatigue Rating Scale (FRS). Based on FRS, 2 groups of patients were created: group A with slight to moderate fatigue (1-60 points) and group B patients with severe fatigue (61-120 points). Results A total of 48 IBD patients were included; mean age was 40.9±16.0 years, 60.4% females; 89.6% UC. Mean disease duration was 5±4.6 years. Of UC patients, 44.2% were in clinical remission, 16.3% had mild disease, 30.2% moderate disease, and 9.3% severe disease. Of CD patients, 40% were in clinical remission and 60% had active disease. Severe fatigue was found in 8/48 (16.7%) of patients, and was significantly higher in those with active disease (p=0.039), presence of inflammation (p=0.018), and anxiety (p=0.059). Mean fatigue score was 35.4±22.4 points with no statistical difference between CD and UC (p=0.404). Higher fatigue scores were observed among patients with presence of active disease (p=0.036); among patients with higher TMS scores (p = 0.022); in patients with anxiety (p=0.01), and in patients with depression (p=0.004). On multiple linear regression, only vitamin D levels and working status were associated with fatigue severity (p= 0.052; p= 0.049, respectively R2 =0.062). Conclusion Our study findings confirm that the most important factors associated with fatigue during IBD course, are disease activity, presence of inflammation, presence of anxiety and/or depression. Low vitamin D level and working status were predictive factors for fatigue severity. These results highlight the complexity and variability of fatigue in IBD patients.

Intersections between pneumonia, lowered oxygen saturation percentage and immune activation mediate depression, anxiety, and chronic fatigue syndrome-like symptoms due to COVID-19: A nomothetic network approach

BackgroundCOVID-19 is associated with neuropsychiatric symptoms including increased depressive, anxiety and chronic fatigue-syndrome (CFS)-like and physiosomatic symptoms. AimsTo delineate the associations between affective and CFS-like symptoms in COVID-19 and chest computed tomography scan anomalies (CCTAs), oxygen saturation (SpO2), interleukin (IL)-6, IL-10, C-Reactive Protein (CRP), albumin, calcium, magnesium, soluble angiotensin converting enzyme (ACE2) and soluble advanced glycation products (sRAGEs). MethodThe above biomarkers were assessed in 60 COVID-19 patients and 30 healthy controls who had measurements of the Hamilton Depression (HDRS) and Anxiety (HAM-A) and the Fibromyalgia and Chronic Fatigue (FF) Rating Scales. ResultsPartial Least Squares-SEM analysis showed that reliable latent vectors could be extracted from a) key depressive and anxiety and physiosomatic symptoms (the physio-affective or PA-core), b) IL-6, IL-10, CRP, albumin, calcium, and sRAGEs (the immune response core); and c) different CCTAs (including ground glass opacities, consolidation, and crazy paving) and lowered SpO2% (lung lesions). PLS showed that 70.0% of the variance in the PA-core was explained by the regression on the immune response and lung lesions latent vectors. One common “infection-immune-inflammatory (III) core” underpins pneumonia-associated CCTAs, lowered SpO2 and immune activation, and this III core explains 70% of the variance in the PA core, and a relevant part of the variance in melancholia, insomnia, and neurocognitive symptoms. DiscussionAcute SARS-CoV-2 infection is accompanied by lung lesions and lowered SpO2 which may cause activated immune-inflammatory pathways, which mediate the effects of the former on the PA-core and other neuropsychiatric symptoms due to SARS-CoV-2 infection.

COMPASSION FATIGUE OF TEACHERS HANDLING STUDENTS WITH DISRUPTIVE BEHAVIOURS IN INCLUSIVE CLASSROOM

The present study, the investigator aims to compassion fatigue of teachers while handling students with disruptive behaviours in inclusive classroom. One Hundred and Fifty teachers handling students with disruptive behaviours in inclusive setup from Sivaganga District in Tamil Nadu were chosen as sample, by using purposive sampling technique and administered with a compassion fatigue Rating Scale. The results of the research questions tested revealed that teachers were signicantly more likely to have high and moderate risk of compassion fatigue, while teachers handling students with disruptive behaviours. Male teachers experience higher level of compassion fatigue than the female teachers. This result shows that the female teachers are experiencing less compassion fatigue than male teachers and it may be due to their nature of patience, tolerance and societal &amp; cultural background. This study revealed the need for compassion fatigue reduction training programme for the teachers handling students with disruptive behaviour. Educational Bodies like NCERT, SCERT, DIET should design in service and pre service training programme for teachers to overcome their depression and compassion fatigue while handling disruptive behaviours. Training to male counterparts to strength their emotional stability is also to be designed to combat the compassion fatigue arising out of their nature.

Intracortical GABAergic dysfunction in patients with fatigue and dysexecutive syndrome after COVID-19

ObjectiveA high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. MethodsTwelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. ResultsPost-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. ConclusionsThe present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. SignificanceTMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.

Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale.Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS.Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABAB-ergic dysfunction. This impairment might be related to the neuropsychological alterations.COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits.

Measurement and correlation of fatigue and sleep quality in Parkinson’s disease: a cross sectional study

Background: Fatigue corresponds to a non-motor symptom of high prevalence in Parkinson’s disease (PD) affecting about one thirdof patients with the disease. This symptom negatively affects daily activities, contributing to the deterioration of the quality of life ofthese subjects. Objectives: To estimate fatigue in PD and to correlate with demographic characteristics, sleep, disease stage, motorfunction and daily activities. Methods: The sample consisted of patients with PD. The following measuring instruments were used for thestudy:Hoehn and Yahr scale, Fatigue Rating Scale, Unified Parkinson’s Disease Rating Scale, Parkinson’s Disease Sleep Scale. Results: Thisstudy highlights the high prevalence of fatigue in subjects with PD, and the screening and treatment of this symptom is extremelyrelevant in clinical practice. There were no significant correlations between fatigue and other variables analyzed. Conclusions: Mostparticipants reported fatigue as a relevant problem, so it is important the use of instruments for fatigue screening in clinical practiceand the need to develop therapies related to this symptom in the PD.

Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial

ObjectiveTo investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. DesignParallel group randomized controlled trial with 1- and 12-week follow-ups. SettingCommunity health center. ParticipantsAdults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. InterventionsParticipants were randomized to COMMENCE or usual care. Main Outcome MeasuresPrimary: Function measured using the Short Musculoskeletal Function Assessment–Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment–Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. ResultsCOMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=−8.0; 95% CI, −14.7 to −1.3), bother with functional difficulties (MD, −12.0; 95% CI, −20.8 to −3.2), pain intensity (MD, −1.0; 95% CI, −2.1 to −0.1), catastrophizing (MD , −8.2; 95% CI, −14.5 to −2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. ConclusionCOMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.

Assesment Work Fatigue To Workers In Environment Underground Mining Areas Based On Fatigue Assesment Scale Questionnaires

Fatigue is recognized as a high potential risk for accidents and therefore an assessment of work fatigue is required. The purpose of this study is to describe the overall work fatigue assessment and based on work fatigue factors using questionnaires for the fatigue rating scale for workers in underground mining areas. This study used a descriptive method to describe the overall assessment of work fatigue and assessment of work fatigue based on factors related to fatigue using questionnaire scale fatigue assessment of workers in underground mining areas at PT. Y. Overall fatigue assessment based on fatigue evaluation questionnaire results obtained 54.55% of workers who experience fatigue. Fatigue assessment based on factors related to work fatigue shows that workers who tend to experience fatigue are&gt; 45 years of age, &lt;7 hours of sleep,&gt; 5 years of work, 12 hours of work, supervisor type II / jumbo operator drill, jumbo drill operator, LHD operator, and service crew / helper jumbo drill, work climate&gt; NAB (&gt; 29.00 C) and noise&gt; NAB (&gt; 85 dB A). Underground mining workers tend to experience fatigue. The older the worker's age, the less sleep time, the longer the work period, the longer work time, the heavier the type of work, the hotter the working climate and the noisier it tends to experience fatigue.

Psychometric Properties of Three Fatigue Rating Scales in Individuals With Late Effects of Polio.

ObjectiveTo evaluate the psychometric properties of the Fatigue Severity Scale (FSS), the Fatigue Impact Scale (FIS), and the Multidimensional Fatigue Inventory (MFI-20) in persons with late effects of polio (LEoP). More specifically, we explored the data completeness, scaling assumptions, targeting, reliability, and convergent validity.MethodsA postal survey including FSS, FIS, and MFI-20 was administered to 77 persons with LEoP. Responders received a second survey after 3 weeks to enable test-retest reliability analyses.ResultsSixty-one persons (mean age, 68 years; 54% women) responded to the survey (response rate 79%). Data quality of the rating scales was high (with 0%–0.5% missing item responses), the corrected item-total correlations exceeded 0.4 and the scales showed very little floor or ceiling effects (0%–6.6%). All scales had an acceptable reliability (Cronbach’s α ≥0.95) and test-retest reliability (intraclass correlation coefficient, ≥0.80). The standard error of measurement and the smallest detectable difference were 7%–10% and 20%–28% of the possible scoring range. All three scales were highly correlated (Spearman’s correlation coefficient rs=0.79–0.80; p<0.001).ConclusionThe FSS, FIS, and MFI-20 exhibit sound psychometric properties in terms of data completeness, scaling assumptions, targeting, reliability, and convergent validity, suggesting that these three rating scales can be used to assess fatigue in persons with LEoP. As FSS has fewer items and therefore is less time consuming it may be the preferred scale. However, the choice of scale depends on the research question and the study design.

Clinical research of acupoint application combined traditional Chinese medicine foot bath for the treatment of chronic fatigue syndrome

Objective To investigate the clinical application of acupoint sticking combined traditional Chinese medicine foot bath for the treatment of chronic fatigue syndrome (CFS). Methods According to the random table method, 91 CFS patients were divided into control group (n=45) and the research group (n=46). The patients in the control group were treated with western medicine and acupoint application, while the patients in the research group were treated with Chinese medicine foot bath on the basis of control group. Two groups of patients were treated for 30 consecutive days. The clinical total effective rate of two groups of patients after treatment was assessed. The Pittsburgh sleep quality index scale (PSQI), BELL's chronic fatigue syndrome integral table and fatigue rating scale (FS-14) were determined respectively before and after treatment, at the same time, the levels of serum interleukin IL-1β, IL-6, IL-2 and interferon IFN-λ were detected respectively before and after treatment. In addition, the adverse reactionincidence and recurrence rate of two groups of patients were observed Results The total effective rate of research group was 91.3% (42/46), whilethe total effective rate of control group was 71.1% (32/45). The difference between two groups was statistically significant (χ2=6.106, P=0.014). After treatment, the PSQI (3.65 ± 0.71 vs. 4.77 ± 0.62, t=-8.008), FS-14 (6.16 ± 1.52 vs. 8.03 ± 1.43, t=-6.042), IL-1β (3.28 ± 0.63 pg/ml vs. (6.86 ± 1.14) pg/ml, t=-18.595)] and IL-6 (20.03 ± 5.79 pg/ml vs. 24.85 ± 6.88 pg/ml, t=-3.619) of research group were significantly lower than the control group (P<0.05), while the BELL's (66.71 ± 12.79 vs. 50.62 ± 10.22, t=-6.621), IL-2 (32.96 ± 6.57 pg/ml vs. 26.78 ± 6.01 pg/ml, t=4.679) and IFN-λ (36.27 ± 6.71 pg/ml vs. 25.63 ± 5.89 pg/mL, t=8.032) of research group were significantly higher than the control group (P<0.05). No serious adverse reactions occurred during the treatment of both groups. The recurrence rate of control group was 25.0% (8/32), which was significantly higher than the research group of 7.1% (3/42) (χ2=4.576, P=0.032). Conclusions The clinical curative effect of acupoint sticking combined Chinese medicine foot bath on the treatment for CFS is significantly, which can significantly improve the patient's quality of sleep and fatigue index, at the same time improve the serum level of inflammatory factors. Key words: Fatigue syndrome, chronic; Acupoint therapy; Compounds(TCD); Steaming washing therapy

Effect of low moderate aerobic exercise on fatigue and sleep quality in patients with maintenance hemodialysis

Objective To explore the influence of low-to-moderate-intensity aerobic exercise to reducing fatigue and improving sleep disorders among maintenance hemodialysis patients. Methods 97 patients with maintenance hemodialysis in our hospital were selected as the research subjects.The patients were randomly divided into control group(48 cases) and intervention group(49 cases). The control group received hemodialysis routine nursing care.The intervention group accepted standard, simple, low-to-moderate-intensity aerobic exercise on the basis of the control group.The fatigue and sleep disorder levels were assessed in two groups. Results Before intervention, the fatigue rating scale, Pittsburgh sleep quality index score between the two groups had no statistically significant differences (all P>0.05). After intervention, the fatigue rating scale score, Pittsburgh sleep quality index of the intervention group were (42.98±6.12)points, (7.98±1.85)points, which of the control group were (37.04±9.89)points, (10.22±4.24)points, there were statistically significant differences between the two groups(t=4.409, 7.467, all P<0.05). Conclusion Specification, simple, low-to-moderate-intensity aerobic exercise can effectively improve the fatigue and sleep disorder of hemodialysis patients, and improve the quality of life of the patients. Key words: Exercise; Fatigue; Sleep disorder; Hemodialysis

Screening Poststroke Fatigue; Feasibility and Validation of an Instrument for the Screening of Poststroke Fatigue throughout the Rehabilitation Process

Our objective is to investigate the feasibility and validity of a new instrument to screen for determinants of poststroke fatigue during the rehabilitation process. This prospective cohort study was conducted within the stroke department of a rehabilitation center. The participants in the study were postacute adult stroke patients. The Detection List Fatigue (DLF)was administered 2 weeks after the start of the rehabilitation program and again 6 weeks later. To determine the construct validity, the Hospital Anxiety and Depression Scale, the Checklist Individual Strength subscale fatigue, and the Fatigue Severity Scale--7-item version were administered. A fatigue rating scale was used to measure the patients' fatigue experience. Frequency analyses of the number of patients reporting poststroke fatigue determinants according to the DLF were performed. One hundred seven patients (mean age 60 years) without severe communication difficulties were included in the study. The DLF was easy to understand and quick to administer. The DLF showed good internal consistency (Cronbach's alpha: .79 and .87), high convergent validity (rs = .85 and rs = .79), and good divergent validity (rs = .31 and rs = .45). The majority of the patients (88.4%-90.2%) experienced at least 2 poststroke fatigue (PSF) determinants,of which "sleeping problem" was most frequently reported. The DLF is a feasible and valid instrument for the screening of PSF determinants throughout the rehabilitation process in stroke patients. Future studies should investigate whether the use of the list in determining a treatment plan prevents the development of PSF.

The symptoms of pathological fatigue, apathy, and depression in patients after stroke

Objective: to comparatively analyze the rate and correlation of the symptoms of pathological fatigue, apathy, and depression in patients in the termination phase of an acute stroke period. Patients and methods. The symptoms of asthenia (pathological fatigue), apathy, and depression were comparatively investigated in 105 patients at 3–4 weeks after stroke. The fatigue rating scale, apathy rating scale, and hospital anxiety and depression (HAD) scale were used to evaluate the symptoms of pathological fatigue, apathy, and depression. The level of anxiety was also estimated using the appropriate HAD subscale and the Epworth daytime sleepiness scale; the magnitude of cognitive impairments was judged from the Montreal cognitive assessment. The type, basin, and recurrence of stroke were registered. The severity of neurological deficit was evaluated using the U.S. National Institutes of Health Stroke Scale (NIHSS); limited functional capacities were estimated by the modified Rankin scale (mRS). The presence of prestroke fatigue was also determined. Results and discussion. The symptoms of asthenia were observed in 56% of the patients and associated with the severity of poststroke disability. The symptoms of apathy were detected in 10.5% of the patients; those of depression were present in 18% and determined by the magnitude of neurological deficit and the degree of poststroke disability and cognitive impairments. All the three phenomena were correlated with the magnitude of anxiety, daytime sleepiness, and between them. This suggests that they may complicate a reciprocal course in some cases. The symptoms of depression, asthenia, and apathy may also develop on their own, which is borne out by their different rates and correlations. Each of these phenomena requires an individual approach to diagnosis and treatment. Conclusion. The symptoms of pathological fatigue are most common and least specific in patients with mild poststroke neurological deficit. Apathy may be also associated with depression or develop on its own. Further investigation of mechanisms for the development of poststroke pathological fatigue and apathy is important for developing effective methods to correct these abnormalities.

In vivo 1H MRS study of potential associations between glutathione, oxidative stress and anhedonia in major depressive disorder

Inflammation and oxidative stress are important mechanisms that have been implicated in the pathophysiology of major depressive disorder (MDD). Glutathione (GSH) is the most abundant antioxidant in human tissue, and a key index of antioxidant capacity and, hence, of oxidative stress. The aims of this investigation were to examine possible relationships between occipital GSH and dimensional measures of depressive symptom severity, including anhedonia – the reduced capacity to experience pleasure – and fatigue. We hypothesized that the magnitude of anhedonia and fatigue will be negatively correlated with occipital GSH levels in subjects with MDD and healthy controls (HC). Data for eleven adults with MDD and ten age- and sex-matched HC subjects were included in this secondary analysis of data from a previously published study. In vivo levels of GSH in a 3cm×3cm×2cm voxel of occipital cortex were obtained by proton magnetic resonance spectroscopy (1H MRS) on a 3T MR system, using the standard J-edited spin-echo difference technique. Anhedonia was assessed by combining interest items from depression and fatigue rating scales, and fatigue by use of the multidimensional fatigue inventory. Across the full sample of participants, anhedonia severity and occipital GSH levels were negatively correlated (r=−0.55, p=0.01). No associations were found between fatigue severity and GSH in this sample. These preliminary findings are potentially consistent with a pathophysiological role for GSH and oxidative stress in anhedonia and MDD. Larger studies in anhedonic depressed patients are indicated.

Fatigue in Parkinson's Disease: Measurement Properties of a Generic and a Condition-Specific Rating Scale

ContextHigh-quality fatigue rating scales are needed to advance the understanding of fatigue and determine the efficacy of interventions. Several fatigue scales are used in Parkinson's disease, but few have been tested using modern psychometric methodology (Rasch analysis). ObjectivesTo examine the measurement properties of the generic Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale and the condition-specific 16-item Parkinson Fatigue Scale (PFS-16) using Rasch analysis. MethodsPostal survey data (n=150; 47% women; mean age 70 years) were Rasch analyzed. The PFS-16 scores were tested according to both the original polytomous and the suggested alternative dichotomized scoring methods. ResultsThe PFS-16 showed overall Rasch model fit, whereas the FACIT-F showed signs of misfit, which probably was the result of a sleepiness-related item and mixing of positively/negatively worded items. There was no differential item functioning by disease duration but by fatigue status (greater likelihood of needing to sleep or rest during the day among people classified as nonfatigued) in the PFS-16 and FACIT-F. However, this did not impact total score-based estimated person measures. Targeting and reliability (≥0.86) were good, but the dichotomized PFS-16 showed compromised measurement precision. Polytomous and dichotomized PFS-16 and FACIT-F scores identified six, three, and four statistically distinct sample strata, respectively. ConclusionWe found general support for the measurement properties of both scales. However, polytomous PFS-16 scores exhibited advantages compared with dichotomous PFS-16 and FACIT-F scores. Dichotomization of item responses compromises measurement precision and the ability to separate people, and should be avoided.

Fatigue rating scales critique and recommendations by the Movement Disorders Society task force on rating scales for Parkinson's disease

Fatigue has been shown to be a consistent and common problem in Parkinson's disease (PD) in multiple countries and cultures. It is one of the most disabling of all symptoms, including motor dysfunction, and appears early, often predating the onset of motor symptoms. Several studies of the epidemiology of fatigue have been published, often using different scales, but few on treatment. The Movement Disorder Society (MDS) commissioned a task force to assess available clinical rating scales, critique their psychometric properties, summarize their clinical properties, and evaluate the evidence in support of their use in clinical studies in PD. Six clinical researchers reviewed all studies published in peer reviewed journals of fatigue in PD, evaluated the scales' previous use, performance parameters, and quality of validation data, if available. Scales were rated according to criteria provided by the MDS. A scale was "recommended" if it has been used in clinical studies beyond the group that developed it, has been used in PD and psychometric studies have established that it is a valid, reliable and sensitive to change in people with PD. Requiring a scale to have demonstrated sensitivity to change in PD specifically rather than in other areas in order to attain a rating of "recommended" differs from the use of this term in previous MDS task force scale reviews. "Suggested" scales failed to meet all the criteria of a "recommended" scale, usually the criterion of sensitivity to change in a study of PD. Scales were "listed" if they had been used in PD studies but had little or no psychometric data to assess. Some scales could be used both to screen for fatigue as well as to assess fatigue severity, but some were only used to assess severity. The Fatigue Severity Scale was "recommended" for both screening and severity rating. The Fatigue Assessment Inventory, an expanded version of the Fatigue severity Scale, is "suggested" for both screening and severity. The Functional Assessment of Chronic Illness Therapy-Fatigue was "recommended" for screening and "suggested" for severity. The Multidimensional Fatigue Inventory was "suggested" for screening and "recommended" for severity. The Parkinson Fatigue Scale was "recommended" for screening and "suggested" for severity rating. The Fatigue Severity Inventory was "listed" for both screening and severity. The Fatigue Impact Scale for Daily Use, an adaptation of the Fatigue Impact Scale was "listed" for screening and "suggested" for severity. Visual Analogue and Global Impression Scales are both "listed" for screening and severity. The committee concluded that current scales are adequate for fatigue studies in PD but that studies on sensitivity and specificity of the scales are still needed.

Hydration status and water turnover of dogsled drivers during an endurance sled dog even in the Arctic

Objectives. To determine changes in common urinary markers of hydration maintained by the drivers (mushers) during a wilderness endurance event in the arctic and to determine water turnover in this select group of individuals.Study Design. During this descriptive study, data was systematically collected on hydration, water turnover, changes in resting and exercise heart rate, fatigue and rating of perceived exertion during an arduous dogsled race in the arctic.Methods. Sixteen mushers were recruited for the study, 13 of whom completed the entire race. At five different checkpoints along the 1049-mile trail (symbolic distance), urine was collected. Urine osmolality (Uosm) was determined using freezing point depression. Urine specific gravity (Usg) was determined using a hand-held refractometer. Water turnover was measured in 5 mushers from rates of deuterium (2H2O) elimination (rH2O). Prior to the start of the race, and at five checkpoints along the trail, a resting heart rate, fatigue rating scale and a rating of perceived exertion (RPE), were collected.Results. Out of the 13 subjects that completed the event, four of the mushers had a Usg ≥ 1.030 (mean 1.023 ± 0.007) at some point during the event. Ten had a urine osmolality ≥ 900 mOsm L-1 at some point during the event, with an average Uosm of 868 ± 277 mOsm L-1 over the duration of the event. Water turnover demonstrated that rH2O averaged 2.85 ± 1.18 ml kg-1 day-1 (range 2.03 — 4.60) over the duration of the event. Resting heart rate increased significantly over the course of the race. The RPE was related to the overall fatigue rating scale.Conclusions. These data demonstrate that the majority of mushers studied showed signs of dehydration based on common urinary markers during the long-distance dogsled race. The dehydration appears to have had an influence on the resting heart rate, overall fatigue and the rating of perceived exertion during the race.