Subjective Assessment Of Fatigue Research Articles

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

CSM 2017 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1–SPO152)

Caffeine administration at night during extended wakefulness effectively mitigates performance impairment but not subjective assessments of fatigue and sleepiness

The current study investigated the effects of repeated caffeine administration on performance and subjective reports of sleepiness and fatigue during 50h extended wakefulness. Twenty-four, non-smokers aged 22.5±2.9y (mean±SD) remained awake for two nights (50h) in a controlled laboratory environment. During this period, 200mg of caffeine or placebo gum was administered at 01:00, 03:00, 05:00 and 07:00 on both nights (total of 800mg/night). Neurobehavioral performance and subjective reports were assessed throughout the wake period. Caffeine improved performance compared to placebo, but did not affect overall ratings of subjective sleepiness and fatigue. Performance and sleepiness worsened with increasing time awake for both conditions. However, caffeine slowed performance impairments such that after 50h of wakefulness performance was better following caffeine administration compared to placebo. Caffeine also slowed the increase in subjective sleepiness and performance ratings, but only during the first night of wakefulness. After two nights of sleep deprivation, there was no difference in sleepiness ratings between the two conditions. These results demonstrate that strategic administration of caffeine effectively mitigates performance impairments associated with 50h wakefulness but does not improve overall subjective assessments of sleepiness, fatigue and performance. Results indicate that while performance impairment is alleviated, individuals may continue to report feelings of sleepiness. Individuals who use caffeine as a countermeasure in sustained operations may feel as though caffeine is not effective despite impairments in objective performance being largely mitigated.

Does fatigue complaint reflect memory impairment in multiple sclerosis?

Background and Purpose. Fatigue and memory impairment are common symptoms in multiple sclerosis (MS) and both may interact with cognition. This can contribute to making a complaint misrepresentative of the objective disorder. We sought to determine whether fatigue complaint in MS reflects memory impairment and investigated whether patients' subjective fatigue is associated with memory complaint. Methods. Fifty MS patients complaining of fatigue underwent subjective assessment of fatigue and memory complaint measured using self-assessment scales. Cognitive functions were assessed using a battery of neuropsychological tests, including a test of verbal episodic memory, the selective reminding test (SRT). Correlations were studied between subjective fatigue, memory complaint, and performance in verbal episodic memory. Results. Depression score, psychotropic and/or antiepileptic drug use, Expanded Disability Status Scale (EDSS) score, and MS form were confounding factors. After adjusting for these confounding factors, neither fatigue complaint nor memory complaint was correlated with SRT performance. Subjective fatigue was significantly associated with memory complaint. Conclusion. Although complaint of fatigue in MS was correlated with memory complaint, subjective fatigue was not the expression of memory impairment.

The tiring anaesthetist

The tiring anaesthetist

Detection of Clinically Important Change in Multiple Sclerosis-Related Fatigue and Relationship to Cognitive Performance (P04.109)

Objective: Evaluate 1) the responsiveness of the Modified Fatigue Impact Scale (MFIS) for multiple sclerosis (MS)-related fatigue and 2) relationships between subjective fatigue assessment and measures of cognitive function. Background MS-related fatigue, including cognitive fatigue, is common. The MFIS is routinely used to measure MS-related fatigue but its responsiveness and ability to detect clinically important change after therapy is not known. Previous research found that cognitive performance and fatigue were not related. However, potentially more sensitive instruments such as the MFIS might detect an underlying relationship. Design/Methods: Ambulatory patients with MS-related fatigue persisting at least 6 weeks completed the MFIS, Fatigue Severity Scale (FSS), SF-36, and questionnaires. Cognitive performance measures included the Paced Auditory Serial Addition Test (PASAT) and others. All testing was administered on days 0, 7, and 21. Amantadine was initiated on day 7. Global assessment of change (GAC) comparing pre-to post-treatment status was rated as poor, fair, good, or excellent. Paired t-tests and Fisher9s exact test were used to evaluate outcomes and correlations were calculated for mean change scores. Effect size and correlations between changes in MFIS, GAC, and PASAT were calculated. Results: 22 patients were enrolled. Improvement in post-treatment scores was detected for the MFIS (p=0.004) and the PASAT (p=0.02), among others. The MFIS effect size was moderate (0.61) but there was a weak association between MFIS change and GAC (r=0.26; NS). Changes in PASAT scores correlated with changes in the SF-36 physical subscale (r=0.42; p=0.05), MFIS-Cognitive subscale (r=0.39; p=0.07), and MFIS-Social subscale (r=0.37; p=0.09). Conclusions: Fatigue, as measured by the MFIS, may be associated with cognitive performance. However, despite moderate effect size, change in MFIS is not associated with qualitative self-assessment of therapeutic response. Further work is needed to find instruments that detect clinically important change in subjective fatigue and objective cognitive performance. Disclosure: Dr. Thaera has nothing to disclose. Dr. Wingerchuk has received research support from Genentech, Inc,, Genzyme Corporation, Alexion and the Guthy-Jackson Charitable Foundation.

CIRCADIAN MISALIGNMENT AS AN ENDOPHENOTYPE FOR DEPRESSION

occur chronically, across the range of injury severity, and negatively impact on acute recovery, long term rehabilitation, mood and quality of life. Effective treatment is not well established. Recent research investigating short wavelength (blue) light exposure has demonstrated potency for acute subjective and physiological alerting effects, circadian phase shifting and enhancement of mood. The current study aimed to investigate the effects of 4 weeks of short-wavelength light therapy (LT) on fatigue and excessive daytime sleepiness (EDS) in individuals with TBI. Materials and Methods: Using a randomised, placebo-controlled design, we investigated a 4-week, 45min/day ‘at-home’ treatment with short wavelength (blue) light therapy (goLITE®, Philips Lighting) (465nm, 85 μW/cm2) compared with yellow light therapy (574nm, 19 μW/cm2) designed specifically to be deficient in short wavelength blue light or treatment as usual in 25 individuals (8, 9, 8) with TBI who self reported fatigue and/or EDS. Subjective assessments of fatigue and EDSwere conducted at baseline (week 0), mid-way through and at the end of LT (weeks 4 & 6), and again 4 weeks following cessation of LT (week 10). Results: We observed a trend for the mean decrease in fatigue (from baseline) across the 4-week treatment phase to be highest in the blue group (-1.14±1.25), compared with yellow (-0.17±0.64) or treatment as usual (-0.24±0.74), (p=0.07). The mean decrease in EDS was also highest in the blue group (-4.00±5.25) compared with yellow (-2.61±2.50) and treatment as usual (-0.56±2.57), although group differences were not significant (p=0.19). Conclusion: Preliminary findings suggest that short wavelength light may be effective in alleviating fatigue and possibly EDS following TBI. The trial is ongoing. Acknowledgements: Supported by grants from: The Jack Brockhoff Foundation, Centre for Integrated Research and Understanding Sleep (CIRUS, Woolcock Institute of Medical Research), RACV Sir Edmund Herring Memorial Scholarship, and Victorian Neurotrauma Initiative. goLITE®

Effects of Sleep Deprivation on Human Postural Control, Subjective Fatigue Assessment and Psychomotor Performance

This study aimed to investigate the effects of sleep deprivation on postural control, subjective fatigue assessment and psychomotor performance, and to assess the efficiency of an objective posturographic test as an indicator of mental fatigue. Postural sway using static posturography (Romberg's test), subjective fatigue assessment (Stanford Sleepiness Scale) and psychomotor performance (Sternberg dual-task test) were assessed in 12 subjects before and after 24 h of sustained wakefulness. After sustained wakefulness, the Romberg test parameters of circumference area and rectangle area with the eyes-closed, and standard deviation in the anterior-posterior direction with the eyes-open were significantly higher compared with baseline values (before sustained wakefulness). Subjective fatigue assessment scores were also significantly increased, while psychomotor performance was unchanged. Sleep deprivation can arouse a feeling of fatigue and can affect postural stability, hence an objective posturographic test score may be useful as an indicator of mental fatigue.

Impaired natural immunity, cognitive dysfunction, and physical symptoms in patients with chronic fatigue syndrome: preliminary evidence for a subgroup?

Objective The diagnostic criteria of chronic fatigue syndrome (CFS) define a heterogeneous population composed of several subgroups. Past efforts to identify subgroup markers have met with mixed success. This study was designed to examine natural killer cell activity (NKCA) as a potential subgroup marker by comparing the clinical presentations of CFS patients with and without clinically reduced NKCA. Methods Forty-one female CFS patients were classified into having either low or normal NKCA levels. These subgroups were then compared on objective measures of cognitive functioning and subjective assessments of fatigue, vigor, cognitive impairment, and daytime dysfunction. Results Relative to CFS patients in the normal-NKCA subgroup, low-NKCA patients reported less vigor, more daytime dysfunction, and more cognitive impairment. In addition, low-NKCA patients performed less on objective measures of cognitive functioning relative to normal-NKCA patients. Conclusions The results are offered as preliminary evidence in support of using NKCA as an immunological subgroup marker in CFS. Findings are also discussed in terms of known associations between dysregulated immune functions, somatic symptoms, and psychological stress.

Brief posturographic test as an indicator of fatigue

The purpose of the present paper was to analyze the efficiency of an abbreviated, albeit objective posturographic test as an indicator of fatigue. Posturography was measured in 10 healthy adults (age 18-33 years, male/female 7/3). Baseline posturographic measurements were taken for each subject. Later, a shorter (3-min) posturographic test was administered 12 times during 25 h of sleep deprivation. This was correlated with subjective assessment of fatigue using a questionnaire and cognitive performance assessed with a reaction time test (Psychomotor Vigilance Test). Although showing significant individual differences, the score of the abbreviated posturographic examination, normalized to each subject's baseline performance ('fatigue index') had a pronounced circadian pattern with a peak of instability in the early morning hours. Fatigue index was highly correlated with the cognitive test (r=0.80-0.90). A substantial, albeit weaker correlation was found between the fatigue index and the subjective fatigue scores (r=0.59-0.75). Fourier spectral analysis showed that low median sway (0.10-0.50 Hz), considered to be an expression of vestibular control, was most affected by fatigue. The study demonstrates that cognitive deterioration caused by fatigue can be objectively predicted by an abbreviated postural test of <or=3 min. This test is promising to be valid, reliable, and practicable, while being significantly correlated with physiological markers and validated cognitive measures of fatigue obtained by substantially more time-consuming and less convenient methods.

Effect of one-rescuer compression/ventilation ratios on cardiopulmonary resuscitation in infant, pediatric, and adult manikins

Optimal chest compression to ventilation ratio (C:V) for one-rescuer cardiopulmonary resuscitation (CPR) is not known, with current American Heart Association recommendations 3:1 for newborns, 5:1 for children, and 15:2 for adults. C:V ratios influence effectiveness of CPR, but memorizing different ratios is educationally cumbersome. We hypothesized that a 10:2 ratio might provide adequate universal application for all age arrest victims. Clinical study. Tertiary care children's hospital. Thirty-five health care providers. Thirty-five health care providers performed 5-min epochs of one-rescuer CPR at C:V ratios of 3:1, 5:1, 10:2, and 15:2 in random order on infant, pediatric, and adult manikins. Compressions were paced at 100/min by metronome. The number of effective compressions and ventilations delivered per minute was recorded by a trained basic life support instructor. Subjective assessments of fatigue (self-report) and exertion (change in rescuer pulse rate compared with baseline) were assessed. Analysis was by repeated measures analysis of variance and paired Student's t-test. Effective infant compressions per minute did not differ by C:V ratio, but ventilations per minute were greater at 3:1 vs. 5:1, 10:2, and 15:2 (p < .05). Effective pediatric compressions per minute were less at 3:1 vs. 5:1, 10:2, and 15:2 (p < .05) and not different between 5:1, 10:2, and 15:2 ratios. Effective pediatric ventilations per minute were greater at 3:1 than all other ratios and both 5:1 and 10:2 were >15:2 (p < .05). Effective adult compressions per minute were progressively greater with 3:1 vs. 5:1 vs. 10:2 vs. 15:2 (p < .05). Self-efficacy was assessed, and rescuers always subjectively rated 10:2 and 15:2 ratios as easier than 5:1 or 3:1 ratios for all manikins. Rescuer pulse change (exertion) was greater after pediatric and adult vs. infant CPR (p < .05), with no significant difference by C:V ratio. C:V ratio and manikin size have a significant influence on the number of effective compressions and ventilations delivered during ideal, metronome-paced, one-rescuer CPR. Low ratios of 3:1, 5:1, and 10:2 favor ventilation, and high ratios of 15:2 favor compression, especially in adult manikins. Rescuers subjectively preferred C:V ratios of 10:2 and 15:2 over 3:1 or 5:1. Infant CPR caused less exertion and subjective fatigue than pediatric or adult CPR technique, without significant difference by C:V ratio. We speculate that a universal 10:2 C:V ratio for one-rescuer layperson CPR is physiologically reasonable but warrants further study with particular attention to educational value and technique retention.

Issues in relation to the repeatability of and correlation between EMG and Borg scale assessments of neck muscle fatigue

Introduction The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods. Method To establish between-days reliability, 33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC (1,1), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson’s correlation co-efficient were calculated for the analysis of the results. Results Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC (1,1) = 0.28–0.61; SEM = 0.33–0.60%/s; SDD = 132.7–703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC (1,1) = 0.64–0.81; SEM = 2.8–8.8 Hz; SDD = 19.9–38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD = 29.2–136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue ( r = −0.01–0.39). Conclusion The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area.

Fatigue in cancer patients treated by external radiotherapy. An application of the Revised Piper Fatigue Scale in Malay

Fatigue is commonly associated with cancer and its therapy. The assessment of fatigue became increasingly important in cancer patients, as clinical interview may not indicate the severity of fatigue. Subjective assessment of fatigue in multi-dimensi ons indicates the level of severity of fatigue clearly to therapist, and the scores can be used to monitor response to cancer therapy. This study showed that the Revised Piper Fatigue Scale in Malay is a reliable and valid assessment tool. In 112 patients receiving external radiotherapy for various cancers, there was no significant difference of fatigue levels between gender and age ranges. Fatigue was significantly worse in nasopharengeal carcinoma on radiotherapy, presumably due to higher dose of radiation.

Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome

Summary Background No somatic treatment has been found to be effective for chronic fatigue syndrome (CFS). Antidepressant therapy is commonly used. Fluoxetine is recommended in preference to tricyclic agents because it has fewer sedative and autonomic nervous system effects. However, there have been no randomised, placebo-controlled, double-blind studies showing the effectiveness of antidepressant therapy in CFS. We have carried out such a study to assess the effect of fluoxetine in depressed and non-depressed CFS patients. Methods In this randomised, double-blind study, we recruited 44 patients to the depressed CFS group, and 52 to the non-depressed CFS group. In each group participants were randomly assigned to receive either fluoxetine (20 mg once daily) or placebo for 8 weeks. The effect of fluoxetine was assessed by questionnaires, self-observation lists, standard neuropsychological tests, and a motion-sensing device (Actometer), which were applied on the day treatment started and on the last day. Findings The two groups were well matched in terms of age, sex distribution, employment and marital status, and duration of CFS. There were no significant differences between the placebo and fluoxetine-treated groups in the change during the 8-week treatment period for any dimension of CFS. There was no change in subjective assessments of fatigue, severity of depression, functional impairment, sleep disturbances, neuropsychological function, cognitions, or physical activity in the depressed or the non-depressed subgroup. Interpretation Fluoxetine in a 20 mg daily dose does not have a beneficial effect on any characteristic of CFS. The lack of effect of fluoxetine on depressive symptoms in CFS suggests that processes underlying the presentation of depressive symptoms in CFS may differ from those in patients with major depressive disorder.

Post-operative fatigue — a real phenomenon attributable to the metabolic effects of surgery on body nutritional stores

Ambulatory monitoring of activity was undertaken in 97 patients before and at intervals following surgery employing a lightweight recorder and sensors to monitor posture and movement over 24h periods. A subjective assessment of fatigue, anthropometric measurements and clinical details were noted prior to each recording. Results were assessed using multiple regression analysis. Few patients exhibited any subjective feeling of fatigue. However, objective assessment did show a reduction in activity, several of the changes correlating with factors related to surgical stress and post-operative nutritional depletion. Reduction in time standing was related to both weight change at 2 weeks (p < 0.005) and duration of surgery (p < 0.05). Increase in time spent lying correlated with muscle loss at 2 weeks (p < 0.005). Number of steps walked was only influenced by weight change at 2 weeks (p < 0.05). Reduction in post-operative mobility may be related to the metabolic consequences of the surgery and its effects on depletion of nutritional stores. Manipulation of the response and aggressive nutritional support might well reduce post-operative fatigue.

Recombinant Erythropoietin Improves Exercise Capacity in Anemic Hemodialysis Patients

The objective of this study was to quantitate the improvement in exercise capacity produced in anemic chronic hemodialysis (HD) patients after correction of their anemia with recombinant human erythropoietin (rHuEPO). The maximal exercise capacity and quadriceps strength of 19 anemic HD patients was tested before and after correction of the anemia with rHuEPO. A progressive work exercise protocol (PWET) on a cycle ergometer was used to compare measurements of maximal oxygen uptake (VO2max), maximal heart rate, and subjective assessment of fatigue during the test. Measurements of quadriceps strength were performed before the cycle ergometer studies. At baseline, all patients had reduced VO2max (15.3 +/- 5.4 mL/kg/min) and maximal exercise heart rates (138.5 +/- 23.9 beats/min). rHuEPO increased the mean hematocrit from 21.2% to 35%, and this was associated with a 17% increase (P less than 0.0005) in the VO2max. At any specified work load, rHuEPO treatment decreased heart rate, minute ventilation, and the subjective perception of fatigue. Both isometric and isokinetic measurements of quadriceps strength were improved following administration of rHuEPO. The maximal exercise heart rate was decreased in comparison to the baseline measurements (P less than 0.04), suggesting that in contrast to normal subjects, HD patients stop exercise before oxygen transport limitations are reached. In this unselected group of chronic HD patients, rHuEPO produced clinically significant improvements in both aerobic exercise capacity and isometric and isokinetic quadriceps strength. The improvement in aerobic capacity was substantially less than would have been expected from the correction of a comparable degree of anemia in non-HD patients. None of the 19 treated patients attained the exercise performance level predicted for a sedentary normal subject.

Effects of prolonged sleep deprivation, with and without chronic physical exercise, on mood and performance.

ABSTRACTThe effects of physical exercise and sleep deprivation on mood and cognitive performance were studied in 12 healthy young male volunteers deprived of sleep on two occasions. During the first 60‐hr period without sleep, half of the subjects walked on a treadmill at 25–30% of their maximum aerobic capacity (Exercise condition) for 1 out of every 3 hrs while the remaining 6 subjects remained physically inactive (No Exercise condition) during that same hour. Eight weeks later the same 12 subjects underwent an identical sleep‐deprivation protocol except that those who were previously inactive exercised, while those who previously exercised remained inactive. Throughout the sleep deprivation periods, subjects in both conditions completed subjective assessments of fatigue, sleepiness and mood every 3 hrs, performed an auditory vigilance task every 6 hrs, and completed a cognitive test battery every 12 hrs. The results revealed clear decrements in mood and performance as a function of sleep loss. However, with the exception of somewhat more long reaction times in the Exercise condition, exercise neither increased nor decreased the impairment induced by sleep deprivation.

Quantitative subjective assessment of fatigue in static muscle effort

The possibility of subjective assessment of fatigue in a static muscle load has been demonstrated. Six subjects performed a static muscle exercise with 25, 35 and 45% of their voluntary maximum force. They quantified their subjective feeling of fatigue by means of an assessment scale. The method of fatigue assessment used in these experiments appears to be very reliable and the discriminatory power is great. Differences in assessment of fatigue between the three imposed loads were already significant after 1 min in the working period; they became more significant during this period. They differed also in the first minute of recovery. This method of fatigue assessment has a greater discriminatory power than recording of heart rate.