Significant Levels Of Fatigue Research Articles

Psychosomatic Rehabilitation for Post-COVID

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

A-044 Using ID-Vit Test Systems to Assess the Effect of Vitamin B Supplementation on Fatigue Symptoms in Professional Athletes

Abstract Background Training and competition stress may result in temporary decrements (muscle damage, impaired immune system) in physical performance and significant levels of fatigue in professional athletes. Evidence suggest a causal association between these prevalent fatigue symptoms, temporary decrements and low serum levels of B vitamins. Therefore, it is suggested that supplementing B vitamins has a positive effect on reducing fatigue symptoms. However existing studies failed to show the connection with the traditional methodology like HPLC or LC/MS where only one analyte is quantified. Thus, the aim of this study was to assess the effects of vitamin B complex supplementation on fatigue symptoms, in professional athletes by measuring bioavailable vitamins with ID-vit test systems, that quantifies the bioavailable B vitamins. Methods The serum samples of 57 professional athletes (12 female, 23.6 ± 6.9years) before and after 3 months of daily vitamin B complex supplementation (20 mg thiamine, 15 mg riboflavin, 30 mg niacin, 10 mg pantothenic acid, 15 mg pyridoxal-5-phosphate, 400 µg 5-methyltetrahydrofolate, 1000 µg methylcobalamine, 1000 µg biotin) were compared. CBC was determined by standard tests. Bioavailable vitamins B2, B6, folic acid, B12 in serum and B1 in whole blood were measured by the ID-Vit® test kits from Immundiagnostik AG. The test system is based on a microbiological method. The microorganisms used in this test system can metabolize various vitamers that are equally available in vivo. Thus, a functional system is simulated that quantifies the bioavailable B vitamins in comparison to other methods as e.g., HPLC or LC/MS, where only one analyte is quantified. The results of the methodology correlate very well with the observed symptoms and are therefore a promising tool for therapy monitoring. Using 5-point Likert scales, fatigue, sleep quality, muscle damage and impairment of immune system were assessed at the baseline and after 3 months intervention. Results Ultimately 29 professional athletes (10 female, 22.6 ± 7.9years) were completed the study. The bioavailable vitamin B levels were significantly higher after the 3 months supplementation period. (for vitamin B1 35.6 ± 9.4 µg/L and 48.1 ± 18.3 µg/L, for vitamin B2 99.9 ± 63.3 µg/L and 125.0 ± 66.4 µg/L, for vitamin B6 10.2 ± 13.8 µg/L and 30.7 ± 29.2 µg/L, for vitamin folic acid 9.3 ± 7.4 µg/L and 12.7 ± 9.1 µg/L, for vitamin B12 362.9 ± 335.2 µg/L and 445.2 ± 367.5 µg/L respectively). The level of feeling tired significantly lowered (6.0 ± 2.9 vs 1.9 ± 1.8, P < 0.001) after 3 months in parallel to higher serum bioavailable vitamin B levels. The professional athletes significantly less troubles with their sleep quality (34.5% vs 6.9%; P < 0.001), muscle damage (58.6% vs 6.9%; P = 0.033), and infection rate (44.8% vs 0.0%; P < 0.001). Performance fatigue was reported in 75.9% and mental fatigue was reported in 79.3% of the athletes before vitamin B complex supplementation and significantly decreased to 0.0% and 13.8% after 3 months of supplementation period (P < 0.001). Conclusion Low serum bioavailable vitamin B values found to be related to fatigue, sleep quality, muscle damage and impairment of immune system. The supplementation of B complex vitamins was effective on reducing fatigue symptoms, infection frequency, muscle damage and helped increasing sleep quality. The ID-vit tests system is an effective and easy to apply tool to quantify the bioavailable B vitamins in clinical settings to assess undersupply.

Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis

Patients with end-stage kidney disease (ESKD) undergoing long-term hemodialysis often experience a high burden of debilitating symptoms for which effective treatment options are limited. To compare the effectiveness of a stepped collaborative care intervention vs attention control for reducing fatigue, pain, and depression among patients with ESKD undergoing long-term hemodialysis. Technology Assisted Stepped Collaborative Care (TĀCcare) was a parallel-group, single-blinded, randomized clinical trial of adult (≥18 years) patients undergoing long-term hemodialysis and experiencing clinically significant levels of fatigue, pain, and/or depression for which they were considering treatment. The trial took place in 2 US states (New Mexico and Pennsylvania) from March 1, 2018, to June 31, 2022. Data analyses were performed from July 1, 2022, to April 10, 2023. The intervention group received 12 weekly sessions of cognitive behavioral therapy delivered via telehealth in the hemodialysis unit or patient home, and/or pharmacotherapy using a stepped approach in collaboration with dialysis and primary care teams. The attention control group received 6 telehealth sessions of health education. The coprimary outcomes were changes in fatigue (measured using the Functional Assessment of Chronic Illness Therapy Fatigue), average pain severity (Brief Pain Inventory), and/or depression (Beck Depression Inventory-II) scores at 3 months. Patients were followed up for 12 months to assess maintenance of intervention effects. There were 160 participants (mean [SD] age, 58 [14] years; 72 [45%] women and 88 [55%] men; 21 [13%] American Indian, 45 [28%] Black, 28 [18%] Hispanic, and 83 [52%] White individuals) randomized, 83 to the intervention and 77 to the control group. In the intention-to-treat analyses, when compared with controls, patients in the intervention group experienced statistically and clinically significant reductions in fatigue (mean difference [md], 2.81; 95% CI, 0.86 to 4.75; P = .01) and pain severity (md, -0.96; 95% CI, -1.70 to -0.23; P = .02) at 3 months. These effects were sustained at 6 months (md, 3.73; 95% CI, 0.87 to 6.60; P = .03; and BPI, -1.49; 95% CI, -2.58 to -0.40; P = .02). Improvement in depression at 3 months was statistically significant but small (md -1.73; 95% CI, -3.18 to -0.28; P = .02). Adverse events were similar in both groups. This randomized clinical trial found that a technology assisted stepped collaborative care intervention delivered during hemodialysis led to modest but clinically meaningful improvements in fatigue and pain at 3 months vs the control group, with effects sustained until 6 months. ClinicalTrials.gov Identifier: NCT03440853.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ И ОЦЕНКА ПРОВОДИМОЙ ТЕРАПИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ НА ТРЕТЬЕМ УРОВНЕ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ В РЕСПУБЛИКЕ ТАТАРСТАН

Objective: to identify clinical data and treatment methods for COPD patients on the third level of medical care, and assess their correlations with exacerbations, the fatigue syndrome, and patient adherence to treatment. Materials and methods. We examined 330 patients with diagnosed COPD. We collected case records, assessed drugs and routes of administration, established results of clinical and laboratory studies, smoking status, and compliance. Results. GOLD-III and type D spirometry disorders prevailed. Frequent exacerbations were typical for patients with high mMRC and CAT scores and low FEV1 values. The proportion of adherent patients was 29.4%. Patients with frequent exacerbations, decreased FEV1, and pronounced symptoms were more adherent to treatment. COPD patients received short-acting bronchodilators (85.5%), ICS/LABA (54.5%), and dual long-acting bronchodilators (18.8%). The fatigue syndrome was established using the FAS questionnaire in 61.9% of patients. Patients with significant levels of fatigue were predominantly of the older age, often with FEV1 of 50% or less of the due value, more pronounced clinical symptoms by the CAT and mMRC scale, two or more exacerbation episodes, and concomitant diseases. Conclusion. COPD patients treated on the third level had lower adherence to treatment, poor skills in inhalation technique and control, and they excessively used short-acting bronchodilators. The present study confirmed the expediency of simultaneous use of two classifications of COPD and the necessity to assess fatigue levels during management of COPD patients.

Interventions for the management of fatigue in adults with a primary brain tumour.

Fatigue is a common and disabling symptom in people with a primary brain tumour (PBT). The effectiveness of interventions for treating clinically significant levels of fatigue in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 4, 2016. To assess the effectiveness and safety of pharmacological and non-pharmacological interventions for adults with PBT and clinically significant (or high levels) of fatigue. For this updated review, we searched CENTRAL, MEDLINE and Embase, and checked the reference lists of included studies in April 2022. We also searched relevant conference proceedings, and ClinicalTrials.gov for ongoing trials. We included randomised controlled trials (RCTs) that investigated any pharmacological or non-pharmacological intervention in adults with PBT and fatigue, where fatigue was the primary outcome measure. We restricted inclusion specifically to studies that enrolled only participants with clinically significant levels of fatigue to improve the clinical utility of the findings. Two review authors (JD, DC) independently evaluated search results for the updated search. Two review authors (JD, SYK) extracted data from selected studies, and carried out a risk of bias assessment. We extracted data on fatigue, mood, cognition, quality of life and adverse events outcomes. The original review identified one study and this update identified a further two for inclusion. One study investigated the use of modafinil, one study the use of armodafinil and one study the use of dexamfetamine. We identified three ongoing studies. In the original review, the single eligible trial compared modafinil to placebo for 37 participants with a high- or low-grade PBT. One new study compared two doses of armodafinil (150 mg and 250 mg) to placebo for 297 people with a high-grade glioma. The second new study compared dexamfetamine sulfate to placebo for 46 participants with a low- or high-grade PBT. The evidence was uncertain for both modafinil and dexamfetamine regarding fatigue outcome measures, compared to controls, at study endpoint. Two trials did not reach the planned recruitment target and therefore may not, in practice, have been adequately powered to detect a difference. These trials were at a low risk of bias across most areas. There was an unclear risk of bias related to the use of mean imputation for one study because the investigators did not analyse the impact of imputation on the results and information regarding baseline characteristics and randomisation were not clear. The certainty of the evidence measured using GRADE was very low across all three studies. There was one identified study awaiting classification once data are available, which investigated the feasibility of 'health coaching' for people with a PBT experiencing fatigue. There were three ongoing studies that may be eligible for an update of this review, all investigating a non-pharmacological intervention for fatigue in people with PBT. There is currently insufficient evidence to draw reliable and generalisable conclusions regarding potential effectiveness or harm of any pharmacological or non-pharmacological treatments for fatigue in people with PBT. More research is needed on how best to treat people with brain tumours with high fatigue.

123 ACUTE-PHASE BED-REST DURATION WAS ASSOCIATED WITH LOWER GRIP STRENGTH IN A POST-COVID-19 COHORT

Abstract Background Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort. Methods Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model. Results Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39–522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta = −0.158, 95% Confidence Interval − 0.242 to −0.074, p = 0.001). Conclusion In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.

0481 Impact of Lemborexant on Fatigue Severity in Subjects with Clinically Significant Levels of Fatigue at Baseline

Abstract Introduction In Phase 3 SUNRISE-1 (NCT02783729; E2006-G000-304) and SUNRISE-2 (NCT02952820; E2006-G000-303), lemborexant (LEM) provided significant benefit versus placebo on sleep diary-based sleep onset/maintenance outcomes over 1mo and 6mo, respectively, in subjects with insomnia disorder. The impact of LEM on patient-reported fatigue, assessed using the Fatigue Severity Scale (FSS), in subjects with clinically significant fatigue (CSF) at baseline was examined for each study. Methods SUNRISE-1 was a 1mo, randomized, double-blind, placebo- and active-controlled, parallel-group study in female (≥55y) and male (≥65y) subjects (n=1006); subjects received placebo, LEM 5mg (LEM5), LEM 10mg (LEM10) or zolpidem tartrate extended-release (not reported here). SUNRISE-2 was a 12mo, randomized, double-blind study in subjects age ≥18y (n=949). Subjects received placebo, LEM5, or LEM10 for 6mo. Placebo subjects were rerandomized to LEM5 or LEM10 for another 6mo; LEM subjects continued assigned treatment. CSF was defined as FSS total score (FSSts) ≥36. Results In subjects with baseline CSF, in SUNRISE-1, baseline FSSts was 46.8, 46.5, and 46.6 in placebo (n=117), LEM5 (n=157), and LEM10 (n=153) groups, respectively, and, in SUNRISE-2, was 45.7, 46.4, and 45.8 in placebo (n=169), LEM5 (n=181), and LEM10 (n=173) groups, respectively. At 1mo, mean changes from baseline in FSSts were not significantly different vs placebo for LEM5 in both studies, and for LEM10 in SUNRISE-1. In SUNRISE-2, LEM10 significantly decreased mean [SD] FSSts from baseline vs placebo at 1mo (LEM10, −11.2[13.9] vs placebo, −8.7[10.5]; P=0.03). By 6mo in SUNRISE-2, both LEM5 and LEM10 significantly decreased mean [SD] FSSts from baseline versus placebo (LEM5, −15.4[13.8]; LEM10, −15.0[14.2] vs placebo, −11.2[11.6]; both P<0.05). At 12mo, mean [SD] FSSts improvements were sustained for LEM5 (−20.4[12.8]) and LEM10 (−18.1[14.7]). Conclusion In subjects with CSF, longer treatments (>1mo) may be needed to observe significant FSSts improvements, which were evident at 6mo and sustained at 12mo with continuous LEM treatment. Support Eisai Inc.

Treatment of fatigue with physical activity and behavioural change support in vasculitis: study protocol for an open-label randomised controlled feasibility study

IntroductionFatigue is a major cause of morbidity, limiting quality of life, in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The aetiology of fatigue is multifactorial; biological and psychosocial mediators, such...

Inverse relationship between reduced fatigue and severity of anemia in oncology patients treated with integrative medicine: understanding the paradox.

To assess the impact of integrative medicine (IM) on cancer-related fatigue in patients undergoing chemotherapy for early and advanced breast and gynecological (ovarian, endometrial, and cervical) cancer. Patients reporting significant levels of fatigue (on the Edmonton Symptom Assessment Scale (ESAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), or Measure Yourself Concerns and Wellbeing questionnaire (MYCAW)) were offered complementary and integrative medicine (CIM) treatments in addition to standard supportive care. Patients who did not undergo IM treatments were designated as controls. Attending at least five CIM treatments less than 30days between each session was considered as high adherence to integrative care (AIC). Of 258 eligible patients reporting significant fatigue, follow-up assessment at 6 and 12weeks was considered optimal for 120 patients in the intervention group and for 64 controls; 88 of treated patients found to be adherent to the IM intervention. At 12weeks, ESAS (P < 0.001) and EORTC (p = 0.001) scores for fatigue improved more significantly in treated patients, with a higher percent with optimal relative dose intensity in the AIC subgroup, both at 6weeks (P = 0.002) and at 12weeks (P < 0.001). IM treatment was paradoxically associated with a greater decrease in hemoglobin levels at 12weeks (P = 0.016), more so in the AIC subgroup (P = 0.024). Integrative medicine program may alleviate cancer-related fatigue in patients with breast and gynecological cancer undergoing chemotherapy.

Risk Assessment of Obstructive Sleep Apnea and its Association with Fatigue and Sleepiness Among Hospital Inpatients

Background: Obstructive sleep apnea (OSA) is a common sleep related disorder. Objectives: To identify OSA, its risk factors and to study its association with fatigue and day time sleepiness. Methods: In-patients were interviewed using the STOP-BANG questionnaire, the Fatigue Severity Scale questionnaire and the Epworth Sleepiness Scale. Height, weight and neck circumference of the participants were measured using standard procedures. Results: Of the total 296 participants, 10(3.4%) were known cases of OSA. Of the remaining 286 cases, 189(66.1%) were at low, 82(28.7%) were at intermediate and 15(5.2%) were at high risk of OSA. Age >50 years (P<0.001), male gender (P<0.001) and family history of snoring (P=0.004) among patients were associated with high risk/known status of OSA. Multiple morbidities were seen among greater proportion of participants with higher risk/known status of OSA (P=0.024). Increased body mass index (P=0.013) was associated with higher risk/known status of OSA. High risk/known status of OSA was associated with significant levels of fatigue (P=0.001) and abnormal day time sleepiness (P=0.006) among participants. Multivariate analysis of variables showed age, snoring, witnessed stoppage of breathing, nasal congestion and hypertension as independent risk factors for high risk/known status of OSA. Conclusion: Several factors were identified to predict high risk/known status of OSA among inpatients in this study. High risk/ known cases of OSA were found to suffer from multiple comorbidities, significant levels of fatigue and abnormal day time sleepiness. Therefore, inpatients with these associated risk factors need to be screened for OSA so as to ensure comprehensive case management.

Sleep Quality, Fatigue, and Quality of Life Among Teenage and Young Adult Cancer Survivors.

Teenage and young adult (TYA) cancer survivors experience a range of health-related problems during and beyond the active treatment period. This study examined associations between fatigue, sleep quality, and health-related quality of life (HRQOL) among TYA survivors. Self-reported data on sleep quality (Pittsburgh Sleep Quality Index), fatigue (Functional Assessment of Chronic Illness Therapy Fatigue), and HRQOL (EuroQoL-5) were gathered from United Kingdom TYA survivors between 13 and 24 years of age. TYA survivors were stratified into those on (n = 67) and off (n = 135) treatment. Linear regression analyses were used with HRQOL as the dependent variable to investigate potential associations. Fatigue and sleep were entered separately and together in the same model. Age at survey and diagnosis, gender, and ethnicity were included as covariates. 85.07% of TYAs on and 62.69% of TYAs off treatment had sleep quality scores suggestive of clinically significant sleep disorders. 56.72% of TYAs on and 26.67% of TYAs off treatment reported clinically significant levels of fatigue. Strong independent associations between sleep (B = 0.05, 95% confidence intervals [CI] = 0.03-0.07, p < 0.001), fatigue (B = 0.02, 95% CI = 0.01-0.03, p < 0.001), and HRQOL were observed among TYA survivors on treatment. TYAs off treatment showed moderate to strong associations between sleep (B = 0.04, 95% CI = 0.02-0.05, p < 0.001) and fatigue (B = 0.02, 95% CI = 0.01-0.02, p < 0.001), and HRQOL, when examined separately. Sleep was not independently associated with HRQOL among TYAs off treatment (B = 0.01, 95% CI = -0.01 to 0.02, p = 0.296). The significant associations reported suggest that sleep quality and fatigue are potential modifiable factors associated with HRQOL. Further research is warranted to understand the direction of associations.

Mobile Technology Use by People Experiencing Multiple Sclerosis Fatigue: Survey Methodology.

BackgroundFatigue is one of the most commonly reported symptoms of multiple sclerosis (MS). It has a profound impact on all spheres of life, for people with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group, and Internet cognitive behavioral therapy–based approaches to supporting people with MS to manage their fatigue have been shown to be effective.ObjectiveThe aim of this project was to (1) survey the types of mobile devices and level of Internet access people with MS use or would consider using for a health intervention and (2) characterize the levels of fatigue severity and their impact experienced by the people in our sample to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS.MethodsSurvey methodology using an online questionnaire was used to assess people with MS. A total of 51 people with MS participated. The average age was 48.5 years, and the large majority of the sample (77%) was female.ResultsParticipants reported significant levels of fatigue as measured with the summary score of the Neurological Fatigue Index (mean 31.4 [SD 5.3]). Most (84%) respondents scored on average more than 3 on the fatigue severity questions, reflecting significant fatigue. Mobile phone usage was high with 86% of respondents reporting having a mobile phone; apps were used by 75% of respondents. Most participants (92%) accessed the Internet from home.ConclusionsNew Zealand respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the Internet. These findings, along with limited access to face-to-face cognitive behavioral therapy–based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioral therapy–based intervention to decrease the severity and impact of fatigue in people with MS.

The Family Experience of Fatigue in Heart Failure.

Fatigue is a symptom experienced almost universally by people living with a chronic illness. People diagnosed with heart failure have described experiencing significant levels of fatigue. The family experience of fatigue, that is, how families perceive, respond to, and manage fatigue, is unknown. Semistructured family group interviews with 22 families ( N = 62 family members) were conducted. Thematic analysis was undertaken to explore the family experience of fatigue. Fatigue was described as a significant symptom that affected physical, emotional, and social functioning at a family level. Fatigue was described as difficult to manage, and while most family members interviewed had developed a shared understanding of fatigue, some family members found acceptance of this invisible symptom more difficult. Spouses were more likely to express concern that fatigue, and especially increased fatigue, represented a decline in health. The study highlighted the importance of a shared understanding of fatigue from a family perspective.

Interventions for the management of fatigue in adults with a primary brain tumour.

Fatigue is a common and disabling symptom in people with a primary brain tumour (PBT). The effectiveness of interventions for treating clinically significant levels of fatigue in this population is unclear. To assess the effectiveness and safety of pharmacological and non-pharmacological interventions for adults with PBT and high levels of fatigue. In March 2016, we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO and CINAHL and checked the reference lists of included studies. We also searched relevant conference proceedings, searched for ongoing trials via ClinicalTrials.gov and contacted major co-operative groups with trials in this area. We included randomised controlled trials (RCTs) that investigated any pharmacological or non-pharmacological intervention in adults with PBT and fatigue, where fatigue was the primary outcome measure. We restricted inclusion specifically to studies that enrolled only participants with clinically significant levels of fatigue. Three review authors (JD, SYK, DC) independently evaluated search results, extracted data from selected studies and carried out a bias risk assessment. We extracted data on fatigue, cognition, mood, quality of life and adverse events outcomes. We identified nine studies. We excluded eight of these as they did not restrict participation to people with high fatigue. The single eligible trial investigated the use of modafinil compared to placebo. Although this study found a significant improvement over time in the primary outcome of fatigue, the improvement occurred after both modafinil and placebo with no significant difference in response between the two groups. The included trial did not reach its planned recruitment target and therefore may not, in practice, have been adequately powered to detect a difference. The trial was at a low risk of bias across most areas. There was an unclear risk of bias related to the use of mean imputation because the investigators did not analyse the impact of imputation on the results. There was insufficient evidence to draw reliable and generalisable conclusions regarding potential effectiveness or harm of any pharmacological or non-pharmacological treatments for fatigue in people with PBT. More research is needed on how best to treat people with brain tumours with high fatigue.

Electromyography comparison of normal chair-desk system and assistant chair-desk system on fatigue.

[Purpose] This study was designed to test the effects of the Assistant Chair-Desk System (ACDS), which can reduce the forward tilt of the neck and trunk and the level of fatigue during long lasting study in the sitting position. [Subjects] Fourteen middle school students and 14 college students of mixed gender participated in this study. [Methods] Fatigue level, the trapezius muscle, and the forward tilt angle of the head and trunk as well as distance factors were assessed before after using a normal chair-desk system (NCDS) and the ACDS for 120 minutes. [Results] There was an interaction effect in the angle and length of the neck from the sitting posture changes after 2 hours of studying using the NCDS and ACDS. There were also significant differences in the fatigue levels, hip joint angles and the lengths from the head according to the main effects of the chair-systems. [Conclusion] The studying position while using the ACDS was determined to prevent significant fatigue levels of the muscle and body, provide support to the head, by limiting the forward movement of the neck, and prevent forward tilt of the neck and trunk, by enabling the target point and gaze to be closer to the horizontal direction.

The Importance of Unresolved Fatigue in Depression: Costs and Comorbidities

To assess the cost outcomes of patients with a history of depression and clinically significant fatigue. Adults with ≥ 2 claims with depression diagnosis codes identified from the HealthCore Integrated Research Database were invited to participate in this study linking survey data with retrospective claims data (12-mo presurvey and postsurvey periods). Patient surveys included measures for depression (Quick Inventory of Depressive Symptomatology), fatigue (Fatigue Associated with Depression Questionnaire), anxiety (7-item Generalized Anxiety Disorder scale), sleep difficulty (Athens Insomnia Scale), and pain (Brief Pain Inventory). After adjusting for demographic and clinical characteristics using propensity scores, postsurvey costs were compared between patients with and without fatigue using nonparametric bootstrapping methods. Of the 1982 patients who had completed the survey and had complete claims data, 653 patients had significant levels of fatigue. Patients with fatigue reported significantly higher scores, indicating greater severity, on measures of depression, pain, sleep difficulty, and anxiety (all p < 0.05). These patients also had higher levels of overall medication use and were more likely to have lower measures of socioeconomic status than patients without significant levels of fatigue (all p < 0.05). Mean annual total costs were greater for patients with fatigue than those without fatigue ($14,462 vs $9971, respectively, p < 0.001). These cost differences remained statistically significant after adjusting for clinical and demographic differences. Clinically significant fatigue appears to add to the economic burden of depression. This reinforces the need for aggressive treatment of all symptoms and further examination of the variability of this relationship as patients approach remission.

Impact of transient ischaemic attack and minor stroke on daily life

Background: The aim of this study was to identify functional, emotional and cognitive problems following transient ischaemic attack (TIA) and minor stroke (mS). Methods: Participants were recruited from patients who were attending a TIA and minor stroke clinic. A control group of healthy adults was recruited through community groups. Participants were asked to complete questionnaire measures to assess independence in activities of daily living, mood, fatigue and quality of life. Findings: Questionnaires were returned by 106 people with TIA or minor stroke and 67 healthy controls. Those with TIA or minor stroke scored significantly lower on the Nottingham Extended Activities of Daily Living Scale compared with the control group (P&lt;0.001). Difficulties were most frequently reported in leisure activities and mobility tasks. A high proportion of participants with TIA or minor stroke reported clinically significant levels of fatigue (41%), anxiety (31%) and depression (28%). There were significant differences between those with TIA or minor stroke and healthy controls on these questionnaire measures (P&lt;0.05). Conclusions: People with TIA and minor stroke have residual functional impairments and high levels of distress. Further longitudinal research is recommended to establish the nature of persisting symptoms and potential treatments.

Sleep, Fatigue, and Functional Health in Psychotic Patients

This study sought to examine the association between sleep, fatigue, and functional health in psychotic patients. Participants included 93 psychotic inpatients (n = 67 with schizophrenia) who completed the Chalder Fatigue Scale (ChFS), the Fatigue Symptom Inventory (FSI), the Pittsburgh Sleep Quality Index (PSQI), and the SF36 Health Survey. Patients were classified on the basis of their performance on sleep and fatigue measures: 60% reported significant levels of fatigue and 67% significant sleep disturbances. 28.4% reported both, suggesting that fatigue and sleep dysfunctions do not necessarily cooccur. A closer examination of patterns showed that fatigue was only related to qualitative aspects of sleep and not quantifiable aspects of sleep disturbances. The results also showed that functional health was the lowest in patients with high levels of fatigue, compared to patients with sleep problems only or patients with neither symptom. A regression analysis further showed that the size of the contribution of fatigue onto functional health was twice as much as that of sleep dysfunctions. In conclusion, the results show that (i) dissatisfaction with sleep—and not sleep itself—is related to fatigue symptoms and that (ii) fatigue is particularly detrimental to functional health, regardless of the presence of sleep dysfunctions.

The association between multiple sclerosis-related fatigue and balance as a function of central sensory integration

BackgroundFatigue and impaired upright postural control (balance) are the two most common complaints in persons with multiple sclerosis (MS), with limited evidence on how they are related. ObjectiveTo examine the relationship between symptomatic fatigue and balance as a function of central sensory integration in persons with multiple sclerosis. Materials and methodsSeventeen persons with relapsing-remitting MS were enrolled in this cross-sectional study. Primary measurements included fatigue (modified fatigue impact scale – MFIS); balance (dynamic posturography, sensory organization testing – SOT); and walking capacity (six-minute walk test – 6MWT). ResultsFatigue scores were significantly associated with balance: MFIS total (r=−0.78; p<0.001), physical subscale (r=−0.77; p<0.001), cognitive subscale (r=−0.75; p=0.001) and psychosocial subscale (r=−0.53; p=0.030) scores. MFIS total score was a significant predictor of balance (p≤0.001), accounting for 62% of the variability in SOT composite scores. Significant differences in fatigue (d=1.75; p=0.005) and balance (d=1.74; p=0.005) were found for participants who had cerebellar and brainstem involvement compared to those without. ConclusionsSymptomatic fatigue is significantly related to balance and is a significant predictor of balance as a function of central sensory integration in persons with MS. Fatigue and balance are associated with cerebellar and brainstem involvement. This study provides early evidence supporting the theory that for those persons with MS who struggle to maintain steady balance during tasks that stimulate the central sensory integration process, complaints of significant levels of fatigue are probable.

Assessing Fatigue and Distress in Caregivers of Hematopoetic Stem Cell Transplant Patients.

Abstract 3169Hematopoietic stem cell transplant (HSCT) is an established treatment for certain hematologic malignancies (Thomas, 2004). The process of undergoing HSCT is intense and time consuming. Patients and their caregivers are required to commit to several months of treatment and close follow-up. Our program requires patients to have a full-time caregiver to assist them with transportation, treatment compliance, nutritional intake and emotional support. Patients are not allowed to be alone, go to public areas, or independently manage their medications. The need for a caregiver places an extra burden on the patient and their loved ones, as caregivers are not able to work full time while caring for an HSCT patient. Many studies have looked at the quality of life and various psychological symptoms in patients undergoing HSCT. Studies have analyzed the impact of HSCT on patient health related quality of life (HRQOL) during and after HSCT. However, little is known about the impact of HSCT on spouses/partners or other primary caregivers. More recently, transplant programs have begun to identify needs of HSCT caregivers. Researchers have begun to recognize caregivers as an important and often overlooked participant in the HSCT process. The current literature on HSCT caregivers suggests that caregivers for HSCT patients do report feeling stressed, exhausted emotionally and physically, and in need of support (Aslan, 2006; Boyle, 2000; Foxall, 2006). One study identified high levels of stress and depression pre-transplant (Harris, 2009). A study by Gaston-Johansson (2004), found that primary caregivers of patients with breast cancer scheduled for HSCT experience fatigue, anxiety, burden of care, and low quality of life. The purpose of this study is to examine the impact of HSCT on the caregiver’s overall level of fatigue and distress. In this study, twenty-eight caregivers were evaluated using the Brief Symptom Inventory-18 (BSI-18) and Brief Fatigue Inventory (BFI) at four time points during the transplant process (PreBMT, Day 0, Day +7, and Day +30) in order to assess global stress and fatigue. These 28 caregivers were the sole caregiver responsible for a patient undergoing autologous HSCT, and did not have someone else to replace them as a caregiver during the transplant process. Caregivers were majority female (71%), Caucasian (75%), spouses/significant others (75%), and able to live at home for transplant (64%). The mean caregiver age was 55 (range = 32–69). Results indicate that there was a significant increase in fatigue for caregivers between PreBMT and Day 0 (p=.04). There was also a difference (p=.08) showing increased fatigue for caregivers between the initial PreBMT and all other time points (Days 0, 7, and 30). The caregivers indicated that their level of fatigue significantly interferes with daily functioning, including general activity and mood. The scores assessing distress (BSI-18) showed no significant difference in across the different time periods. However, throughout the transplant process, approximately 4% to 10% of caregivers did report clinically significant levels of distress, including clinically significant levels of anxiety, depression and/or somatic complaints. There was no difference in the level of distress or fatigue based on gender. In conclusion, primary caregivers of patients scheduled for HSCT experience significant levels of fatigue. Caregivers reported that their fatigue often interferes with their ability to function daily and that this fatigue increased once the transplant process began. This correlates with the requirement for the caregiver to be with the patient full time with the initiation of the preparative regimen just before Day 0. Some caregivers also report clinically significant levels of distress, although it does not appear to change significantly during the transplant process. Further research is needed to evaluate the impact of caregiver fatigue on the patient’s transplant outcome and factors that might assist with caregiver distress and fatigue. Disclosures:No relevant conflicts of interest to declare.