Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Assessment of Daily and Weekly Fatigue Among African American Cancer Survivors Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Functional Incapacity and Physical and Psychological Symptoms: How They Interconnect in Chronic Fatigue Syndrome Measurement of fatigue. determining minimally important clinical differences. Psychometric testing of fatigue instruments for use with cancer patients. Fatigue, as measured using the Modified Fatigue Impact Scale, is a predictor of processing speed improvement induced by exercise in patients with multiple sclerosis: data from a randomized controlled trial Fatigue in multiple sclerosis: multidimensional assessment and response to symptomatic treatment Chief complaint fatigue: a longitudinal study from the patient's perspective. The Nature of the Depressive Symptomatology Preceding Myocardial Infarction The mental health of patients with a chief complaint of chronic fatigue. A prospective evaluation and follow-up. Reliability and structural validity of the Multidimensional Fatigue Inventory (MFI) in patients with idiopathic Parkinson's disease. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Fatigue. Measures and relation to pain Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up Prospective Study of the Prognosis of Unexplained Chronic Fatigue in a Clinic-Based Cohort Predicting high physical function in people with fibromyalgia.
In this paper the psychometric properties of the multidimensional fatigue inventory ( MFI-20 ) are established further in cancer patients . The MFI is a 20-item self-report instrument design ed to measure fatigue . It covers the following dimensions : general fatigue , physical fatigue , reduced activity , reduced motivation and mental fatigue . The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy .  The dimensional structure was assessed using confirmatory factor analyses ( Lisrel 's unweighted least-squares method ) . The hypothesised five-factor model appeared to fit the data in both sample s ( adjusted goodness of fit ; AGFI : 0.97 and 0.98 ) . Internal consistency of the separate scales was good in both the Dutch and Scottish sample s with Cronbach 's alpha coefficients ranging from 0.79 to 0.93 . Construct validity was assessed by correlating the MFI-20 to activities of daily living , anxiety and depression . Significant relations were assumed . Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist . Results support the validity of the MFI-20 . The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust This investigation evaluates two common measures of cancer-related fatigue , one multidimensional/retrospective and one unidimensional/same day . Fifty-two African American survivors of diverse cancers completed  fatigue visual analogue scales once daily , and the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) once weekly , for four weeks . Zero-order correlations showed retrospective fatigue was significantly related to average , peak , and most recent same-day fatigue . Multilevel r and om coefficient modeling showed unidimensional fatigue shared the most variance with the MFSI-SF 's General subscale for three weeks , and with the Vigor subscale for one week . Research ers and clinicians may wish to prioritize multidimensional measures when assessing cancer-related fatigue , if appropriate BACKGROUND Chronic fatigue syndrome ( CFS ) is a condition that may be associated with substantial disability . The Medical Outcomes Study Short-Form General Health Survey ( SF-36 ) is an instrument that has been widely used in outpatient population s to determine functional status . Our objectives were to describe the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue ( CF ) , major depression ( MD ) , or acute infectious mononucleosis ( AIM ) , and from healthy control subjects ( HC ) . An additional goal was to ascertain if subscale scores correlated with the signs and symptoms of CFS or the presence of psychiatric disorders and fibromyalgia . DESIGN Prospect ively collected case series . SETTING Patients with CFS and CF were seen in a university-based referral clinic and had undergone a complete medical and psychiatric evaluation . Other study subjects were recruited from the community to participate in research studies . PARTICIPANTS The study included 185 patients with CFS , 246 with CF , 111 with AIM , and 25 with MD . There were 99 HC subjects . MEASURES The  SF-36 and a structured psychiatric interview  were used . The SF-36 contains 8 subscales : physical , emotional , social , and role functioning , body pain , mental health , vitality , and general health- and a structured psychiatric interview .  RESULTS Performance characteristics ( internal reliability coefficients , convergent validity ) of the SF-36 were excellent . A strikingly consistent pattern was found for the physical functioning , role functioning , social functioning , general health , and body pain subscales , with the lowest scores in CFS patients , intermediate scores in AIM patients , and the highest scores in the HC subjects . The CFS patients had significantly lower scores than patients with CF alone on the physical functioning ( P < or = 0.01 ) , role functioning ( P < or = 0.01 ) , and body pain ( P < or = 0.001 ) subscales . The emotional functioning and mental health scores were worst among those with MD . The presence of fibromyalgia , being unemployed , and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains , with increasing fatigue appearing to have the greatest effect . CONCLUSIONS The SF-36 is useful in assessing functional status in patients with fatiguing illnesses . Patients with CFS and CF have marked impairment of their functional status . The severity and pattern of impairment as documented by the SF-36 distinguishes patients with CFS and CF from those with MD and AIM , and from HC , but does not discriminate between CF and CFS Background : It has been argued that perceived functional incapacity might be a primary characteristic of chronic fatigue syndrome ( CFS ) and could be explained by physical symptoms . If so , it could be expected to be closely associated with physical , but not psychological symptoms . The study tests this hypothesis . Sampling and Methods : The sample consisted of 73 patients , with a diagnosis of CFS according to the Oxford criteria , r and omly selected from clinics in the Departments of Immunology and Psychiatry at St. Bartholomew ’s Hospital , London . The degree of fatigue experienced by patients was assessed using the  Chalder Fatigue Question naire and a visual analogue scale . Self-rated instruments were used to measure physical and social functioning , quality of life , and physical and psychological symptoms . Results : Principal-component analysis of all scale scores revealed 2 distinct components , explaining 53 % of the total variance . One component was characterized by psychological symptoms and generic quality of life indicators , whilst the other component was made up of physical symptoms , social and physical functioning and indicators of fatigue . Conclusions : The findings suggest that perceived functional incapacity is a primary characteristic of CFS , which is manifested and /or explained by physical symptoms The purpose was to determine the minimally important clinical difference ( MICD ) in fatigue as measured by the Profile of Mood States , Schwartz Cancer Fatigue Scale ( SCFS ) , General Fatigue Scale , and a 10-point single-item fatigue measure . The MICD is the smallest amount of change in a symptom ( e.g. , fatigue ) measure that signifies an important change in that symptom . Subjects rated the degree of change in their fatigue over 2 days on a Global Rating Scale . 103 patients were enrolled on this multisite prospect i ve repeated measures design . MICD was determined following established procedures at two time points . Statistically significant changes were observed for moderate and large changes in fatigue , but not for small changes . The scales were sensitive to increases in fatigue over time . The MICD , presented as mean change , for each scale and per item on each scale is : POMS = 5.6 , per item = 1.1 , SCFS = 5.0 , per item = 0.8 , GFS = 9.7 , per item = 1.0 , and the single item measure of fatigue was 2.4 points . This information may be useful in interpreting scale scores and planning studies using these measures BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF Background Few studies have evaluated the impact of physical activity ( PA ) on cognition and fatigue , and none have considered the effects of PA on the relationship between cognition and fatigue . Objectives We evaluated the effect of PA in people with multiple sclerosis ( pwMS ) in a 6-month-long single-blind r and omized controlled trial . We focused on the impact of exercise on cognition , fatigue , and the relationship between cognition and fatigue . Methods We recruited pwMS , who were then r and omly assigned 1:1 to either a  PA protocol group or a  control group ( CG ) . All patients underwent assessment s using the Brief International Cognitive Assessment for Multiple Sclerosis including symbol digit modality test ( SDMT ) , Berg Balance Scale ( BBS ) , gait analysis , 6-Minute Walk Test , Timed Up and Go ( TUG ) test , and the Modified Fatigue Impact Scale ( MFIS ) at the beginning of the study ( T0 ) , at the end of the study ( EOS ) 24 weeks after T0 , and at 24 weeks following the EOS ( FU ) . Results A Wilcoxon test revealed a significant effect of exercise in the PA group , but not in the CG . Significant differences between T0 and EOS were found in the spatiotemporal parameters of gait , and performance on the SDMT , TUG , BBS , and MFIS . These differences were also present during the FU period . A regression model revealed that the baseline MFIS score predicted processing speed improvement ( R2 = 0.65 , p < 0.01 ) , as the SDMT T score increased by 0.3 for each one-unit increase in the MFIS score at T0 . Conclusion PA affects multiple aspects of the pathology in pwMS . Patients with greater fatigue must not be discouraged from exercise , as they may greatly benefit from PA . Specifically , PA was shown to improve information processing speed Sixty relapsing-remitting multiple sclerosis ( MS ) patients were selected on the basis of their score on the Fatigue Severity Scale ( FSS ) and formed two groups : 40 patients ( fatigued MS ; MSf ) scored above the 75th percentile of a previously assessed representative MS sample ( 100 patients ) , and 20 age- and sex-matched patients ( nonfatigued MS patients ; MSnf ) scored below the 25th percentile . The patients underwent clinical evaluation ( Exp and ed Disability Status Scale ( EDSS ) ) , further assessment of fatigue ( Fatigue Impact Scale ) , scales evaluating depression ( Hamilton Depression Rating Scale ( HDRS ) and Beck ’s Depression Inventory ( BDI ) ) and neuropsychological tests . All patients were evaluated for muscle fatigability and central activation by means of a biomechanical test of sustained contraction ; they also underwent somatosensory evoked potentials ( SSEPs ) and transcranial magnetic stimulation ( TMS ) . The patients of the MSf subgroup were then r and omized to one of the following two treatments : 4-aminopyridine ( 4-AP ) 24 mg/day and fluoxetine ( FLX ) 20 mg/day . After a one-week titration this treatment proceeded for 8 weeks . At the end of the treatment , EDSS , fatigue and depression scores were further evaluated . At baseline , fatigue test scores consistently correlated with depression and cognitive test scores , but not with the fatigability test . Fatigue scores decreased in both treatment groups in a similar way . Due to the design of the study , this can not be disjoined from a placebo effect . The changes of fatigue scores could not be predicted in the FLX group , whereas in the 4-AP group higher basal fatigability test scores were associated with greater reduction in fatigue scores Fatigue is one of the 10 most common reasons for visiting a physician . Yet little is known about its course or impact , from the patient 's perspective , on quality of life or utilization of medical care . The Dartmouth COOP Project , a primary care research network , conducted a one-year prospect i ve study comparing chief complaint fatigue ( CCF ) patients with two age/sex matched comparison groups ( N = 243 ) . Results show that almost 67 % of the CCF patients improved over one year ; however , they had much higher utilization rates and substantial limitations in physical and emotional function . Fatigue was associated with physical symptoms and interference with many aspects of daily life . We conclude that fatigue has a powerful , adverse effect on quality of life . We hope the findings may help physicians to better underst and and treat patients who seek care for fatigue Abstract Little is known about the nature of the depressive symptomatology preceding myocardial infa rct ion ( MI ) . Specification of the depressive symptomatology is important for the development of hypotheses about the biological mechanisms relating depressive symptoms to MI . To test the hypothesis that feelings of fatigue and loss of energy have the strongest predictive power of all depressive symptoms , the authors reanalyzed data from a prospect i ve study of 3877 healthy men aged 40 to 65 years . The men 's mental state was assessed using the  Maastricht Question naire  , a scale that measures vital exhaustion , which is characterized by unusual fatigue and lack of energy , increased irritability , and depressive symptoms , including demoralization . Oblique factor analysis was used to vali date these dimensions . Results of Cox 's regression analyses showed that the fatigue subscale has the strongest predictive power for incident MI and that depression and irritability subscales lose their predictive power when controlled for fatigue To determine the psychiatric morbidity of patients complaining of chronic fatigue , we undertook a prospect i ve evaluation of 100 adults ( 65 women and 35 men ; mean age , 41 years ; and mean duration of chronic fatigue , 13 years ) . The study was conducted in an internal medicine outpatient clinic . In addition to a comprehensive medical evaluation , the patients were administered the 260-item Diagnostic Interview Schedule  , a highly structured instrument that enabled the physician-interviewer to make accurate psychiatric diagnoses . A thorough follow-up examination was given an average of 8.4 months later . Sixty-six patients had one or more psychiatric disorders that were considered a major cause of their chronic fatigue ( mood disorder , 47 patients ; somatization disorder , 15 patients ; and anxiety disorder , nine patients ) . Five patients had medical conditions that were considered a major cause of their fatigue . The complaint of chronic fatigue remained unexplained in 31 patients . In this prospect i ve study , two thirds of cases of chronic fatigue appeared to be caused by psychiatric disorders . A thorough evaluation of the mental health of patients complaining of chronic fatigue could therefore provide pharmacologic and psychotherapeutic approaches and avoid unnecessary and costly medical investigations and therapies INTRODUCTION The Multidimensional Fatigue Inventory ( MFI ) is commonly used in patients with Parkinson 's disease ( PD ) . However , most measurement properties have not been investigated in this population . The aim of this study was to investigate internal consistency , test-retest reliability , measurement error , structural validity , and floor and ceiling effects of the MFI in PD . METHODS Patients with PD ( N = 153 ) completed the MFI at baseline and week 3 in a r and omized clinical trial . Cronbach 's α , intraclass correlation coefficient ( ICC ) , and the smallest detectable change ( SDC ) were calculated . Bl and and Altman analysis was performed . Principal Component Analysis ( PCA ) was used to explore structural validity . Floor and ceiling effects were investigated . RESULTS Cronbach 's α for the MFI-total and subscales ranged from 0.74 ( reduced motivation ( RM ) ) to 0.92 ( MFI-total ) . ICC 's ranged from 0.65 ( mental fatigue ( MF ) to 0.81 ( physical fatigue ( PF ) ) , SDC ranged from 4 points ( PF and RM ) to 15 points ( MFI-total ) . Bl and and Altman analysis showed no systematic differences between assessment s. A floor effect was found for MF and ceiling effects for PF and reduced activity ( RA ) . A four-factor model was extracted , combining general fatigue ( GF ) and PF as one factor . CONCLUSIONS The MFI is reliable and valid to assess fatigue in patients with PD . Clinicians and research ers interested in assessing specific aspects of fatigue should consider interpreting GF and PF as one subscale measuring physical aspects of fatigue . To establish whether the MFI can detect meaningful changes , studies on anchor-based responsiveness and the minimal important change are needed in PD Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment . But even though several authors have tried to conceptualise fatigue , its mechanisms are still poorly understood . The aim of this study was twofold : ( a ) to explore fatigue in cancer patients inductively , and ( b ) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts . A qualitative research strategy was adopted using a grounded-theory approach . The prospect i ve study took place in the oncology department of the Kantonsspital , St. Gallen , Switzerl and , with sample s of 20 cancer patients and 20 healthy individuals .  Unstructured , tape-recorded interviews were conducted to collect data . The transcripts of the interviews were analysed using content analysis and constant comparison . Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical , affective and cognitive expressions of fatigue/tiredness . Physical signs were more frequent than affective and cognitive signs in both groups . In the cancer patients , fatigue involved decreased physical performance , extreme , unusual tiredness , weakness and an unusual need for rest , which was distinctly different for healthy persons . Affective and cognitive distress was also more prominent in cancer patients . Interestingly , the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population . Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon . A step-like theory , explaining the production of fatigue/tiredness was tentatively put forward involving nociception , perception and expression of tiredness . The emerging concepts break tiredness/fatigue into an expression of physical , affective and cognitive tiredness/fatigue . The experience is different between healthy individuals and cancer patients . Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further , controlled studies Fatigue describes reduced capacity to sustain force or power output , reduced capacity to perform multiple tasks over time and simply a subjective experience of feeling exhausted , tired , weak or having lack of energy . Pain and fatigue have several components in common , such as being subjective , prevalent in most patients with cancer and caused by multiple factors of both a physical and psychological nature . In order to explore the relationship between fatigue and pain , data from five studies were used : two r and om sample s from the Norwegian population ( n=2323 and n=1965 ) , Hodgkin ’s disease survivors ( n=459 ) , palliative care patients ( n=434 ) and patients with bone metastases ( n=94 ) . All patients had completed one or more of the following instruments : EORTC QLQ‐C30 , SF‐36 and /or Fatigue Question  naire . The level of fatigue was much higher in the two palliative care population s ( 54.4 and 63.2 ) as compared to the normal population sample s ( 25.0 ) . Patients with bone metastases had significantly more pain ( 72.0 ) than the patients in the palliative care trial ( 47.4 ) and norms ( 20.5 ) . In the two palliative care and bone metastases population s fatigue was almost unchanged over time , while pain was reduced . In the palliative care population a high level of fatigue ( 80.3 ) and pain ( 57.8 ) was reported 0–1 month before death . The relationship between pain , fatigue and the health‐related quality of life domains should be explored in more detail , especially in follow‐up studies in order to assess possible changes over time . In addition , the validity of the existing instruments measuring fatigue should be investigated for use in patients with advanced disease and short life expectancy Chronic fatigue syndrome ( CFS ) produces physical and neurocognitive disability that significantly affects health-related quality of life ( HRQL ) .  Multidisciplinary treatment combining grade d exercise therapy ( GET ) cognitive behavioural therapy ( CBT ) and pharmacological treatment has shown only short-term improvements . To compare the effects on HRQL of ( 1 ) multidisciplinary treatment combining CBT , GET , and pharmacological treatment , and ( 2 ) usual treatment ( exercise counselling and pharmacological treatment ) at 12 months of follow-up . Prospect i ve , r and omized controlled trial with a follow-up of 12 months after the end of treatment . Patients consecutively diagnosed with CFS ( Fukuda criteria ) were r and omly assigned to intervention ( n = 60 ) or usual treatment ( n = 60 ) groups . HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form question naire ( SF-36 ) . Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Question naire ( HAQ ) and comorbidities . At baseline , the two groups were similar , except for lower SF-36 emotional role scores in the intervention group . At 12 months , the intervention did not improve HRQL scores , with worse SF-36 physical function and bodily pain scores in the intervention group . Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL . The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis Objectives To determine prospect i ve changes in clinical status related to chronic fatigue over an 18-month period , and to test demographic and clinical predictors of outcome . Methods A cohort of 100 patients with unexplained chronic fatigue ( UCF ) , which encompasses both chronic fatigue syndrome ( CFS ) and idiopathic chronic fatigue ( ICF ) , completed question naire measures and medical and psychiatric evaluations on four occasions , each six months apart . Results Approximately 21 % of the sample did not meet criteria for either CFS or ICF at their last research appointment 1.5 years after their index visit . Vitality increased over time , and physical functioning tended to improve , but UCF symptoms did not decrease significantly . Less education , being unemployed , worse mental health , more use of sedating and antidepressant medications , and more somatic attributions for their symptoms were associated with worsening symptom severity over time . Older age , current depression , and more somatic attributions predicted worsening physical functioning . Better mental health , less use of sedating medications , and fewer somatic attributions for illness were significant predictors of increases in vitality . Conclusions Demographic and clinical variables predict outcomes over time among a cohort of patients with unexplained chronic fatigue PURPOSE The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia ( FM ) . DESIGN Cross-sectional descriptive , correlational study of 2,580 persons with FM who responded to an online survey during fall 2005 . METHODS The survey indicated self-reported physical activity levels , functional abilities , symptoms , health care costs , employment status , work productivity , self management strategies . It had adequate validity and reliability . A significant binary logistic regression model of predictors of physical function ( individual factors , symptoms , self management strategies ) was vali date d using backwards logistic regression . FINDINGS Significant explanatory variables of high physical function were : men , greater education , younger age , lower intensity fatigue , spasticity , and balance problems , not using prescription pain medications , using aerobic or strength training exercise , and not using relaxation methods . CONCLUSIONS People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional . Given knowledge of predictors of physical function in FM , health care providers might be able to develop strategies to promote better functioning . Prospect i ve trials are needed to track the natural course of study variables , measuring their effect on function , and to test effects of interventions to maximize function
The MFSI-SF demonstrated moderate test-retest reliability in a small number of studies .
The MFSI-SF fatigue subscales were positively correlated with measures of distress , depressive , and anxious symptoms .
Purpose Fatigue is a subjective complaint that is believed to be multifactorial in its etiology and multidimensional in its expression .
Fatigue may be experienced by individuals in different dimensions as physical , mental , and emotional tiredness .
The purpose s of this study were to review and characterize the use of the 30-item Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) in published studies and to evaluate the available evidence for its psychometric properties .