Self-report Measures Of Fatigue Research Articles

QOL-39. FATIGUE AS A RISK FACTOR FOR REDUCED SOCIAL CONNECTEDNESS IN PEDIATRIC BRAIN TUMOR SURVIVORS

Abstract BACKGROUND Pediatric brain tumor survivors (PBTS) experience reduced social connectedness, including fewer friendships, less social acceptance, and greater isolation. Identifying modifiable factors contributing to social issues would yield treatment opportunities. Fatigue is common among PBTS and may relate to social challenges. This study evaluated fatigue among PBTS and its associations with various indices of social connectedness. METHODS Survivors (N = 34) of three types of brain tumors—medulloblastoma (N = 11), pilocytic astrocytoma (N = 15), and craniopharyngioma (N = 8)—completed self-reported measures of fatigue and social connectedness. Laboratory studies assessed thyroid function and growth hormone status. Caregivers completed measures of social functioning. Descriptive statistics summarized fatigue and endorsement of fatigue items. ANOVAs, t-tests, and Pearson correlations evaluated fatigue according to various medical factors, and Pearson correlations evaluated associations between self-reported fatigue and indices of social connectedness. RESULTS Over 20% of survivors reported elevated fatigue, with 53% and 35% indicating fatigue interfering with attention and socialization, respectively. We did not detect associations between self-reported fatigue and diagnosis, current age or age at diagnosis, time since end of treatment, or history of chemotherapy or cranial radiation therapy. We did not detect an association between BMI Z-score and collected hormones. Mean T scores on the self-reported peer relationships measure were below the reference mean (M = 45.8, SD = 11.9), with 22% of survivors endorsing concerns. Higher self-reported fatigue was significantly correlated with poorer self-reported peer relationships (r = -.62, p < 0.001) and more parent-reported social impairments (r =.61, p < 0.001). CONCLUSIONS Fatigue is common among PBTS and may interfere with peer relationships. Clinicians should screen for fatigue as a risk factor for reduced social connectedness. Further research is needed to identify predictors of fatigue and social difficulties and determine temporal associations between fatigue and social connectedness.

Outcomes of a Fatigue Management Intervention for People With Post COVID-19 Condition.

Fatigue is identified as one of the most prevalent and persistent problems reported by people with post COVID-19 condition that negatively impacts on everyday living and resumption of pre-COVID-19 lifestyle. A pilot occupational therapy fatigue management intervention was designed for patients presenting with post COVID-19 condition fatigue. A retrospective analysis was carried out after the delivery of the fatigue management intervention. Self-reported measures of fatigue, well-being, and health status were taken at baseline and repeated at 2 wks after intervention. Baseline and postintervention scores were compared using nonparametric analysis. Sixty participants (73% female), median age 50.5 yrs (range, 17-74), 93% reporting symptoms persisting for 12 wks or longer, completed the fatigue management intervention. All participants reported moderate to severe fatigue impacting on everyday activity at baseline. The greatest impact of fatigue was on engagement in leisure and work activity. Statistically significant improvement in fatigue ( P < 0.001), well-being ( P < 0.001), and health status ( P < 0.001) were noted after the intervention. Findings indicate the potential of occupational therapy fatigue management interventions to enable self-management strategies and reduce the negative impact of fatigue among people with post COVID-19 condition.

Assessment of Sleep Disturbances and Sleep Disordered Breathing in Primary Immunodeficiency Disorders

IntroductionPatients with primary immunodeficiency disorders (PIDD) have lower health related quality of life (HRQoL) compared to the general population. Fatigue is a predominant symptom for PIDD patients and previous publications have demonstrated increased self-reported measures of fatigue in this population, including PROMIS-29 scores. Fatigue is also seen in patients with sleep related disorders including sleep disordered breathing (SDB). Thus, we examined the prevalence of sleep disturbances and SDB in patients with PIDD. MethodsPatients from our institution with a physician-confirmed diagnosis of PIDD were recruited for this IRB-approved study. Patients under 18 years of age, currently pregnant, or with previous diagnosis of SDB were excluded. Patients completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires via REDCap. Patients then completed a home sleep apnea test (HSAT) using the Watch-PAT One device. ResultsA total of 24 patients with PIDD were enrolled in the study. Median age was 49.4 (range: 22.5–68.7) years, 18/24 (75%) patients were female. 22 out of 24 patients completed the questionnaires. Median values for PSQI, ESS, and FSS were 9.0 (2–18), 7.5 (0–20), and 4.9 (1.0–7.0), respectively. The median PROMIS Fatigue score was 57.9 (33.7–75.8). 14 out of 24 patients completed HSATs at the time of abstract submission. Sleep disordered breathing was defined as having an apnea-hypopnea index (AHI) of 5 events/hour or greater. For patients who completed HSATs, 10 (71%) met the threshold for having SDB. Based on guidelines established by the American Academy of Sleep Medicine, 6 (43%) had mild SDB, 3 (21%) had moderate SDB, and 1 (7%) had severe SDB. ConclusionPatients with an established diagnosis of PIDD, without previously diagnosed SDB, show a higher burden of poor sleep quality, daytime sleepiness, and fatigue based on scoring of self-reported questionnaires as compared to the general population. Overall, these patients were also noted to have a higher burden of sleep disordered breathing. These results provide preliminary evidence that undiagnosed sleep disturbances and SDB may contribute to the increased burden of fatigue in patients with PIDD.

Characterizing Fatigue Subtypes in Adolescents with Chronic Musculoskeletal Pain and Pain-Free Controls.

ContextGeneral fatigue, sleep-related fatigue, and cognitive fatigue are prevalent and disruptive in adults with chronic musculoskeletal (MSK) pain, but little is known about these fatigue subtypes in pediatric musculoskeletal pain.ObjectiveTo compare fatigue and its subtypes between adolescents with chronic MSK pain and pain-free controls and to test if fatigue subtypes were associated with concurrent pain and its impact (pain intensity, number of pain sites, pain interference, and functional disability) or experimental pain (intensity and tolerance) in adolescents with chronic MSK pain. Finally, we sought to explore adolescents’ qualitative characterizations of their fatigue.MethodsAdolescents with chronic MSK pain (12–17 y.o., n = 26) and pain-free controls (n = 26) completed validated self-report measures of fatigue, pain, and functional disability, underwent an experimental pain tolerance task (cold water immersion of the hand), and provided qualitative descriptions of their fatigue (pain group only).ResultsAdolescents with chronic MSK pain reported significantly greater general, sleep-related, and cognitive fatigue than pain-free controls (all p’s < 0.001). In adolescents with chronic MSK pain, fatigue subtypes were associated with clinical pain and pain impact (r’s = 0.43–0.84) but not experimental pain measures (p’s > 0.05). Adolescents with chronic MSK pain qualitatively described the negative implications of the different fatigue subtypes, particularly when perceived as long-lasting.ConclusionThis preliminary study suggests that fatigue subtypes are prevalent and impactful in pediatric patients with chronic MSK pain. When planning multi-disciplinary treatment for pediatric MSK pain, providers should recognize fatigue as another disabling symptom.

Impact of community-based exercise on fatigue in early breast cancer survivors: identifying potential determinants of change.

Exercise has been shown to reduce fatigue in early breast cancer survivors (EBCS), though it is unclear if these results translate to community-based exercise settings. Mechanisms that influence changes in fatigue seen after exercise are also poorly understood. This study sought to evaluate the impact of community-based exercise and identify associations of fatigue in EBCS. Twenty-nine EBCS and 13 non-cancer controls (CON) enrolled. Pre/post-intervention measurements included measures of fitness/function, balance, and adherence/compliance as well as self-reported measures of fatigue, health-related quality of life (HRQOL), well-being, self-efficacy, and physical activity. Both groups participated in a supervised 16-week aerobic + resistance exercise intervention. A mixed model ANOVA and Cohen's D effect size assessed fatigue changes, and univariable linear regressions identified fatigue associations. Fatigue improved for EBCS (- 2.6, Cohen's D = 0.51) but not CON (0.0, Cohen's D = 0.02); no interaction effect was observed. Post-intervention fatigue in EBCS was associated with better QOL (R2 = 0.387; p < 0.01), depression (R2 = 0.251; p < 0.01), self-efficacy, (R2 = 0.453; p < 0.01), outcome expectations from exercise (R2 = 0.254; p < 0.01), balance (R2 = 0.167; p < 0.05), and the6-minute walk test (R2 = 0.193; p < 0.05). EBCS improvements in fatigue were associated with improvements in self-reported physical health (R2 = 0.425; p < 0.01), depression (R2 = 0.233; p < 0.01), pain (R2 = 0.157; p < 0.05), outcome expectations from exercise (R2 = 0.420; p < 0.01), and the6-minute walk test (R2 = 0.172; p < 0.05). Less fatigue in the CON group was shown be associated with better sleep quality (R2 = 0.309; p < 0.05) and pain (R2 = 0.259; p < 0.05). Community-based exercise appears beneficial for alleviating fatigue in EBCS. These improvements may be driven by parallel improvements in psychosocial outcomes and objectively measured functional outcomes.

Cross-sectional study of the effects of self-efficacy on fatigue and pain interference in black women with systemic lupus erythematosus: the role of depression, age and education

ObjectiveWhile fatigue and pain are pervasive symptoms in SLE, self-efficacy can mitigate their intensity and impact on patients’ daily activity. We examined the relationships of these domains and their interactions...

Motivational interviewing intervention for increasing physical activity and improving dietary behaviors: The Lupus Intervention Fatigue Trial protocol

The Lupus Intervention Fatigue Trial (LIFT) is a prospective, randomized controlled trial to assess the effectiveness of a six-month motivational interviewing intervention program versus an educational control to reduce fatigue in persons with systematic lupus erythematosus (SLE). Participants are randomized using a stratified, 1:1 allocation design to the LIFT intervention or control arm. We plan to enroll 236 participants to achieve the target of 200 persons with six-month follow-up for the primary endpoint. Specific aims of this study are to evaluate the impact of the LIFT intervention on 1) self-reported measures of fatigue and 2) impact on accelerometer-measured physical activity. The primary study outcome is six-month change in fatigue from baseline, assessed by the Fatigue Severity Score (FSS). Additional outcomes include objective measures of physical activity, including non-sedentary behavior and moderate-to-vigorous activity (secondary outcome), and adherence to the LIFT dietary intervention, as assessed by nutrient density (diet quality) and recommended food groups/eating patterns (exploratory outcome) in persons with SLE. Intervention effectiveness will be assessed using an intention-to-treat two-arm comparison of six-month change in FSS, with one interim monitoring analysis. A two-sample independent group t-test will compare the six-month changes in FSS between the study arms. Intervention effect durability will be assessed 12-months after baseline (6 months after completion of the intervention). Enrollment began in June 2019 and is expected to end in June 2023. This study will inform future intervention strategies that promote physical activity and improved diet quality to reduce fatigue in persons with SLE.

Cognitive performance, fatigue, emotional, and physiological strains in simulated long-duration flight missions

ABSTRACT Pilots in long-duration flight missions in single-seat aircraft may be affected by fatigue. This study determined associations between cognitive performance, emotions and physiological activation and deactivation – measured by heart rate variability (HRV) – in a simulated 11-h flight mission in the 39 Gripen aircraft. Twelve participants volunteered for the study. Perceived fatigue was measured by the Samn-Perelli Fatigue Index (SPFI). Cognitive performance was measured by non-executive and executive tasks. Emotions were assessed by the Circumplex Affect Space instrument. HRV was considered in relation to the cognitive tasks in four time points – Hours 3, 5, 7, 9 – and their associations with emotional ratings. Results indicated a decrease in performance in the non-executive task after approximately 7 h. This result was correlated with self-reported measures of fatigue. HRV, assessed by indices of parasympathetic modulation, remained unchanged for both non-executive and executive tasks over time (p > .05 for all). Significant correlations were observed between emotions and HRV; with increased boredom, increased passiveness, decreased stimulation, and decreased activeness, HRV indicators increased (p < .05). This suggests that a low self-regulatory effort for maintaining performance in these conditions was prevalent and that pilots could adapt to some degree to the demands and fatigue of long-duration missions.

Social Cognitive Theory variables as correlates of physical activity in fatigued persons with multiple sclerosis

BackgroundThere is interest in the application of behavioral interventions based on theory for increasing physical activity among adults with multiple sclerosis (MS). To date, researchers have applied theory such as Social Cognitive Theory (SCT) for identifying correlates of physical activity that can then inform the design and delivery of behavioral interventions. Such research often has been conducted in heterogeneous samples of persons with MS without a focus on those with a specific symptom, such as fatigue, that may be targeted by physical activity behavioral interventions. To that end, this study examined SCT variables (i.e., self-efficacy, barriers, outcome expectations, goal-setting, planning, social support, and functional limitations) as correlates of physical activity in persons with MS who self-reported elevated fatigue. MethodsPersons with MS (N=210; aged 49.6[13.2] years) who ambulated with or without assistance participated in the study. Participants completed self-report measures of fatigue, physical activity, and SCT variables and wore an ActiGraph GT3X+ accelerometer on a belt around the waist for 7 days. The accelerometer data were processed and delineated into time spent in light and moderate-to-vigorous physical activity (MVPA) based on MS-specific cut-points. We generated groups of fatigued (n=134) and non-fatigued (n=76) persons with MS based on the cut-off score of 4 for the Fatigue Severity Scale. ResultsThere were differences in physical activity and SCT variables between fatigued and non-fatigued persons with MS. Among those with fatigue, functional limitations (ρ=0.52), self-efficacy (ρ=0.31), and goal-setting (ρ=0.25) were associated with device-measured MVPA, and all SCT variables except outcome expectations were associated with self-reported physical activity. The regression analyses indicated self-efficacy, functional limitations, and goal-setting as significant correlates of MVPA in those with fatigue. ConclusionSelf-efficacy, goal-setting, and social support may be important targets of SCT-based behavioral interventions for increasing physical activity among persons with MS who have fatigue.

A Greek Validation Study of the Multiple Sclerosis Work Difficulties Questionnaire-23.

The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. The study sample consisted of 196 PwMS, all currently working in part- or full-time jobs. Participants underwent clinical examination and cognitive screening with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and completed self-report measures of fatigue, psychological functioning, and quality of life, along with the MSWDQ-23 questionnaire. Confirmatory Factor Analysis (CFA) was performed, and goodness-of-fit measures were used to evaluate construct validity. Convergent validity was checked by correlating MSWDQ-23 scores with study measures. Cronbach’s alpha value was produced to assess internal consistency. CFA yielded a model with a fair fit confirming the three-factor structure of the instrument. Higher work difficulties were associated with higher Expanded Disability Status Scale (EDSS) scores, poorer cognitive function, more fatigue, stress, anxiety, and depression, and poorer health status, supporting the convergent validity of MSWDQ-23. Internal consistency (Cronbach’s alpha = 0.94) and test–retest reliability (ICC = 0.996, 95%, CI = 0.990–0.998) were excellent. The Greek MSWDQ-23 can be considered a valid patient-reported outcome measure and can be used in interventions aiming to improve the vocational status of PwMS.

Fatigue Perpetuating Factors as Mediators of Change in a Cognitive Behavioral Intervention for Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia: A Pilot Study.

Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) has demonstrated preliminary efficacy in reducing fatigue in patients treated with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML). The aim of the current analyses was to explore whether fatigue perpetuating factors (disturbed sleep/wake cycle, dysregulated activity patterns, maladaptive cognitions about fatigue and cancer, insufficient processing of cancer and treatment, inadequate social support and interactions, heightened fear of cancer progression) changed over time in patients receiving CBT-TTF, and whether the effect of CBT-TTF on fatigue was mediated by these factors. Secondary data analyses were conducted from a pilot randomized controlled trial. Patients with CML treated with a TKI who reported moderate to severe fatigue were randomized 2:1 to CBT-TTF delivered via FaceTime for iPad or a waitlist control condition (WLC). Self-report measures of fatigue and fatigue perpetuating factors were obtained before randomization and post-intervention (i.e., approximately 18 weeks later). Mixed model and mediation analyses using bootstrap methods were used. A total of 36 participants (CBT-TTF n = 22, WLC n = 14) who had baseline and 18-week follow-up data and attended >5 sessions for CBT-TTF were included. Participants randomized to CBT-TTF reported improvements in activity (mental, physical, social, p's ≤ .023) and cognitions (helplessness, catastrophizing, focusing on symptoms, self-efficacy, p's ≤ .003) compared to WLC. Mental activity, social activity, self-efficacy, helplessness, and focusing on symptoms, as well as sleep and insufficient processing (avoidance) mediated the relationship between treatment group and fatigue. CBT-TTF appears to improve TKI-related fatigue in CML patients through changes in behavior (sleep, activity patterns) and cognitions about fatigue and cancer. A larger randomized controlled trial is warranted to confirm these findings.

Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis.

ObjectiveThe aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA.MethodsA systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case–control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571).ResultsTwenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue.ConclusionTargets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations.

Salivary Immunoendocrine and Self-report Monitoring Profiles across an Elite-Level Professional Football Season.

This investigation examined the longitudinal changes and interrelationships of salivary and self-report monitoring measures across a professional football season. Measures were collected biweekly from 18 senior professional male players across a 6-wk preseason and eight 5-wk in-season mesocycles and analyzed using a linear mixed-effects model. Analysis identified a small (P = 0.003) cross-season suppression of salivary immunoglobulin A, small reductions to salivary α-amylase (P = 0.047) and salivary cortisol (P = 0.007), and trivial changes to salivary testosterone (P > 0.05). The testosterone/cortisol ratio typically responded inversely to changes in player workload. Self-report measures of fatigue (P = 0.030), sleep quality (P = 0.003), and muscle soreness (P = 0.005) improved (ES = small) across the first half of the season. Fatigue and sleep measures were most consistently related to hormonal measures (R2 = 0.43-0.45). For these relationships, increases in cortisol were associated with compromised self-report responses, whereas increases in testosterone/cortisol were associated with improved responses. Nonlinear relationships were identified for fatigue with immunoglobulin A (P = 0.017; ES = trivial) and testosterone (P = 0.012; ES = trivial), for sleep quality with testosterone (P < 0.001; ES = trivial), for muscle soreness with testosterone (P = 0.012; ES = trivial), and for the self-report inventory sum with testosterone (P = 0.027; ES = trivial). For these relationships, self-report responses were optimal at mean immunoglobulin A and testosterone levels, and very low levels (-2 SD) exerted the most compromising effects. Players can experience a chronic cross-season suppression of mucosal immunity. Salivary immunoglobulin A, testosterone, cortisol, and testosterone/cortisol measures relate to self-report measures of fatigue, sleep quality, and muscle soreness. In-season reductions in testosterone, cortisol, and testosterone/cortisol or increases in cortisol among elite football players could be used to indicate the need for reduced workload, which might lead to improved well-being.

Fatigue and Associated Symptoms in Patients with a Primary Brain Tumor

Purpose: To determine the prevalence and predictors of fatigue in clinically stable primary brain tumor patients, we used objective and subjective measures and a cross-sectional design. Methods: Eighty-five brain tumor patients completed self-report measures of fatigue, sleep disturbance, mood and growth hormone deficiency. Objective measures of sleep, cognition and neurological function were carried out. Comparisons were made between patients with no-mild, moderate and severe fatigue. Results: Sixty-seven per cent of patients (n=57) were experiencing moderate or severe fatigue at the time of assessment. Statistically significant differences between no-mild, moderate and severe fatigue groups were found when examining percentage daytime activity (p=0.035), processing speed (p = 0.0006), anxiety (p=0.008), depression (p&lt;0.0001), neurological function (p&lt;0.0001), growth hormone deficiency (p&lt;0.0001) and epileptic drug type (p=0.011). Memory, executive function and verbal fluency were not found to significantly differ across groups. Sleep duration and efficiency were not correlated with fatigue. Using regression analysis, anxiety and neurological function predictors were independently found to be associated with fatigue (p=0.017 and p=0.0003 respectively). Conclusions: Findings suggest neurological function and anxiety independently contribute to fatigue in stable brain tumor patients. A ‘neurological model’ may offer a better understanding of fatigue in the brain tumor population than a ‘cancer model’. This study supports the recommendation of a core data set for assessing fatigue that includes a measure of neurological function, alongside patient perceptions of causation (physical and mental fatigue). This may potentially be helpful in selecting treatment options or in interpretation of drug trials of fatigue.

Fatigue in patients on oral targeted or chemotherapy for cancer and associations with anxiety, depression, and quality of life.

Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described. At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy - General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests. At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. -19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue. One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.

Predictive Models of Cognitive Fatigue in Multiple Sclerosis.

Cognitive fatigue (CF) can be defined as decreased performance with sustained cognitive effort. The present study examined the interrelatedness of disease severity, fatigue, depression, and sleep quality in order to evaluate their predictive roles of CF in MS. Four theoretical models examining these variables were assessed. Fifty-eight individuals with a diagnosis of MS were recruited. CF was measured by examining last third versus first third performance on the Paced Auditory Serial Addition Test (PASAT). The PASAT and self-report measures of fatigue, depression, and sleep quality were administered. Path analysis was used to evaluate each of the models. CF was correlated only with depression (r = .362, p = .006) and sleep quality (r = .433, p = .001). Sleep quality was the greatest significant independent predictor of CF (β = .433, t(1,55) = 3.53, p < .001), accounting for 17.3% of the total variance. The best fitting model showed sleep quality as the largest contributor to CF; however, depression played a smaller predictive role. Furthermore, depression emerged as the strongest predictor of sleep quality and fatigue. Disease severity weakly predicted depression. Sleep quality is the most significant predictor of CF in MS. As such, sleep quality may be a treatable cause of CF. Sleep quality itself, however, accounted for only 17.3% of the variance in CF suggesting that other variables which were not formally assessed in this sample (e.g., anxiety, etc.) may also play a predictive role. Follow-up studies should evaluate how results may differ with a larger sample size.

Fatigue and Sleep in Multiple Sclerosis Patients: A Comparison of Self-Report and Performance-Based Measures.

Multiple sclerosis (MS) patients suffer very often from MS fatigue and sleep problems. Despite the detrimental impact on the activities of daily living, a short and objective quantification of fatigue and sleep problems is currently lacking. The objective of the study was to systematically investigate tonic, intrinsic, and phasic alertness and the relationship of these performance-based measures with self-report measures of fatigue and quality of sleep. Thirty-three MS patients without (MS-) and 26 with selected comorbid disorders (MS+) and 43 healthy controls (HCs) performed the pupillographic sleepiness test (measuring tonic alertness) and the alertness subtest of the Test of Attentional Performance (measuring intrinsic and phasic alertness). Self-reported and performance-based measures revealed poorer performance for both MS groups compared to HC. MS+ patients presented higher rates of MS fatigue, sleep problems and depressive symptoms but similar alertness scores compared to MS- patients. However, tonic alertness was only higher in MS- patients compared to HC. Intrinsic and phasic alertness correlated moderately with fatigue ratings. In the diagnostic process of MS fatigue and quality of sleep comorbid disorders (depression, anemia, thyroid dysfunction) and performance-based measures such as alertness should be considered in daily clinical practice.

Secretory sphingomyelinase (S-SMase) activity is elevated in patients with rheumatoid arthritis.

The goals of this study were to determine if secretory sphingomyelinase (S-SMase) activity is elevated in patients with rheumatoid arthritis (RA) compared to control subjects and to examine the relationships of S-SMase activity with functional status, quality of life, and RA disease activity measurements. We collected data on 33 patients who were diagnosed with RA and 17 non-RA controls who were comparable in terms of age, sex, and race. Demographic, clinical data and self-reported measures of fatigue, pain, and physical function were obtained directly from patients and controls. RA patients also completed quantitative joint assessment using a 28-joint count and functional status and quality of life assessment using the Modified Health Assessment Questionnaire (MHAQ). Archived serum samples were used to analyze retrospectively serum S-SMase activity in patients and controls. The mean serum S-SMase activity was 1.4-fold higher in patients with RA (RA 2.8±1.0nmol/ml/h vs. controls 2.0±0.8nmol/ml/h; p=0.014). Spearman's rho correlations between S-SMase activity and oxidant activity, markers of inflammation and endothelial activation with the exception of P-selectin (rho=0.40, p=0.034), measures of disease activity, functional status, and quality of life were not statistically significant in patients with RA. We confirmed that S-SMase activity is higher among RA patients compared to controls, as in other acute and chronic inflammatory diseases. Future studies can build on the present findings to understand more fully the biologic role(s) of S-SMase activity in RA.

Fronto-striatal network activation leads to less fatigue in multiple sclerosis

Background: The fronto-striatal network has been implicated in both fatigue, a common multiple sclerosis (MS) symptom, and goal attainment, which has been shown to reduce fatigue in healthy individuals. Objectives: To investigate whether stimulation of the fronto-striatal network through goal attainment (potential monetary gain) leads to fatigue reduction in MS and healthy control (HC) participants. Methods: In all, 14 healthy and 19 MS participants performed a gambling task during functional magnetic resonance imaging (fMRI). Participants were presented with an opportunity to receive monetary reward during the outcome condition of the task but not during the no outcome condition. Self-reported fatigue measures were obtained after each condition and outside of the scanner. Structural alterations were also examined. Results: A significant decrease in fatigue was observed after the outcome condition compared to the no outcome condition in both groups. Significantly greater activation was observed in the ventral striatum in association with the outcome condition compared to the no outcome condition in both groups. Ventromedial prefrontal cortex showed significantly greater activation during the no outcome condition compared to the outcome condition with greater difference between conditions in the HC group. Conclusion: This is the first functional neuroimaging study showing that stimulation of the fronto-striatal network through goal attainment leads to decreased on-task fatigue in MS and healthy participants.

Self-reported Measures Of Fatigue during Golf Performance

PURPOSE: To determine the influence of directional compression core shorts on self-reported measures of pain and fatigue and maximum driving distance during repeated, maximum-effort golf drives. METHODS: Nine participants with an average PGA handicap of 1.2 (range: 0 to 3) performed 52 drives on an outdoor driving range: 12 practice drives, 20 drives with a driver, 20 drives with a 6 iron. Half of the drives were performed while wearing directional compression core shorts (DCP). Visual analog scores (VAS, 150 mm) for low back pain (LBP), low back muscle fatigue (LBF), quadriceps fatigue (QF) and total fatigue (TotF) were measured at the beginning and end of each 26 trial condition (none, DCP). A launch monitor was used to measure carry distance. Two-way repeated measures ANOVA were computed to contrast the VAS (compression (none, DCP); time (pre, post)) variables. Carry distance was measured with a launch monitor and the maximum carry distance was contrasted with a repeated measures ANOVA between conditions for each club. The coefficient of variation and Cronbach’s Alpha were computed to determine the reliability of carry distance for each club (driver, 6 iron) and condition (none, DCP). RESULTS: Significant time by compression statistical interactions were found for LBF (p=.019), QF (p=.046) and TotF (p=.033). The pre-to-post change in these variables were 57%, 75%, and 57% lower during the DCP condition for LBF (none, 14.6 ± 10.9%; DCP, 6.2 ± 8.0%), QF (none, 7.9 ± 9.6%; DCP, 2.0 ± 4.8%) and TotF (none, 14.9 ± 12.0%; DCP, 6.4 ± 8.7%). Maximum carry distance was not different between conditions for the 6 iron (p=.777; none, 268.6 ± 14.6 yards; DCP, 268.0 ± 17.1 yards) or driver (p=.916; none, 183.0 ± 9.4 yards; DCP, 183.1 ± 9.1 yards). Reliability for the 6 iron drives were .881 and .976 for none and DCP conditions whereas the driver drives were .962 and .975, respectively. The coefficient of variation measurements were 5.6 ± 4.0% and 4.4 ± 1.5% for the 6 iron drives during the none and DCP conditions whereas the variation for the driver drives were 2.8 ± 0.9% and 2.8 ± 1.3%. CONCLUSION: Directional compression core shorts improved self-reported measures of low back, quadriceps and total body muscle fatigue but did not influence carry distance when performing golf drives with a 6 iron or driver.