Applicability, validity, and reliability of the Piper Fatigue Scale in postpolio patients

Development and Validation of a Brief Version of the Vanderbilt Fatigue Scale for Adults: The VFS-A-10

OBJECTIVES

Listening-related fatigue can be a significant problem for adults who struggle to hear and understand, particularly adults with hearing loss. However, valid, sensitive, and clinically useful measures for listening-related fatigue do not currently exist. The purpose of this study was to develop and validate a brief clinical tool for measuring listening-related fatigue in adults.

DESIGN

The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening-related fatigue. The study consisted of two phases. Phase 1 ( N = 580) and Phase 2 ( N = 607) participants consisted of convenience samples of adults recruited via online advertisements, clinical records review, and a pool of prior research participants. In Phase 1, results from item response theory (IRT) analyses of VFS-A-40 items were used to identify high-quality items for the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated using exploratory factor analyses (EFAs) and item quality and characteristics were evaluated using IRT. VFS-A-10 reliability and validity were assessed in multiple ways. IRT reliability analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability was assessed in a subset of Phase 2 participants ( n = 145) who completed the VFS-A-10 a second time approximately one month after their initial measure (range 5 to 90 days). IRT differential item functioning (DIF) was used to assess item bias across different age, gender, and hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10 responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self-reported hearing loss.

RESULTS

EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed all test items were high quality. IRT reliability analysis revealed good measurement fidelity over a wide range of fatigue severities. Test-retest reliability was excellent ( rs = 0.88, collapsed across participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening-related fatigue regardless of respondent age, gender, or hearing status. An examination of associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak-to-moderate correlations (Spearman's correlation coefficient, rs = -0.36 to 0.57). Stronger associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties ( rs = 0.79 to 0.81) providing evidence of convergent construct validity. In addition, the VFS-A-10 was more sensitive to fatigue associated with self-reported hearing difficulties than generic measures. It was also more sensitive than generic measures to variations in fatigue as a function of degree of hearing impairment.

CONCLUSIONS

These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability make it appropriate for clinical use. The scale will be useful for identifying those most affected by listening-related fatigue and for assessing benefits of interventions designed to reduce its negative effects.

Impact of symptom burden on work performance status in Spanish women diagnosed with endometriosis

OBJECTIVE

To explore work performance status in Spanish women with endometriosis and to identify those endometriosis-related symptoms that potentially contribute to the reduced work performance.

DESIGN

Cross-sectional study.

SETTING

Spain.

POPULATION

Women with endometriosis working at enrolment (n = 148).

METHODS

Work performance status was assessed through the Work Role Functioning Questionnaire (WRFQ). Endometriosis-related symptoms (pelvic pain, catastrophizing thoughts related to pain, chronic fatigue, sleep quality, mood status, gastrointestinal discomfort and social support) were also evaluated through validated scales. Statistical analyses were performed through multivariate linear regression analyses.

MAIN OUTCOME MEASURES

Work performance status.

RESULTS

Median WRFQ score was 72.0, with the lowest scores found in demands related to worker's needs to manage the workday from beginning to end and those dynamic and static physical loads required in the conduct of work duties. Severe pelvic pain, depressive mood and poorer sleep quality was inversely related to work performance status (p-values <0.020). Finally, self-perceived social support was borderline associated with better work performance (p = 0.057). Considered together, these four psychosocial factors were responsible to explain the 37.9 % of the limitations on work performance observed in our study sample.

CONCLUSIONS

Spanish women with endometriosis reported lower WRQF scores (predominantly in work scheduling and physical demands) in comparison with previous studies on Spanish healthy adults. Psychosocial factors, including pelvic pain, sleep quality and depressive mood are related with work performance status. Thus, the effectiveness of physical and psychological rehabilitation programs in work productivity in women with endometriosis should be evaluated in the close future.

The Revised Piper Fatigue Scale (PFS-R) for Italian Cancer Patients: A Validation Study

Background and aim

Fatigue is one of the most frequently reported symptoms by cancer patients. In recent years, much effort has been directed to designing fatigue measures which are psychometrically appropriate as well as easily administered. Among these, the Revised Piper Fatigue Scale (PFS-R) is widely used in assessing fatigue in cancer patients and other populations. Despite its large utilization in different national contexts and with different populations, its structure appears to vary across cultures, suggesting the need for its validation before use. The main aim of the present work was to verify the validity (i.e., dimensional structure and construct validity) and reliability (i.e., internal consistency) of an Italian translation of the PFS-R to reassure Italian oncology practitioners about its appropriate usage in practice and research.

Methods and study design

One-hundred ten Italian oncological inpatients were administered an Italian translation of the PFS-R together with a form for the collection of personal identification and clinical data and other fatigue and quality of life measures (POMS and EORTC QLQ-C30) already validated for Italy.

Results

Principal component exploratory factor analysis revealed a four-factor structure quite similar to (although not overlapping) the original described by Piper and colleagues; all four factors proved to be reliable and to correlate with one another and with previous validated measures of fatigue and quality of life. Preliminary descriptive statistics were also provided for data comparisons.

Conclusions

Despite the discussed limitations, PFS-R seems a valid and reliable multidimensional fatigue measure also adequate in Italian oncological settings.

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in Polio survivors: a randomised controlled trial

Objective:

To investigate the effect of an eight-week home-based arm ergometry aerobic exercise programme on physical fitness, fatigue, activity and quality of life in Polio Survivors.

Design:

An assessor blinded randomised controlled trial.

Setting:

Home-based exercise.

Subjects:

Fifty-five Polio survivors randomised to exercise or control groups.

Intervention:

Home-based arm ergometry at an intensity of 50%-70% maximum heart rate, compared with usual physiotherapy care.

Main measures:

The Six-minute Arm Test, Fatigue Severity Scale, Physical Activity Scale for Individuals with Physical Disabilities and SF-36. Assessments were completed at baseline and at eight weeks.

Results:

There was no significant difference in the primary outcome, exercising heart rate during the Six-minute Arm Test, between the groups at follow-up [97.6 (SD10.1) compared to 102.4 (SD13.7) beats per minute ( P=0.20)]. Blood pressure was significantly lower in the intervention group at follow-up [systolic blood pressure 132(18.6)mmHg compared to 144.1(14.6)mmHg ( P=0.002)]. There were no between group differences in the Fatigue Severity Scale ( P=0.25) or Physical Activity Scale for Individuals with Physical Disabilities ( P=0.49), with a small difference in SF-36 physical component score ( P=0.04).

Conclusions:

This home-based arm ergometry programme successfully facilitated aerobic exercise in Polio Survivors, but did not result in a significant change in physical fitness, measured by the Six-minute Arm Test.

A randomized controlled trial of coenzyme Q10 for fatigue in the late-onset sequelae of poliomyelitis

OBJECTIVE

To determine if coenzyme Q(10) alleviates fatigue in the late-onset sequelae of poliomyelitis.

DESIGN

Parallel-group, randomized, placebo-controlled trial.

BACKGROUND SETTING

Coenzyme Q(10) has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue.

PARTICIPANTS

Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded.

METHOD

Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q(10) or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome.

RESULTS

Of 103 participants, 54 were assigned to receive coenzyme Q(10) and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q(10) was safe and well-tolerated.

CONCLUSION

A daily dose of 100 mg coenzyme Q(10) for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis. The registration number for the clinical trial is ACTRN 12612000552886.

Assessment of subjective and motor fatigue in Polio survivors, attending a Postpolio clinic, comparison with healthy controls and an exploration of clinical correlates

PURPOSE

Polio survivors experience declining mobility, pain and fatigue. The extent of motor fatigue and its impact on mobility and quality of life, in addition to other commonly reported impairments requires evaluation.

METHODS

An observational, case-control, cross-sectional design was used to assess 30 Polio survivors and 30 age- and sex-matched controls. Muscle strength and motor fatigue were assessed using fixed dynamometry. Fatigue, pain and quality of life were assessed using the Piper Fatigue Scale, the Fatigue Severity Scale, visual analogue scales and the RAND Short Form-36, respectively. An 8-min walking test, including physiological cost index (PCI), evaluated mobility.

RESULTS

A significant difference in motor fatigue was identified only in hand grip (p = 0.03). Polio survivors were significantly weaker (p < 0.001) and more fatigued (p < 0.001) than controls. Motor fatigue was not related to subjective fatigue, mobility or quality of life. Muscle strength predicted mobility. Pain and fatigue were associated with lower mental quality of life, while PCI was associated with physical quality of life.

CONCLUSION

Motor fatigue has been identified in Polio survivors but was only significantly different in hand grip, using this approach. Pain, fatigue and elevated energy cost of walking negatively influenced quality of life. Motor fatigue was unrelated to subjective fatigue, mobility or quality of life.

Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome

ObjectiveIt was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle.MethodsThirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years).ResultsOur study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography.ConclusionFatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS.

Psychometric properties of the Fatigue Severity Scale in polio survivors

The objective of this study was to evaluate by means of classical test theory and Rasch analysis the scaling characteristics and psychometric properties of the Fatigue Severity Scale (FSS) in polio survivors. A questionnaire,consisting of five general questions (sex, age, age at time of acute polio, sequelae of polio, and new symptoms), the FSS, and three questions from the Visual Analog Scale questions on fatigue was sent to all 196 polio survivors at the Institute for Rehabilitation in Ljubljana. Responses were assessed in terms of Cronbach's a, item-to-total correlation, factor analysis, and Rasch analysis. Of the128 (65.3%) valid questionnaires returned, those presenting no missing values were used for subsequent analyses (n = 117). The FSS showed good internal consistency: Cronbach's a was greater than 0.95,item-to-total correlation ranged from 0.68 to 0.88. A reduction from seven to three rating categories was necessary to comply with criteria for correct category function. Item difficulty estimates spanned from – 0.91to + 1.09 logits. No item bias was found for sex and age.The internal consistency of FSS was high and its item separation reliability good, indicating a satisfactory replicability of item placement in other samples. In conclusion, Rasch analysis enabled us to confirm the validity of FSS (in its 8-item version, without item 1) as a measure of the severity and impact of physical symptoms of fatigue in polio survivors, so providing a useful starting point for further studies aimed at examining additional psychometric aspects and confirming the appropriateness of the simplification of its rating categories.

Measuring fatigue in clinical and community settings

OBJECTIVE

The Chalder Fatigue Scale (CFQ) is a widely used instrument to assess fatigue in both clinical and nonclinical settings. Psychometric properties of the scale and discriminative abilities were examined.

METHODS

A total of 361 patients with CFS and 1615 individuals in the community were assessed with the CFQ. Principal component analysis (PCA) was used to explore the structure of the scale. Receiver-operating characteristic curve (ROC) was used to investigate the discriminative properties.

RESULTS

Two components, physical and mental fatigue, were identified in the CFS patient group and in the general population samples. Area under the curve for ROC was .91. The fatigue scale effectively discriminates, at high scores, between CFS patients and the general population.

CONCLUSION

Physical and mental fatigue are clearly separable components of fatigue. The CFQ can discriminate reliably between clinical and nonclinical conditions.

Effective intervention strategies for management of impaired posture and fatigue with post-polio syndrome: A case report

This case report describes effective intervention strategies that included gait training with the use of an acceptable, assistive device for the management of impaired posture and fatigue associated with post-polio syndrome. Review of videotaped gait-training sessions enhanced patient compliance with the assistive device, a single forearm crutch. The 49-year-old female acquired childhood polio with resulting leg length discrepancy, lower extremity weakness, and complaints of fatigue. She walked with a right ankle foot orthosis and increased right lateral trunk flexion during right stance. Interventions consisted of patient education regarding the diagnosis and management of post-polio syndrome, health promotion, and energy conservation strategies that included gait training with a single forearm crutch. An outcome measure not previously documented in the post-polio literature was used to measure the patient's perceived fatigue. Six-month and 18-month reexaminations found that the patient was compliant with the assistive device, reported a 30% reduction in fatigue, and walked with a more upright posture for longer distances in a shorter period of time. Patient education, health promotion, and energy conservation strategies that included walking with a properly fitting assistive device reduced perceived fatigue and improved posture and function in an individual with post-polio syndrome.

Development and factor analysis of an index of post-polio sequelae

PURPOSE

This present study describes the development, factor structure and initial validation of the Index of Post-Polio Sequelae (IPPS).

METHOD

The IPPS was tested on a sample of 849 community-dwelling polio survivors between the ages of 40 and 93 years old who participated in a large, national study of menopause and aging in late polio. Items from the IPPS were submitted to a factor analysis using principal components extraction and rotated to oblique simple structure using promax rotation. Convergent validity was assessed using bivariate correlation.

RESULTS

Three factors were extracted that accounted for approximately 53% of the variance in the original IPPS items. Factor 1 (Pain) was loaded most heavily by two items referring to muscle and joint pain. Factor 2 (Atrophy) was loaded by items referring to muscle atrophy, involved muscle weakness, and fatigue. Factor 3 (Bulbar) was comprised of two items referring to breathing and swallowing problems. Bivariate correlations between health and psychosocial variables and each of the factors all were significant and in expected directions.

CONCLUSIONS

This first validation of a standardized scale to assess the severity of post-polio sequelae in polio survivors suggests a psychometrically sound instrument whose factor structure represents commonly reported problems in the extant post-polio literature.

Fatigue in Brazilian cancer patients, caregivers, and nursing students: a psychometric validation study of the Piper Fatigue Scale-Revised

GOALS OF WORK

The objective of this study was to validate the Piper Fatigue Scale-Revised (PFS-R) for use in Brazilian culture.

PATIENTS AND METHODS

Translation of the PFS-R into Portuguese and validity and reliability tests were performed. Convenience samples in Brazil we as follows: 584 cancer patients (mean age 57 +/- 13 years; 51.3% female); 184 caregivers (mean age 50 +/- 12.7 years; 65.8% female); and 189 undergraduate nursing students (mean age 21.6 +/- 2.8 years; 96.2% female); Instruments used were as follows: Brazilian PFS, Beck Depression Inventory (BDI), and Karnofsky Performance Scale (KPS).

MAIN RESULTS

The 22 items of the Brazilian PFS loaded well (factor loading > 0.35) on three dimensions identified by factor analysis (behavioral, affective, and sensorial-psychological). These dimensions explained 65% of the variance. Internal consistency reliability was very good (Cronbach's alpha ranged from 0.841 to 0.943 for the total scale and its dimensions). Cancer patients and their caregivers completed the Brazilian PFS twice for test-retest reliability and results showed good stability (Pearson's r > or = 0.60, p < 0.001). Correlations among the Brazilian PFS and other scales were significant, in hypothesized directions, and mostly moderate contributing to divergent (Brazilian PFS x KPS) and convergent validity (Brazilian PFS x BDI). Mild, moderate, and severe fatigue in patients were reported by 73 (12.5%), 167 (28.6%), and 83 (14.2%), respectively. Surprisingly, students had the highest mean total fatigue scores; no significant differences were observed between patients and caregivers showing poor discriminant validity.

CONCLUSIONS

While the Brazilian PFS is a reliable and valid instrument to measure fatigue in Brazilian cancer patients, further work is needed to evaluate the discriminant validity of the scale in Brazil.

Influence of rheumatoid arthritis on work participation in Australia

BACKGROUND

The aim of the study was to determine the prevalence of work disability in a cohort of Australians with rheumatoid arthritis.

METHODS

A cross-sectional study of a sample of 497 individuals aged 18-65 years with rheumatoid arthritis in Adelaide, South Australia, was carried out.

RESULTS

Of those employed, 130 (51%) were in full-time employment (> or= 35 h per week) work and 124 (49%) were in part-time employment (average 20 h per week). Overall, the observed/expected numbers working were 254/316 (relative risk 0.8 (0.69-0.91)). Using a comparator adjusted by removing those on the disability support pension, the relative risk of the working was 0.74. The observed/expected numbers working part time in the study group were 124/89 (relative risk 1.4 (1.25-1.65)). Those who continued to work had lower Health Assessment Questionnaire scores, less morning stiffness, superior scores for patient assessed level of function, lower pain scores, lower joint counts, a lower C-reactive protein, better measures of 'patient global assessment' and higher levels of education compared with the group who had ceased work. Overall, of those working at the time of diagnosis, 20% had ceased work within 5 years and approximately 40% had ceased work by 20 years. Of those who ceased work, the mean duration from time of diagnosis to work cessation was 7 years with half the subjects who ceased work doing so within 4 years of diagnosis.

CONCLUSION

Work disability associated with rheumatoid arthritis in Australia is very significant and costly. Work disability occurs relatively early in the disease and is associated with several identifiable variables, many of which may be amenable to intervention strategies.

Factor analysis of the Revised Piper Fatigue Scale in a caregiver sample

The Revised Piper Fatigue Scale (R-PFS) is an instrument designed to measure subjective fatigue that was developed in samples with physical illness. Its psychometric properties in nonclinical samples are unknown. The purpose of this study was to examine the psychometric properties of the R-PFS in a sample of caregivers of stroke survivors. The convenience sample of 132 caregivers was primarily women (74%), White (71%), college-educated (73%), and employed (52%), with a mean age of 56.7 years (SD = 13.71). Internal consistency reliabilities for the four R-PFS subscales and the total scale were excellent, ranging from .90 to .97. Principal axis factor analysis with oblique rotation was conducted to examine construct validity of the R-PFS. A three-factor solution explained 75.9% of the common variance. Two factors totally replicated the behavioral/severity and affective meaning subscales of the R-PFS. The third factor incorporated a combination of Piper's sensory and cognitive/mood subscales and appeared to summarize how fatigue makes the caregiver feel. The R-PFS demonstrated strong internal consistency reliability and construct validity in this sample. However, data suggest that caregivers may perceive certain feelings associated with fatigue as conceptually similar when these feelings are conceptually distinct in Piper's breast cancer sample. The study supports the need for psychometric evaluation of instruments developed in clinical populations prior to their use in nonclinical populations.

Theories of fatigue: application in HIV/AIDS

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.

Fatigue and neuromuscular diseases

PURPOSE

To identify the role of fatigue, its evaluation and its causes in the pathophysiology context of acquired or hereditary neuromuscular diseases of the spinal anterior horn cell, peripheral nerve, neuromuscular junction and muscle.

MATERIAL AND METHODS

A literature review has been done on Medline with the following keywords: neuromuscular disease, peripheral neuropathy, myopathy, fatigue assessment, exercise intolerance, force assessment, fatigue scale and questionnaire, then with the terms: Fatigue Severity Scale, Chalder Fatigue Scale, Fatigue Questionnaire, Piper Fatigue Scale, electromyography and the combination of the word Fatigue with the following terms: Amyotrophic Lateral Sclerosis (ALS), Post-Polio Syndrome (PPS), Guillain-Barre Syndrome, Immune Neuropathy, Charcot-Marie-Tooth Disease, Myasthenia Gravis (MG), Metabolic Myopathy, Mitochondrial Myopathy, Muscular Dystrophy, Facioscapulohumeral Dystrophy, Myotonic Dystrophy.

RESULTS

Fatigue is a symptom very frequently reported by patients. Fatigue is mainly evaluated by strength loss after an exercise, by change in electromyographic activity during a given exercise and by questionnaires that takes into account the subjective (psychological) part of fatigue. Due to the large diversity of motor disorders, there are multiple clinical expressions of fatigue that differ in their presentation, consequences and therapeutic approach.

CONCLUSION

This review shows that fatigue has to be taken into account in patients with neuromuscular diseases. In this context, pathophysiology of fatigue often implies the motor component but the disease evolution and the physical obligates of daily life also induce an important psychological component.

Prevalence and Correlates of Fatigue in Long-Term Survivors of Childhood Leukemia

Purpose

To estimate the prevalence of fatigue, identify the factors associated with fatigue, and to explore the relationship between fatigue and quality of life (QOL) in long-term survivors of childhood acute lymphoblastic leukemia (ALL).

Methods

One hundred sixty-one ALL survivors diagnosed at Childrens Hospital Los Angeles (Los Angeles, CA) before age 18 years and between January 1, 1975 and December 31, 1995, participated in a structured telephone interview. Participants were aged 18 to 41 years and off treatment for an average of 14 years. Four measures of fatigue, including the Revised–Piper Fatigue Scale, were used to assess fatigue; depression was assessed using the Center for Epidemiological Studies Depression Scale. Multivariate logistic regression models were developed to identify factors associated with fatigue and depression.

Results

Prevalence of fatigue (30%) fell within the general population normal limits. Fatigue and depression were highly correlated (Pearson r = 0.75). Fatigue was associated with marriage (OR = 0.11; 95% CI, 0.02 to 0.50), having children (OR = 5.80; 95% CI, 1.30 to 25.82), sleep disturbances (OR = 6.15; 95% CI, 2.33 to 16.22), pain (OR = 5.56; 95% CI, 2.13 to 14.48), obesity (OR = 3.80; 95% CI, 1.41 to 10.26), cognitive impairment (OR = 2.56; 95% CI, 1.02 to 6.38), and exercise-induced symptoms (OR = 2.98; 95% CI, 1.11 to 8.02). Four factors associated with fatigue were also associated with depression: sleep disturbances, pain, obesity, and cognitive impairment. Fatigue was inversely related to QOL.

Conclusion

Some survivors of childhood ALL experience fatigue many years after treatment. Fatigued survivors represent a high-risk subgroup as they report more depression and poorer QOL than nonfatigued survivors and their peers.

Randomized controlled trial of modafinil for the treatment of fatigue in postpolio patients

The purpose of this study was to test whether modafinil is effective in alleviating the symptoms of fatigue in postpolio patients, because it has been helpful for such symptoms in other neurologic disorders. Using a double-blind, randomized, placebo-controlled cross-over design, 14 postpolio patients with moderate to severe fatigue were assigned to receive modafinil or placebo first. Piper Fatigue Scale, Epworth Sleepiness Scale, digit span, and reaction time tests were done at baseline and then at weekly intervals. The Piper Fatigue Scale scores improved by 27 +/- 40% (mean +/- SD) following modafinil and by 43 +/- 36% following placebo. Scores for most of the other tests did not change during the study. Therefore, we conclude that modafinil was not effective in alleviating the symptoms of fatigue in postpolio patients.

[Postpolio syndrome. Neurologic and psychiatric aspects]

Postpolio syndrome is defined as a clinical syndrome of new pareses in individuals who had been affected by acute paralytic poliomyelitis years before. The objective of this study was to describe neurologic and psychiatric signs of the disease. We evaluated the clinical signs and treatment of 16 patients with postpolio syndrome. Possible symptoms of depression were evaluated by the Hamilton and Geriatric Depression Scales. Postpolio syndrome manifested at a median age of 57.5 years (range 25-73) in a median of 41 years (range 16-70 years) after acute poliomyelitis. Muscles already affected during acute poliomyelitis were affected in all patients with postpolio syndrome. Six of 16 patients (37.5%) developed paresis in muscles formerly not affected by acute poliomyelitis. In eight of 15 patients (53%), depressive episodes were recognized according to the ICD-10 criteria. Symptoms of depression should be recognized in patients with postpolio syndrome and incorporated in therapy based on physiotherapy.

The assessment of fatigue: a practical guide for clinicians and researchers

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.