Prevalence of fatigue symptoms and correlations in the general adult population

A systematic review on the effects of non-pharmacological interventions for fatigue among people with upper and/or lower limb osteoarthritis

Objectives

To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA.

Methods

A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions.

Results

Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue.

Conclusions

Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation.

Prevalence, severity, and risk factors of cancer-related fatigue among working cancer survivors: a systematic review and meta-analysis

PURPOSE

The aim of this study is to evaluate the prevalence, severity, and risk factors of cancer-related fatigue among currently working cancer survivors.

METHODS

We searched the PubMed, Embase, Scopus, CINAHL, Cochrane Library, and ICHUSHI databases. The risk of bias was evaluated independently using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). A meta-analysis was conducted to determine the prevalence, severity, and related factors associated with cancer-related fatigue among currently working cancer survivors.

RESULTS

Our meta-analysis included 18 studies and revealed that 42.2% of currently working cancer survivors experience cancer-related fatigue. The fatigue severity in this group was significantly higher than that in workers without cancer (absolute standardized mean difference (SMD) = 0.67), but lower than that in cancer survivors who had previously worked and were not currently working (absolute SMD = 0.72). Distress was identified as a potential risk factor for cancer-related fatigue in working cancer survivors (partial correlation coefficient = 0.38).

CONCLUSIONS

The high prevalence of cancer-related fatigue among employed cancer survivors underscores the need for targeted workplace interventions and fatigue management strategies. While the severity of fatigue is less than that seen in non-working survivors, the comparison with the general working population highlights a significant health disparity. The association between distress and fatigue suggests the necessity for a holistic approach to fatigue management that considers both physical and mental factors in working cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings highlight the critical need for healthcare professionals and employers to monitor fatigue levels among working cancer survivors and offer appropriate support.

Specificity of performance validity tests in patients with confirmed epilepsy

Objective: While assessment of performance validity is essential to neuropsychological evaluations, use of performance validity tests (PVTs) in an epilepsy population has raised concerns due to factors that may result in performance fluctuations. The current study assessed whether specificity was maintained at previously suggested cutoffs in a confirmed epilepsy population on the Warrington Recognition Memory Test (WRMT) - Words and Test of Memory Malingering (TOMM). Method: Eighty-two confirmed epilepsy patients were administered the WRMT-Words and TOMM as part of a standardized neuropsychological evaluation. Frequency tables were utilized to investigate specificity rates on these two PVTs. Results: The suggested WRMT-Words Accuracy Score cutoff of ≤42 was associated with a specificity rate of 90.2%. Five out of the 8 individuals falling below the Accuracy Score cutoff scored 42, suggesting specificity could be further improved by slightly lowering the cutoff. The WRMT-Words Total Time cutoff of ≥207 seconds was associated with 95.1% specificity. A TOMM Trial 1 cutoff of <40 was associated with 93.9% specificity, while the established cutoff of <45 on Trial 2 and the Retention Trial yielded specificity rates of 98.6% and 100.0%, respectively. Conclusions: Our findings demonstrate acceptable performance on two PVTs in a select confirmed epilepsy population without a history of brain surgery, active seizures during testing, and/or low IQ, irrespective of various factors such as seizure type, seizure lateralization/localization, and language lateralization. The possible presence of interictal discharges were not controlled for in the current study, which may have contributed to reduced PVT performances.

Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis

BACKGROUND

The World Health Organization's definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality.

METHODS

This retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18-65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50- < 60, 40- < 50, < 40).

RESULTS

A total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1.

CONCLUSION

Evidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).

Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis

Objective

The aim was systematically to identify and evaluate factors related to fatigue in individuals with hip and/or knee OA.

Methods

A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case–control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool, and factors were synthesized within a bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571).

Results

Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of an association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of an association was found between severe pain, high numbers of co-morbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most sociodemographic factors and radiographic OA severity with fatigue.

Conclusion

Targets for fatigue management might include improving physical function, reducing depressive symptoms, pain and co-morbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand the causal effect of fatigue determinants within the hip and knee OA populations.

Rutin and Gallic Acid Regulates Mitochondrial Functions via the SIRT1 Pathway in C2C12 Myotubes

Mitochondria are highly dynamic organelles, balancing synthesis and degradation in response to increases in mitochondrial turnover (i.e., biogenesis, fusion, fission, and mitophagy) and function. The aim of this study was to investigate the role of polyphenols in the regulation of mitochondrial functions and dynamics in C2C12 myotubes and their molecular mechanisms. Our results indicate that gallic acid and rutin are the most potential polyphenol compounds in response to 15 phenolic acids and 5 flavonoids. Gallic acid and rutin were associated with a significantly greater mitochondrial DNA (cytochrome b and COX-II), mitochondrial enzymatic activities (including citrate synthase and cytochrome c oxidase), and intracellular ATP levels in C2C12 myotubes. Moreover, gallic acid and rutin significantly increased the gene expressions of mitochondrial turnover in C2C12 myotubes. Our findings indicated that gallic acid and rutin may have a beneficial effect on mitochondrial dynamics via regulation of the SIRT1-associated pathway in C2C12 myotubes.

Fatigue and cognitive functions in epilepsy: A review of the literature

Epilepsy is a common neurological disorder affecting people of all ages and inducing cognitive impairments. While research has advanced in terms of neuropsychological enquiries of the various epileptic syndromes, the understanding of more complex and ill-defined phenomena such as fatigue is still unclear for epilepsy. It is suggested that fatigue is not just physical, but there can also be a cognitive element to it. Although studies in other conditions have been able to identify a relationship between fatigue and particular cognitive components, similar evidence is sparse in patients with epilepsy. This review is an attempt to gather, analyze, integrate, and critically discuss available information on fatigue and its rapport with various aspects of epilepsy, particularly focusing on cognition. Future directions are discussed urging researchers to target cognitive components of fatigue.

Measuring Fatigue in Older Adults With Joint Pain: Reliability and Validity Testing of the PROMIS Fatigue Short Forms

BACKGROUND AND PURPOSE

Limited literature exists regarding the psychometric properties of the Patient-Reported Outcome Measurement Information System (PROMIS) Fatigue Short Form 8a. This study compared the psychometric properties of the 8a to the established PROMIS Fatigue Short Form 7a.

METHODS

This was a cross-sectional study of 31 older adults with joint pain. Equivalent forms reliability and a Rasch analysis explored reliability (equivalent forms, internal consistency), validity (unidimensionality, item INFIT/OUTFIT), and additional psychometrics (item mapping).

RESULTS

The measures were equivalent in measuring fatigue (r = 0.75, p < .001) with good internal consistency (α = .87-.92). Both were unidimensional. Even though the 8a had better fitting items, neither measure could differentiate low levels of fatigue.

CONCLUSION

The 8a has comparable psychometric properties to the 7a in this population. Future work is needed in larger, more diverse samples.

Tonight's Sleep Predicts Tomorrow's Fatigue: A Daily Diary Study of Long-Term Care Employees With Nonwork Caregiving Roles

BACKGROUND AND OBJECTIVES

Long-term care employees and employees with nonwork caregiving roles are at high risk for sleep problems and fatigue. Little is known, however, about relationships between sleep and fatigue among long-term care employees who occupy nonwork caregiving roles. This study examined whether longer sleep duration and better sleep quality reduce fatigue occurrence and severity within and between long-term care employees with nonwork caregiving roles, and investigated nonwork caregiving role occupancy as a moderator of these relationships.

RESEARCH DESIGN AND METHODS

The sample comprised 166 women working in U.S.-based nursing homes. All women had children aged 9-17 years and some also had nonwork caregiving responsibilities for adult relatives. Sleep (duration and quality) and fatigue (occurrence and severity) were assessed via telephone interviews for eight consecutive evenings. Multilevel modeling was used to examine within-person and between-person associations.

RESULTS

At the within-person level, nights characterized by longer-than-usual sleep duration or better-than-usual sleep quality were followed by days with lower odds of reporting fatigue; these same sleep characteristics predicted less severe next-day fatigue. At the between-person level, employees with better average sleep quality, but not longer sleep duration, had lower odds of experiencing fatigue. Relationships between sleep and fatigue were generally similar regardless of nonwork caregiving responsibilities for children or for both children and adults.

DISCUSSION AND IMPLICATIONS

Findings suggest that tonight's sleep predicts tomorrow's fatigue. Given the serious and wide-ranging consequences of fatigue, sleep constitutes a worthwhile intervention target with potential benefits for employees, care recipients, and organizations.

The Contribution of Vascular Risk Factors in Prevalence of Fatigue Four Years Following Stroke: Results from a Population-Based Study

BACKGROUND

Fatigue is a debilitating symptom after stroke, which may persist for many years. Survivors of stroke commonly have comorbid medical conditions such as hypertension and diabetes mellitus that may produce fatigue by themselves. The contribution of vascular and other risk factors on long-term poststroke fatigue (PSF) has not been sufficiently investigated at a population-based level.

METHODS

Adults (N = 256) with stroke, who consented into the Auckland Regional Stroke Outcomes Study (ARCOS-IV), completed assessments including the Fatigue Severity Scale (FFS) at 4 years poststroke. A mean score greater than 4 was indicative of fatigue. A multiple regression model identified baseline associations (reported as adjusted odds ratio [AOR] with 95% confidence intervals [CI]) with long-term fatigue.

RESULTS

Fatigue was present in 141 stroke survivors (55%) 4 years after stroke, with a mean FSS score of 5.2 ± 1.3. Having hypertension (AOR = 2.05, 95% CI: 1.05-3.99, P < .05), diabetes mellitus (AOR = 2.15, 95% CI: 1.09-4.25, P < .05), and arrhythmia (AOR = 3.01, 95% CI: 1.46-6.20, P < .01) at the time of stroke were associated with increased PSF at 4 years. Nonvascular risk factors including female sex (AOR = 1.99, 95% CI: 1.06-03.70, P < .05) and depression (AOR = 1.18, 95% CI: 1.01-1.39, P < .05) were related to PSF.

CONCLUSIONS

PSF was prevalent in the majority of survivors, with comorbid vascular factors significantly contributing to persistent fatigue. The implications of these findings are important as potentially modifiable factors can be targeted and treated from acute onset. Additional research examining PSF predictors in other populations and trialing targeted interventions to control predictors of PSF are warranted.

Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial

BACKGROUND

Rhodiola rosea roots and rhizomes are a herbal medicine for temporary relief of stress symptoms such as fatigue and sensed weakness. A daily dosage of 400 mg is recommended.

METHODS

A dry ethanolic extract of R. rosea (WS® 1375) was studied in 100 subjects with prolonged or chronic fatigue symptoms. In an uncontrolled, open-label multicenter clinical trial, the subjects were administered 2 × 200 mg WS® 1375 over 8 weeks. Outcome measures were scales and tests related to fatigue. They were evaluated in an exploratory data analysis to generate hypotheses regarding efficacy. The pilot character of the trial is marked by its broad focus on subjects suffering from fatigue in general and by its comparatively long duration.

RESULTS

The greatest change was observed after 1 week of treatment. The fatigue symptoms continued to decline further, with statistically significant improvement at week 8. The safety assessments of WS® 1375 during the trial proved to be favorable, with most adverse events being of mild intensity and not related to the study drug.

CONCLUSIONS

The results indicate that 2 × 200 mg WS® 1375 may be an effective treatment in subjects suffering from prolonged or chronic fatigue. The safety and tolerability of WS® 1375 also presented a favorable profile.