Multidimensional Assessment Of Fatigue Scale Research Articles

The impact of fatigue on people with Fibromyalgia Syndrome: A survey.

Fibromyalgia syndrome (FMS) is a common pain syndrome associated with fatigue and anxiety. The aim of this survey was to determine the impact of fatigue on the quality of life (QoL) of people with FMS and to explore the relationships between fatigue, pain, and anxiety. A postal survey was conducted among support groups. Demographic data were collected and participants were asked to complete the Multi-dimensional Assessment of Fatigue Scale (MAF) and two visual analog scales (VAS) measuring pain and anxiety. Data were analysed using descriptive statistics, and relationships between variables were explored using Pearson's correlation coefficient and Fisher's Exact Probability Test. Ethical approval was granted from Ulster University's research ethics committee. A response rate of 52.5% was achieved (105/200). Fatigue was found to severely impact the QoL of those with FMS. From the MAF, a mean Global Fatigue Index score of 40.7 (range 1=no fatigue-50=severe fatigue) was calculated. Fatigue was significantly associated with both pain (r=0.674) and anxiety (r=0.546) (both p values<0.0001), and no significant relationship was found between the duration of FMS and fatigue (r=0.106; p=0.320). Fatigue has a major impact on the QoL of patients with FMS. There is a strong relationship between fatigue and other variables such as pain and anxiety. However, there is no relationship between the time since diagnosis and fatigue experienced. Fatigue management should feature highly in any treatment programme for those with FMS.

Effectiveness of Intradialytic Leg Ergometry and Stretching Exercises on Fatigue and Muscle Cramps Among Patients Subjected to Hemodialysis at Tertiary Care Hospitals of Sikkim

significant impact on patients' health-related quality of life and are common in chronic hemodialysis patients. The purpose of this study was to see how effective intradialytic leg ergometry and stretching exercises were at reducing fatigue and muscle cramps in hemodialysis patients at tertiary care hospitals.A quasi-experimental study conducted among 58 patients undergoing hemodialysis, randomly selected experimental and control group. Experimental group received intradialytic leg ergometry and stretching exercises during the first 2 hrs of dialysis session for a total duration of 4 weeks. Data on fatigue and muscle cramps were assessed using Multidimensional Assessment of Fatigue Scale (MAF) and PENN Spasm Frequency Scale (PSFS) respectively, at the beginning prior to implementation of intervention and re assessed during the 4th week. The study finding showed that the mean posttest score of fatigue in the experimental group was 26.86±8.228 was lesser than mean posttest score in control group 32.40±8.726, where the differences between the two groups was statistically significant at p&lt;0.05 level. Similarly with regard to muscle cramps the mean posttest score in experimental group was 1.21±0.491 was lesser than mean posttest score in control group 2.07±0.884 where the differences between the two groups was statistically significant at p&lt;0.05 level. The findings concluded that intradialytic leg ergometry and stretching exercises were beneficial in reducing fatigue and muscle cramps in hemodialysis patient. Keywords: [Hemodialysis, Fatigue, Muscle Cramps, Intradialytic ergometry]

Depression and Fatigue in Rheumatoid Arthritis- A Study in Southern India

Rheumatoid Arthritis is a chronic autoimmune condition in which the patient experiences pain, joint immobility which in some instance can also lead to disability, and thus difficulty in carrying out various activities of daily living. It is a natural consequence that patients may experience varying degrees of depressive symptoms and fatigue. Aim and Objectives: In our study, it is our objective to find out the prevalence of depression, its severity and its correlation with disease activity, pain and inflammatory markers like ESR. We also attempted to quantify the fatigue using the MAF scale by calculating the GFI (Global Fatigue Index) and its prevalence in remission vs non remission patients. Study design: The study is a cross-sectional observational study of consecutive patients with a diagnosis of RA as per EULAR 2020 criteria. The patients were interviewed using standard questionnaires MAF (multidimensional assessment of fatigue questionnaire) and PHQ9 (Patient Health Questionnaire 9). Tools used in the study: Fatigue was measured by using MAF (Multidimensional Assessment of Fatigue). Depression is measured using the PHQ9 questionnaire. Results: The population studied was found to have a prevalence of 33.5% depression. The patients’ mean age was 52.4510.53 years and disease duration 8.026.22 years. Their mean DAS28 was 2.961.1. The mean PHQ-9 score was 3.993.5., mild (26%), moderate (5.5%), moderately severe (1.5%) and severe (0.5%) degrees. Correlation of PHQ9 scores with DAS, VAS and ESR was done to see if there is a relation of depression to any of the clinical outcomes. It was found that depression had a positive correlation with disease activity score DAS 28 (coefficient of correlation 0.167, p = 0.018), VAS pain scores (coefficient = 0.361, p &lt; 0.001) as well as ESR (coefficient = 0.217, and p = 0.002). Fatigue was evaluated using the MAF which gave the Global Fatigue Index (GFI). The mean MAF score was 8.623.33. 78% of patients had fatigue in the level (0-10), 20.5% in the (10-20) level and 1.5% in the (20-30) level. Statistical test for comparison between groups using t test was found to be significant with p value 0.034. Conclusion: Our study on both depression and fatigue once again emphasises the need for rheumatologists especially in the Indian scenario to address them in their routine clinical practice. There should be regular screening for these conditions during the patient visits similar to other risk factors screening in RA.

Autonomous motivation to reduce sedentary behaviour is associated with less sedentary time and improved health outcomes in rheumatoid arthritis: a longitudinal study

BackgroundThis longitudinal study investigated whether changes in autonomous and controlled motivation to reduce sedentary behaviour were associated with variability in sedentary, standing and stepping time and, in turn, disease activity, systemic inflammation, pain and fatigue in rheumatoid arthritis (RA).MethodsPeople with RA undertook assessments at baseline (T1, n = 104) and 6 months follow-up (T2, n = 54) to determine autonomous and controlled motivation to reduce sedentary behaviour (Behavioural Regulation in Exercise Questionnaire-2), free-living sedentary, standing and stepping time (7 days activPAL3μ wear), Disease Activity Score-28 (DAS-28), systemic inflammation (c-reactive protein [CRP]), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). N = 52 participants provided complete data at T1 and T2. Statistical analyses: In a series of models (A and B), path analyses examined sequential associations between autonomous and controlled motivation to reduce sedentary behaviour with activPAL3μ-assessed behaviours and, in turn, RA outcomes.ResultsModels demonstrated good fit to the data. Model A (sedentary and stepping time): autonomous motivation was significantly negatively associated with sedentary time and significantly positively related to stepping time. In turn, sedentary time was significantly positively associated with CRP and pain. Stepping time was not significantly associated with any health outcomes. Model B (standing time): autonomous motivation was significantly positively associated with standing time. In turn, standing time was significantly negatively related to CRP, pain and fatigue.ConclusionsAutonomous motivation to reduce sedentary behaviour is associated with sedentary and standing time in RA which may, in turn, hold implications for health outcomes.

Screening for depressive symptoms in patients with rheumatoid arthritis: relationship with pain severity, disease activity, and sleep quality

BackgroundRheumatoid arthritis (RA) is an autoimmune systemic condition that primarily affects all synovial joints, eventually leading to deformity and clinical disability. Much progress has been made in the evaluation of inflammation and disease activity in recent years; however, other factors that can influence these patients’ quality of life, including depression, stress, fatigue, sleep problems, fibromyalgia, sexual activity, and obesity, are often not evaluated by rheumatologists. Our purpose was to explore depressive symptoms in patients with RA and determine how they connected to other aspects of the disease, including pain severity, disease activity, and sleep quality.ResultsA cross-sectional study including 1200 patients with RA was performed. Paints with RA were classified into two groups based on the presence or absence of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Group 1 included patients with both RA and depressive symptoms of varying severity; group 2 included patients with RA but without depressive symptoms. The patients underwent clinical evaluation and application of the Pittsburgh Sleep Quality Index (PSQI), Health Assessment Questionnaire for pain (HAQ-pain), and the Multidimensional Assessment of Fatigue scale (MAF). RA disease activity was evaluated using the DAS28 score. Depressive symptoms of varying severity were prevalent in 96% of our patients with RA, of whom 43.3% had minimal depression, while 13.7% had severe depression. The RA group with depression had a longer duration of disease, prolonged morning stiffness, and high disease activity measured by the DAS28 score than patients with only RA. In RA patients with concomitant depression, pain, sleep, and fatigue scores were also worse.ConclusionsThe presence of depression among patients with RA was associated with worse DAS28, HAQ, PASQI, and fatigue scores. Screening and recognition of such psychosocial disorders may help patients achieve optimal disease control and a good outcome.

Muscle architecture in patients with primary Sjögren syndrome.

This study aims to investigate skeletal muscle architecture and strength in patients with primary Sjögren syndrome (pSS). Between July 01, 2017 and November 30, 2017, 19 pSS patients (19 females; mean age: 54.1±6.6 years; range, 42 to 62 years) and 19 age-, body mass index-, and sex-matched healthy controls (19 females; mean age: 53.2±6.7 years; range 42 to 61 years) were included. Sjögren symptoms were assessed with the European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI). Muscle thickness, pennation angle, and fascicle length were measured at quadriceps femoralis, gastrocnemius and soleus muscles. Isokinetic muscle strength tests were performed at 60 and 180°/sec for knee and at 30 and 120°/sec for ankle. Anxiety and depression evaluated with the Hospital Anxiety and Depression Scale (HADS), fatigue with Multidimensional Assessment of Fatigue scale (MAF), and functionality with Health Assessment Questionnaire (HAQ). In the pSS group, the mean ESSPRI was 7.70±1.17. The mean scores of depression (10.05±3.09 vs. 4.47±2.29; p<0.0001), anxiety (8.26±4.28 vs. 3.79±2.42; p<0.0001), functionality (0.94±0.78 vs. 0.22±0.26; p<0.0001), and fatigue (37.69±5.47 vs. 17.69±5.26; p<0.0001) were significantly higher in patients with pSS. Only, the pennation angle of vastus medialis in dominant leg was significantly greater in healthy controls (p=0.049). Peak torques/body weight of knee and ankle muscles were found to be similar. Excluding a minor decrease of the pennation angle at vastus medialis, muscle structure of lower extremity of pSS patients were similar to healthy controls. In addition, isokinetic muscle strength did not significantly differ in patients with pSS compared to healthy controls. In patients with pSS, disease activity and fatigue level were negatively correlated with isokinetic muscle strength measurements.

0252 Sleep Hygiene Education Intervention: Psychological and Physiological Associations with Sleep in College Students

Abstract Introduction College students tend to struggle with managing healthy sleep habits; these unhealthy behaviors can lead to poor sleep and impact their overall mental and physical health. More specifically, sleep is intimately connected to psychological and physiological factors such as anxiety, depression, and blood pressure. The focus of the current study was to examine habitual sleep habits in college students, provide a brief educational intervention, and investigate potential changes in psychological and physiological health. Methods Participants included 14 undergraduate students (6 men, average age M=20.64 years, SD=2.13) who wore wrist actigraphs to measure their typical sleep habits. After one week, participants completed questionnaires about sleep (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Multidimensional Assessment of Fatigue Scale, MAF), and psychological symptoms (i.e., depression, anxiety, and stress; Depression Anxiety Stress Scales, DASS-21). Blood pressure and heart rate were measured using a wrist device. Subjects participated in a short lecture about healthy sleep hygiene habits and the importance of sleep and then repeated the one-week observational study. Results Paired sample t-tests revealed a significant increase from baseline average sleep duration (M=5.83 hours) to post-intervention sleep duration (6.64 hours; t(13)=-2.532, p=.013). Sleep efficiency (actigraphy) and quality (PSQI) did not improve significantly. ESS scores decreased significantly (t(13)=3.76, p=.002 (pre M=9.29; post M=5.43) and MAF scores decreased significantly (t(13)=2.19, p=.047 (pre M=20.48; post M=15.60). No significant differences were found in depressive, anxiety, or stress symptoms when comparing DASS-21 scores pre- vs post-intervention. Baseline systolic blood pressure (M=114.88) significantly decreased compared to post-intervention recordings (M=108.21). Diastolic blood pressure and heart rate did not differ significantly. Conclusion The results of this study suggest that one educational lecture about sleep hygiene may be a start to improving sleep in college students. Even a 48-minute increase resulted in decreased sleepiness and fatigue. However, no improvements were found in sleep quality or efficiency. Although a slight improvement was found in systolic blood pressure, no other physiological or psychological benefits were noted. More research should be conducted on how to improve sleep habits in college students beyond an educational approach. Support (If Any) None.

0122 Sleep Hygiene Education Intervention: Sleep Factors and Cognition in College Students

Abstract Introduction College students often struggle to adjust to the demanding nature of college life, which can translate to decreased overall health and poor sleep. Healthy sleep practices are important for obtaining good sleep quality and quantity, leading to optimal cognitive performance. Interventions, including educational approaches to improve sleep in college students, may lead to better concentration, memory retention, and subsequent academic performance. The focus of the current study was to examine habitual sleep habits in college students, provide a brief educational intervention, and investigate potential changes in sleep and cognition. Methods Participants included 14 undergraduate students (6 men, average age M=20.64 years, SD=2.13) who wore wrist actigraphs to measure their typical sleep habits. After one week, participants completed questionnaires about sleep (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Epworth Sleepiness Scale, ESS), and fatigue (Multidimensional Assessment of Fatigue Scale, MAF). Participants also completed cognitive tests (Stroop, Digit Span, and Simple Reaction Time). Subjects participated in a short lecture about healthy sleep hygiene habits and the importance of sleep and then repeated the one-week observational study. Results Paired sample t-tests revealed a significant increase from baseline average sleep duration (M=5.83 hours) to post-intervention sleep duration (6.64 hours; t(13)=-2.532, p=.013). Sleep efficiency (actigraphy) and quality (PSQI) did not improve significantly. ESS scores decreased significantly (t(13)=3.76, p=.002 (pre M=9.29; post M=5.43) and MAF scores decreased significantly (t(13)=2.19, p=.047 (pre M=20.48; post M=15.60). A difference in reaction times for Stroop incongruent prompts approached significance (p=.083, pre M=979.46; post M=884.70), but no differences were found for errors, Digit Span, or Simple Reaction Times. Conclusion The results of this study suggest that one educational lecture about sleep hygiene may be a start to improving sleep in college students. Even a 48-minute increase resulted in decreased sleepiness and fatigue. However, no improvements were found in sleep quality or efficiency. Although a slight improvement was found in reaction time, no other cognitive benefits were noted. More research should be conducted on how to improve sleep habits in college students beyond an educational approach. Support (If Any) None.

Does food insecurity affect musculoskeletal symptoms, fatigue, and productivity of municipality cleaners? A cross-sectional study.

Municipality cleaners are exposed to food insecurity, Musculoskeletal Symptoms (MSs), and fatigue. This study aimed to investigate the effect of food insecurity on MSs, fatigue, and productivity among municipality cleaners. This study was conducted on 399 Iranian male municipality cleaners with at least one year of working experience. The data were gathered via a demographic/occupational questionnaire, the Persian version of the Household Food Insecurity Access Scale (P-HFIAS), the Persian version of Nordic Musculoskeletal Questionnaire (P-NMQ), the Persian version of the Multidimensional Assessment of Fatigue scale (P-MAF), and the Persian version of Health and Work Questionnaire (P-HWQ). Data were analyzed using descriptive statistics, multiple logistic regression (Forward Wald), and multiple linear regression (Stepwise). The findings revealed that 42.6%of the municipality cleaners were in the 'severely food insecure' category. The highest prevalence of MSs in the past week were related to knees (35.8%), lower back (35.1%), and ankles/feet (28.8%). Based on the results, the chance of MSs in the shoulders (OR = 1.66) and ankles/feet (1.60) regions, and MSs at least in one body region (OR = 1.47) was higher in the individuals with severe food insecurity than the others. Considering the P-MAF, food insecurity was associated with the 'degree and severity', 'distress that it causes', and 'timing of fatigue' subscales and 'total fatigue'. Considering the P-HWQ, food insecurity was associated with 'productivity', 'other's assessment', 'concentration/focus', 'supervisor relations', 'non-work satisfaction', and 'impatience/irritability' subscales. The study revealed an association between food insecurity and MSs in some body regions and fatigue and productivity subscales among the municipality cleaners. Nutritional and ergonomic programs are recommended to reduce municipality cleaners' food insecurity, MSs, and fatigue and enhance their productivity.

Abstract PS4-16: Symptoms of cold discomfort are reduced in breast cancer patients with a composite cytokine pattern associated with increased anti-tumor immunity

Abstract Background: In preclinical models of breast cancer (BC), chronic stress enhances tumor growth and metastasis through β-adrenergic signaling as part of the “fight or flight” stress response pathway. These effects involve norepinephrine-mediated sympathetic regulation of cancer-related immunity. In a novel discovery, adrenergic stress in tumor-bearing mouse models of BC was associated with symptoms of intense cold discomfort, reduced CD8+ T cells, and higher immunosuppressive myeloid derived suppressor cells (MDSC) and regulatory T cells. BC survivors often experience heightened sympathetic activation and anecdotally report symptoms of feeling overly cold. Based on preclinical findings, symptoms of cold discomfort reported by BC survivors are hypothesized to identify those with reduced anti-cancer immunity and increased immunosuppression. Methods: Women with incident stage I to III BC were prospectively enrolled into the Women’s Health after Breast Cancer Study prior to BC treatment at Roswell Park Comprehensive Cancer Center. Participants provided blood samples and completed a survey assessing BC risk factors at the time of diagnosis and survivorship outcomes one-year post. Symptoms of being persistently and inappropriately cold as well as the occurrence of hot flashes and sweats were assessed using a Likert scale patterned on the validated Multidimensional Assessment of Fatigue Scale. A total of 424 women who had questionnaire data and plasma samples were included in the study. A panel of 27 Th1, Th2, Th9, and Th17 cytokines were assayed using a multiplex Luminex bead-based approach. Perceived symptoms of thermal discomfort were evaluated using logistic regression over cytokine tertiles (T1, T2, T3). Principal component analysis (PCA) was used to identify clusters of cytokines associated with symptoms of thermal discomfort. Cytokine composite scores were further refined based on their role with anti-tumor or pro-tumor activity. Multivariate models were adjusted for age, race, menopausal status, body mass index, stage, estrogen receptor status, grade, and treatment received. Results: Forty-six percent (195/424) of patients reported symptoms of feeling cold while 65% (275/424) experienced hot flashes and night sweats. There were no differences in patient or tumor characteristics between women who reported feeling cold versus those who did not, with women receiving chemotherapy more likely to report feeling cold (p = 0.01). Importantly, menopausal onset occurring after BC diagnosis or receipt of hormonal therapy were not associated with symptoms of feeling cold, but as expected were associated with experiencing hot flashes indicating that feeling cold is a distinct symptom from hot flashes. Higher pre-treatment levels of IL-6 was associated with 40-55% lower risk of feeling inappropriately cold 1-year post-diagnosis (T3 vs T1: OR=0.58, 95% CI: 0.34-1.00, p=0.01). PCA analysis identified a composite cytokine score at 1-year post diagnosis, which included the Th1 cytokines IL-12p70 and TNFα, IL-9 and IL-21 as cytokines involved in Th9 antitumor immunity, and the type 3 interferon IFN-λ2/IL-28α, which are all associated with increased CD8+ T cell activity. Increased scores were associated with reduced odds of feeling cold (T3 vs T1: OR=0.42, 95% CI: 0.23-0.77, p=0.02). Hot flashes in contrast were not associated with individual cytokine levels or composite scores. Conclusions: Symptoms of cold discomfort are less likely to be reported by BC survivors with a composite cytokine pattern associated with increased anti-tumor immunity. Further research is needed to determine if this symptom is associated with increased adrenergic stress and worse BC outcomes as observed in preclinical models. Citation Format: Shipra Gandhi, Maithreyi Sarma, Kristopher Attwood, Christine B. Ambrosone, Elizabeth A. Repasky, Chi-Chen Hong. Symptoms of cold discomfort are reduced in breast cancer patients with a composite cytokine pattern associated with increased anti-tumor immunity [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-16.

Pain and fatigue are longitudinally and bi-directionally associated with more sedentary time and less standing time in rheumatoid arthritis.

ObjectivesThe aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA.MethodsPeople living with RA undertook identical assessments at baseline (T1, n = 104) and 6-month follow-up (T2, n = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to assess physical function (HAQ), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). Participants’ free-living sedentary, standing and stepping time (min/day) were assessed over 7 days using the activPAL3µ™. For the statistical analysis, hierarchical regression analysis was employed to inform the construction of path models, which were subsequently used to examine bi-directional associations of pain and fatigue with sedentary, standing and stepping time. Specifically, where significant associations were observed in longitudinal regression analysis, the bi-directionality of these associations was further investigated via path analysis. For regression analysis, bootstrapping was applied to regression models to account for non-normally distributed data, with significance confirmed using 95% CIs. Where variables were normally distributed, parametric, non-bootstrapped statistics were also examined (significance confirmed via β coefficients, with P < 0.05) to ensure all plausible bi-directional associations were examined in path analysis.ResultsLongitudinal bootstrapped regression analysis indicated that from T1 to T2, change in pain, but not fatigue, was positively associated with change in sedentary time. In addition, change in pain and fatigue were negatively related to change in standing time. Longitudinal non-bootstrapped regression analysis demonstrated a significant positive association between change in fatigue with change in sedentary time. Path analysis supported the hypothesized bi-directionality of associations between change in pain and fatigue with change in sedentary time (pain, β = 0.38; fatigue, β = 0.44) and standing time (pain, β = –0.39; fatigue, β = –0.50).ConclusionFindings suggest pain and fatigue are longitudinally and bi-directionally associated with sedentary and standing time in RA.

Questionários para avaliação da fadiga em trabalhadores: uma revisão sistemática de literatura

O objetivo do trabalho foi identificar os questionários utilizados para avaliar a fadiga em trabalhadores. Uma revisão sistemática foi realizada nas bases de dados MEDLINE/PubMed e LILACS. Dos 407 estudos encontrados, 21 se enquadraram nos critérios de seleção. Foram identificados sete questionários para avaliação da fadiga em trabalhadores que apresentam tradução e adaptação para o português e que foram validados no país, são eles: Questionário de Avaliação da Fadiga de Yoshitake; Questionário Bipolar de Avaliação da Fadiga; Questionário de Fadiga de Chalder; Escala de Necessidade de Descanso; Checklist of Individual Strength; Questionário Multidimensional da Fadiga e Escala de Severidade da Fadiga. As métricas de cada um deles foram discutidas, observando-se suas diferenças. Identificou-se que os questionários se complementam, pois não foi encontrado um questionário que separe a fadiga física e mental e que também verifique a intensidade da fadiga. Desse modo, sugere-se o uso de mais de um questionário nas pesquisas envolvendo essa temática, a fim de abranger diferentes perspectivas de avaliação da fadiga.

The value of a post-polio syndrome self-management programme.

BackgroundPost-polio syndrome is characterised by symptoms of fatigue, pain and new-onset neuromuscular weakness, and emerges decades after the initial poliovirus infection. We sought to evaluate the only post-polio syndrome specific self-management programme in the United Kingdom.MethodsThis was a retrospective study of patients who had completed a residential self-management programme led by a multi-disciplinary clinical team. Following a confirmed diagnosis of post-polio syndrome by rehabilitation and neurology specialists, patients were offered to participate in the programme. Although group-based, patients also received individually tailored support on physical exercise and fatigue management. Physical effects, physical function, psychosocial well-being measures were assessed at baseline and 6 months follow-up. Knowledge was tested at baseline and immediately following the programme. Statistical comparisons were made using paired t-test and Wilcoxon signed rank test according to the data distribution.ResultsOver a period of 17 years, 214 participants (median age 61.3 years old, 63% female) attended 31 programmes. At 6 months the following post-polio syndrome specific symptoms improved significantly: fatigue, as measured by the Multidimensional Assessment of Fatigue scale [37.6 (7.1) vs. 34.2 (9.3), P=0.005]; and pain [15.0 (6.1) vs. 13.1 (6.7), P=0.001], atrophy [10.0 (8.0–12.0) vs. 9.0 (7.0–11.0), P=0.002] and bulbar symptoms [3.0 (1.0–5.0) vs. 2.0 (0–4.0), P=0.003] as measured by the Index of Post-polio Sequelae scale. Knowledge related to post-polio syndrome also significantly increased [14.0 (11.0–16.0) vs. 17.0 (16.0–19.0), P=0.001]. Participants were able to walk at a faster speed over 10 meters [0.77 (0.59–1.00) vs. 0.83 (0.67–1.10) m/s, P=0.003] and walked longer distances during the 2-minute walk test [76.9 (31.7) vs. 82.0 (38.4) m, P=0.029]. Depression and anxiety scores did not change over time [PHQ-9, 2.0 (0.3–10.8) vs. 2.0 (0.3–6.8), P=0.450; GAD-7, 2.0 (0–7.0) vs. 1.0 (0–3.0), P=0.460] nor was there change in self-reported quality of life {60 [50–70] vs. 60 [55–70], P=0.200}.ConclusionsThis study suggests that a post-polio syndrome self-management programme led to improvement in symptoms, knowledge and walking speed, but not quality of life. Anxiety and depression scores remained low.

Acupuncture for primary fibromyalgia: Study protocol of a randomized controlled trial

BackgroundAcupuncture is well recognized for its unique therapeutic effect for many diseases as a nonpharmacological therapy in traditional Chinese medicine (TCM). However, whether acupuncture can effectively treat fibromyalgia is currently unclear. Therefore, we aim to design a study protocol of a randomized controlled clinical trial and assess the effectiveness of acupuncture for patients with fibromyalgia, which may lead to alleviation of clinical symptoms and improvement of patients’ quality of life.MethodsThe study is designed as a randomized, blinded, placebo-controlled trial of two cohorts conducted at Guang’anmen Hospital of China Academy of Chinese Medical Sciences and Shenzhen Traditional Chinese Medicine Hospital, respectively. A total of 68 patients with primary fibromyalgia, diagnosed with the American College of Rheumatology criteria, are randomly allocated with a 1:1 ratio to acupuncture or sham acupuncture groups. All subjects will receive acupuncture intervention for 8 weeks with follow-up assessments every 4 weeks for 16 weeks. The primary outcome will be evaluated using the visual analogue scale (VAS) and revised fibromyalgia impact questionnaire (FIQR) for pain intensity. The secondary outcome measures will include: Multidimensional Assessment of Fatigue scale (MAF), Short Form-36 (SF-36), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Chinese perceived stress scales (pss-14), changes in the number of 18 tender points, patient satisfaction for the treatment and adverse events. The mentioned outcome measurements will be assessed every 4 weeks for 6 months.DiscussionThis clinical trial will use advanced research methods to evaluate the efficacy and safety of acupuncture on fibromyalgia. The results of this trial may provide clinical evidence on the beneficial effects of acupuncture in treating fibromyalgia.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016826: AMCTR-IOR-18000184. Registered 27 June 2018, http://www.acmctr.org/listbycreater.aspx

0407 Sleep, Stress, Cardiovascular, and Psychological Health in College Students

Abstract Introduction Epidemiological studies have long established that sleep factors, stress, and cardiovascular health are related. College students often struggle with the demands of college life, which leads to increased stress, symptoms of depression and anxiety, and poor sleep. The focus of the current study was to examine habitual sleep habits in college students, in association with psychological factors and physiological factors. Methods Participants included 51 undergraduate students (18 men, average age M=20.25 years, SD=1.78) who wore wrist actigraphs to measure their typical sleep habits. After one week, participants completed questionnaires about psychological symptoms (i.e., depression, anxiety, and stress; Depression Anxiety Stress Scale, DASS-21) and subjective physiological symptoms (i.e., fatigue; Multidimensional Assessment of Fatigue Scale, MAF). Blood pressure and heart rate were measured using a wrist cuff. Results Overall total sleep time was 6.59 hours and sleep efficiency was 82.55%. Pearson correlational analyses revealed a negative moderate association between sleep efficiency and diastolic blood pressure (r(49) = -.318, p = .024). Global PSQI scores were moderately associated with stress (r(49) = .419, p = .002). MAF Global Fatigue Index scores revealed positive associations with depression (r(49) = .344, p =.014), anxiety (r(49) = .474, p&amp;lt;.001), and stress (r(49) = .620 p&amp;lt;.001). Heart rate was positively associated with depressive symptoms r(49) = .296, p= .035), stress symptoms r(49) = .447, p= .001), and fatigue r(49) = .456, p= .001). Conclusion As expected, college students’ sleep was short in duration and poor in efficiency. Sleep factors, cardiovascular factors, psychological factors, and stress were all related, demonstrating the importance of sleep on physiological and psychological health. More research should be conducted to further examine the relationships and directionality between sleep, psychological factors, and stress as there may be underlying mechanisms important for cardiovascular health. Support None.

Comparison of the Psychometric Properties of Three Fatigue Scales in Persian-Speaking Patients with Multiple Sclerosis.

Fatigue is the most disabling symptom in patients with multiple sclerosis (MS). Although there is no standard tool to evaluate fatigue in clinical settings, the Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Multidimensional Assessment of Fatigue (MAF) scale are popular instruments for this purpose. The aim of this study was to compare the psychometric properties of the Persian versions of these scales. One hundred thirty adult patients with MS and 60 controls participated in this study. They completed the scales on two occasions 3 days apart. Reproducibility and internal consistency were evaluated as intraclass correlation coefficients (ICCs) and Cronbach α. Convergent validity was assessed by evaluating the association of the fatigue scales with age, sex, Expanded Disability Status Scale (EDSS) score, disease duration, and sleep quality. Dimensionality was evaluated using confirmatory factor analysis. Acceptability and known-group validity were investigated. The effect size of each scale was computed. The ICC of all instruments was 0.99. Internal consistency was 0.97 for the MAF scale, 0.93 for FSS, and 0.83 for FIS. The instruments showed moderate-to-good correlations with Pittsburgh Sleep Quality Index, EDSS score, and disease duration. Acceptability was acceptable. The FIS had three dimensions, and the FSS and MAF scale were unidimensional. All scales were able to discriminate patients with MS from controls. The Persian version of the MAF scale seems to be the most suitable instrument to evaluate fatigue in patients with MS based on its time efficiency, effect size, and detailed data about various aspects of fatigue.

Trajectory and Predictors of Fatigue Among Chinese Immigrant and Chinese Canadian-Born Women in the Postpartum Period

ObjectiveTo describe the proportion of women with improving or worsening symptoms of fatigue at 1, 3, 6, and 12 months after birth; to model the trajectory of fatigue across the first year after birth and identify baseline predictors (e.g., immigrant status) and time-varying predictors; and to describe the degree to which fatigue interferes with activities of daily living across the first year after birth among a cohort of Chinese immigrant and Chinese Canadian-born women. DesignProspective cohort study. SettingToronto, Ontario, Canada. ParticipantsChinese women who were recent immigrants (n = 244), nonrecent immigrants (n = 247), or Canadian born (n = 100). MethodsWomen completed surveys at 1, 3, 6, and 12 months after birth. We measured fatigue with the use of the Multidimensional Assessment of Fatigue scale. Fatigue predictor variables were classified as baseline (e.g., immigrant status) or time varying (e.g., depression). We used latent growth curve modeling to examine fatigue trajectories and identify predictors over time. ResultsFatigue followed a nonlinear pattern: it improved from 1 to 6 months after birth and then worsened from 6 to 12 months after birth. Depression, anxiety, infant sleep characteristics, and breastfeeding problems, but not immigrant status, significantly increased risk for fatigue. Several daily activities were significantly influenced by fatigue, particularly early in the postpartum period as well as later, which showed a U-shaped relationship between fatigue and activities of daily living. ConclusionFatigue is common and persistent across the postpartum period. Modifiable risk factors related to mental health, infant sleep, and breastfeeding difficulties suggest that preventive strategies for maternal fatigue warrant further investigation.

Depression, Quality of Life, and Self-Esteem of Moroccan Postmenopausal Women with Osteoporosis before the Occurrence of Fractures.

ObjectivesPrevious researches have investigated depression in postmenopausal women (PMW) with osteoporosis and fractures, but little is known regarding Moroccan PMW without fractures. We investigated depression prevalence and severity in Moroccan PMW with osteoporosis without fractures and its relationship with quality of life (QoL) and physical and psychological state.MethodsThis cross-sectional study enrolled 100 PMW with osteoporosis without fractures. Depressive symptoms, QoL, self-esteem, and fatigue were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Arabic version of ECOS-16 questionnaire, Rosenberg self-esteem scale, and Arabic version of the Multidimensional Assessment of Fatigue scale, respectively. A questionnaire including sociodemographic factors, bone density features, pain intensity, and sleep disturbance was completed.ResultsOverall, 58% patients suffered from depression and 55% from pain (63.8% depressed women vs. 42.9% nondepressed patients; P = 0.03). Bone mineral density, lumbar spine T-score, ECOS-16, and self-esteem in depressed and nondepressed women were 0.791 (0.738–0.840) vs. 0.835 (0.790–0.866); −3.25 (−3.8 to −2.875) vs. −2.9 (−3.425 to −2.700), P = 0.02; 2.338 ± 0.605 vs. 1.638 ± 0.455; and 13.517 ± 5.487 vs. 18.404 ± 5.771, P < 0.0001, respectively. Depression severity correlated with pain, QoL, self-esteem, and fatigue (r = 0.367, r = −0.390, r = −0.390, and r = 0.369, respectively; P < 0.0001) as well as lumbar spine bone mineral density and T-score (r = −0.258 and r = −0.255, respectively; P = 0.01). Multiple linear regression analysis revealed impaired QoL (β = 0.526; P < 0.0001), fatigue (β = 0.177; P = 0.02), and lower self-esteem (β = −2.170; P = 0.005) as the strongest risk factors of depression.ConclusionsOur study shows that even without fractures, Moroccan PMW with osteoporosis suffered from depression, pain, impaired QoL, and lower self-esteem.

The Effect of Bolus Vitamin D Supplementation

Objectives : Vitamin D plays an important role in musculoskeletal and nervous system health. Although, the prevalence of vitamin D deficiency is fairly high and it may lead to bone abnormalities and muscle weakness, it is a preventable condition. The aim of this prospective study was to assess the effects of vitamin D supplementation on balance, mobility, grip strength, fatigue, depression and quality of life. Materials and Methods : Between October 1, 2015 and December 31, 2015, a total of 92 patients with vitamin D insufficiency/deficiency were included in the study. Demographic characteristics of age, gender, height, weight, serum 25-hydroxyvitamin [25-(OH)D], parathyroid hormone, alkaline phosphatase (ALP), calcium, and phosphorus levels were recorded. The primary outcome was assessed the [25-(OH) D] levels at 1 month and 3 month post-treatment. The secondary outcomes were the efficacy of vitamin D administration on fatigue, mobility, balance, depression, quality of life (QoL), muscle strength using The Multidimensional Assessment of Fatigue Scale (MAF), Timed Up and Go Test (TUG), Single leg stance test (SLS), Beck Depression Inventory (BDI), The Nottingham Health Profile(NHP), hand dynamometer, respectively at all visits. Results : After the 1 month, the vitamin D supplementation had significantly improved muscle strength, balance ability, mobility, QoL, depression, and fatigue symptoms. The levels of [25-(OH) D] significant decreased after 3 months. Conclusion : Supplemental vitamin D consistently demonstrated beneficial effects on muscle strength, mobility, balance control, depression, fatigue and QoL. The 300,000 bolus of vitamin D was well-tolerated and safe in adult population. We would recommend evaluating vitamin D status once in three months.

Fatigue in Pregnancy: The validity and reliability of the Farsi Multidimensional Assessment of Fatigue scale.

ObjectivesFatigue is a common discomfort experienced during pregnancy and may contribute to severe labour pain and postpartum depression. This study aimed to translate the Multidimensional Assessment of Fatigue (MAF) scale into Farsi and validate it in a sample of pregnant Irani women.MethodsThis cross-sectional questionnaire study was conducted between January and June 2016 at eight healthcare centres in Sabzevar, Iran. The English version of the MAF scale was translated into Farsi and assessed for content validity. Participants completed the Farsi MAF scale and the Farsi World Health Organization-5 Well-being index (WHO-5). Construct validity was assessed through exploratory factor analysis (EFA). Cronbach’s alpha coefficient and the intraclass correlation coefficient (ICC) were used to determine the internal consistency and stability of the Farsi MAF scale.ResultsA total of 582 women met the inclusion criteria, of which 541 completed the MAF scale (response rate: 93%). The EFA of the 15 items confirmed the previously proposed one-factor structure with a Cronbach’s alpha coefficient of 0.957 for the Farsi MAF scale. Stability was confirmed by the ICC value (0.702) for the Global Fatigue Index (GFI) and the mean GFI was 20.33 ± 12.71. Concurrent validity was confirmed by a moderate negative correlation (r = −0.35; P <0.001) between the scores of the Farsi MAF scale and the Farsi WHO-5. Women who received a high level of support from their husbands, who were satisfied with the quality of their marital relationship and with a well-being score of >50 reported a lower level of fatigue than the other groups (P ≤0.012).ConclusionThe Farsi MAF scale is a reliable and valid questionnaire to investigate fatigue in pregnant Irani women. Interventions to promote marital satisfaction and women’s well-being are recommended.