1
|
Bradley H, Zhu Y, Duan X, Kang H, Qu B. HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties. JMIR Public Health Surveill 2022; 8:e39015. [PMID: 36222289 PMCID: PMC9782451 DOI: 10.2196/39015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/03/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS. OBJECTIVE The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. METHODS This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation. RESULTS A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation). CONCLUSIONS This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.
Collapse
Affiliation(s)
| | - Yaxin Zhu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Xiyu Duan
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Hao Kang
- Administration Department of Nosocomial Infection, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bo Qu
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China.,School of Public Health, China Medical University, Shenyang, China
| |
Collapse
|
2
|
Zhang Q, Li X, Qiao S, Liu S, Shen Z, Zhou Y. Association between hair cortisol, hair cortisone, and fatigue in people living with HIV. Stress 2021; 24:772-779. [PMID: 33913374 DOI: 10.1080/10253890.2021.1919616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cumulative evidence to date largely supports an association between dysregulation of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and fatigue. People living with HIV (PLHIV), in particular, are vulnerable to both HPA axis dysregulation and fatigue. Few investigations have examined the possible role of HPA-axis dysfunction in the occurrence of fatigue in PLHIV. This cross-sectional study aimed to investigate the association between glucocorticoids in hair, retrospective indicators of long-term HPA axis activity and biomarkers of chronic stress, and fatigue in PLHIV. A total of 446 PLHIV from Guangxi China provided hair samples for cortisol and cortisone assay and provided information on fatigue levels, sociodemographic, lifestyle, and HIV-related characteristics. Results showed that before and after controlling sociodemographic, lifestyle, and HIV-related characteristics, hair cortisone levels, but not hair cortisol levels, were associated with fatigue levels in PLHIV. In conclusion, we found that higher cortisone levels are associated with greater fatigue levels in a large cohort of Chinese PLHIV.LAY SUMMARYWe found that hair cortisone levels were significantly associated with fatigue levels in a large cohort of Chinese PLHIV. Hair cortisol levels were, however, not associated with fatigue levels in the PLHIV studied. We thus show that Chinese PLHIV who have higher cortisone levels are associated with higher fatigue levels.
Collapse
Affiliation(s)
- Quan Zhang
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Institute of Pedagogy and Applied Psychology, School of Public Administration, Hohai University, Nanjing, China
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shuaifeng Liu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| |
Collapse
|
3
|
Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity. J Assoc Nurses AIDS Care 2020; 30:392-404. [PMID: 31241504 DOI: 10.1097/jnc.0000000000000022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People living with HIV (PLWH) experience high rates of fatigue, which can be improved with physical activity. We examined relationships between HIV infection, fatigue, cardiorespiratory fitness, physical activity, and myokines. Twenty PLWH and 20 HIV-uninfected adults completed a fatigue assessment, a maximal cardiometabolic exercise test, serum measures of myokines, and wore an accelerometer for 7 days. Measures were completed at baseline, 3 months, and 6 months. At baseline, PLWH had more fatigue (4.7 ± 2.6 vs. 2.8 ± 2.5, p = .01) and higher peak ventilatory efficiency (VE/VCO2; 33 ± 5.5 vs. 30.2 ± 2.5; p = .06). Half of PLWH engaged in at least one 10-minute bout of physical activity in the previous week, compared with control subjects (65%). Over time, HIV infection and fibroblast growth factor 21 were associated with fatigue (p < .05). People living with HIV have more fatigue and a higher ventilatory efficiency; expression of fibroblast growth factor 21 may underpin this relationship.
Collapse
|
4
|
Barroso J, Madisetti M, Mueller M. A Feasibility Study to Develop and Test a Cognitive Behavioral Stress Management Mobile Health Application for HIV-Related Fatigue. J Pain Symptom Manage 2020; 59:242-253. [PMID: 31539601 PMCID: PMC6989380 DOI: 10.1016/j.jpainsymman.2019.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Exacerbated by life stressors, fatigue is the most common symptom for people living with HIV. OBJECTIVE To adapt, develop, and assess the feasibility of a Cognitive Behavioral Stress Management Mobile Health (CBSM mHealth) application (app) for HIV-related fatigue. METHODS This study had two phases: app development with key informants (N = 5) and a randomized controlled trial (N = 30). Patients randomized to the intervention group completed 10 weekly CBSM modules; those in the control group received a generic healthy lifestyle app. Measures included HIV-related fatigue, depression, anxiety, stressful life events, CD4 count, HIV viral load, credibility and acceptability of the intervention, and barriers to treatment participation. RESULTS We were able to recruit participants for this study, and they were able to complete the required measures. They found the intervention to be credible and acceptable and reported few barriers to treatment participation. The direction of change in the primary outcome, a decrease in fatigue, is in the expected direction and provides evidence of the promise of the intervention, which still needs to be tested in an adequately powered trial. For completers (randomized to the intervention group and completed at least 80% of the modules), there were significant changes (95% CI; lower scores indicate improvement) in fatigue intensity (from 64.2 to 59.7) and overall fatigue-related functioning (from 6.6 to 4.2). CONCLUSION We have proof of concept as to the feasibility, acceptability, and initial signals of efficacy for an mHealth intervention to help people with HIV-related fatigue better cope with stress and reduce their fatigue.
Collapse
Affiliation(s)
- Julie Barroso
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
5
|
Measuring Fatigue in TBI: Development of the TBI-QOL Fatigue Item Bank and Short Form. J Head Trauma Rehabil 2019; 34:289-297. [PMID: 31498228 DOI: 10.1097/htr.0000000000000530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. SETTING Five TBI Model Systems rehabilitation centers in the US PARTICIPANTS:: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review. DESIGN Cross-sectional field testing via phone or in-person interview. MAIN MEASURES TBI-QOL Fatigue item bank, short form, and CAT. RESULTS A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]). CONCLUSIONS The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI.
Collapse
|
6
|
Bergamaschi A, d'Arripe-Longueville F, Gray LL, Colson SS, Goujard C, Ferez S, Rouanet I, Durant J, Rosenthal E, Pradier C, Duracinsky M, Schuft L. Perceived HIV-related physical fatigue, sociodemographic characteristics and physical activity: A cross-sectional study. J Clin Nurs 2019; 28:2147-2156. [PMID: 30667107 DOI: 10.1111/jocn.14793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To get a deeper understanding of correlates of perceived HIV-related fatigue by exploring its associations with sociodemographic characteristics and physical activity level of HIV-infected people. BACKGROUND Previous studies on HIV-related fatigue have mainly focused on physiological and psychological characteristics, but few have considered its associations with sociodemographic variables. In addition, while physical activity has been found to reduce acute fatigue among HIV-infected people, its links with chronic HIV-related fatigue remain to be explored. DESIGN The study employed an observational and cross-sectional survey design. The manuscript was organised according to STROBE guidelines. METHOD A total of 560 people living with HIV in France completed a measure of perceived physical fatigue using the Fatigue Intensity Scale. The predictors targeted sociodemographic characteristics and two measures of individuals' reported level of physical activity. Data were analysed by a stepwise multiple regression model. RESULTS The results showed that lower age, higher physical activity level and socio-economic status were significantly associated with reduced perceived physical fatigue, explaining 25% of the variance. CONCLUSIONS The results highlighted the importance of considering sociodemographic and lifestyle characteristics to better characterise HIV-related fatigue, in particular in an era where HIV as a chronic illness challenges questions of quality of life throughout increasingly longer lifespans. RELEVANCE TO CLINICAL PRACTICE The results of this study have implications for HIV care professionals in terms of improving strategies for managing chronic fatigue or promoting physical activity according to more specific profiles of HIV-infected people.
Collapse
Affiliation(s)
| | | | | | | | - Cecile Goujard
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France
| | - Sylvain Ferez
- Laboratory Health, Education, Handicap Situations (EA 4614 SANTESIH), University of Montpellier, Montpellier, France
| | - Isabelle Rouanet
- Department of Infectious Diseases, Hospital of Nîmes, Nîmes, France
| | - Jacques Durant
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Eric Rosenthal
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Christian Pradier
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Nice, France
| | - Martin Duracinsky
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France.,Patient-Centered Outcomes Research (EA 7334 REMES), University of Paris-Diderot, Paris, France
| | | |
Collapse
|
7
|
Gray L, Chalabaev A, Durant J, Rosenthal E, Pradier C, Duracinsky M, Rouanet I, Schuft L, Colson SS, d'Arripe-Longueville F. Exercise stereotypes and fatigue in people living with HIV: does self-efficacy play a mediating or a moderating role? ACTA ACUST UNITED AC 2018; 76:23. [PMID: 29719721 PMCID: PMC5925845 DOI: 10.1186/s13690-018-0269-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022]
Abstract
Background Recent research suggests that exercise stereotypes may influence physical activity through ego depletion and internalization mechanisms. The objective of this study was to better understand exercise stereotypes mechanisms among people living with HIV (PLHIV) by further examining the role of exercise self-efficacy and perceived physical fatigue in the relationship between exercise stereotypes and physical activity. Methods Three hundred five people living with HIV were recruited to provide data on their stereotypes related to exercise, exercise self-efficacy, perceived physical fatigue as well as their level of physical activity (PA). Results From the different models tested, the serial mediation model with exercise self-efficacy and perceived physical fatigue as mediators of the relationship between exercise stereotypes and PA, as well as the moderated mediation model with exercise selfefficacy as a moderator of exercise stereotypes and perceived physical fatigue a mediator, provided good fits to the data. However, the moderated mediation model (with indirect associations between negative exercise stereotypes and PA via perceived physical fatigue being moderated by exercise self-efficacy) explained the most variance in PA (R2 = .27). Conclusion The moderated mediation model suggests that exercise stereotypes might influence PA through ego depletion mechanisms and be tempered by exercise self-efficacy.
Collapse
Affiliation(s)
- Laura Gray
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | | | - Jacques Durant
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Archet 1, France
| | - Eric Rosenthal
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Archet 1, France
| | - Christian Pradier
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Archet 1, France
| | - Martin Duracinsky
- AP-HP Department of Clinical Research Bicêtre Hospital, (Le Kremlin Bicêtre), France
| | - Isabelle Rouanet
- Department of Infectious Diseases Nîmes Hospital, (Nîmes), France
| | - Laura Schuft
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | - Serge S Colson
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| | - Fabienne d'Arripe-Longueville
- 1Faculté des Sciences du Sport, Université Côte d'Azur Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS - EA 6312), 261 Boulevard du Mercantour, 06203, Cedex 3 Nice, France
| |
Collapse
|
8
|
Perazzo J, Rodriguez M, Currie J, Salata R, Webel AR. Creation of Data Repositories to Advance Nursing Science. West J Nurs Res 2017; 41:78-95. [PMID: 29277149 DOI: 10.1177/0193945917749481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Data repositories are a strategy in line with precision medicine and big data initiatives, and are an efficient way to maximize data utility and form collaborative research relationships. Nurse researchers are uniquely positioned to make a valuable contribution using this strategy. The purpose of this article is to present a review of the benefits and challenges associated with developing data repositories, and to describe the process we used to develop and maintain a data repository in HIV research. Systematic planning, data collection, synthesis, and data sharing have enabled us to conduct robust cross-sectional and longitudinal analyses with more than 200 people living with HIV. Our repository building has also led to collaboration and training, both in and out of our organization. We present a pragmatic and affordable way that nurse scientists can build and maintain a data repository, helping us continue to make to our understanding of health phenomena.
Collapse
Affiliation(s)
- Joseph Perazzo
- 1 Case Western Reserve University, Cleveland, OH, USA.,2 University of Cincinnati, OH, USA
| | | | | | - Robert Salata
- 1 Case Western Reserve University, Cleveland, OH, USA
| | | |
Collapse
|
9
|
A Review of HIV-Specific Patient-Reported Outcome Measures. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:187-202. [PMID: 27637488 DOI: 10.1007/s40271-016-0195-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The use of patient-reported outcome (PRO) measures to provide added feedback to health providers is receiving interest as a means of improving clinical care and patient outcomes, and contributing to more patient-centered care. In human immunodeficiency virus (HIV), while PROs are used in research, their application in clinical practice has been limited despite their potential utility. PRO selection is an important consideration when contemplating their use. As past reviews of PROs in HIV have focused on particular areas (e.g. disability, satisfaction with care), a more comprehensive review could better inform on the available instruments and their scope. This article reviews HIV-specific PROs to produce an inventory and to identify the central concepts targeted over time. Seven databases were searched (HAPI, MEDLINE, PsychINFO, PubMed, EMBASE, CINAHL, Google Scholar), generating 14,794 records for evaluation. From these records, 117 HIV-specific PROs were identified and categorized based on a content analysis of their targeted concept: Health-Related Quality of Life (23; 20 %), ART and Adherence-Related Views and Experiences (19; 16 %), Healthcare-Related Views and Experiences (15; 13 %), Psychological Challenges (12; 10 %), Symptoms (12; 10 %), Psychological Resources (10; 9 %), HIV Self-Management and Self-Care (8; 7 %), HIV-Related Stigma (8; 7 %), Body and Facial Appearance (4; 3 %), Social Support (3; 3 %), Sexual and Reproductive Health (2; 2 %), and Disability (1; 1 %). This review highlights the variety and evolution of HIV-specific PROs, with the arrival of seven categories of PROs only after the advent of highly-active antiretroviral therapy. Our inventory also offers a useful resource. However, the interest of further HIV-specific PRO development should be explored in sexual health, which received little independent attention.
Collapse
|
10
|
Gibbons LE, Fredericksen R, Batey DS, Dant L, Edwards TC, Mayer KH, Mathews WC, Morales LS, Mugavero MJ, Yang FM, Paez E, Kitahata MM, Patrick DL, Crane HM, Crane PK. Validity assessment of the PROMIS fatigue domain among people living with HIV. AIDS Res Ther 2017; 14:21. [PMID: 28400850 PMCID: PMC5387298 DOI: 10.1186/s12981-017-0146-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate psychometric characteristics and cross-sectional and longitudinal validity of the 7-item PROMIS® Fatigue Short Form and additional fatigue items among people living with HIV (PLWH) in a nationally distributed network of clinics collecting patient reported data at the time of routine clinical care. Methods Cross-sectional and longitudinal fatigue data were collected from September 2012 through April 2013 across clinics participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We analyzed data regarding psychometric characteristics including simulated computerized adaptive testing and differential item functioning, and regarding associations with clinical characteristics. Results We analyzed data from 1597 PLWH. Fatigue was common in this cohort. Scores from the PROMIS® Fatigue Short Form and from the item bank had acceptable psychometric characteristics and strong evidence for validity, but neither performed better than shorter instruments already integrated in CNICS. Conclusions The PROMIS® Fatigue Item Bank is a valid approach to measuring fatigue in clinical care settings among PLWH, but in our analyses did not perform better than instruments associated with less respondent burden. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0146-y) contains supplementary material, which is available to authorized users.
Collapse
|
11
|
Perazzo JD, Webel AR, Voss JG, Prince-Paul M. Fatigue Symptom Management in People Living With Human Immunodeficiency Virus. J Hosp Palliat Nurs 2017; 19:122-127. [PMID: 29398974 PMCID: PMC5793939 DOI: 10.1097/njh.0000000000000329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fatigue is a subjective, unpleasant, potentially disabling symptom rooted in physiological, psychological, and behavioral causes. People living with HIV are a population highly affected by fatigue due to risk factors associated with HIV-infection, treatment, and psychosocial disease burden. People with HIV are living longer, and are facing the challenge of a longer disease trajectory. Palliative nurses with expertise in symptom management can play a crucial role in helping people with HIV to engage in health behaviors that prevent or mitigate fatigue. In this paper we present a definition and overview of fatigue, describe the problem of fatigue in people living with HIV, and present a case study that illustrates the role of the palliative nurse in helping a person with HIV to cope with fatigue.
Collapse
Affiliation(s)
- Joseph D Perazzo
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Allison R Webel
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| | - Maryjo Prince-Paul
- Frances Payne Bolton School of Nursing; Case Western Reserve University; Cleveland, OH
| |
Collapse
|
12
|
Affiliation(s)
- Joanne Potterton
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
Webel AR, Perazzo J, Decker M, Horvat-Davey C, Sattar A, Voss J. Physical activity is associated with reduced fatigue in adults living with HIV/AIDS. J Adv Nurs 2016; 72:3104-3112. [PMID: 27485463 PMCID: PMC5118117 DOI: 10.1111/jan.13084] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to describe the relationships among home-based physical activity, fatigue, sleep, gender and quality of life in people living with HIV/AIDS BACKGROUND: Fatigue is a common and distressing symptom among people living with HIV/AIDS. Few interventions exist that effectively reduce fatigue in this population. Physical activity has shown promise to reduce fatigue in other populations, but its impact on fatigue in HIV/AIDS has not yet been explored. DESIGN This study was conducted using a prospective, descriptive cohort design. METHODS Overall, 90 adults living with HIV/AIDS completed cross-sectional measures. Home-based physical activity was measured using a 7-day self-report diary. Fatigue was measured using the self-reported HIV-Related Fatigue Scale. Sleep was assessed using wrist actigraphy and quality of life was assessed using the HIV-Associated Quality of Life Scale. Data were collected from December 2012-April 2013 and analysed using correlations and multiple linear regression. RESULTS The number of minutes of home-based physical activity was significantly associated with reduced fatigue among people living with HIV/AIDS. In addition, increased fatigue was associated with decreased quality of life. No associations were found among fatigue, sleep or gender. CONCLUSIONS Our study demonstrates that physical activity in the home setting is an effective strategy to reduce fatigue among people living with HIV/AIDS. Future work developing and testing interventions to improve home-based physical activity in this population is needed.
Collapse
Affiliation(s)
- Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-4904, USA, 012163683939, , Twitter: @allisonwebelPhD
| | - Joe Perazzo
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | - Michael Decker
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| | | | - Abdus Sattar
- School of Medicine, Case Western Reserve University
| | - Joachim Voss
- Sarah Cole Hirsh Center for Evidence-Based Practice, Frances Payne Bolton School of Nursing, Case Western Reserve University
| |
Collapse
|
14
|
Phillips KD, Sowell RL, Rojas M, Tavakoli A, Fulk LJ, Hand GA. Physiological and Psychological Correlates of Fatigue in HIV Disease. Biol Res Nurs 2016; 6:59-74. [PMID: 15186708 DOI: 10.1177/1099800404264846] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.
Collapse
Affiliation(s)
- Kenneth D Phillips
- College of Nursing, University of South Carolina, 1601 Green Street, Columbia, SC 29208, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Improvements in Depression and Changes in Fatigue: Results from the SLAM DUNC Depression Treatment Trial. AIDS Behav 2016; 20:235-42. [PMID: 26525221 DOI: 10.1007/s10461-015-1242-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fatigue and depression are common co-morbid conditions among people with HIV infection. We analyzed a population of HIV-infected adults with depression, who were enrolled in a depression treatment trial, to examine the extent to which improvements in depression over time were associated with improvements in HIV-related fatigue. Data for this analysis come from a randomized controlled trial to evaluate the effectiveness of improved depression treatment on antiretroviral adherence. Fatigue was measured using the HIV-Related Fatigue Scale, and depressive symptoms were measured with the Hamilton Depression Rating Scale. Participants (n = 234) were on average nearly 44 years of age and predominantly male, black or African American, and unemployed. Individuals who experienced stronger depression response (i.e., greater improvement in depression score) had larger decreases in fatigue. However, even among those who demonstrated a full depression response, nearly three-quarters continued to have either moderate or severe fatigue at 6 and 12 months.
Collapse
|
16
|
Liu Z, Yang J. Health related quality of life: is it another comprehensive evaluation indicator of Chinese medicine on acquired immune deficiency syndrome treatment? J TRADIT CHIN MED 2015; 35:600-5. [PMID: 26591693 DOI: 10.1016/s0254-6272(15)30146-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Health related quality of life (HRQOL) can better reflect changes in acquired immune deficiency syndrome (AIDS) patients and inform economic evaluation of AIDS treatment services, and the assessment of HRQOL can help us to detect problems that may influence the progression of the disease, hence HRQOL has become a particularly important assessment indictor for HIV comprehensive interventions. Being a multi-angle, multi-level, and diversified complex intervention, roles of Chinese medicine (CM) in AIDS treatment have been recognized and accepted by more and more patients, and HRQOL has been widely used to evaluate the comprehensive management effects of CM on AIDS. In this article, the authors analyze the definition and measurement of HRQOL, measurement of HRQOL of HIV/AIDS patients and effects of CM on AIDS, and give some reasonable advices for the usage of the scale of HRQOL. The authors hold that some new HRQOL instruments specific for CM treatment of AIDS should be developed and further prospective studies should be carried out to demonstrate the practicality, reliability and validity of HRQOL as an evaluation indictor for CM treatment of AIDS.
Collapse
|
17
|
Barroso J, Leserman J, Harmon JL, Hammill B, Pence BW. Fatigue in HIV-Infected People: A Three-Year Observational Study. J Pain Symptom Manage 2015; 50:69-79. [PMID: 25701691 PMCID: PMC4492863 DOI: 10.1016/j.jpainsymman.2015.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 12/18/2022]
Abstract
CONTEXT HIV-related fatigue remains the most frequent complaint of seropositive patients. OBJECTIVES To describe the natural course of fatigue in HIV infection, in a sample (n=128) followed for a three-year period. METHODS A longitudinal prospective design was used to determine what factors influenced changes in fatigue intensity and fatigue-related impairment of functioning in a community-dwelling sample of HIV-infected individuals. Participants were followed every six months for a three-year period. At each study visit, we collected data on a large number of physiological and psychosocial markers that have been shown to be related to fatigue in HIV-infected people. At three month intervals between study visits, we collected data on fatigue via mailed questionnaires. RESULTS Fatigue in HIV infection is largely a result of stressful life events, and is closely tied to the anxiety and depression that accompany such events. Fatigue did not remit spontaneously over the course of the study, indicating the need for interventions to ameliorate this debilitating symptom. CONCLUSION Intervening to help people who are suffering from HIV-related fatigue to deal with stressful life events may help to ameliorate this debilitating symptom.
Collapse
Affiliation(s)
- Julie Barroso
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
| | - Jane Leserman
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James L Harmon
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Bradley Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
18
|
Claborn KR, Miller MB, Meier E. Initial Validation of the HIV Treatment Regimen Fatigue Scale for Adults Prescribed Antiretroviral Therapy. J Assoc Nurses AIDS Care 2015; 26:308-15. [PMID: 26066687 DOI: 10.1016/j.jana.2015.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
Clinical observations have linked antiretroviral nonadherence to treatment regimen fatigue in persons living with HIV (PLWH). Although nonadherence appears to be a consequence of treatment regimen fatigue, little is known about the onset, course, and duration of this construct. Our study developed and evaluated psychometric properties of a measure of treatment regimen fatigue for PLWH. Based on a recent review, the concept was hypothesized to reflect decreased motivation, treatment cynicism, and low self-efficacy to adhere to treatment. Items comprising these factors were generated based on measures of similar constructs in the literature. Exploratory factor analyses suggested that a two-factor solution best fit the data and accounted for 35.8% of the variance. Our study supported a two-factor model of treatment regimen fatigue consisting of Treatment Cynicism and Self-Efficacy. The scale provides a new tool to assess treatment regimen fatigue in PLWH and can be used to inform and improve treatment of HIV.
Collapse
|
19
|
Bengtson AM, Pence BW, O'Donnell J, Thielman N, Heine A, Zinski A, Modi R, McGuinness T, Gaynes B. Improvements in depression and changes in quality of life among HIV-infected adults. AIDS Care 2014; 27:47-53. [PMID: 25105320 DOI: 10.1080/09540121.2014.946386] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Improving quality of life (QOL) for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research has quantified the potential of improvement in depression to prospectively improve QOL among HIV-infected adults. We analyzed data from 115 HIV-infected adults with depression enrolled in a randomized controlled trial to evaluate the effectiveness of improved depression care on antiretroviral drug adherence. Improvement in depression, the exposure of interest, was defined as the relative change in depression at six months compared to baseline and categorized as full response (≥50% improvement), partial response (25-49% improvement), and no response (<25% improvement). Multivariable linear regression was used to investigate the relationship between improvement in depression and four continuous measures of QOL at six months: physical QOL, mental QOL, HIV symptoms, and fatigue intensity. In multivariable analyses, physical QOL was higher among partial responders (mean difference [MD] = 2.51, 95% CI: -1.51, 6.54) and full responders (MD = 3.68, 95% CI: -0.36, 7.72) compared to individuals who did not respond. Mental QOL was an average of 4.01 points higher (95% CI: -1.01, 9.03) among partial responders and 14.34 points higher (95% CI: 9.42, 19.25) among full responders. HIV symptoms were lower for partial responders (MD = -0.69; 95% CI: -1.69, 0.30) and full responders (MD = -1.51; 95% CI: -2.50, -0.53). Fatigue intensity was also lower for partial responders (MD = -0.94; 95% CI: -1.94, 0.07) and full responders (MD = -3.00; 95% CI: -3.98, -2.02). Among HIV-infected adults with depression, improving access to high-quality depression treatment may also improve important QOL outcomes.
Collapse
Affiliation(s)
- Angela M Bengtson
- a Department of Epidemiology , University of North Carolina-Chapel Hill , Chapel Hill , NC , USA
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Powell DJH, Liossi C, Moss-Morris R, Schlotz W. Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis. Psychoneuroendocrinology 2013; 38:2405-22. [PMID: 23916911 DOI: 10.1016/j.psyneuen.2013.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/04/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is a psychoneuroendocrine regulator of the stress response and immune system, and dysfunctions have been associated with outcomes in several physical health conditions. Its end product, cortisol, is relevant to fatigue due to its role in energy metabolism. The systematic review examined the relationship between different markers of unstimulated salivary cortisol activity in everyday life in chronic fatigue syndrome (CFS) and fatigue assessed in other clinical and general populations. Search terms for the review related to salivary cortisol assessments, everyday life contexts, and fatigue. All eligible studies (n=19) were reviewed narratively in terms of associations between fatigue and assessed cortisol markers, including the cortisol awakening response (CAR), circadian profile (CP) output, and diurnal cortisol slope (DCS). Subset meta-analyses were conducted of case-control CFS studies examining group differences in three cortisol outcomes: CAR output; CAR increase; and CP output. Meta-analyses revealed an attenuation of the CAR increase within CFS compared to controls (d=-.34) but no statistically significant differences between groups for other markers. In the narrative review, total cortisol output (CAR or CP) was rarely associated with fatigue in any population; CAR increase and DCS were most relevant. Outcomes reflecting within-day change in cortisol levels (CAR increase; DCS) may be the most relevant to fatigue experience, and future research in this area should report at least one such marker. Results should be considered with caution due to heterogeneity in one meta-analysis and the small number of studies.
Collapse
Affiliation(s)
- Daniel J H Powell
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.
| | | | | | | |
Collapse
|
21
|
Barroso J, Harmon JL, Madison JL, Pence BW. Intensity, chronicity, circumstances, and consequences of HIV-related fatigue: a longitudinal study. Clin Nurs Res 2013; 23:514-28. [PMID: 23814175 DOI: 10.1177/1054773813492998] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV-related fatigue remains the most troubling complaint of seropositive people. Researchers often use tools to measure fatigue that were developed for other patient populations; thus, the measurement of fatigue specific to HIV is needed. This article describes results from the HIV-Related Fatigue Scale (HRFS) including: (a) the variability in intensity and chronicity of HIV-related fatigue, (b) the circumstances surrounding changes in fatigue, (c) the impact of fatigue on activities of daily living (ADLs), and (d) the consequences of HIV-related fatigue. We collected data every 3 months over a 3-year period from 128 people. HIV-related fatigue was chronic and did not appear to remit spontaneously; those who were the most fatigued at the beginning of the study remained the most fatigued over 3 years. Fatigue interfered more with instrumental activities of daily living than basic ADLs; it also interfered with work, family, and social life. Stress and depression increased fatigue.
Collapse
Affiliation(s)
| | | | - Jane Leserman Madison
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Wells Pence
- Department of Community and Family Medicine, Duke Global Health Institute, and Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| |
Collapse
|
22
|
Voss JG, Dobra A, Morse C, Kovacs JA, Danner RL, Munson PJ, Logan C, Rangel Z, Adelsberger JW, McLaughlin M, Adams LD, Raju R, Dalakas MC. Fatigue-related gene networks identified in CD(14)+ cells isolated from HIV-infected patients: part I: research findings. Biol Res Nurs 2013; 15:137-51. [PMID: 23324479 DOI: 10.1177/1099800411421957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV)-related fatigue (HRF) is multicausal and potentially related to mitochondrial dysfunction caused by antiretroviral therapy with nucleoside reverse transcriptase inhibitors (NRTIs). METHODOLOGY The authors compared gene expression profiles of CD14(+) cells of low versus high fatigued, NRTI-treated HIV patients to healthy controls (n = 5/group). The authors identified 32 genes predictive of low versus high fatigue and 33 genes predictive of healthy versus HIV infection. The authors constructed genetic networks to further elucidate the possible biological pathways in which these genes are involved. RELEVANCE FOR NURSING PRACTICE: Genes including the actin cytoskeletal regulatory proteins Prokineticin 2 and Cofilin 2 along with mitochondrial inner membrane proteins are involved in multiple pathways and were predictors of fatigue status. Previously identified inflammatory and signaling genes were predictive of HIV status, clearly confirming our results and suggesting a possible further connection between mitochondrial function and HIV. Isolated CD14(+) cells are easily accessible cells that could be used for further study of the connection between fatigue and mitochondrial function of HIV patients. IMPLICATION FOR PRACTICE The findings from this pilot study take us one step closer to identifying biomarker targets for fatigue status and mitochondrial dysfunction. Specific biomarkers will be pertinent to the development of methodologies to diagnosis, monitor, and treat fatigue and mitochondrial dysfunction.
Collapse
Affiliation(s)
- Joachim G Voss
- Biobehavioral Nursing & Health Systems Department, University of Washington, School of Nursing, Seattle, WA 98195, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Morse CG, Voss JG, Rakocevic G, McLaughlin M, Vinton CL, Huber C, Hu X, Yang J, Huang DW, Logun C, Danner RL, Rangel ZG, Munson PJ, Orenstein JM, Rushing EJ, Lempicki RA, Dalakas MC, Kovacs JA. HIV infection and antiretroviral therapy have divergent effects on mitochondria in adipose tissue. J Infect Dis 2012; 205:1778-87. [PMID: 22476717 PMCID: PMC3357134 DOI: 10.1093/infdis/jis101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) affect mitochondrial DNA (mtDNA) content and function, comprehensive evaluations of their effects on mitochondria in muscle, adipose tissue, and blood cells are limited. METHODS Mitochondrial DNA quantification, mitochondrial genome sequencing, and gene expression analysis were performed on muscle, adipose tissue, and peripheral blood mononuclear cell (PBMC) samples from untreated HIV-positive patients, HIV-positive patients receiving nucleoside reverse transcriptase inhibitor (NRTI)-based ART, and HIV-negative controls. RESULTS The adipose tissue mtDNA/nuclear DNA (nDNA) ratio was increased in untreated HIV-infected patients (ratio, 353) and decreased in those receiving ART (ratio, 162) compared with controls (ratio, 255; P < .05 for both comparisons); the difference between the 2 HIV-infected groups was also significant (P = .002). In HIV-infected participants, mtDNA/nDNA in adipose tissue correlated with the level of activation (CD38+ /HLA-DR+) for CD4+ and CD8+ lymphocytes. No significant differences in mtDNA content were noted in muscle or PMBCs among groups. Exploratory DNA microarray analysis identified differential gene expression between patient groups, including a subset of adipose tissue genes. CONCLUSIONS HIV infection and ART have opposing effects on mtDNA content in adipose tissue; immune activation may mediate the effects of HIV, whereas NRTIs likely mediate the effects of ART.
Collapse
Affiliation(s)
- Caryn G Morse
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1403, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Lerdal A, Kottorp A, Gay C, Aouizerat BE, Portillo CJ, Lee KA. A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model. Qual Life Res 2011; 20:1447-56. [PMID: 21547359 DOI: 10.1007/s11136-011-9877-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the psychometric properties of the 9-item Fatigue Severity Scale (FSS) using a Rasch model application. METHODS A convenience sample of HIV-infected adults was recruited, and a subset of the sample was assessed at 6-month intervals for 2 years. Socio-demographic, clinical, and symptom data were collected by self-report questionnaires. CD4 T-cell count and viral load measures were obtained from medical records. The Rasch analysis included 316 participants with 698 valid questionnaires. RESULTS FSS item 2 did not advanced monotonically, and items 1 and 2 did not show acceptable goodness-of-fit to the Rasch model. A reduced FSS 7-item version demonstrated acceptable goodness-of-fit and explained 61.2% of the total variance in the scale. In the FSS-7 item version, no uniform Differential Item Functioning was found in relation to time of evaluation or to any of the socio-demographic or clinical variables. CONCLUSION This study demonstrated that the FSS-7 has better psychometric properties than the FSS-9 in this HIV sample and that responses to the different items are comparable over time and unrelated to socio-demographic and clinical variables.
Collapse
Affiliation(s)
- Anners Lerdal
- Lovisenberg Deaconal University College, Lovisenbergveien 15b, 0456, Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
25
|
Barroso J, Hammill BG, Leserman J, Salahuddin N, Harmon JL, Pence BW. Physiological and psychosocial factors that predict HIV-related fatigue. AIDS Behav 2010; 14:1415-27. [PMID: 20352317 DOI: 10.1007/s10461-010-9691-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fatigue is one of the most common and debilitating symptoms experienced by HIV-infected people. We report the results of our longitudinal analysis of physiological and psychosocial factors that were thought to predict changes in HIV-related fatigue in 128 participants over a 1-year period, in an effort to sort out the complex interplay among a comprehensive set of physiological and psychosocial variables. Physiological measures included hepatic function (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, total bilirubin, hepatitis C status), thyroid function (thyroid stimulating hormone, thyroxine), HIV viral load, immunologic function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, dehydroepiandrosterone), hematologic function (hemoglobin, hematocrit, serum erythropoietin), and cellular injury (lactic acid). Psychosocial measures included childhood and adult trauma, anxiety, depression, social support, stressful life events, and post-traumatic stress disorder (PTSD). Unemployment, not being on antiretroviral therapy, having fewer years since HIV diagnosis, more childhood trauma, more stressful life events, less social support, and more psychological distress (e.g., PTSD, anxiety and depression) put HIV-infected persons at risk for greater fatigue intensity and fatigue-related impairment in functioning during 1-year follow-up. Physiological variables did not predict greater fatigue. Stressful life events had both direct and indirect effects on fatigue.
Collapse
Affiliation(s)
- Julie Barroso
- School of Nursing, Duke University, DUMC 3322, Durham, NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Michel L, Villes V, Dabis F, Spire B, Winnock M, Loko MA, Poizot-Martin I, Valantin MA, Bonnard P, Salmon-Céron D, Carrieri MP. Role of treatment for depressive symptoms in relieving the impact of fatigue in HIV-HCV co-infected patients: ANRS Co13 Hepavih, France, 2006-2008. J Viral Hepat 2010; 17:650-60. [PMID: 20002565 DOI: 10.1111/j.1365-2893.2009.01223.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fatigue is a major component of quality of life (QOL) and is associated with depression in HIV-HCV co-infected individuals. We investigated whether treating depressive symptoms (DS) could mitigate the impact of fatigue on daily functioning in co-infected patients, even those at an advanced stage of disease. The analysis was conducted on enrollment data of 328 HIV-HCV co-infected patients recruited in the French nationwide ANRS CO 13 HEPAVIH cohort. Data collection was based on medical records and self-administered questionnaires which included items on socio-behavioural data, the fatigue impact scale (FIS) in three domains (cognitive, physical and social functioning), depressive symptoms (CES-D classification) and use of treatments for depressive symptoms (TDS). After multiple adjustment for gender and unemployment, CD4 cell count <200 per mm(3) was associated with a negative impact of fatigue on the physical functioning dimension (P = 0.002). A higher number of symptoms causing discomfort significantly predicted a higher impact of fatigue on all three dimensions (P < 0.001). This was also true for patients with DS receiving TDS when compared with those with no DS but receiving TDS. A significant decreasing linear trend (P < 0.001) of the impact of fatigue was found across the categories 'DS/TDS', 'DS/no TDS', 'no DS/TDS' and 'no DS/no TDS'. Despite limitations related to the cross-sectional nature of this study, our results suggest that routine screening and treatment for DS can reduce the impact of fatigue on the daily functioning of HIV-HCV co-infected patients and relieve the burden of their dual infection.
Collapse
|
27
|
O'Brien KK, Bayoumi AM, Strike C, Young NL, King K, Davis AM. How do existing HIV-specific instruments measure up? Evaluating the ability of instruments to describe disability experienced by adults living with HIV. Health Qual Life Outcomes 2010; 8:88. [PMID: 20723244 PMCID: PMC2936441 DOI: 10.1186/1477-7525-8-88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 08/19/2010] [Indexed: 11/10/2022] Open
Abstract
Background Despite the multitude of health challenges faced by adults living with HIV, we know of no HIV-specific instrument developed for the purpose of describing the health-related consequences of HIV, a concept known as disability. In a previous phase of research, adults living with HIV conceptualized disability as symptoms/impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty that may fluctuate on a daily basis and over the course of living with HIV. In this paper, we describe the extent to which existing HIV-specific health-status instruments capture the experience of disability for adults living with HIV. Methods We searched databases from 1980 to 2006 for English language, HIV-specific, self-reported questionnaires consisting of at least two items that were tested for reliability and validity. We then conducted a content analysis to assess how well existing questionnaires describe disability as defined by the Episodic Disability Framework, a framework that conceptualizes this experience from the perspective of adults living with HIV. We matched items of the instruments with categories of the framework to evaluate the extent to which the instruments capture major dimensions of disability in the framework. Results We reviewed 4274 abstracts, of which 30 instruments met the inclusion criteria and were retrieved. Of the four major dimensions of disability, symptoms/impairments were included in all 30 instruments, difficulties with day-to-day activities in 16, challenges to social inclusion in 16, and uncertainty in 9. Seven instruments contained at least 1 item from all 4 dimensions of disability (breadth) however, the comprehensiveness with which the dimensions were represented (depth) varied among the instruments. Conclusions In general, symptoms/impairments and difficulties carrying out day-to-day activities were the disability dimensions characterized in greatest depth while uncertainty and challenges to social inclusion were less well represented. Although none of the instruments described the full breadth and depth of disability as conceptualized by the Episodic Disability Framework, they provide a foundation from which to build a measure of disability for adults living with HIV.
Collapse
Affiliation(s)
- Kelly K O'Brien
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
28
|
Rabkin JG, McElhiney MC, Rabkin R, McGrath PJ. Modafinil treatment for fatigue in HIV/AIDS: a randomized placebo-controlled study. J Clin Psychiatry 2010; 71:707-15. [PMID: 20492840 PMCID: PMC2892004 DOI: 10.4088/jcp.09m05171bro] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/15/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of modafinil in the treatment of fatigue in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and to assess effect on depressive symptoms. METHOD Patients who were HIV+ and had clinically significant fatigue (according to the Fatigue Severity Scale [FSS]) were included in a 4-week randomized, placebo-controlled, double-blind trial. This was followed by an additional 8 weeks of open-label treatment for modafinil responders and 12 weeks for placebo nonresponders. The primary outcome measure for fatigue and depression was the Clinical Global Impressions-Improvement scale, supplemented by the FSS, Hamilton Depression Rating Scale, and Beck Depression Inventory. Safety was assessed with assays of CD4 cell count and HIV ribonucleic acid (RNA) viral load. Visits were weekly for 4 weeks, then biweekly, with a follow-up visit at 6 months. Maximum trial dose of modafinil was 200 mg/d. Data for this study were collected between December 2004 and December 2008. RESULTS 115 patients were randomly assigned. In intention-to-treat analyses, fatigue response rate to modafinil was 73% and to placebo, 28%. Attrition was 9%. Modafinil did not have an effect on mood alone in the absence of improved energy. At week 4, CD4 cell counts did not change significantly; HIV RNA viral load showed a trend decline for patients taking modafinil but not for those taking placebo. At 6 months, those still taking modafinil had more energy and fewer depressive symptoms than patients who were not taking modafinil, and only those still taking modafinil showed a significant decline from baseline in their HIV RNA viral load. CONCLUSIONS Modafinil appears to be effective and well tolerated in treating fatigue in HIV+ patients. Consideration of its use is warranted considering the high prevalence of fatigue in the HIV community, its minimal side effects, and overall patient acceptance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00118378.
Collapse
Affiliation(s)
- Judith G Rabkin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
| | | | | | | |
Collapse
|
29
|
Pence BW, Barroso J, Harmon JL, Leserman J, Salahuddin N, Hammill BG. Chronicity and remission of fatigue in patients with established HIV infection. AIDS Patient Care STDS 2009; 23:239-44. [PMID: 19281346 DOI: 10.1089/apc.2008.0175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fatigue is one of the most common and debilitating complaints of HIV-positive individuals, potentially leading to important functional limitations. We recruited 128 HIV-positive individuals (fatigued and nonfatigued) between March 2005 and May 2006; 66% were male, 66% were African American, 45% had greater than a high school education, 67% were unemployed, and ages ranged from 26-66 (median, 44). Every 3 months for 15 months, participants completed a 56-item self-report fatigue scale developed and validated by the authors. Participants were classified as fatigued or not fatigued at each assessment and received scores for fatigue intensity and impact of fatigue on functioning. We used linear mixed-effects models to assess longitudinal variation in fatigue scores and generalized estimating equations for binary outcomes to model predictors of fatigue remission among those fatigued at baseline. At baseline, 88% of the sample was fatigued. Fatigue measures were highly correlated across time points (rho 0.63-0.85 [intensity], 0.63-0.80 [functioning]) and showed no evidence of overall improvement, deterioration, or convergence over time. Predictors of lower fatigue scores included higher income, employment, longer time since HIV diagnosis, and antiretroviral therapy use. Those employed at baseline were likely to show improvements in fatigue while those unemployed were not. Of those fatigued at baseline, 11% experienced remission during follow-up; remission was associated with Caucasian race and employment. In summary, fatigue intensity and related functional limitations were persistent, stable, and unlikely to remit over 15 months of follow-up in this sample of patients with established HIV infection.
Collapse
Affiliation(s)
- Brian Wells Pence
- Health Inequalities Program, Center for Health Policy, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Global Health Institute, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Community and Family Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Julie Barroso
- School of Nursing, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - James L. Harmon
- School of Nursing, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jane Leserman
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Naima Salahuddin
- School of Nursing, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Bradley G. Hammill
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
30
|
Salahuddin N, Barroso J, Leserman J, Harmon JL, Pence BW. Daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue. J Assoc Nurses AIDS Care 2009; 20:6-13. [PMID: 19118766 DOI: 10.1016/j.jana.2008.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Accepted: 05/06/2008] [Indexed: 11/19/2022]
Abstract
In this report, the authors describe the relationships between daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue in a sample of 128 individuals; they report the baseline results of a longitudinal observational study. They examined sleep using the Pittsburgh Sleep Quality Index (a measure of the quality of nighttime sleep), and the Epworth Sleepiness Scale, (a measure of daytime sleepiness). Recent stressful life events were measured via a methodology developed in a previous 9-year HIV study. Poor nighttime sleep was significantly correlated with fatigue intensity (r = .46, p < .05), as was daytime sleepiness (r = .20, p < .05). However, in multiple regression models, the association between stress and fatigue intensity was not explained by daytime sleepiness and was only partially explained by nighttime sleep quality. Further research is needed to better elucidate these relationships.
Collapse
|
31
|
Leserman J, Barroso J, Pence BW, Salahuddin N, Harmon JL. Trauma, stressful life events and depression predict HIV-related fatigue. AIDS Care 2009; 20:1258-65. [PMID: 18608079 DOI: 10.1080/09540120801919410] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the fact that fatigue is a common and debilitating symptom among HIV-infected persons, we know little about the predictors of fatigue in this population. The goal of this cross-sectional study was to examine the effects of early childhood trauma, recent stressful life events and depression on intensity and impairment of fatigue in HIV, over and above demographic factors and clinical characteristics. We studied 128 HIV-infected men and women from one southern state. The median number of childhood traumatic events was two and participants tended to have at least one moderate recent stressful event. Multiple regression findings showed that patients with less income, more childhood trauma, more recent stressful events and more depressive symptoms had greater fatigue intensity and fatigue-related impairment in daily functioning. Recent stresses were a more powerful predictor of fatigue than childhood trauma. None of the disease-related measures (e.g. CD4, viral load, antiretroviral medication) predicted fatigue. Although stress and trauma have been related to fatigue in other populations, this is the first study to examine the effects of traumatic and recent stressful life events on fatigue in an HIV-infected sample.
Collapse
Affiliation(s)
- J Leserman
- University of North Carolina at Chapel Hill, NC, USA.
| | | | | | | | | |
Collapse
|
32
|
Whitehead L. The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 2009; 37:107-28. [PMID: 19111779 DOI: 10.1016/j.jpainsymman.2007.08.019] [Citation(s) in RCA: 278] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 08/22/2007] [Accepted: 08/31/2007] [Indexed: 12/17/2022]
Abstract
Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980-2007. Criteria for judging the "ideal" measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.
Collapse
Affiliation(s)
- Lisa Whitehead
- Department of Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
| |
Collapse
|
33
|
Pence BW, Barroso J, Leserman J, Harmon JL, Salahuddin N. Measuring fatigue in people living with HIV/AIDS: psychometric characteristics of the HIV-related fatigue scale. AIDS Care 2008; 20:829-37. [PMID: 18608084 DOI: 10.1080/09540120701694063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the era of life-prolonging antiretroviral therapy, chronic fatigue is one of the most prevalent and disabling symptoms of people living with HIV/AIDS, yet its measurement remains challenging. No instruments have been developed specifically to describe HIV-related fatigue. We assessed the reliability and construct validity of the HIV-Related Fatigue Scale (HRFS), a 56-item self-report instrument developed through formative qualitative research and designed to measure the intensity and consequences of fatigue as well as the circumstances surrounding fatigue in people living with HIV. The HRFS has three main scales, which measure fatigue intensity, the responsiveness of fatigue to circumstances and fatigue-related impairment of functioning. The functioning scale can be further divided into subscales measuring impairment of activities of daily living, impairment of mental functioning and impairment of social functioning. Each scale demonstrated high internal consistency (Cronbach's alpha=0.93, 0.91 and 0.97 for the intensity, responsiveness and functioning scales, respectively). The HRFS scales also demonstrated satisfactory convergent validity when compared to other fatigue measures. HIV-Related Fatigue Scales were moderately correlated with quality of nighttime sleep (rho=0.46, 0.47 and 0.35) but showed only weak correlations with daytime sleepiness (rho=0.20, 0.33 and 0.18). The scales were also moderately correlated with general mental and physical health as measured by the SF-36 Health Survey (rho ranged from 0.30 to 0.68 across the 8 SF-36 subscales with most >0.40). The HRFS is a promising tool to help facilitate research on the prevalence, etiology and consequences of fatigue in people living with HIV.
Collapse
Affiliation(s)
- B W Pence
- Sanford Institute of Public Policy, Duke University, Durham, NC, USA.
| | | | | | | | | |
Collapse
|
34
|
Demographic and illness-related variables associated with HIV-related fatigue. J Assoc Nurses AIDS Care 2008; 19:90-7. [PMID: 18328959 DOI: 10.1016/j.jana.2007.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 08/30/2007] [Indexed: 11/21/2022]
Abstract
Fatigue is one of the most debilitating symptoms suffered by those with HIV infection, yet little is known about its correlates. The primary aims of this study were to describe the degree to which fatigue affects daily functioning and the demographic and illness-related predictors of fatigue. The sample (n = 128) was composed of primarily poor, unemployed people of color. Fatigue most often interfered with the ability to think quickly, perform household chores, exercise, work, engage in recreational activities, walk, plan activities, and think clearly. The consequences of fatigue were highest for lowered motivation, difficulty concentrating, increased drowsiness, losing patience, and interference with work, family, and social life. Multiple linear regression analyses showed statistically significant associations of employment status, monthly income, current antidepressant use, and number of years living with HIV infection as predictors of fatigue. These must be better understood to develop interventions to successfully ameliorate HIV-related fatigue.
Collapse
|
35
|
The experience of fatigue in the first 2 years after moderate-to-severe traumatic brain injury: a preliminary report. J Head Trauma Rehabil 2008; 23:17-24. [PMID: 18219231 DOI: 10.1097/01.htr.0000308717.80590.22] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fatigue is a well-recognized issue for individuals with traumatic brain injury (TBI). This prospective study examined the rate and types of fatigue that are experienced by a cohort of individuals with TBI within the first 2 years, using a multidimensional fatigue scale. The impact of factors such as demographics, injury severity indices, and concomitant psychosocial variables was also examined. Using 2 measures of overall fatigue, 16%-32% at Year 1 and 21%-34% at Year 2 reported significant levels of fatigue. Fatigue did not appear to change between 1 and 2 years post-TBI. Sleep quality was the most prevalent concomitant disturbance followed by depression and pain.
Collapse
|
36
|
Patterns of fatigue and its correlates over the first 2 years after traumatic brain injury. J Head Trauma Rehabil 2008; 23:25-32. [PMID: 18219232 DOI: 10.1097/01.htr.0000308718.88214.bb] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study used a prospective longitudinal design to quantify fatigue and associated factors during the first 2 years after traumatic brain injury (TBI). Fifty-one individuals were assessed at 3 time points: within the first 6, 12, and 18-24 months after TBI. Self-reported fatigue improved during the first year, as did pain, sleep quality, cognitive independence, and involvement in productive activity. Further changes up to 2 years after TBI were not observed. The subset of individuals who reported significant increases in fatigue over the first 2 years demonstrated poorer outcomes in cognition, motor symptoms, and general functioning than those with decreased or stable fatigue.
Collapse
|
37
|
Abstract
Our primary aim is to describe the relationship of multiple physiological variables and HIV-related fatigue. We report baseline data collected from 128 human immunodeficiency virus (HIV)-positive individuals. The HIV-Related Fatigue Scale was used to measure several aspects of fatigue. Blood was drawn for the following physiological variables: hepatic function, thyroid function, HIV viral load, immunologic function, gonadal function, hematologic function, serum cortisol, and cellular injury. In bivariable analyses, free testosterone (p=0.03) and CD8 (p=0.07) were negatively correlated with fatigue intensity, and nonlinear relationships were observed between fatigue intensity and total testosterone (p=0.02), thyroxine (p=0.01), hematocrit (p=0.06), and total bilirubin (p=0.06). However, none of these associations persisted in multivariable models. It is possible that fatigue suffered by seropositive people is better predicted by other variables, which must be better understood to develop interventions to successfully ameliorate HIV-related fatigue.
Collapse
Affiliation(s)
- Julie Barroso
- Duke University School of Nursing, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
38
|
|
39
|
Voss JG, Sukati NA, Seboni NM, Makoae LN, Moleko M, Human S, Molosiwa K, Holzemer WL. Symptom Burden of Fatigue in Men and Women Living With HIV/AIDS in Southern Africa. J Assoc Nurses AIDS Care 2007; 18:22-31. [PMID: 17662921 DOI: 10.1016/j.jana.2007.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Indexed: 11/26/2022]
Abstract
HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.
Collapse
|
40
|
Abstract
AIMS The aim of this study was to go beyond objective clinical assessment and explore the experience of fatigue and self-care strategies with adults who live with HIV. RATIONALE This study responded to a perceived lack of available evidence to inform the practice of service providers about ways fatigue impacts on the lives of people with HIV. Prior understandings of fatigue are derived from survey or instrument-based tools or studies that do not consider the complexities of the personal experience that in-depth interviews can elicit. The focus remains generally on description, measurement or management from a biomedical perspective. METHODS A qualitative study using participatory action research methods was conducted during 2003 with 15 adults diagnosed with HIV who perceived fatigue was a problem in their lives. Data were collected by individual interviews, researcher's notes and two participatory action research groups. RESULTS Thematic analysis of data demonstrated that fatigue remains silent and invisible to participant's families, friends and employers. Fatigue experienced by people living with HIV generally also met with a lack of acknowledgement and understanding from health professionals. People developed self-care strategies over many years of trial and error. RELEVANCE TO CLINICAL PRACTICE People living with a HIV seek to be acknowledged that fatigue is a legitimate concern, not only by health care professionals, but also people with whom they live. It is imperative that nurses who work with people living with HIV-related fatigue consider the wider social aspects of the person's life as well as physical symptoms. Most importantly, there then needs to be a process of engagement and active listening to the individual's account of their experience of fatigue. Advocating that fatigue is a legitimate complaint to the person living with HIV as well as the wider public and professional community is imperative.
Collapse
Affiliation(s)
- Peter Jenkin
- Royal District Nursing Service, Glenside, Australia
| | | | | |
Collapse
|
41
|
Fatigue in the First Year After Traumatic Brain Injury. J Head Trauma Rehabil 2006. [DOI: 10.1097/00001199-200609000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Abstract
A number of theoretical fatigue frameworks have been developed by nurse scientists with the intention of guiding research, practice, and education in fatigue. However, there is a significant gap between theory development and research utilization of fatigue frameworks in clinical and intervention trials. The purpose of this report is to assess an example of an inductive fatigue framework and a deductive symptom management model: The Integrated Fatigue Model (IFM) and the revised University of California, San Francisco, Symptom Management Model (UCSF-SMM), to investigate their potential to guide future nursing research projects on fatigue. The IFM is a fatigue-specific comprehensive framework of 14 biological and psychosocial patterns that influence signs and symptoms of fatigue and trigger six fatigue dimensions. The developers emphasized that patterns could be interrelated and influence the dimensionality of fatigue. The UCSF-SMM is a multidimensional symptom management model embedded within the three nursing domains: person, environment, and health and illness. The model places symptom perceptions, symptom management strategies, and outcomes within these nursing domains to be the key components of a highly complex symptom management process. The IFM is an important development in the understanding and conceptualization of fatigue in cancer and in HIV/AIDS. However, it does not reach the level of integration of the UCSF-SMM in taking fatigue research a significant step forward by integrating symptom impact, symptom management, and symptom outcomes. Both models have significant weaknesses because of their complexity.
Collapse
Affiliation(s)
- Joachim G Voss
- National Institute for Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | | | | |
Collapse
|
43
|
Barroso J, Burrage J, Carlson J, Carlson BW. Salivary Cortisol Values in HIV-Positive People. J Assoc Nurses AIDS Care 2006; 17:29-36. [PMID: 16829360 DOI: 10.1016/j.jana.2006.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fatigue is one of the most prevalent and troubling symptoms suffered by people with HIV infection. As part of a pilot study to examine physiological and psychosocial correlates of fatigue, the authors report results from a sample of 40 HIV-positive men and women who collected three saliva samples each over the course of a day. Few in the sample exhibited the normal salivary cortisol slope (a peak in the morning and falling throughout the day). There were four groups (N = 36) based on salivary cortisol plots: a normal downward trend (n = 7), an afternoon peak (n = 15), an afternoon drop (n = 9), and an upward trend (n = 5). The data in each of these groups were then analyzed on the key variables of sex, age, depression, state/trait anxiety, fatigue severity, CD4 count, and HIV viral load; the group that had an upward trend in cortisol values had a tendency toward more depression, more state and trait anxiety, higher fatigue severity, and higher HIV viral load. However, they also trended toward higher CD4 counts than the other three groups. The need to compare additional variables over a period of time is discussed.
Collapse
|
44
|
Abstract
Although various physiological and psychological causes of fatigue in HIV-positive persons have been proposed, it is still not well understood. Bioimpedance analysis has proved to be an easily used, non-invasive measurement of body composition and cellular integrity. This study, looking at whether body composition as measured by bioimpedance analysis is associated with fatigue, is part of a pilot study looking for physiological and psychological biomarkers that could be factors in the fatigue experienced by HIV-positive people. Twenty-nine men and eleven women were measured for height, weight, and bioimpedance analysis. Correlations were examined between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, extracellular mass, and phase angle. Because of the fat redistribution that has occurred with some people taking protease inhibitors, we also examined differences in weight, body mass index, body cell mass, fat-free mass, and fatigue intensity between those taking and those not taking protease inhibitors. There was no association between fatigue intensity and weight, body mass index, body cell mass, fat-free mass, or phase angle, nor were there differences between those taking and those not taking protease inhibitors. However, it was noted that both the phase angle and the ratio of extracellular mass to body cell mass (extracellular mass:body cell mass) were below their respective normal ranges, indicating that the participants were somewhat compromised nutritionally and with regard to cell membrane integrity. Although fatigue was not shown to be related to body composition measurement in this study, further work is needed on the causes of fatigue, because its effects on the lives of HIV-positive people can be devastating.
Collapse
Affiliation(s)
- Janet Meynell
- Yancey County Health Department, Burnsville, NC, USA
| | | |
Collapse
|
45
|
Fehnel SE, Bann CM, Hogue SL, Kwong WJ, Mahajan SS. The development and psychometric evaluation of the Motivation and Energy Inventory (MEI). Qual Life Res 2004; 13:1321-36. [PMID: 15473510 DOI: 10.1023/b:qure.0000037502.64077.4d] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Because depressed patients commonly experience reductions in motivation and energy, both as symptoms of their disorder and as side effects of pharmacotherapy, it is important to identify interventions that can restore their vitality. The Motivation and Energy Inventory (MEI) was recently developed to facilitate the evaluation of such efforts both in depression research, as well as in other therapeutic areas where vitality is an important issue. The constructs addressed by the MEI were identified through a combination of literature review, consultation with experts, and patient focus groups. Potential problems identified during cognitive testing and addressed in subsequent revisions related to the instructions, reference period, response scale sizes, and response scale labels, as well as a number of item-specific issues. Most recently, the data from two randomized, placebo-controlled clinical trials were utilized to evaluate the psychometric properties of the new questionnaire. In general, the data collected during the first and second trial were used for exploratory and confirmatory analysis, respectively. Consistent with the measurement model of the MEI, the psychometric results confirm that the instrument has three factors generally addressing physical energy, mental energy, and social motivation. Furthermore, these results provide evidence for the internal consistency, construct validity, and responsiveness of all three MEI subscales. Additional work is currently underway to examine test-retest reliability and establish minimal clinically important difference values for the MEI subscales.
Collapse
Affiliation(s)
- S E Fehnel
- RTI Health Solutions, RTI International, Research Triangle Park, NC 27709-2194, USA.
| | | | | | | | | |
Collapse
|
46
|
Siegel K, Bradley CJ, Lekas HM. Causal attributions for fatigue among late middle-aged and older adults with HIV infection. J Pain Symptom Manage 2004; 28:211-24. [PMID: 15336333 DOI: 10.1016/j.jpainsymman.2003.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2003] [Indexed: 11/24/2022]
Abstract
Fatigue, a symptom with many possible causes, is highly prevalent among persons with HIV/AIDS. The causal attributions HIV+ individuals make for their fatigue are important because they largely guide the coping responses they use to manage it. In a study to better understand the symptom appraisal process among 100 HIV+ older adults (50+), 49 participants discussed in depth their experience with fatigue. Many participants felt confused, at least initially, about the source of their fatigue, although most offered their HIV disease as a possible cause. However, many who did so also believed it was caused in part by other, generally less threatening causes, such as age, overexertion, or excess weight. HIV medications and other symptoms or comorbidities were also frequently cited as causes of fatigue. Health care professionals and HIV+ peers often helped to shape or reinforce participants' attributions for their fatigue.
Collapse
Affiliation(s)
- Karolynn Siegel
- Center for the Psychosocial Study of Health and Illness, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | | | | |
Collapse
|
47
|
Abstract
OBJECTIVES Fatigue is a common feature of physical and neurological disease as well as psychiatric disorders, often reported amongst patients' most severe and distressing symptoms. A large number of scales have been developed attempting to measure the nature, severity and impact of fatigue in a range of clinical populations. The aim of the present review is to guide the clinician and researcher in choosing a scale to suit their needs. METHODS Database searches of Medline, PsycINFO and EMBASE were undertaken to find published scales. RESULTS Details of 30 scales are reported. These vary greatly in how widely they have been used and how well they have been evaluated. The present review describes the scales and their properties and provides illustrations of their use in published studies. CONCLUSIONS Recommendations are made for the selection of a scale and for the development and validation of new and existing scales.
Collapse
Affiliation(s)
- A J Dittner
- Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | | | | |
Collapse
|
48
|
Barroso J, Carlson JR, Meynell J. Physiological and psychological markers associated with HIV-related fatigue. Clin Nurs Res 2003; 12:49-68. [PMID: 12583499 DOI: 10.1177/1054773803238740] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fatigue is among the most common and debilitating complaints of HIV-positive individuals. These data are part of a larger exploratory study investigating the relationships of selected psychological and physiological factors among 40 participants with HIV-related fatigue. Fatigue severity was measured using the HIV-Related Fatigue Scale. Fatigue was correlated with depression (r = .40, p < .01), state anxiety (r = .40, p <.01), and trait anxiety (r = .46, p <.01). Of the physiological factors, there were three statistically significant correlations: thyroid-stimulating hormone was negatively correlated with fatigue severity (r = -.36, p = .02), and platelets (r = .35, p = .03) and alkaline phosphatase (r = .27, p = .09) were positively correlated with fatigue severity. There were no correlations between fatigue severity and CD4 count (r = -.16, p = .31) or fatigue severity and HIV viral load levels (r = .031, p = .84). Even among the group with excellent viral suppression, fatigue scores were still very high for many participants.
Collapse
|