Factors related to fatigue; priority of interventions to reduce or eliminate fatigue and the exploration of a multidisciplinary research model for further study of fatigue

Interventions to Mitigate Fatigue Induced by Physical Work: A Systematic Review of Research Quality and Levels of Evidence for Intervention Efficacy

OBJECTIVE

We present a literature review on workplace physical fatigue interventions, focusing on evaluating the methodological quality and strength of evidence.

BACKGROUND

Physical fatigue is a recognized workplace problem, with negative effects on performance and health-related complaints. Although many studies have focused on the mechanisms and consequences of fatigue, few have considered the effectiveness of interventions to mitigate fatigue.

METHOD

A systematic review of the workplace safety literature for controlled trials of physical fatigue interventions was conducted. Data on intervention type, subject characteristics, targeted tasks and body locations, outcome measures, and study design were extracted. The methodological quality for each study was evaluated using the PEDro scale, and the level of evidence was based on quality, amount, and consistency.

RESULTS

Forty-five controlled trials were reviewed, examining 18 interventions. We categorized those interventions into individual-focused (N = 28 studies, nine interventions), workplace-focused (N = 12 studies, five interventions), and multiple interventions (N = 5 studies, four interventions). We identified moderate evidence for interventions related to assistive devices and task variation. There was moderate evidence supporting no fatigue attenuation for the garment change category of interventions. The interventions in the remaining categories had limited to minimal evidence of efficacy. The heterogeneity of the included trials precludes the determination of effect size.

CONCLUSION

This review showed a lack of high levels of evidence for the effectiveness of most physical fatigue interventions.

APPLICATION

Due to a lack of high levels of evidence for any category of reviewed physical fatigue interventions, further high-quality studies are needed to establish the efficacy of others.

Understanding determinants of social networking service fatigue: an interpretive structural modeling approach

Purpose

The purpose of this paper is to build a comprehensive structural model to demonstrate the interrelationships of factors influencing social networking service (SNS) fatigue and to identify the varying degrees of influence.

Design/methodology/approach

A total of 14 factors influencing SNS fatigue are identified through an extensive literature review. Interpretive structural modeling (ISM) and Matrice d'Impacts Croisés Multiplication Appliqué à un Classement (MICMAC) analysis are employed to build a hierarchical model and classify these factors into four clusters.

Findings

The results revealed that ubiquitous connectivity and immediacy of feedback are key factors contributing to SNS fatigue through their strong influence on other factors. Privacy concern, impression management concern and work–life conflict lead directly to SNS fatigue. In contrast, system feature overload and system pace of change are relatively insignificant in generating SNS fatigue.

Originality/value

This study represents an initial step toward comprehensively understanding the interrelationships among the factors leading to SNS fatigue and reveals how determinants of SNS fatigue are hierarchically organized, thus extending existing research on SNS fatigue. It also provides logical consistency in the ISM-based model for SNS fatigue by grouping identified factors into dependent and independent categories. Moreover, it extends the applicability of the integration of the ISM and MICMAC approaches to the phenomenon of SNS fatigue.

Predicting post-experiment fatigue among healthy young adults: Random forest regression analysis

The current study utilized a random forest regression analysis to predict post-experiment fatigue in a sample of 212 healthy participants (mean age = 20.5, SD = 2.21; 52% women) between the ages of 18 and 30 following a mildly stressful experiment. We used a total of 30 features of demographic variables, lifestyle variables, alcohol and other drug use behaviors and problems, state anxiety and depressive symptoms, and physiological indicators that were lab assessed or self-reported. A random forest regression analysis with 10-fold cross-validation resulted in accurate prediction of post-experiment fatigue (R² equivalent = 0.93) with the average "out-of-bag" (OOB) R² = 0.52. Not surprisingly, self-reported pre-experiment fatigue was the most important variable (54%) in the prediction of post-experiment fatigue. Feeling anxious (state anxiety) pre- and post-experiment (3%, 7%), feeling less vigorous post experiment (3%), systolic and diastolic blood pressure (3%, 2%) and LF HRV (2%) assessed at baseline, and self-reported alcohol-related problems (3%) and sleep (2%) additionally contributed to the prediction of post-experiment fatigue. Other remaining input variables had relatively minimal importance. Substantively, this study suggests that complex interactions across multiple systems domains that support regulation may be linked to fatigue. A random forest regression analysis can relatively easily be implemented with a built-in cross-validation function and reveal a web of connections undergirding health behavior and risks.

Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare

Background

Patients with heart failure (HF) in primary healthcare are in many respects not comparable to those in specialized care and the knowledge about different patient groups with and without HF is limited.

Aims

To compare fatigue and health-related quality of life (Hr-QoL) when adjusting for age, gender and social provision in patients with confirmed HF ( n=49) to a group of patients with symptoms indicating HF but without HF (NHF, n=59) and to an age-and sex-matched control-group ( n=40).

Method

A questionnaire including the Multidimensional Fatigue Inventory, the SF-36, and the Social Provisions Scale was used.

Results

The average age in all groups was 78 years. Patients in the HF and NHF groups reported worse physical QoL and more general and physical fatigue than the control group. HF patients had worse general health than the NHF group.

Conclusion

Elderly patients in primary healthcare with confirmed heart failure and patients with symptoms similar to heart failure perceived they had a significantly worse physical QoL and more general and physical fatigue than an age- and sex-matched control group. The similarities between the patient groups indicate the importance of the symptom experience for Hr-QoL.

Fatigue in Chronic Heart Failure – Does Gender Make a Difference?

The primary aim of this study was to describe and compare the experience of fatigue in a group of elderly women and men with severe chronic heart failure. A sample of 158 patients (66 women and 92 men, with a mean age of 83 and 78 years, respectively) was invited to participate in a study on admission to a hospital outpatient heart failure clinic. A registered nurse interviewed patients using a modified version of the Fatigue Interview Schedule (FIS). Descriptions of the experiences of fatigue generally showed good agreement between men and women; however, some gender differences were found. Women expressed a clear role to fulfil because they were engaged in maintenance activities of their household. Although we still have only limited knowledge about the impact of gender on the experiences and coping strategies in disease and aging, it is important for care providers to consider gender differences when planning caring interventions.

Burnout of registered nurses in South Africa

AIM

The aims of this study were to validate the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for registered nurses in South Africa and to analyse the differences between the levels of burnout of different biographical groups.

BACKGROUND

The nursing profession is seen as a stressful and emotionally demanding profession, which makes nurses susceptible to burnout.

METHOD

A cross-sectional survey design with a stratified random sample (n = 818) was used. The MBI-HSS and a biographical questionnaire were administered.

RESULTS

Exploratory factor analysis resulted in a three-factor structure of burnout, consisting of emotional exhaustion, depersonalization and personal accomplishment. Construct equivalence and reliability of the three factors were confirmed. Significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

CONCLUSIONS

The MBI-HSS showed acceptable validity and reliability for South African nurses. Burnout is associated with specific factors, including language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of the MBI-HSS is recommended to assess burnout of nurses in South Africa. Organisations employing nurses should intervene to prevent and/or manage burnout.

Demographic correlates of fatigue in the US general population: results from the patient-reported outcomes measurement information system (PROMIS) initiative

OBJECTIVE

To investigate demographic correlates of fatigue in the US general population using a new instrument developed by the Patient-Reported Outcome Measurement Information System (PROMIS). First, we examined correlations between the new PROMIS instrument and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and the SF-36v2 Vitality subscale. Based on prior findings, we further examined several demographic correlates of fatigue: whether women would report higher levels of fatigue compared to men, and whether married people would experience lower levels of fatigue compared to unmarried people. We also explored the relationship between age, education, and fatigue.

METHODS

Analyses were based on fatigue ratings by 666 individuals from the general population. Fatigue was assessed with the new PROMIS instrument, the FACIT-F, and the SF-36v2 Vitality subscale. Differences in fatigue were examined with independent samples t-tests and univariate ANOVAs.

RESULTS

The three fatigue instruments were highly intercorrelated. Confirming prior reports, women reported higher levels of fatigue than men. Married participants reported significantly less fatigue than their unmarried counterparts. Univariate ANOVAs yielded a main effect for participants' age; younger participants gave significantly higher fatigue ratings. We also found a main effect for participants' education. Participants with a masters or doctoral degree had significantly lower ratings of fatigue than participants with some college education and education up to high school.

CONCLUSION

Female gender, not being married, younger age and lower educational attainment were each associated with increased fatigue in the general population and the three fatigue instruments performed equally well in detecting the observed associations.

Fatigue in older adults: an early indicator of the aging process?

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

Characteristics of fatigue in heart failure patients: a literature review

This is a literature review report to describe characteristics (frequency, intensity and correlates) of fatigue in cases of heart failure. MedLine and LILACS were the examined databases. Out of 89 articles identified, 27 were selected for data extraction. Fatigue frequency ranged from 69% to 88% and fatigue intensities are incomparable due to differences in measurement scales. Quality of life, illness progression, physical activity, social and demographic variables, comorbidity, treatment and who assessed the fatigue were variables studied in relation to fatigue. The diversity of fatigue assessment methods causes difficulties to integrate results on fatigue frequency, characteristics and related factors. No study was found on fatigue characteristics in samples of Brazilian heart failure patients.

Temperament and fatigue management in persons with chronic rheumatic disease

BACKGROUND

In persons with chronic conditions, fatigue is often a disruptive symptom with a devastating impact on overall well-being. Descriptions of experiences with fatigue contribute to advancing knowledge and improving health outcomes.

AIM

To describe the influence temperament has on fatigue representation, self-care strategies, and strategy success.

METHOD

A secondary analysis of an existing database of personal characteristics and symptom experiences of adults with chronic rheumatic diseases was conducted. All participants who reported fatigue at least once during the first week of participation in the study were included. Relationships were examined among demographic variables, temperamental dispositions, and symptom representation.

RESULTS

Significant relationships were demonstrated between perceived symptom seriousness, interference and helpfulness of selected strategies, and both demographic variables and temperamental dispositions.

CONCLUSIONS

When choosing interventions for the individual experiencing fatigue, be aware of demographic data and use assessment techniques to promote positive health practices.

Lifestyle risk factors associated with fatigue in graduate students

BACKGROUND/PURPOSE

Fatigue is not only common in clinical patients but is also prevalent in the healthy population. This study aimed to estimate the prevalence rate of fatigue and identify significant risk factors among graduate students.

METHODS

Health check-ups were carried out on graduate students who were newly admitted to the National Taiwan University in this cross-sectional study. A total of 1806 attendees (response rate, 84%) agreed to participate in the fatigue survey, which used the Checklist Individual Strength questionnaire (CIS-20). The modified Baecke's questionnaire was used to quantify the intensity of physical activity.

RESULTS

The prevalence rates of fatigue were 45.8% for males and 48.9% for females. Regular meal (odds ratio [OR], 0.69) and exercise habits (OR, 0.68), insomnia (OR, 2.23), greater amount of sleeping time (OR, 0.7), identity (doctorate vs. master students; OR, 0.61), and chronic disease history (OR, 1.61) were statistically significant predictors for fatigue. Intensity of physical activity was a protective factor (ORs, 0.72, 0.50 and 0.36 in the 2nd, 3rd and top quartiles vs. 1st quartile; p < 0.001).

CONCLUSION

A high prevalence rate of fatigue among the graduate students was demonstrated. The risk factors among young adults are not only related to current chronic disease and insomnia but are also attributed to the lack of physical activity.

Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review

AIM

This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions.

BACKGROUND

A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap.

METHODS

The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue.

RESULTS

Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons.

CONCLUSION

Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.

Fatigue and social impairment in multiple sclerosis: the role of patients' cognitive and behavioral responses to their symptoms

OBJECTIVES

The aim of this study was to test whether the way in which multiple sclerosis (MS) patients interpret and respond to their symptoms may help to explain their experience of fatigue and social impairment.

METHOD

In a cross-sectional study, 149 patients with a definite diagnosis of MS completed validated questionnaires that measured their symptom interpretation and behavioral response, fatigue, mood, and social adjustment. A neurologist assessed their level of neurological impairment.

RESULTS

Regression analyses revealed that patients' cognitive interpretations of their symptoms, such as a tendency to attribute a wide range of symptoms to their MS and feelings of embarrassment about symptoms, were significantly associated with fatigue and social adjustment over and above neurological impairment, remission status, and mood. The behavioral variables including an all-or-nothing response to symptoms and rest/avoidance behaviours were also strongly associated with fatigue and social impairment. The degree of neurological deficit was not associated with either physical or mental fatigue, although it was associated with social impairment. Depression, anxiety, and remission status were also related to fatigue, and depression to social impairment.

CONCLUSION

These findings suggest that treatment approaches that challenge unhelpful cognitive interpretations and behavioural responses to symptoms, and address anxiety and depression, may be important in improving the overall management of fatigue in MS.

Health Promotion in Heart Failure—A Paradigm Shift

For people living with heart failure, levels of health exist along a continuum in correlation with the illness experience. A focus on health promotion rather than only disease or symptom management expands opportunities for self-care and presents an emerging paradigm shift in the care of people with heart failure. Results from 2 studies revealed that few health-promoting behaviors were reported by patients with heart failure until a focused intervention that emphasized health promotion as part of self-care was implemented.

Women's experiences of fatigue in chronic illness

AIM

The aim of this paper is to add a qualitative dimension to the body of knowledge about fatigue by revealing the meaning given by women living with chronic illness to the experience of fatigue.

BACKGROUND

Fatigue is a common symptom experienced by people who live with chronic illness. It pervades every aspect of life and may be experienced in physical, psychological, emotional or social dimensions. Management of fatigue relies heavily on the individual's ability to employ self-care actions. The invisibility of fatigue is recognized as one of the most frustrating aspects, which can lead to lack of understanding and misunderstanding by others.

METHOD

We report the findings of data from research in progress (2003-2005). Data were generated via email group conversations between us and 30 women who live with long-term illness.

FINDINGS

A recurring conversational thread has been women's experiences of fatigue when living with long-term illness. Although fatigue has been reported to be a major obstacle to maintaining usual daily activities and quality of life, few studies have explored this common symptom from the perspective of people themselves. Common themes found in the experience of fatigue as described by women are the meaning of fatigue, awareness as self-care, fatigue as invisible to others, seeking medical validation and accountability for self-care.

CONCLUSION

It is vital for healthcare workers to give opportunities for women to talk about fatigue, validate their experiences and provide support with self-care. Healthcare workers are encouraged to challenge their own meanings and expectations surrounding a person's report of fatigue so that opportunities for therapeutic intervention can be facilitated.

Exploring Underlying Life Patterns of Women With Multiple Sclerosis or Rheumatoid Arthritis: Comparison With NANDA Dimensions

In Newman’s theory, disease is one of many manifestations of underlying pattern and its existence provides meaningful information about person-environment interactions. Underlying patterns manifest differently over time, so clues to their understanding can be found within life stories. Further interpretation subsequent to illustrating expanding consciousness for seven women living with multiple sclerosis or rheumatoid arthritis suggested six underlying patterns expressed in theoretical terms as energy~fatigue, giving~receiving, rejecting~accepting, vulnerability~resilience, control~release, and being silent~speaking out. Discussion and comparison with the North American Nursing Diagnosis Association’s dimensions for assessment of human response patterns illustrates how nurses caring for women could identify and use underlying patterns in practice.

A neuroendocrine-based regulatory fatigue model

PURPOSE

To provide an overview of select existing fatigue models and propose a neuroendocrine-based regulatory fatigue model that can serve as a foundation for interventions to manage fatigue.

CONCEPTUAL FRAMEWORK

Biobehavioral systems based on a neuroendocrine regulatory framework.

METHODS

Empirical data and literature review to develop a fatigue model to serve as a foundation for interventions to manage fatigue.

CONCLUSIONS

The proposed model will facilitate testing of interventions based on the premise that common neuroendocrine transmitters provide the mechanisms of fatigue in patients diagnosed with chronic illnesses, such as with cancer treatment-related fatigue. The model may also be used to identify predictors of fatigue in specific patient populations, provide guidance for clinicians in their selection of precise interventions to be implemented, and identify the effects of treatments captured in these populations. By clearly identifying the mechanisms of fatigue, we can discover which interventions are effective for particular types of fatigue.

Nursing Intervention Research and Quality of Care

BACKGROUND

Improvement of healthcare in the United States is a national priority. Nursing intervention science can contribute substantially to addressing this priority.

OBJECTIVES

The aim of this study was to describe strategies needed to maximize the base of nursing intervention science.

METHODS

The study involved a review of reports on the state of quality in healthcare and an examination of nurse-led intervention studies funded by the National Institute of Nursing Research aimed at improving healthcare processes and outcomes.

RESULTS

Nursing has contributed valuable data regarding the meaning of quality from the perspectives of individuals, families, and communities. Increased efforts are needed to ensure that this science informs ongoing initiatives to define, assess, and improve the quality of healthcare.

CONCLUSIONS

Nurse-led intervention research is making significant contributions to the advancement of the science underpinning quality healthcare. However, the message regarding the substantive and unique contributions of this body of work needs to be disseminated more broadly. Future nursing intervention research aimed at improving healthcare quality should consider individual behavior in a broader context, extend the traditional foci of interventions, and be grounded in the sciences of multiple disciplines.

The experience of fatigue for people living with hepatitis C

Hepatitis C affects approximately 3% of the world population, with fatigue being acknowledged as the cardinal symptom. Despite growing recognition that hepatitis C fatigue impacts in a negative manner on quality of life, at the time of this study no empirical information existed regarding the nature of this fatigue or the way in which it affects a person's life. Such information is needed to enable nurses to engage in appropriate sensitive symptom management which is the core nursing activity with this population, as to date there is no vaccine or widely effective pharmacological therapy. The aim of the study was to ascertain the nature of hepatitis C fatigue. A qualitative approach using a grounded theory approach was employed. Theoretical sampling generated 28 participants for in-depth interview. Data analysis consisted of three coding processes, each type of coding having its own purpose and method. Ethical approval was obtained, both from the principal author's academic institution and the participating health care institution. Hepatitis C fatigue emerged as being multidimensional in nature, with both acute and chronic versions existing. The hepatology community is beginning to acknowledge the significant prevalence of hepatitis C fatigue. This study provides a valuable insight into its nature. This information can serve as resource for practitioners in their development of interventions to enable the hepatitis C virus population live with fatigue in a proactive manner.

Fatigued elderly patients with chronic heart failure: do patient reports and nurse recordings correspond?

PURPOSE

To compare descriptions of fatigue from interviews with elderly people with chronic congestive heart failure (CHF) and data recorded by nurses at an outpatient heart failure clinic.

METHODS

Patients (N = 158) were screened for moderate to severe CHF and interviewed using a revised form of the Fatigue Interview Schedule (FIS). Seventy-nine of these patients were offered visits at a nurse-monitored heart failure clinic. Nursing documentation of fatigue in patient records (n = 56) at the heart failure clinic was compared to the patient interviews.

FINDINGS

Results indicated poor concordance between patients' descriptions and record content concerning fatigue. Decreased libido was linked to fatigue according to the patients but not to the nurses' notes. Cognitive characteristics of fatigue were rarely recorded, but were more frequent in patient interviews.

CONCLUSIONS

Nurses must recognize characteristics and factors related to fatigue in patients and develop strategies to help patients cope with their restricted ability in daily life.

PRACTICE IMPLICATIONS

Using the words and expressions of the patients and the diagnostic characteristics of fatigue in record-keeping can support the nurses understanding of patients living with CHF.