Fatigue Visual Analogue Scale Research Articles

Sipjeondaebo-tang in patients with breast cancer with fatigue: a protocol for a pilot, randomised, double-blind, placebo-controlled, cross-over trial

IntroductionCancer-related fatigue is a frequent symptom in patients with cancer and one of the most distressing symptoms in patients with breast cancer. Sipjeondaebo-tang (Juzen-taiho-to in Japanese or Shi-Quan-Da-Bu-Tang in Chinese)...

Cognitive motor interference in patients with multiple sclerosis

Patients with multiple sclerosis (PwMS) present cognitive and motor dysfunction. The Cognitive Motor Interference (CMI) could have a negative impact in PmMS’ daily-life activities especially in those situations when the concomitances of these two components are crucial (e.g., walking and talking with someone, cross a traffic light). CMI have been experimentally evaluated based on a dual task paradigm. Recent studies suggest that there is some inconsistence in the literature regarding whether dual task condition differs between PwMS and healthy peers. The objectives of this study were (i) to determine the impact of the CMI in the gait of PwMS by comparing with healthy peers and (ii) to determine which clinical, cognitive and motor, parameters were more associated with dual task gait. Forty-nine PwMS and 15 healthy peers participated in this study. The evaluations were composed by a current clinical evaluation, SDMT cognitive test, visual analogue scale of fatigue and gait evaluated at self-selected and dual task (arithmetic calculations) conditions. Afterward, the dual task cost (DTC), which is the ratio between the velocities of the 2 gait conditions, was calculated. Significant differences in the cognitive and motor performances were found between PwMS and healthy groups ( P = 10 −5 ). However, in terms of DTC, no significant difference was found between groups ( P = 0.12). EDSS score was the only significant parameter able to explain the DTC variance at 8%. The gait at self-selected condition could explain 92% of the variance of the gait at dual task condition. The CMI occurs in the same proportion in both PwMS and healthy persons. Despite the preponderance of the motor component in the DTC and in gait dual task condition, a combined motor and cognitive rehabilitation approach may have better results than a rehabilitation programs based on separated components.

Effect of Fatigue on Medial Elbow Torque in Baseball Pitchers: A Simulated Game Analysis

Background: The incidence of overuse injury to the elbow among baseball pitchers continues to rise, despite extensive efforts at pitch count regulations and emphasis on proper throwing mechanics. Purpose: To determine if the medial elbow experiences increased torque levels as a baseball pitcher fatigues through the course of a simulated game. Study Design: Descriptive laboratory study. Methods: High school and collegiate baseball pitchers were recruited for this simulated game study. Each pitcher completed a simulated game consisting of 6 innings and a standardized pitching scheme of fastballs, curveballs, and changeups. In total, each pitcher threw 90 pitches. Fatigue was reported per inning with a visual analog scale, and pitch velocity was captured per pitch with a radar gun. Outcome measures were assessed with a validated mobile sensor and included medial elbow torque, arm speed, arm rotation, and arm slot. Linear and quadratic regression modeling was used to evaluate the relationship between pitcher fatigue and pitching kinematics. Results: A total of 11 pitchers (mean age, 17.6 years; range, 15-20 years) completed the study. Visual analog scale fatigue scores increased 0.72 points per inning pitched (P < .01, effect size = 0.64). Medial elbow torque also increased beyond inning 3, with an increase of 0.84 N·m each inning (P < .01, effect size = 0.08), while pitch velocity decreased (0.28 mph per inning, P < .01, effect size = 0.27). Fastballs generated the greatest amount of medial elbow torque (49.3 ± 1.4 N·m, P < .01, effect size = 0.24). There were no differences in arm rotation (P = .42) or arm speed (P = .80) as the game progressed. However, arm slot decreased with each successive inning (0.73° on average per inning, P = .03, effect size = 0.12). No adverse outcomes were noted with use of the mobile sensor. Conclusion: In this simulated game analysis, pitchers experienced increased fatigue after each successive inning. While the average pitch velocity declined with each successive inning, the torque on the medial elbow increased after inning 3. These findings signify a possible relationship between fatigue and injury risk.

Anti-Fatigue Effects of Yogurt Fermented with Lactobacillus delbureckii subsp. bulgaricus OLL1073R-1 in Healthy People Suffering from Summer Heat Fatigue: A Randomized, Double-Blind, Placebo-Controlled Trial.

Fatigue caused by summer heat is a typical indefinite complaint along with anorexia, loss of sleep, stress, lack of motivation and, in some cases, catching a cold. Yogurt fermented with Lactobacillus delbrueckii subsp. bulgaricus OLL1073R-1 has been shown to stimulate the immune system and reduce the risk of catching colds. Here, we conducted a randomized, double-blinded, placebo-controlled trial to investigate whether ingesting this yogurt could ameliorate summer heat fatigue in 49 healthy males (median age 40.0 ± 6.0 years; 30–49 years) who felt fatigued every summer. Fatigue was evaluated by visual analogue scales (VAS) and the balance of sympathetic/parasympathetic nervous systems. After 12 weeks of ingestion in early autumn, the VAS fatigue scores in the yogurt group were lower than those of the placebo group. These results indicate that yogurt fermented with L. bulgaricus OLL1073R-1 can ameliorate summer heat fatigue lasting up to early autumn.

Study of the physiological and mental health effects caused by exposure to low-frequency noise in a simulated control room

The purpose of this study was to investigate the physiological and mental health effects caused by exposure to low-frequency noise in typical control rooms and office-like areas. The participants were 35 male students who were exposed to noise at levels of 55, 65, 70, and 75 dBA. The N-back test was used at three cognitive performance loads (low workload ( n = 1), medium workload ( n = 2), and high workload ( n = 3) to evaluate working memory simultaneously in an air conditioning chamber in four sessions with a constant level. The electroencephalography, electrocardiogram, and electrooculography were measured using Nexus 4 by Bio traces software (Mind Media Co.). For evaluation of mental fatigue, fatigue visual analog scale, and psycho-physiological indices were also used. The results showed that the losses of physiological and mental health were rapidly increased with exposure to noise levels of 65–75 dBA. The results showed that mental fatigue significantly affected heart rate, low- to high-frequency ratios, and electroencephalogram indices such as theta, alpha, as well as eye activities and working memory. The findings confirmed that the mental fatigue caused by low-frequency noise significantly impacted the employees’ psycho-physiological and working memory responses. Implementation of the effective interventions to overcome employees’ mental fatigue in typical control rooms and office-like areas can improve the health and acoustic comfort and, consequently, the cognitive performance.

Serological lymphocytic activity and patient-reported outcomes in Sjögren's syndrome.

This study was set to investigate whether serum markers of lymphocytic activity are associated with patient-reported outcomes in Sjögren's syndrome (SS). Forty-six patients with SS were included in this cross-sectional study. Patients with monoclonal gammopathy, history of malignant lymphoma, or with secondary SS were excluded. Serum levels of IgG, β2-microglobulin (β2M), soluble interleukin-2 receptor (sIL2-R), and free light chains (FLC) were assessed. Systemic disease activity was measured by the EULAR SS disease activity index (ESSDAI). Patient-reported symptoms were recorded by visual analogue scales (VAS) of pain, fatigue, and dryness, as compiled in the EULAR SS patient-reported index (ESSPRI). Depressive symptoms were determined by the Patient Health Questionnaire 9 (PHQ-9). Serum concentrations of κFLC (r = 0.491, p = 0.001), λFLC (r = 0.326, p = 0.027), and β2M (r = 0.421, p = 0.004) correlated with the ESSDAI, whereas sIL-2R and IgG did not. No correlations between serum markers of lymphocytic activity and the ESSPRI, or single VAS measures of pain, dryness, or fatigue, were found. In patients with VAS fatigue scores in the upper quartile, sIL-2R serum levels were even decreased (p = 0.019). Only depressive symptoms as determined by PHQ-9 were positively correlated with fatigue (r = 0.536, p < 0.001). In this well-defined cohort of patients with SS, serological lymphocytic activity was not correlated with patient-reported outcomes and sIL-2R levels were even decreased in patients with high fatigue scores. Only depressive symptoms were correlated with fatigue. This highlights the need to further understand the link between inflammation and disease characteristics in SS.

Visual analogue scales for interstitial lung disease: a prospective validation study.

Visual analogue scales (VAS) are simple symptom assessment tools which have not been validated in interstitial lung disease (ILD). Simple measures of ILD disease burden would be valuable for non-specialist clinicians monitoring disease away from ILD specialist centres. To validate VAS to assess change in dyspnoea, cough and fatigue in ILD, and to define the minimal clinically important difference (MCID) for change in these. Patients of 64 with ILD completed VAS for dyspnoea, cough and fatigue. Baseline King's Brief ILD questionnaire (K-BILD) scores, lung function and 6-min walk test results were collected. Tests were repeated 3-6 months later, in addition to a seven-point Likert scale. The MCID was estimated using median change in VAS in patients who reported 'small but just worthwhile change' in symptoms at follow-up. Methods were repeated in a validation cohort of 31 ILD patients to confirm findings. VAS scores were significantly higher for patients who reported a 'small but just worthwhile change' in symptoms vs. 'no change' or 'not worthwhile change' (P < 0.01). The MCID for VAS Dyspnoea was estimated as 22.0 mm and 14.5 mm for VAS Fatigue. These results were reproducible in the validation cohort. Results were not significant for VAS Cough. Change in VAS Dyspnoea correlated with change in K-BILD (r = -0.51, P < 0.01), forced vital capacity (r = -0.32, P = 0.01) and 6-min walking distance (r = -0.37, P = 0.01). The VAS is valid for assessing change in dyspnoea and fatigue in ILD. The MCID is estimated as 22.0 mm for dyspnoea and 14.5 mm for fatigue. This could be used to monitor disease in settings away from ILD specialist review. Lung Diseases, Interstitial, Dyspnoea, Fatigue, Cough.

Low starting dosage of infliximab with possible escalating dosage in psoriatic arthritis gives the same treatment results as standard dosage of adalimumab or etanercept: results from the nationwide Icelandic ICEBIO registry.

ObjectiveTo explore differences in response to a low dosage regimen of infliximab with an escalating dosage in comparison to a standard dosage of etanercept and adalimumab in patients with psoriatic arthritis (PsA).MethodsBiologically naïve PsA patients who were beginning anti-TNF-α therapy were selected from the ICEBIO registry. Demographics and clinical differences were compared in four treatment groups: infliximab <4 mg/kg; infliximab >4 mg/kg; etanercept or adalimumab at baseline and on follow-up (6 and 12 months, last visit). The Kruskal–Wallis rank sum test was used for comparison of the groups and the Wilcoxon test to compare the two infliximab dosage regimens.ResultsOne hundred and eighty-five patients (61% female) were identified; 84 patients received infliximab, 66 etanercept, and 35 adalimumab. A total of 19% of the patients treated with infliximab escalated their dosage ≥4 mg/kg. No significant differences were observed at baseline in respect to visual analog scale (VAS) pain, VAS fatigue, Health Assessment Questionnaire, C-reactive protein (CRP), numbers of swollen or tender joints, or Disease Activity Score (DAS) 28-CRP values. A similar treatment response was observed in all four treatment groups on follow-up.ConclusionIn respect to treatment effects, a low dosage of infliximab with possible escalating dosage is acceptable for the majority of PsA patients who are in need of biological treatment.

The effect of cognitive fatigue and hypoxia on repeated arm bike sprint performance: A combined and individual stressors approach

High‐altitude ascent can expose individuals to both physical and cognitive stress in combination. Despite this, limited research has investigated the combined influence of low oxygen concentrations and cognitive fatigue on high‐intensity exercise performance. The aim of the present study was to investigate the combined effects of cognitive fatigue and normobaric hypoxia on repeated arm bike sprint ability. Six active healthy males completed four experimental conditions in a balanced order (mean ± SD; age: 25.2 ± 2.9 years, body fat percentage: 14.4 ± 1.6%, max power during 5‐s arm bike sprint: 380 ± 77 W). All conditions were completed at 17°C environmental temperature, 50% relative humidity, with a wind speed 0.4 m.s−1. The four experimental conditions were: 1) normobaric normoxia (0.209 FiO2) with no prior cognitive fatigue (CON), 2) normobaric normoxia (0.209 FiO2) with cognitive fatigue induced using an individualised 16‐min dual‐task cognitive test prior to performance test (CF), 3) normobaric hypoxia (0.12 FiO2) with no prior cognitive fatigue (HYP), 4) normobaric hypoxia (0.12 FiO2) with cognitive fatigue induced as before (HYP+CF). To assess physical performance for each condition, participants completed 10 × 20‐s ‘all‐out’ arm sprints, followed by a 60‐s isometric bicep maximal voluntary contraction (MVC) at 100% maximal voluntary strength. Central and peripheral fatigue were assessed using Supramaximal Nerve Stimulation (400 V square wave, 10 ms spaced doublets, 37 ± 5 mA), with stimulations superimposed every 10‐s during the 60‐s MVC using the twitch interpolation method. Voluntary activation percentage (VA) and resting potentiated twitch force (Qtw,pot) were calculated. Near Infra‐Red Spectroscopy (NIRS), heart rate, oxygen consumption and subjective ratings of perceived exertion, physical discomfort and thermal sensation, were also measured. Cognitive fatigue was successfully induced prior to the performance test as verified (p≤0.001) using the Brunel Mood Scale (BRUMS), Stanford Sleepiness Scale (SSS) and the Visual Analogue Scale of Fatigue (VASF). High‐altitude resulted in decreased (p=0.002) NIRS muscle oxygenation by 9.7 ± 3.8%. Individually, cognitive fatigue (p=0.032) and hypoxia (p=0.037) lowered power output across all ten sprints by 7.3 ± 6.4 W and 10.5 ± 8.8 W respectively, when compared to control conditions (CON: 188 ± 22 W, HYP: 182 ± 16 W, CF: 185 ± 18 W, HYP+CF: 170 ± 16 W). Exposure to both stressors in combination produced a greater decline in average power output, and the effect was additive for the two stressors (no interaction, p=0.127). Post‐exercise perceptual and subjective sensations, as well as MVC force, VA and Qtw,pot were not different between trials (p≥0.126). In conclusion, separate exposure to cognitive fatigue and hypoxia significantly impaired self‐paced physical performance during repeated arm bike sprints. When combined, exposure to cognitive fatigue and hypoxia diminished performance additively for the two stressors.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract P2-11-10: Toxicity analysis of elderly breast cancer patients using different accelerated partial breast irradiation techniques

Abstract PURPOSE We investigated the acute toxicity of Accelerated Partial Breast Irradiation using external beam (EB-APBI) and intraoperative radiotherapy (IORT) technique. MATERIALS AND METHODS Women ≥60 years with unifocal breast tumors of ≤30 mm undergoing breast conserving therapy were eligible for this prospective multi-centre cohort study. After informed consent, patients were treated with IORT in one institute, EB-APBI was applied in other institutes. IORT was applied with electrons directly on the tumor bed following lumpectomy (21 Gy at 90% isodose). EB-APBI was delivered using 3D-conformal radiotherapy or IMRT in 10 daily fractions of 3.85 Gy. Acute toxicity was scored using the CTCAE v.3, initially by the treating physician and retrospectively by blinded researchers. The highest reported toxicity until 3 months after treatment was used. Patient reported symptoms were analysed using Visual Analogue Scales (VAS) for pain and fatigue (scale 0-10), and single items from the EORTC QLQ-C30 and Breast Cancer module questionnaires at different time points up till 3 months. P&amp;lt;0.01 was deemed significant. RESULTS Between January 2011 and August 2016, 622 patients were eligible, eventually 268 patients underwent IORT and 207 underwent EB-APBI. Of those, 267 (IORT) and 206 (EB-APBI) were available for toxicity analysis. Patient characteristics are shown in table 1. Although more patients experienced &amp;gt;grade 2 acute toxicity in the IORT group (10.4% IORT and 4.9% EB-APBI; p=0.027), grade 3 toxicity was low and did not significantly differ between groups (3.3% IORT and 1.5% EB-APBI). No grade 4 toxicity occurred. After IORT more wound infections requiring oral antibiotics (5.2% versus 1.5%) and more seroma requiring aspiration (2.2% versus 0.5%) were observed. Results for EORTC symptoms and VAS scores are displayed in table 2. Patients treated with EB-APBI experienced significantly less fatigue direct postoperatively (EORTC p=0.003, VAS p&amp;lt;0.001). After 3 months, this difference dissolved, and only pain according to the VAS scale was significantly worse in the EB-APBI group (p=0.003). Table 1. Patient characteristics IORT, n=267EB-APBI, n=206p-valueAge(median; range) 68; 59-9067; 59-860.683pT stagepTis7%13%0.020 pT184%74% pT29%13% pN stagepN093%97%0.092 pN17%3% ER statusPositive93%93%0.122Systemic therapyNo59%62%0.509 Table 2. EORTC and VAS scores BaselinePostoperativeAfter EB-APBI3 months after treatment IORTEB-APBIIORTEB-APBIEB-APBIIORTEB-APBIPain771920111013Fatigue1192916241723Breast pain4425211068Swollen breast122516554Oversensitive breast33362715811Skin side effects1147835VAS pain(median) 3.03.02.02.03.0VAS fatigue(median) 4.03.04.03.04.0EORTC: Scores of “quite a bit” and “very much” were scored positive. Percentage of patients that scored positive is shown. CONCLUSION Even though more clinically relevant toxicity is seen in IORT treatment direct postoperatively, acute toxicity in both IORT and EB-APBI treatment is acceptable. IORT patients seem to recover more rapidly regarding fatigue than EB-APBI patients. This may be explained by the fact that IORT treatment is completed in one day. Citation Format: Jacobs DHM, Marijnen CAM, Speijer G, Straver M, Marinelli A, Merkus J, Roelofzzen EMA, Zwanenburg LAG, Fisscher U, Petoukhova AL, Mast ME, Koper P. Toxicity analysis of elderly breast cancer patients using different accelerated partial breast irradiation techniques [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-10.

Physical activity behaviour in men with inflammatory joint disease: a cross-sectional register-based study.

Physical activity is recommended as an essential part of the non-pharmacological management of inflammatory joint disease, but previous research in this area has predominantly included women. The aim of this study was to examine physical activity behaviour in men with inflammatory joint disease. The study was conducted as a cross-sectional register-based study. Data on physical activity behaviour in men with RA, PsA and AS were matched with sociodemographic and clinical variables extracted from the DANBIO registry. Logistic regression analyses using multiple imputations were performed to investigate demographic and clinical variables associated with regular engagement in physical activity (moderate-vigorous ⩾2 h/week). Descriptive statistics were applied to explore motivation, barriers and preferences for physical activity. A total of 325 men were included of whom 129 (40%) engaged in regular physical activity. In univariate analyses, higher age, visual analogue scale (VAS) for pain, VAS fatigue, VAS patient's global, CRP level, disease activity, functional disability and current smoking were negatively associated with regular engagement in physical activity. In the final multivariable regression model only a high VAS fatigue score (⩾61 mm) (OR = 0.228; CI: 0.119, 0.436) remained significantly independently associated with regular physical activity. A majority of men with inflammatory joint disease do not meet the recommendations of regular physical activity. Both sociodemographic and clinical parameters were associated with engagement in physical activity, and fatigue especially seems to play a pivotal role in explaining suboptimal physical activity behaviour in this patient group.

Daytime Sleepiness, Exertion Fatigue, and Task Vigilance in Persons with Aphasia

Daytime Sleepiness, Exertion Fatigue, and Task Vigilance in Persons with Aphasia

Comparison of neuromuscular fatigue in chronic stroke patients with healthy controls

Background and Introduction: Fatigue has been defined as a feeling of early exhaustion, weariness, lack of energy and aversion to effort. Glader et al suggest that survivors of stroke with fatigue have a higher fatality rate three years after stroke due to its association with sedentary lifestyle. Neuromuscular fatigue is defined as an activity induced impairment in the ability to exert force, and is quantified by the reduction in force that a muscle or muscles can exert following or during an activity. Fatigue of the paretic leg muscles is likely to greatly impact walking function post-stroke. Therefore, quantitative measures of neuromuscular fatigue of the paretic leg muscles are expected to be associated with walking function in people post-stroke. There is scant research, which specifically investigates neuromuscular fatigue following stroke. The purpose of the study was to assess and compare the contribution of neuromuscular fatigue in patients following stroke with age and gender matched healthy participants. Methodology: Subjects (N=80) were divided into experimental group (N=40) and control group (N=40) by purposive sampling. Patients who were already been diagnosed with chronic stroke (>6months) by Registered Medical Practitioner (RMP) were included in the study. The muscle activity of the quadriceps and hamstrings on the subject’s paretic as well as non-paretic side were recorded using Dual Bio Amp/Stimulator. Pre- fatigue inducing exercise (Electromyography) EMG signals (integral mean values in mVs) were recorded by performing Maximal Voluntary Contraction (MVC) of both the muscles. Post-fatigue inducing exercise EMG signals (integral mean values in mVs) by performing Sit-To-Stand test (STS). Visual Analog Fatigue Scale (VAFS) was used to assess the subjective levels of fatigue pre and post exercise while Fatigue Severity Scale (FSS) was used to assess chronic fatigue. Results: In paretic, non-paretic and control study group, the mean pre-fatigue EMG activity of hamstrings is significantly higher compared to mean post-fatigue EMG activity of hamstrings (P-value<0.001). In paretic, non-paretic and control study group, the mean pre-fatigue EMG activity of quadriceps is significantly higher compared to mean post-fatigue EMG activity of quadriceps (P-value<0.001). Conclusion: It was concluded that there is a difference seen in the peripheral neuromuscular fatigue in the chronic stroke individuals when compared with age and gender matched control group.

Effect of Chlorella Ingestion on Oxidative Stress and Fatigue Symptoms in Healthy Men.

We examined the effects of dietary chlorella ingestion on oxidative stress and fatigue symptoms in healthy men under resting and fatigue conditions. We conducted a double-blind, parallel-arm controlled study. Twenty-seven healthy male volunteers (mean age, 35.4±10.4 years) were randomly divided into the chlorella and placebo groups, and received chlorella (6 g/day) and lactose as placebo (7.2 g/day), respectively, for 4 weeks. To simulate mild fatigue, subjects underwent exercise (40% of the heart rate reserve) for 30 minutes. Fatigue was measured using the visual analog scale of fatigue (F-VAS) pre- and post-exercise. Serum antioxidant capacity (AC), malondialdehyde levels, and other indices of oxidative stress were measured pre- and post-exercise. All measurements were repeated after the intervention period and the results were compared with baseline measurements. Under resting conditions, AC significantly increased after the intervention period in the chlorella group, but not in the placebo group. Malondialdehyde levels after the intervention period were significantly lower in the chlorella group than in the placebo group. There were no significant differences in any of the oxidative-stress indices measured pre- and post-exercise, either before or after intervention, in either group. F-VAS significantly increased after exercise at all measurement time-points in both groups, except after the intervention period in the chlorella group. Under fatigue conditions, there were no significant differences in oxidative stress indices between the groups. Our results suggest that chlorella ingestion has the potential to relieve oxidative stress and enhance tolerance for fatigue under resting conditions.

Fatigue in Intensive Care Nurses and Related Factors.

Background: Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems. Objective: To determine the level of fatigue among nurses working in intensive care units and the related factors. Methods: This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index. Results: The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001). Conclusion: Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

Translation and validation of the Fatigue Severity Scale, Pittsburgh Sleep Quality Index and Modified Health Assessment Questionnaire into the Maltese Language, in a cohort of Maltese Systemic Lupus Erythematosus patients.

PURPOSE:The assessment of fatigue, sleep quality and functional disability requires the use of validated instruments such as the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI) and the Modified Health Assessment Questionnaire (mHAQ) respectively. The aim of this study was to translate and validate these instruments into the Maltese Language.METHOD:Forward translation from the original English version into Maltese was carried out by two translators. The two versions were compiled to produce a preliminary initial Maltese translation. This was translated back into English by two other translators. This led to the development of the pre-final version of the Maltese translation, which was pilot-tested in 20 bilingual patients with systemic lupus erythematosus.RESULTS:Psychometric testing revealed good reliability of the Maltese translation of the three questionnaires. Cronbach’s alpha of the Maltese versions of the FSS, PSQI and mHAQ were 0.877, 0.859 and 0.897 respectively, showing good internal consistency. Validity of the Maltese version of the FSS was shown, since it had a significant positive correlation with visual analogue scale for fatigue (r=0.809, p<0.001).CONCLUSION:The Maltese translations were thus finalised, and could be used for clinical assessment or research purposes.

Light therapy for multiple sclerosis-associated fatigue: Study protocol for a randomized controlled trial.

Background:Fatigue is the most commonly reported symptom among multiple sclerosis (MS) patients, more than a quarter of whom consider fatigue to be their most disabling symptom. However, there are few effective treatment options for fatigue. We aim to investigate whether supplemental exposure to bright white light will reduce MS-associated fatigue.Methods:Eligible participants will have clinically confirmed multiple sclerosis based on the revised McDonald criteria (2010) and a score ≥36 on the Fatigue Severity Scale (FSS). Participants will be randomized 1:1 to bright white light (10,000 lux; active condition) or dim red light (<300 lux; control condition) self-administered for 1 hour twice daily. The study will include a 2-week baseline period, a 4-week treatment period, and a 4-week washout period. Participants will record their sleep duration, exercise, caffeine, and medication intake daily. Participants will record their fatigue using the Visual Analogue Fatigue Scale (VAFS) 4 times every third day, providing snapshots of their fatigue level at different times of day. Participants will self-report their fatigue severity using FSS on 3 separate visits: at baseline (week 0), following completion of the treatment phase (week 6), and at study completion (week 10). The primary outcome will be the change in the average FSS score after light therapy. We will perform an intention-to-treat analysis, comparing the active and control groups to assess the postintervention difference in fatigue levels reported on FSS. Secondary outcome measures include change in global VAFS scores during the light therapy and self-reported quality of life in the Multiple Sclerosis Quality of Life-54.Discussion:We present a study design and rationale for randomizing a nonpharmacological intervention for MS-associated fatigue, using bright light therapy. The study limitations relate to the logistical issues of a self-administered intervention requiring frequent participant self-report in a relapsing condition. Ultimately, light therapy for the treatment of MS-associated fatigue may provide a low-cost, noninvasive, self-administered treatment for one of the most prevalent and burdensome symptoms experienced by people with MS.

Relationship Between Fatigability and Perceived Fatigue Measured Using the Neurological Fatigue Index in People with Multiple Sclerosis.

Understanding the relationship between perceived fatigue and performance fatigability could lead to more effective interventions to manage multiple sclerosis (MS)-related fatigue. However, the relationship between self-perceived fatigue measured using the Neurological Fatigue Index (NFI-MS) and performance fatigability in people with MS is unknown. We sought to explore the relationship between the NFI-MS and performance fatigability in people with MS. Fifty-two participants (mean ± SD age, 46.8 ± 10.1 years) completed the study. Three measures of performance fatigability were used: percent change in meters walked from first to last minute of the 6-Minute Walk Test, percent change in force exerted from first to last trial on a repetitive maximal hand grip test, and response speed variability on the Continuous Performance Test. Perceived physical and cognitive fatigue were measured using the NFI-MS. The state level of fatigue was examined immediately before and after performing the fatigability measures using a one-item visual analogue fatigue scale. Of the three performance fatigability measures, only the attentional task (response speed variability) was significantly associated with NFI-MS physical (r = 0.326, P = .020) and cognitive (r = 0.276, P = .050) domain scores. Participants demonstrated significantly higher state levels of fatigue after performing all performance fatigability measures (P ≤ .001). The NFI-MS and the performance fatigability measures used in this study are easy to administer. We encourage wider use of these measures in clinical and research settings for comprehensive assessment of MS-related fatigue.

Effect of aromatherapy via inhalation on the sleep quality and fatigue level in people undergoing hemodialysis

The most common problems in hemodialysis patients are sleep disorders and fatigue. This randomized-controlled experimental study was conducted to determine the effect of aromatherapy applied by inhalation on sleep quality and fatigue level in hemodialysis patients. The study was completed in five hemodialysis centers settled in two provinces with 27 intervention group patients and 35 controls, being totally 62 patients, recruited with simple randomization. Ethical approval, informed consent from the individuals and institutional permission were obtained. Data were collected with a questionnaire form and Visual Analogue Scale (VAS) for fatigue, Piper fatigue scale, Pittsburgh Sleep Quality Index (PSQI), and follow-up forms for the patient and the researcher. Aromatherapy inhalation (sweet orange and lavender oil) was performed before going to bed every day for one month to the intervention group patients. No other application has been made to the control group patients except for standard hemodialysis treatment. All of the forms were performed at baseline and at follow-up at the end of the four weeks (baseline and last follow-up), VAS and Piper fatigue scale were performed during follow-ups at the end of every week (the first, second and third follow-ups). Data were statistically analyzed with Independent Samples t-test, one way analysis of variance, Pearson correlation analysis, chi-square test, Friedman and Mann Whitney U tests and Bonferroni test. p<0.05 was set as statistically significant in comparisons. Mean total and sub-dimension scores of VAS, Piper fatigue scale and PSQI (except for daytime sleepiness dysfunction sub-dimension) of the intervention and control groups at baseline were not significantly different (p>0.05). It was found that mean total and sub-dimension scores of VAS, Piper fatigue scale and PSQI of the intervention group significantly decreased in other follow-ups compared to the control group (p<0.05). Consequently, it was determined that aromatherapy applied by inhalation improved sleep quality, decreased fatigue level and severity in hemodialysis patients. Accordingly, aromatherapy prepared with sweet orange and lavender oil may be recommended to increase sleep quality and to decrease fatigue level of the hemodialysis patients.

Patient-reported Outcomes as Predictors of Change in Disease Activity and Disability in Early Rheumatoid Arthritis: Results from the Yorkshire Early Arthritis Register.

To assess patient-reported variables as predictors of change in disease activity and disability in early rheumatoid arthritis (RA). Cases were recruited to the Yorkshire Early Arthritis Register (YEAR) between 1997 and 2009 (n = 1415). Predictors of the 28-joint Disease Activity Score (DAS28) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) at baseline and change over 12 months were identified using multilevel models. Baseline predictors were sex, age, symptom duration, autoantibody status, pain and fatigue visual analog scales (VAS), duration of early morning stiffness (EMS), DAS28, and HAQ-DI. Rates of change were slower in women than men: DAS28 fell by 0.19 and 0.17 units/month, and HAQ-DI by 0.028 and 0.023 units/month in men and women, respectively. Baseline pain and EMS had small effects on rates of change, whereas fatigue VAS was only associated with DAS28 and HAQ-DI at baseline. In patients recruited up to 2002, DAS28 reduced more quickly in those with greater pain at baseline (by 0.01 units/mo of DAS28 per cm pain VAS, p = 0.024); in patients recruited after 2002, the effect for pain was stronger (by 0.01 units/mo, p = 0.087). DAS28 reduction was greater with longer EMS. In both cohorts, fall in HAQ-DI (p = 0.006) was greater in patients with longer EMS duration, but pain and fatigue were not significant predictors of change in HAQ-DI. Patient-reported fatigue, pain, and stiffness at baseline are of limited value for the prediction of RA change in disease activity (DAS28) and activity limitation (HAQ-DI).