Physical Fatigue Scores Research Articles

Transfusion policy after severe postpartum haemorrhage: a randomised non‐inferiority trial

To assess the effect of red blood cell (RBC) transfusion on quality of life in acutely anaemic women after postpartum haemorrhage. Randomised non-inferiority trial. Thirty-seven Dutch university and general hospitals. Women with acute anaemia (haemoglobin 4.8-7.9 g/dl [3.0-4.9 mmol/l] 12-24 hours postpartum) without severe anaemic symptoms or severe comorbidities. Women were allocated to RBC transfusion or non-intervention. Primary outcome was physical fatigue 3 days postpartum (Multidimensional Fatigue Inventory, scale 4-20; 20 represents maximal fatigue). Non-inferiority was demonstrated if the physical fatigue difference between study arms was maximal 1.3. Secondary outcomes were health-related quality of life and physical complications. Health-related quality of life questionnaires were completed at five time-points until 6 weeks postpartum. In all, 521 women were randomised to non-intervention (n = 262) or RBC transfusion (n = 259). Mean physical fatigue score at day 3 postpartum, adjusted for baseline and mode of delivery, was 0.8 lower in the RBC transfusion arm (95% confidence interval: 0.1-1.5, P = 0.02) and at 1 week postpartum was 1.06 lower (95% confidence interval: 0.3-1.8, P = 0.01). A median of two RBC units was transfused in the RBC transfusion arm. In the non-intervention arm, 33 women received RBC transfusion, mainly because of anaemic symptoms. Physical complications were comparable. Statistically, non-inferiority could not be demonstrated as the confidence interval crossed the non-inferiority boundary. Nevertheless, with only a small difference in physical fatigue and no differences in secondary outcomes, implementation of restrictive management seems clinically justified.

Relationship of health-related quality of life with fatigue and exercise capacity in patients with coronary artery disease

The study objective was to evaluate the relationship of health-related quality of life (HRQoL) with fatigue and exercise capacity in coronary artery disease (CAD) patients. A total of 1072 consecutive CAD patients on admission to a cardiac rehabilitation program were evaluated for HRQoL (36-item Short Form Medical Outcome Questionnaire; SF-36), body mass index, clinical characteristics (New York Heart Association (NYHA) class, angina pectoris class, coronary interventions, treatment with beta blockers, hypertension and diabetes), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Multidimensional Fatigue Inventory-20; MFI-20), and exercise capacity (bicycle ergometer test). In univariate regression analyses lower scores on all SF-36 domains were associated with greater scores on all MFI-20 subscales. Exercise capacity was associated with all SF-36 domains, except for social functioning and mental health domains. In multivariate regression analyses, after adjusting for age, gender, body mass index, NYHA class, angina pectoris class, hypertension, diabetes, coronary interventions, treatment with betablockers, and symptoms of depression and anxiety, greater limitation due to physical and due to emotional problems, poor social functioning, decreased energy/vitality, worse general health perception, reduced mental component summary and lower global SF-36 score were independently associated with higher MFI-20 general fatigue score. Reduced physical functioning, greater pain, and reduced physical component summary SF-36 scores were associated with greater MFI-20 physical fatigue score. Lower SF-36 mental health score was associated, with greater MFI-20 mental fatigue score. In CAD patients undergoing rehabilitation, poor HRQoL is associated with greater fatigue and decreased exercise capacity independently from mental distress and CAD severity score.

Effects of 8‐week body weight control program in public health center on self‐reported fatigue in Korean adult obese women

It was reported that self‐reported fatigue of women was higher compared to men and obesity per se lead to fatigue. So we investigated the effects of 8‐week body weight control program in public health center on self‐reported fatigue in obese women. The volunteer subjects (n=20) whose percent body fat was over 30 and lived in Incheon metropolitan city. Body composition was measured using Inbody 720 and serum lipid profiles and adipokines level were analyzed using automatic analyzer and ELISA, respectively. Self‐reported fatigue was determined using questionnaire of ‘subjective symptoms of fatigue test’ and higher fatigue scores indicate heavier self‐reported fatigue. After 8 weeks, average 2.7 kg body weight and 2.0 % body fat was decreased. Serum lipid profiles and adipokines level were not changed significantly after the program. There were significantly improved differences in physical fatigue score (p<0.05), mental fatigue score (p<0.01) and total fatigue score (p<0.05) between before and after the program. Especially, there were significantly decreased differences in the physical fatigue score of question such as “weary eyes” and “head feel heavy”, mental fatigue score of question such as “feel annoyance” and “not have confidence” and nervous fatigue score of question such as “feel dizzy” and “feel anyhow” between before and after the program These results suggest that 8‐week body weight control program in public health center had a positive effect on self‐reported fatigue as well as body composition.

Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial.

Background. Anxiety/depressive symptoms are common in patients with chronic fatigue syndrome- (CFS-) like illness. Qigong as a modality of complementary and alternative therapy has been increasingly applied by patients with chronic illnesses, but little is known about the effect of Qigong on anxiety/depressive symptoms of the patients with CFS-like illness. Purpose. To investigate the effects of Qigong on fatigue, anxiety, and depressive symptoms in patients with CFS-illness. Methods. One hundred and thirty-seven participants who met the diagnostic criteria for CFS-like illness were randomly assigned to either an intervention group or a waitlist control group. Participants in the intervention group received 10 sessions of Qigong training twice a week for 5 consecutive weeks, followed by home-based practice for 12 weeks. Fatigue, anxiety, and depressive symptoms were assessed at baseline and postintervention. Results. Total fatigue score [F(1,135) = 13.888, P < 0.001], physical fatigue score [F(1,135) = 20.852, P < 0.001] and depression score [F(1,135) = 9.918, P = 0.002] were significantly improved and mental fatigue score [F(1,135) = 3.902, P = 0.050] was marginally significantly improved in the Qigong group compared to controls. The anxiety score was not significantly improved in the Qigong group. Conclusion. Qigong may not only reduce the fatigue symptoms, but also has antidepressive effect for patients with CFS-like illness. Trial registration HKCTR-1200.

Fatigue in persons who have lived with spinal cord injury for &gt;20 years

This study aims to assess the prevalence of fatigue among persons who have lived with traumatic spinal cord injury (SCI) for >20 years, and to compare the results with fatigue scores found among the general population (GP). Another objective was to study the association between fatigue and clinical variables, including mental health, among the study population. A cross-sectional study. Sunnaas Rehabilitation Hospital (SunRH), Norway. All SCI survivors (n=237) admitted for rehabilitation at SunRH between 1961 and 1982 were asked to participate. Fatigue was measured with the Fatigue Questionnaire (FQ). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS). Linear regressions were used to examine those variables with the potential to contribute to fatigue. A total of 153 persons responded to the FQ, and in 39 cases the scores were consistent with fatigue. Surprisingly, the prevalence of fatigue (total fatigue (TF)) did not differ between the study population and the norm. However, the results indicated statistically significantly higher score of physical fatigue (PF) and statistically significantly lower score of mental fatigue among the SCI group when compared with the GP. Higher fatigue scores were associated with fatigue-causing pharmaceuticals and with higher scores on the HADS-depression subscale. The prevalence of fatigue was 25% among persons who had lived with SCI for >20 years, and similar to that in the GP. Our results point to medications and mental health aspects as possible contributors to PF severity in SCI.

The correlation between cancer the related fatigue and life quality among lung cancer patients

Objective To explore the relevant factors of cancer-related fatigue among lung cancer patients and the influence for their life quality.Methods Totals of 98 patients with lung cancer were selected and investigated with demographic information,Piper' s Revise fatigue scale (Revise-Pfs) to assessed the fatigue degree of lung cancer patients,Life Quality scale of cancer patients(QLQ-C30) to measured the life quality,then relevant factors were analysed.Results Among 98 cases,mild fatigue cases was 18.4％,moderate degree fatigue cases was 59.2％,severe fatigue cases was 22.4％.Fatigue score was(5.18±1.61),behavioral fatigue score was (5.66±2.22),emotional fatigue score was (5.36±2.26),physical fatigue score was(5.69±1.97),cognitive fatigue score was (4.11±1.81).The health score of patients was (51.02 ± 19.67) which had a medium level,mental function score ( 80.95 ± 16.01 ) and cognitive function score ( 81.97 ± 19.98) was the higher dimension score of function dimension,financial difficulty score( 58.50 ± 27.52)was the highest term score of symptom dimension.There were significant difference on the incidence cancer-related fatigue score among patients with different disease course and whether had religion ( t =5.979,F =3.251 ; P＜0.05 ).Patients with occupational status,age and clinical stage had different score of some dimensions in QLQ-C30,and patients' fatigue total score correlated with total health status and fatigue symptom(r =-0.425,0.303,respeetively;P＜0.01).Conclusions Cancer related fatigue of patients with lung cancer is the important factor influencing patients' life quality,so it is important to provided relative nursing intervention to relief patients' fatigue and to improve the quality of life of them. Key words: Lungs cancer; Life quality; Cancer related fatigue; Correlation

Fatigue in survivors of childhood acute lymphoblastic and myeloid leukemia in Japan

Fatigue in cancer survivors is a serious problem in pediatric oncology, but reports on this issue are limited, especially in Asian countries. Sixty-three patients with acute lymphoblastic leukemia and 18 patients with acute myeloid leukemia who attended a follow-up outpatient clinic were enrolled. Participants were required to be >8 years of age, in remission, and without any cancer treatment for at least the previous 1 year. A control group consisted of 243 subjects whose age and gender were matched with the patient group. A questionnaire consisting of 12 items was devised for fatigue measurement. Principal factor analysis identified three dimensions, defined as physical fatigue, decreased function, and altered mood. The mean total and the three fatigue dimension scores tended to be higher in the control group, but significant differences between the scores were seen only in the total and physical fatigue scores. Multiple regression analysis indicated an association of present older age or shorter duration after completion of treatment with total and physical fatigue, and an association of presence of total body irradiation with decreased function. Pediatric leukemia survivors in Japan experience equal or less fatigue compared with that of controls in different fatigue dimensions. Elucidation of underlying mechanisms of cancer-related fatigue including the differences of cultural background among different countries is necessary for future study of this issue.

Paulinia cupana (Guaraná) for the treatment of cancer related fatigue in patients undergoing radiation therapy or chemotherapy: a meta-analysis of three clinical trials

For cancer patients undergoing radiation therapy (RT) or systemic chemotherapy (CHT), cancer-related fatigue (CRF) is a common problem that can negatively impact their quality of life. Guarana (Paullinia cupana) is a plant native to the Amazon basin that has been used as a stimulant since pre-Columbian times. PURPOSE: To evaluate the effectiveness of guarana extract on fatigue in BC patients undergoing either CHT or RT. A total of 137 cancer patients (85% with Breast Cancer) undergoing either CHT (101) or RT (36) were randomized to receive either a placebo or guarana. In all 3 studies, the guarana was given as an unmanipulated dry extract at a dose of 75 mg PO QD in the first two studies or 50 mg PO BID in the third study. Patients were crossed over to the other experimental arm, and we evaluated fatigue with the Chalder Scale in all three studies. Guarana significantly improved the The Chalder Scale Global Scores (- 0.85; 95% CI:-1.31 to -0.40; p = 0.0002); Physical Fatigue Scores (-0.44; 95% CI: - 0.74 to - 0.13; p = 0.005) and Mental Fatigue Scores (-0.93; 95% CI: - 1.14 to - 0.72; p < 0.00001). Guarana did not produce any CTCAE grades 3 or 4 toxicities in any of the studies. Guarana is an effective, cheap and non-toxic alternative for the treatment of fatigue in cancer patients undergoing treatment.

Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients

Iron deficiency is the commonest cause of anaemia. It is apparent preoperatively in cardiac surgery patients and may influence transfusion requirements. In addition, iron deficiency per se is associated with fatigue. To determine the prevalence of preoperative iron deficiency and its association with perioperative anaemia, blood transfusions and fatigue in cardiac surgery patients. Academic hospital in Paris, France. One hundred consecutive patients without known iron disorder and scheduled for cardiac surgery were prospectively included in this observational study. No intervention was performed. A biological iron profile (transferrin saturation, ferritin, soluble transferrin receptor and C-reactive protein) was assessed on the day of surgery. Diagnosis of iron deficiency was defined using a previously published algorithm. Patient fatigue was assessed before surgery and 1 week afterwards (day 7) using the Multidimensional Fatigue Inventory (MFI-20) score that quotes five distinctive dimensions of fatigue. Thirty-seven out of 100 patients were diagnosed with iron deficiency. These patients were younger [median (first-third quartile) 63 (43-70) vs. 70 (59-77) years (P = 0.004)], and more often female (51 vs. 21%, P = 0.003), than no iron deficiency patients. Preoperative iron deficiency was associated with lower preoperative haemoglobin levels (P = 0.006) and higher perioperative transfusion rates during the first week (62 vs. 35%, P = 0.019). Patients with iron deficiency but without anaemia (n = 25) received more packed red blood cells units than those without iron deficiency or anaemia (n = 50) [2 (0-2) vs. 0 (0-0) units, P < 0.05). Preoperative iron deficiency was associated with higher score of physical fatigue on day 7 (P = 0.01). Preoperative iron deficiency is frequent among cardiac surgery patients and is associated with anaemia, higher transfusion requirements and postoperative fatigue.

The association between perceived fatigue and actual level of physical activity in multiple sclerosis

Background: Both fatigue and reduced physical activity are important consequences of multiple sclerosis (MS). However, their mutual association is poorly understood. Objective: The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS. Methods: Found associations were checked for confounding by age, Expanded Disability Status Scales (EDSS), disease duration, sub-type of MS, anxiety, and depression. Forty-three ambulatory patients with MS were recruited. Ambulatory physical activity was recorded for 24 hours. Fatigue was assessed with the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS) and the Checklist Individual Strength (CIS20R). Linear regression was applied after which potential confounding factors were introduced in a multivariate regression model. Results: No significant associations between physical activity and fatigue scores were found, except for the MFIS sub-scale ‘physical activity’ (ßphysical_activity [ßpa] = −0.044; SE = 0.020). The association between physical activity and the FSS score was distorted by age, MS-type, anxiety and depression and the association between physical activity and the MFIS score by age and depression. The inverse association between MFIS sub-scale ‘physical activity’ and physical activity was significantly strengthened by adjusting for age (ßpa = − 0.052; SE = 0.019), sub-type of MS (ßpa = − 0.048; SE = 0.020), anxiety (ßpa = − 0.070; SE = 0.023) and depression (ßpa = − 0.083; SE = 0.023). Conclusions: In MS, there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.

Paulinia cupana (Guarana) for the treatment of cancer-related fatigue in patients undergoing radiation therapy or chemotherapy: A meta-analysis of three clinical trials.

e19706 Background: For cancer patients undergoing radiation therapy (RT) or systemic chemotherapy (CHT), cancer-related fatigue (CRF) is a common problem that can negatively impact in their quality of life. Guarana (Paullinia cupana) is a plant native to the Amazon basin that has been used as a stimulant since pre-Columbian times. We wanted to evaluate the effectiveness of guarana extract on fatigue in patients undergoing either CHT or RT in three randomized placebo controlled with crossover trials. Methods: 137 cancer patients (85% with breast cancer) undergoing either CHT (101) or RT (36) were randomized to receive either placebo or guarana. In all three studies, guarana was given as an unmanipulated dry extract at a dose of 75 mg PO QD in the first two studies or 50 mg PO BID in the third study. Patients were crossed over to the other experimental arm, and fatigue was evaluated with the Chalder Scale in all three studies. Results: Guarana significantly improved the Chalder Scale Global Scores (-0.75; 95% CI: -1.03 to -0.47; p < 0.00001; heterogeneity p = 0.07 ); Physical Fatigue Scores (-0.73; 95% CI: -1.01 to -0.45; p < 0.00001; heterogeneity p < 0.001) and Mental Fatigue Scores (-0.94; 95% CI: -1.12 to -0.76; p <0.00001; heterogeneity p = 0.97). Guarana did not produce any CTCAE grades 3 or 4 toxicities in any of the studies. Conclusions: Dry guarana extract is an effective, cheap and non-toxic alternative for the treatment of fatigue in cancer patients undergoing oncologic treatment. We believe that Guaraná's positive effects in mental fatigue were very consistent and significant and warrant further investigation.

A study of fatigue status in Chinese adolescents in an urban city, Jixi

The aim of the study was to clarify the charac-teristics of fatigue status in Chinese adolescents. 1018 adolescents (490 males, 528 females) aged 12 or 15 years in Jixi city were enrolled. Between May and September 2009, fatigue status was investigated using a questionnaire devised by ourselves, which consisted of 4 physical and 4 mental fatigue items. These questions were scored from 0 to 3 based on the frequency of an item occurring, given as the average of the past one month, and the fatigue scores were calculated. Lifestyle issues such as daily sleep duration, feeling of refreshment in the morning after wake-up, extracurricular sports activity, and breakfast intake, and a physical examination such as height, weight, and waist circumference were also investigated. Physical and mental fatigue scores were significantly higher in subjects aged 15 yrs old than in those aged 12 yrs old in both genders. These scores in females were significantly higher than those in males at the age of 15 yrs. Multivariate regression analysis showed that total (physical plus mental) fatigue scores were associated with female gender and various lifestyles such as unrefreshed wake-up feeling, poor extracurricular sports activity, and more frequent skipping of breakfast. However, body mass index and waist circumference were not associated with total fatigue scores.

Effects of a gliadin-combined plant superoxide dismutase extract on self-perceived fatigue in women aged 50–65 years

Fatigue syndromes exist on a continuum of severity from mild and transient to the disabling chronic fatigue syndrome, with oxidative stress linked to its pathogenesis. A thermolabile gliadin-combined plant superoxide dismutase (SOD) extract has shown potential in clinical trials as a therapeutic antioxidant. This study investigated the effects of 12 weeks of 500 mg/day of a SOD/gliadin supplement on fatigue. Thirty-eight women aged 50-65 years with self-perceived fatigue entered this randomized, double-blind, placebo-controlled trial. The primary outcome measure was general fatigue determined by the Multidimensional Fatigue Inventory (MFI). Secondary outcome measures included other measures of fatigue from the MFI and blood measures of oxidative stress, antioxidant status and hormones. There were no significant (P>0.05) differences between, or within groups, for decreases in general fatigue (active=1.6%, placebo=4.1%). There were no within or between group differences (P>0.05) in other measures of fatigue (physical fatigue, reduced activity, reduced motivation, mental fatigue and total fatigue score). In regard to the biochemical measures, there were non-significant (P>0.05) differences in increases in plasma SOD activity (active=7.1%, placebo=12.2%), plasma GPx activity (active=2.4%, placebo=0.7%), red blood cell GPx activity (active=9.8%, placebo=4.4%). Markers of oxidative stress were decreased but there were no differences (P>0.05) within or between groups; malondialdehyde (active=4.1%, placebo=1.6%), F-2 isoprostanes (active=14.7%, placebo=22.4%). There was a trend (P=0.08) for a decrease in cortisol in the active group (24.6%), however this was not significantly different from the decrease in the placebo participants (4.1%). DHEA differences were not significant (P<0.05) and declined 1.3% in the active group and 14.4% in the placebo group. In summary, the thermolabile SOD/gliadin supplement had no significant effect on self-perceived fatigue, antioxidants, oxidative stress or hormones in women aged 50-65 years.

Fatigue and plasma cytokine concentrations at rest and during exercise in patients with sarcoidosis

Patients with sarcoidosis exhibit exercise intolerance-related fatigue and increased levels of circulating proinflammatory cytokines at rest. Exercise may result in increased plasma cytokine levels (PCLs) in healthy adults, but such a relationship has not been studied in sarcoidosis patients. To assess relationship of fatigue in sarcoidosis with PCLs at rest and with cardiopulmonary exercise testing (CPET). We assessed lung function, CPET data, multidimensional fatigue inventory, plasma tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) concentrations before, immediately after, and 4-6 h following CPET in 22 sarcoidosis patients (13 receiving immunomodulatory drugs) and 22 controls. Patients exhibited greater fatigue, reduced cardiorespiratory function, higher Medical Research Council (MRC) scores and higher plasma TNF-α concentrations than controls at all times. Plasma IL-1β levels did not differ between cohorts. Patients exhibited a 28% increase (statistically not significant) in TNF-α level immediately post exercise. Plasma IL-β concentrations did not change among cohorts. Treated patients exhibited higher MRC and physical fatigue scores and lower breathing reserve, but no differences in cardiorespiratory function or PCLs compared to untreated patients. In treated patients, pre-exercise plasma IL-1β correlated with physical fatigue, reduced motivation and total fatigue; TNF-α levels only correlated with general fatigue score. Treated sarcoidosis patients exhibit a relation between physical fatigue, reduced motivation and total fatigue and pre-exercise plasma IL-1β concentrations. Acute exercise does not increase PCLs. Whether the reduced MRC score and physical fatigue in treated patients is related to the therapy or to the underlying inflammatory process is difficult to determine.

Prognostic Value of Changes in Health-Related Quality of Life Scores During Curative Treatment for Esophagogastric Cancer

Accumulating evidence suggests that health-related quality of life (HRQL) data before treatment predict survival, but the prognostic value of changes in HRQL scores after treatment is unknown. The aim of this study was to explore whether changes in HRQL scores in esophagogastric cancer predict survival. Consecutive patients undergoing curative treatment completed HRQL questionnaires (EORTC QLQ-C30) at baseline and after six months and were followed up for at least five years. Cox proportional hazard models with adjustments assessed associations between baseline HRQL and survival and between changes in HRQL before and after treatment and survival. Overall, 216 patients initiated curative therapy, of whom 169 completed treatment and survived 6 months. Of these, 132 (7%) had two complete HRQL assessments. Analyses adjusted for age, sex, performance status, tumor stage, and disease site revealed that a 10-point poorer dyspnea score at baseline was significantly associated with an 18% higher risk of death. Additional analyses to adjust for baseline HRQL and treatment showed that a 10-point change in physical function (hazard ratio [HR], 0.85; 95% CI, 0.76 to 0.96; P = .007), pain (HR, 1.20; 95% CI, 1.09 to 1.33; P < .001), and fatigue (HR, 1.16; 95% CI, 1.04 to 1.30; P = .009) scores was associated with better survival. This exploratory study found longer survival beyond the 6 months after starting treatment to be associated with fewer problems with dyspnea before treatment and better recovery of physical function, pain, and fatigue after treatment. More research to confirm these findings and understand the results is needed.

Fatigue Status in Relation to Lifestyle in Healthy Japanese Adolescents

In order to investigate the prevalence of physical, mental, and chronic fatigue syndrome-(CFS-) related fatigue and its relation to lifestyle, 1,225 adolescents (591 males, 634 females) aged 11 to 16 years were asked to complete a self-reported questionnaire on fatigue status and lifestyle in the past one month. There was no gender difference in physical and mental fatigue scores, but CFS-related scores were significantly higher in females than in males. These scores were found to increase with the increase of age. After adjusting for age and gender, multiple regression analysis showed that physical and mental fatigue scores were associated with sleeping hours, extracurricular sports activity, food balance, the frequencies of snacks between regular meals, intake of sugar-sweetened beverages, and visits to the nurse's room. This paper is the first large cross-sectional study on fatigue in healthy adolescents in Japan, albeit there were numerous such studies in Western countries.

Biopsychosocial determinants of physical and mental fatigue in patients with spondyloarthropathy

The objectives of this study are to characterize fatigue in patients with spondyloarthropathy (SpA) using a multidimensional assessment and to delineate contributors to dimensions of fatigue. Fatigue in 125 participants with SpA was assessed using the Multidimensional Fatigue Inventory (MFI-20). Participants completed standardized questionnaires assessing sleep quality, depressed mood, perceived stress, social support, leisure time physical activity, functional capacity, and disease activity. Hierarchical multiple regressions were computed to identify contributors to physical and mental fatigue. Patients scored high on all five MFI-20 fatigue dimensions, with general fatigue and physical fatigue having the highest scores. A hierarchical multiple regression showed that worse functional capacity, greater perceived stress, more depressed mood and less participation in leisure time physical activity contributed to higher physical fatigue scores. The results of the second model found depressed mood to be the strongest determinant of mental fatigue, followed by poorer sleep quality and younger age. These findings indicate that fatigue in SpA is a multidimensional experience, with physical and mental aspects likely having different etiologies. A number of variables potentially amenable to treatment were found to be associated with physical and mental fatigue. A multidimensional assessment of fatigue in SpA is needed to tailor and optimize interventions aimed at alleviating fatigue.

Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items.

BackgroundThe use of global health items permits an efficient way of gathering general perceptions of health. These items provide useful summary information about health and are predictive of health care utilization and subsequent mortality.MethodsAnalyses of 10 self-reported global health items obtained from an internet survey as part of the Patient-Reported Outcome Measurement Information System (PROMIS) project. We derived summary scores from the global health items. We estimated the associations of the summary scores with the EQ-5D index score and the PROMIS physical function, pain, fatigue, emotional distress, and social health domain scores.ResultsExploratory and confirmatory factor analyses supported a two-factor model. Global physical health (GPH; 4 items on overall physical health, physical function, pain, and fatigue) and global mental health (GMH; 4 items on quality of life, mental health, satisfaction with social activities, and emotional problems) scales were created. The scales had internal consistency reliability coefficients of 0.81 and 0.86, respectively. GPH correlated more strongly with the EQ-5D than did GMH (r = 0.76 vs. 0.59). GPH correlated most strongly with pain impact (r = −0.75) whereas GMH correlated most strongly with depressive symptoms (r = −0.71).ConclusionsTwo dimensions representing physical and mental health underlie the global health items in PROMIS. These global health scales can be used to efficiently summarize physical and mental health in patient-reported outcome studies.

Arousal frequency is associated with increased fatigue in obstructive sleep apnea.

ObjectiveFatigue is an important and often underemphasized symptom in patients with obstructive sleep apnea (OSA). Sleep fragmentation, i.e., arousals and disruptions in sleep architecture, is common in patients with OSA and may potentially contribute to their fatigue. We hypothesized that arousal frequency and changes in sleep architecture contribute to the fatigue experienced by patients with OSA.DesignSeventy-three patients with diagnosed but untreated OSA (AHI ≥ 15) were enrolled in this study. A baseline polysomnogram was obtained, and fatigue was measured with the Multidimensional Fatigue Symptom Inventory-short form (MFSI-sf). We evaluated the association between fatigue and arousals and various polysomongraphic variables, including sleep stages and sleep efficiency.ResultsSignificant correlations between MFSI-sf subscale scores and various arousal indices were noted. Emotional fatigue scores were associated with total arousal index (r = 0.416, p = .021), respiratory movement arousal index (r = 0.346, p = .025), and spontaneous movement arousal index (r = 0.378, p = .025). Physical fatigue scores were associated with total arousal index (r = 0.360, p = .033) and respiratory movement arousal index (r = 0.304, p = .040). Percent of stage 1 sleep and REM sleep were also associated with physical and emotional fatigue scores. Hierarchal linear regression analysis demonstrated that emotional fatigue scores were independently associated with spontaneous movement arousals after controlling for age, body mass index, depression, and sleep apnea severity.ConclusionsThese findings suggest that arousals may contribute to the fatigue seen in patients with OSA.

Effects of home-based exercise on fatigue in postpartum depressed women: Who is more likely to benefit and why?

Objectives (1) To explore moderators of the effects of home-based exercise on reductions in physical and mental fatigue scores in postpartum depressed women and (2) to explore mediators of the intervention on changes in physical fatigue. Method Eighty-eight women in the postpartum period (4–38 weeks) obtaining a score ≥10 on the Edinburgh Postnatal Depression Scale were randomly assigned to a 12-week individualized home-based exercise intervention ( n=46) or a no-treatment control group ( n=42). The present analyses include the 35 women who adhered to the intervention and the no-treatment control group. Participants completed a cardiovascular fitness test, and a battery of questionnaires assessing the outcomes (Physical and Mental Fatigue) as well as potential moderators and mediators at baseline and posttreatment. Results Hierarchical linear regressions evaluating moderators of changes in mental fatigue with exercise showed that the intervention was effective for women entering the study later in the postpartum period ( P=.001) and women with higher depression scores ( P=.014). Reductions in physical fatigue with exercise were partially mediated by reductions in perceived stress and increased exercise-related energy expenditure. Conclusion Identification of moderators allows for the tailoring of exercise interventions to particular subgroups of women that are most likely to benefit. The identified mediators may be enhanced and directly tested in future trials.