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Younossi ZM, Kremer AE, Swain MG, Jones D, Bowlus C, Trauner M, Henry L, Gerber L. Assessment of fatigue and its impact in chronic liver disease. J Hepatol 2024; 81:726-742. [PMID: 38670320 DOI: 10.1016/j.jhep.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Patient-reported outcomes (PROs), such as health-related quality of life (HRQL), are important outcome measures for patients with chronic liver diseases (CLDs). Presence of cirrhosis and advanced liver disease have been associated with worsened HRQL and fatigue. On the other hand, some patients with earlier stages of CLD also experience fatigue, causing PRO impairment. Treatment for some CLDs may improve HRQL and, sometimes, levels of fatigue. We aimed to provide an in-depth expert review of concepts related to fatigue and HRQL in patients with primary biliary cholangitis, hepatitis C virus and MASLD (metabolic dysfunction-associated steatotic liver disease). A panel of experts in fatigue and CLD reviewed and discussed the literature and collaborated to provide this expert review of fatigue in CLD. Herein, we review and report on the complexity of fatigue, highlighting that it is comprised of peripheral (neuromuscular failure, often in conjunction with submaximal cardiorespiratory function) and central (central nervous system dysfunction) causes. Fatigue and HRQL are measured using validated self-report instruments. Additionally, fatigue can be measured through objective tests (e.g. grip strength). Fatigue has deleterious effects on HRQL and one's ability to be physically active and socially engaged but does not always correlate with CLD severity. Treatments for hepatitis C virus and MASLD can improve levels of fatigue and HRQL, but current treatments for primary biliary cholangitis do not seem to affect levels of fatigue. We conclude that obtaining PRO data, including on HRQL and fatigue, is essential for determining the comprehensive burden of CLD and its potential treatments.
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Affiliation(s)
- Zobair M Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA.
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Mark G Swain
- Professor of Medicine, Cal Wenzel Family Foundation Chair in Hepatology, University of Calgary Liver Unit, Calgary, Canada
| | - David Jones
- Professor of Liver Immunology, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Bowlus
- Lena Valente Professor and Chief, Division of Gastroenterology and Hepatology, University of California Davis, United States
| | - Michael Trauner
- Div. of Gastroenterology & Hepatology, Dept. of Internal Medicine III, MedUni Wien, Medical University of Vienna, Austria
| | - Linda Henry
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA; Center for Outcomes Research in Liver Diseases, Washington DC, USA
| | - Lynn Gerber
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA; The Global Liver Council, Washington DC, USA
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McCarthy MM, Fletcher J, Wright F, Del Giudice I, Wong A, Aouizerat BE, Vaughan Dickson V, Melkus GD. Factors Associated With the Cardiovascular Health of Black and Latino Adults With Type 2 Diabetes. Biol Res Nurs 2024; 26:438-448. [PMID: 38448370 DOI: 10.1177/10998004241238237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIMS The purpose of this study was to assess the levels of cardiovascular health (CVH) of Black and Latino adults with type 2 diabetes (T2D) and examine the association of individual and microsystem level factors with their CVH score. METHODS This was a cross-sectional design in 60 Black and Latino Adults aged 18-40 with T2D. Data were collected on sociodemographic, individual (sociodemographic, diabetes self-management, sleep disturbance, depressive symptoms, quality of life, and the inflammatory biomarkers IL-6 and hs-CRP) and microsystem factors (family functioning), and American Heart Association's Life's Simple 7 metrics of CVH. Factors significantly associated with the CVH score in the bivariate analyses were entered into a linear regression model. RESULTS The sample had a mean age 34 ± 5 years and was primarily female (75%) with a mean CVH score was 8.6 ± 2.2 (possible range of 0-14). The sample achieved these CVH factors at ideal levels: body mass index <25 kg/m2 (8%); blood pressure <120/80 (42%); hemoglobin A1c < 7% (57%); total cholesterol <200 mg/dL (83%); healthy diet (18%); never or former smoker > one year (95%); and physical activity (150 moderate-to-vigorous minutes/week; 45%). In the multivariable model, two factors were significantly associated with cardiovascular health: hs-CRP (B = -0.11621, p < .0001) and the general health scale (B = 0.45127, p = .0013). CONCLUSIONS This sample had an intermediate level of CVH, with inflammation and general health associated with overall CVH score.
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Affiliation(s)
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Inés Del Giudice
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Agnes Wong
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Ponti L, Hsu K, Damy T, Villacorta E, Verheyen N, Keohane D, Wang R, Ines M, Kumar N, Munteanu C, Cappelli F. Burden of untreated transthyretin amyloid cardiomyopathy on patients and their caregivers by disease severity: results from a multicenter, non-interventional, real-world study. Front Cardiovasc Med 2023; 10:1238843. [PMID: 37711563 PMCID: PMC10497948 DOI: 10.3389/fcvm.2023.1238843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Background The humanistic burden of transthyretin amyloid cardiomyopathy (ATTR-CM) is poorly defined. Methods An international study to comprehensively characterize the burden of ATTR-CM on patients naïve to disease-modifying therapy and their unpaid primary caregivers using study-specific and established surveys (patients: Kansas City Cardiomyopathy Questionnaire Overall Summary [KCCQ-OS], 12-Item Short Form Health Survey [SF-12], Hospital Anxiety and Depression Scale [HADS], Patient-Reported Outcomes Measurement Information System [PROMIS] Fatigue and Dyspnea; caregivers: SF-12, HADS, PROMIS Fatigue, Zarit Burden Interview [ZBI]). All data were summarized descriptively. Results 208 patient and caregiver pairs were included. 86% of patients were male, median age was 81 years, and 91% (141/155 with genetic testing) had wild-type ATTR-CM. Patient responses characterized the mental and physical burden of ATTR-CM, which was numerically higher among those who were New York Heart Association (NYHA) class III (n = 43) vs. class I/II (n = 156). NYHA class III patients had particularly low KCCQ-OS (36) and SF-12 physical component (27) scores, and 67% had a HADS depression score ≥8. Caregivers (median age 68 years; 85% female; 59% spouse of the patient; median duration of caregiving 1.5 years) reported that NYHA III patients more frequently required help with a range of physical activities than NYHA class I/II patients. 51% of caregivers to NYHA class III patients reported at least a mild-to-moderate burden in the ZBI. A plain language summary of this paper can be found as a supplemental material. Conclusions Untreated ATTR-CM is a burden to both patients and their caregivers.
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Affiliation(s)
- Lucia Ponti
- University of Urbino Carlo Bo, Urbino, Italy
| | - Kristen Hsu
- Amyloidosis Research Consortium, Newton, MA, United States
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, CHU Henri Mondor, Créteil, France
| | | | | | | | | | | | | | | | - Francesco Cappelli
- Tuscan Regional Amyloidosis Referral Centre, Careggi University Hospital, Florence, Italy
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Doumen M, De Cock D, Van Lierde C, Betrains A, Pazmino S, Bertrand D, Westhovens R, Verschueren P. Engagement and attrition with eHealth tools for remote monitoring in chronic arthritis: a systematic review and meta-analysis. RMD Open 2022; 8:e002625. [PMID: 36302561 PMCID: PMC9621170 DOI: 10.1136/rmdopen-2022-002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Although eHealth tools are potentially useful for remote disease monitoring, barriers include concerns of low engagement and high attrition. We aimed to summarise evidence on patients' engagement and attrition with eHealth tools for remotely monitoring disease activity/impact in chronic arthritis. METHODS A systematic literature search was conducted for original articles and abstracts published before September 2022. Eligible studies reported quantitative measures of patients' engagement with eHealth instruments used for remote monitoring in chronic arthritis. Engagement rates were pooled using random effects meta-analysis. RESULTS Of 8246 references, 45 studies were included: 23 using smartphone applications, 13 evaluating wearable activity trackers, 7 using personal digital assistants, 6 including web-based platforms and 2 using short message service. Wearable-based studies mostly reported engagement as the proportion of days the tracker was worn (70% pooled across 6 studies). For other eHealth tools, engagement was mostly reported as completion rates for remote patient-reported outcomes (PROs). The pooled completion rate was 80%, although between-study heterogeneity was high (I2 93%) with significant differences between eHealth tools and frequency of PRO-collection. Engagement significantly decreased with longer study duration, but attrition varied across studies (0%-89%). Several predictors of higher engagement were reported. Data on the influence of PRO-reporting frequency were conflicting. CONCLUSION Generally high patient engagement was reported with eHealth tools for remote monitoring in chronic arthritis. However, we found considerable between-study heterogeneity and a relative lack of real-world data. Future studies should use standardised measures of engagement, preferably assessed in a daily practice setting. TRIAL REGISTERATION NUMBER The protocol was registered on PROSPERO (CRD42021267936).
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
- Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Diederik De Cock
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Van Lierde
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Albrecht Betrains
- General Internal Medicine, KU Leuven University Hospitals, Leuven, Belgium
| | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
- Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
- Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
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Obbarius A, Schneider S, Junghaenel DU, Stone AA. Achieving reliable pain change scores for individuals in the postoperative phase: carefully choose sampling density, test length, and administration mode. Pain 2022; 163:170-179. [PMID: 33974578 PMCID: PMC8572319 DOI: 10.1097/j.pain.0000000000002328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/22/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT Despite tremendous efforts to increase the reliability of pain measures and other self-report instruments, improving or even evaluating the reliability of change scores has been largely neglected. In this study, we investigate the ability of 2 instruments from the Patient-Reported Outcomes Measurement Information System, pain interference (6 items) and pain behavior (7 items), to reliably detect individual changes in pain during the postsurgical period of a hernia repair in 98 patients who answered daily diaries over almost 3 weeks after surgery. To identify the most efficient strategy for obtaining sufficiently reliable estimates of change (reliability >0.9), the number of measurement occasions over the study period (sampling density), the number of items (test length), and the mode of administration (ie, static short form vs Computer adaptive testing) were manipulated in post-hoc simulations. Reliabilities for different strategies were estimated by comparing the observed change with the best approximation of "real" (ie, latent) change. We found (1) that near perfect reliability can be achieved if measures from all days over the whole study period, obtained with all pain interference or pain behavior items, were used to estimate the observed change, (2) that various combinations of the number of items and the number of measurement occasions could achieve acceptable reliability, and (3) that computer adaptive testings were superior to short forms in achieving sufficient reliability. We conclude that the specific strategy for assessing individual postoperative change in pain experience must be selected carefully.
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Affiliation(s)
- Alexander Obbarius
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Schneider
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
| | - Doerte U. Junghaenel
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
| | - Arthur A. Stone
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
- Department of Psychology, University of Southern California, Los Angeles, USA
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Light in the Senior Home: Effects of Dynamic and Individual Light Exposure on Sleep, Cognition, and Well-Being. Clocks Sleep 2020; 2:557-576. [PMID: 33327499 PMCID: PMC7768397 DOI: 10.3390/clockssleep2040040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Disrupted sleep is common among nursing home patients and is associated with cognitive decline and reduced well-being. Sleep disruptions may in part be a result of insufficient daytime light exposure. This pilot study examined the effects of dynamic “circadian” lighting and individual light exposure on sleep, cognitive performance, and well-being in a sample of 14 senior home residents. The study was conducted as a within-subject study design over five weeks of circadian lighting and five weeks of conventional lighting, in a counterbalanced order. Participants wore wrist accelerometers to track rest–activity and light profiles and completed cognitive batteries (National Institute of Health (NIH) toolbox) and questionnaires (depression, fatigue, sleep quality, lighting appraisal) in each condition. We found no significant differences in outcome variables between the two lighting conditions. Individual differences in overall (indoors and outdoors) light exposure levels varied greatly between participants but did not differ between lighting conditions, except at night (22:00–6:00), with maximum light exposure being greater in the conventional lighting condition. Pooled data from both conditions showed that participants with higher overall morning light exposure (6:00–12:00) had less fragmented and more stable rest–activity rhythms with higher relative amplitude. Rest–activity rhythm fragmentation and long sleep duration both uniquely predicted lower cognitive performance.
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Stone AA, Wen CKF, Schneider S, Junghaenel DU. Evaluating the Effect of Daily Diary Instructional Phrases on Respondents' Recall Time Frames: Survey Experiment. J Med Internet Res 2020; 22:e16105. [PMID: 32130129 PMCID: PMC7060498 DOI: 10.2196/16105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/22/2019] [Accepted: 12/15/2019] [Indexed: 01/10/2023] Open
Abstract
Background Daily diaries are extensively used for examining participants’ daily experience in behavioral and medical science. However, little attention is paid to whether participants recall their experiences within the time frames prescribed by the task. Objective This study aimed to describe survey respondents’ self-reported recall time frames and to evaluate the impact of different daily diary items on respondents’ reported affective states. Methods In this study, 577 participants completed a mood survey with one of the following 4 time frame instructions: (1) today, (2) since waking up today, (3) during the last 24 hours, or (4) in the last day. They were also asked to indicate the periods they considered when answering these items and to recall the instructional phrases associated with the items. Results Almost all participants in the today (141/146, 96.6%) and since waking up today (136/145, 93.8%) conditions reported using periods consistent with our expectations, whereas a lower proportion was observed in the during the last 24 hours (100/145, 69.0%) condition. A diverse range of responses was observed in the in the last day condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding. Conclusions Overall, these results indicate that today and since waking up today are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other 2 instructional phrases.
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Affiliation(s)
- Arthur A Stone
- Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.,Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Cheng K Fred Wen
- Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
| | - Stefan Schneider
- Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
| | - Doerte U Junghaenel
- Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
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Olson JA, Artenie DZ, Cyr M, Raz A, Lee V. Developing a light-based intervention to reduce fatigue and improve sleep in rapidly rotating shift workers. Chronobiol Int 2019; 37:573-591. [PMID: 31823658 DOI: 10.1080/07420528.2019.1698591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over a quarter of employees in North America and a fifth of those in the European Union do shift work. Working these schedules increases fatigue, sleepiness, and errors at work. In the long term, it may also increase the risk of cardiovascular disease, gastrointestinal problems, and cancer. Some of these consequences may be partly due to circadian misalignment, in which sleep and activity patterns no longer align with one's circadian rhythms. Previous research has found that controlling light exposure can improve circadian alignment in individuals who work permanent night shifts. However, light-based interventions are rarely tested with rapidly rotating shift schedules, which include more than one type of shift within the same week (e.g., day shifts followed by night shifts). Further, many of the available interventions are seldom used in the workplace and may be less feasible in healthcare environments. In hospitals, the health and safety of both workers and patients can be compromised by increases in fatigue. We thus developed a practical intervention based on circadian and sleep hygiene principles to reduce some of the negative consequences associated with shift work. We then tested this intervention in a feasibility study of 33 nurses working rapidly rotating shifts. The study took place over two separate periods: the control (observation) period and the intervention period. Each period included two to four consecutive night shifts as well as the two days before and after those shifts. Nurses completed daily self-report questionnaires during both periods. During the intervention period, the nurses additionally followed a fatigue reduction plan. The plan involved 40 min of bright light exposure from a portable light box before night shifts, light avoidance using sunglasses after those shifts, and suggestions regarding the ideal times to sleep and nap. Results showed that nurses complied with the large majority of these recommendations. During the intervention period, nurses reported less fatigue, fewer work errors, better and longer sleep, and a more positive mood. Moreover, nurses with a preference for evenings (i.e., later chronotypes) reported the strongest benefits. Though more controlled studies are needed to assess causal mechanisms and long-term effectiveness, these promising results suggest that light-based interventions are feasible and may be effective at reducing fatigue in rapidly rotating shift workers.
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Affiliation(s)
- Jay A Olson
- Department of Psychiatry, McGill University, Montreal, Canada
| | | | - Mariève Cyr
- Department of Psychiatry, McGill University, Montreal, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - Amir Raz
- Department of Psychiatry, McGill University, Montreal, Canada.,Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, USA
| | - Virginia Lee
- Department of Nursing, McGill University, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada
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Eyskens JB, Illegems J, De Nil L, Nijs J, Kampen JK, Moorkens G. Assessing chronic fatigue syndrome: Self-reported physical functioning and correlations with physical testing. J Bodyw Mov Ther 2019; 23:598-603. [PMID: 31563377 DOI: 10.1016/j.jbmt.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; no biomarkers have thus far been identified or physical tests designed to underpin its diagnosis. Assessment mainly uses Fukuda's criteria and is based on the exclusion of symptoms related to other diseases/syndromes, subjective self-reporting, and outcomes of self-report questionnaires. In order to improve the baseline assessment and progress evaluation of individuals suspected of CFS and using an association-oriented research strategy and a cross-correlational design, this study investigates possible associations between the performance on two physical tests, i.e. 'Timed Loaded Standing' (TLS), assessing trunk-arm endurance, and the 'Stops Walking with Eyes Closed while performing a secondary Cognitive Task' (SWECCT), measuring impaired automaticity of gait, and the results of two self-report questionnaires, the Checklist Individual Strength (CIS, total score and fatigue subscale score) and the physical functioning and vitality subscales of the Short Form Health Survey (SF-36) to gauge the participants' subjective feelings of fatigue and beliefs regarding their abilities to perform daily-life activities. Comparisons of the outcomes obtained in 27 female patients with a confirmed diagnosis of CFS revealed that trunk-arm endurance as measured with the TLS correlated with the SF-36 physical functioning subscale only (raw p value: 0.004). None of the other correlations were statistically significant. It is concluded that the TLS may have potential as an objective assessment tool to support the diagnosis and monitoring of treatment effects in CFS.
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Affiliation(s)
- Jan B Eyskens
- Department of Internal Medicine, Antwerp University Hospital, Rijsenbergstraat 31, 9000, Belgium.
| | - Jela Illegems
- Behaviour Therapy Division for Fatigue and Functional Symptoms, Department of Internal Medicine, Antwerp University Hospital, Belgium
| | - Luc De Nil
- Physiotherapy and Rehabilitation, Denderbelle, Belgium
| | - Jo Nijs
- Pain in Motion Research Group, Department of Human Physiology and Physiotherapy, Vrije Universiteit Brussel (Free University Brussels) Belgium, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Jarl K Kampen
- StatUA, University of Antwerp, Antwerp, Belgium; Biometris, Wageningen University, Wageningen, the Netherlands
| | - Greta Moorkens
- Head Department of Internal Medicine, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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Kratz AL, Murphy SL, Braley TJ. Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis. Arch Phys Med Rehabil 2017; 98:2142-2150. [PMID: 28729168 DOI: 10.1016/j.apmr.2017.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS). DESIGN Repeated-measures observational study of 7 consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data. SETTING General community. PARTICIPANTS Ambulatory adults (N=107) with MS recruited through the University of Michigan and surrounding community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0 to 10 scale, collected 5 times a day for 7 days. RESULTS Cognitive function and depressed mood exhibited more stable within-person patterns than pain and fatigue, which varied considerably within person. All symptoms increased in intensity across the day (all P<.02), with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7 pm for men (wake-bed B=1.04, P=.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared with younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake-3 pm B=.04, P=.01; wake-7 pm B=.03, P=.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared with those with bachelor-level degrees in the evening (wake-7 pm B=-.47, P=.02; wake-bed B=-.45, P=.04). CONCLUSIONS Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms-fatigue and pain in particular-vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Susan L Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Health Care System, Geriatric Research, Education, and Clinical Center, Ann Arbor, MI
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Psychometric Evaluation of the Patient-Reported Outcomes Measurement Information System Fatigue-Short Form Across Diverse Populations. Nurs Res 2017; 65:279-89. [PMID: 27362514 DOI: 10.1097/nnr.0000000000000162] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The need for reliable, valid tools to measure patient-reported outcomes (PROs) is critical both for research and for evaluating treatment effects in practice. The Patient-Reported Outcomes Measurement Information System Fatigue-Short Form v1.0-Fatigue 7a (PROMIS F-SF) has had limited psychometric evaluation in various populations. OBJECTIVES The aim of the study is to examine psychometric properties of PROMIS F-SF item responses across various populations. METHODS Data from five studies with common data elements were used in this secondary analysis. Samples from patients with fibromyalgia, sickle cell disease, cardiometabolic risk, pregnancy, and healthy controls were used. Reliability was estimated using Cronbach's alpha. Dimensionality was evaluated with confirmatory factor analysis. Concurrent validity was evaluated by examining Pearson's correlations between scores from the PROMIS F-SF, the Multidimensional Fatigue Symptom Inventory-Short Form, and the Brief Fatigue Inventory. Discriminant validity was evaluated by examining Pearson's correlations between scores on the PROMIS F-SF and measures of stress and depressive symptoms. Known groups validity was assessed by comparing PROMIS F-SF scores in the clinical samples to healthy controls. RESULTS Reliability of PROMIS F-SF scores was adequate across samples, ranging from .72 in the pregnancy sample to .88 in healthy controls. Unidimensionality was supported in each sample. Concurrent validity was strong; across the groups, correlations with scores on the Multidimensional Fatigue Symptom Inventory-Short Form and Brief Fatigue Inventory ranged from .60 to .85. Correlations of the PROMIS F-SF with measures of stress and depressive mood were moderate to strong, ranging from .37 to .64. PROMIS F-SF scores were significantly higher in clinical samples compared to healthy controls. DISCUSSION Reliability and validity of the PROMIS F-SF were acceptable. The PROMIS F-SF is a suitable measure of fatigue across the four diverse clinical populations included in the analysis.
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Arvanitis M, DeWalt DA, Martin CF, Long MD, Chen W, Jaeger B, Sandler RS, Kappelman MD. Patient-Reported Outcomes Measurement Information System in Children with Crohn's Disease. J Pediatr 2016; 174:153-159.e2. [PMID: 27157449 PMCID: PMC5157125 DOI: 10.1016/j.jpeds.2016.03.069] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/23/2016] [Accepted: 03/25/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the criterion validity and responsiveness of Patient-Reported Outcomes Measurement Information System (PROMIS) in a web-based cohort of children with Crohn's disease. STUDY DESIGN We recruited children with Crohn's disease (ages 9-17 years) and their parents from the web-based Crohn's and Colitis Foundation of America Kids and Teens Study cohort. Upon entry into the cohort and 6 months later, children self-reported Crohn's disease activity, health-related quality of life, and PROMIS domains of pain interference, anxiety, depression, fatigue, and peer relationships. RESULTS Mean PROMIS scores for the 276 participating patients were worse among those with worse self-reported Crohn's disease activity (per Short Crohn's Disease Activity Index, P < .005 for all), Crohn's disease activity in the prior 6 months (per Manitoba Index, P < .01 for all), and health-related quality of life (per IMPACT-35, P < .001 for all). One hundred forty-three patients and their parents completed follow-up questionnaires, 75% of whom reported stable disease activity. Those with improved Crohn's disease activity reported improved PROMIS scores, and those with worsened Crohn's disease activity reported worse PROMIS scores for all domains except anxiety. All participants reported improved anxiety from baseline, but those with stable or worsened Crohn's disease activity reported less improvement (P = .07). CONCLUSIONS PROMIS scores were significantly associated with Crohn's disease activity in a linear and clinically meaningful manner, and responded to change in Crohn's disease activity over a 6-month period. This supports the criterion validity and responsiveness of pediatric PROMIS.
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Affiliation(s)
| | | | | | | | - Wenli Chen
- University of North Carolina at Chapel Hill
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Zengarini E, Ruggiero C, Pérez-Zepeda MU, Hoogendijk EO, Vellas B, Mecocci P, Cesari M. Fatigue: Relevance and implications in the aging population. Exp Gerontol 2015; 70:78-83. [PMID: 26190478 DOI: 10.1016/j.exger.2015.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 01/03/2023]
Abstract
Frailty has been identified as a promising condition for distinguishing different degrees of vulnerability among older persons. Several operational definitions have proposed fatigue as one of the features characterizing the frailty syndrome. However, such a subjective symptom is still not yet sufficiently explored and understood. Fatigue is a common and distressing self-reported symptom perceived by the person while performing usual mental and physical activities, highly prevalent in older people, and strongly associated with negative health-related events. The understanding of fatigue is hampered by several issues, including the difficulty at objectively operationalizing, the controversial estimates of its prevalence, and the complex pathophysiological mechanisms underlying its manifestation. Despite such barriers, the study of fatigue is important and might be encouraged. Fatigue may be the marker of the depletion of the body's homeostatic reserves to a threshold leading to its psycho-physical functional impairment, mirroring the concept of frailty. Its subjective and symptomatic nature resembles that of other conditions (e.g., pain, depression), which equally affect the individual's quality of life, expose to negative outcomes, and severely burden healthcare expenditures. In the present paper, we present an overview of the current knowledge on fatigue in older persons in order to increase awareness about its clinical and research relevance. Future research on this topic should be encouraged and developed because it could potentially lead to novel interventions against this symptom as well as against frailty and age-related conditions.
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Affiliation(s)
- Elisa Zengarini
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy; Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Emiel O Hoogendijk
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1027, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1027, Université Toulouse III - Paul Sabatier, Toulouse, France
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Völker I, Kirchner C, Bock OL, Wascher E. Body Sway as a Possible Indicator of Fatigue in Clerical Workers. Saf Health Work 2015; 6:206-10. [PMID: 26929829 PMCID: PMC4674495 DOI: 10.1016/j.shaw.2015.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/07/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fatigue has a strong impact on workers' performance and safety, but expedient methods for assessing fatigue on the job are not yet available. Studies discuss posturography as an indicator of fatigue, but further evidence for its use in the workplace is needed. The purpose of the study is to examine whether posturography is a suitable indicator of fatigue in clerical workers. METHODS Thirty-six employees (Ø 34.8 years, standard deviation = 12.5) participated in postural tasks (eyes open, eyes closed, arm swinging, and dual task) in the morning and afternoon. Position of their center of pressure (COP) was registered using a Nintendo Wii Balance Board and commercial software. From registered COP time series, we calculated the following parameters: path length (mm), velocity (mm/s), anterior-posterior variance (mm), mediolateral variance (mm), and confidence area (mm(2)). These parameters were reduced to two orthogonal factors in a factor analysis with varimax rotation. RESULTS Statistical analysis of the first factor (path length and velocity) showed a significant effect of time of day: COP moved along a shorter path at a lower velocity in the afternoon compared with that in the morning. There also was a significant effect of task, but no significant interaction. CONCLUSION Data suggest that postural stability of clerical workers was comparable in the morning and afternoon, but COP movement was greater in the morning. Within the framework of dynamic systems theory, this could indicate that the postural system explored the state space in more detail, and thus was more ready to respond to unexpected perturbations in the morning.
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Affiliation(s)
- Ina Völker
- German Sport University Cologne—Institute of Physiology and Anatomy, Cologne, Germany
- Corresponding author. German Sport University Cologne—Institute of Physiology and Anatomy, Am Sportpark Müngersdorf 6, Cologne, Germany.
| | - Christine Kirchner
- German Sport University Cologne—Institute of Physiology and Anatomy, Cologne, Germany
| | - Otmar Leo Bock
- German Sport University Cologne—Institute of Physiology and Anatomy, Cologne, Germany
| | - Edmund Wascher
- IfADo—Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
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Systematic content evaluation and review of measurement properties of questionnaires for measuring self-reported fatigue among older people. Qual Life Res 2015; 24:2239-55. [PMID: 25778536 DOI: 10.1007/s11136-015-0963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The assessment of fatigue in older people requires simple and user-friendly questionnaires that capture the phenomenon, yet are free from items indistinguishable from other disorders and experiences. This study aimed to evaluate the content, and systematically review and rate the measurement properties of self-report questionnaires for measuring fatigue, in order to identify the most suitable questionnaires for older people. METHODS This study firstly involved identification of questionnaires that purport to measure self-reported fatigue, and evaluation of the content using a rating scale developed for the purpose from contemporary understanding of the construct. Secondly, for the questionnaires that had acceptable content, we identified studies reporting measurement properties and rated the methodological quality of those studies according to the COSMIN system. Finally, we extracted and synthesised the results of the studies to give an overall rating for each questionnaire for each measurement property. The protocol was registered with PROSPERO (CRD42013005589). RESULTS Of the 77 identified questionnaires, twelve were selected for review after content evaluation. Methodological quality varied, and there was a lack of information on measurement error and responsiveness. CONCLUSIONS The PROMIS-Fatigue item bank and short forms perform the best. The FACIT-Fatigue scale, Parkinsons Fatigue Scale, Perform Questionnaire, and Uni-dimensional Fatigue Impact Scale also perform well and can be recommended. Minor modifications to improve performance are suggested. Further evaluation of unresolved measurement properties, particularly with samples including older people, is needed for all the recommended questionnaires.
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Junghaenel DU, Cohen J, Schneider S, Neerukonda AR, Broderick JE. Identification of distinct fatigue trajectories in patients with breast cancer undergoing adjuvant chemotherapy. Support Care Cancer 2015; 23:2579-87. [PMID: 25876159 DOI: 10.1007/s00520-015-2616-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The goal of this study was to characterize changes in daily fatigue in women undergoing chemotherapy for breast cancer. We examined whether there are subgroups of patients with distinct fatigue trajectories and explored potential psychosocial and biomedical predictors of these subgroups. METHODS Participants were 77 women with breast cancer receiving adjuvant chemotherapy with AC-T (2-week cycle) and TC or TCH (3-week cycle) regimens. They completed 28 daily ratings online using an adapted version of the Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue instrument. RESULTS Both regimens followed an "inverted-U-shaped" fatigue pattern over approximately 2 weeks. Growth mixture modeling identified three patient subgroups with distinct trajectories. Fatigue scores in the "low fatigue" group (23 %) increased following the infusion and quickly abated. The "transient fatigue" (27 %) group had a very pronounced increase. Patients in the "high fatigue" (50 %) group reported consistently elevated fatigue with a relatively small increase. Demographic and medical variables were not associated with fatigue trajectory. Patients in the "high fatigue" group reported significantly poorer physical, emotional, and social functioning, poorer general health, and more depressed mood than patients in the "low fatigue" group. The "transient fatigue" group reported significantly better physical and social functioning than the "high fatigue" group, but emotional distress and depression similar to the "high fatigue" group. CONCLUSIONS The identification of patient subgroups with distinct fatigue trajectories during chemotherapy is an essential step for developing preventative strategies and tailored interventions. Our results suggest that different trajectories are associated with patients' psychosocial and general health.
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Affiliation(s)
- Doerte U Junghaenel
- Dornsife Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, Verna & Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA, 90089-3332, USA,
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Badger TA, Heitkemper M, Lee KA, Bruner DW. An experience with the Patient-Reported Outcomes Measurement Information System: pros and cons and unanswered questions. Nurs Outlook 2014; 62:332-8. [PMID: 25218082 DOI: 10.1016/j.outlook.2014.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/17/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023]
Abstract
The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descriptive studies and clinical trials. Doing this has created opportunities and challenges for investigators. This article highlights three projects to show the perspectives of nurse scientists who incorporated PROMIS measures into their research. The first project describes advantages of PROMIS to allow for comparisons of a study population with a national sample and to compliment legacy measures. The second project examines issues in the translation of tools for region-specific Hispanic populations. The third project provides a perspective on the use of PROMIS measures to capture cancer-related fatigue and to develop new components of a sexual function scale. As indicated by these three examples, nurse scientists can contribute an important role in moving the PROMIS initiative forward. Results from these types of projects also move symptom science forward within a more interdisciplinary approach to common measures of interest.
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Affiliation(s)
- Terry A Badger
- Division of Community and Health Systems Science, College of Nursing, Department of Psychiatry, Tucson, AZ
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA.
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California, San Francisco, CA
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