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Elliott TR, Hsiao YY, Randolph K, Urban RJ, Sheffield-Moore M, Pyles RB, Masel BE, Wexler T, Wright TJ. Efficient assessment of brain fog and fatigue: Development of the Fatigue and Altered Cognition Scale (FACs). PLoS One 2023; 18:e0295593. [PMID: 38079429 PMCID: PMC10712873 DOI: 10.1371/journal.pone.0295593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Debilitating symptoms of fatigue and accompanying "brain fog" are observed among patients with various chronic health conditions. Unfortunately, an efficient and psychometrically sound instrument to assess these co-occurring symptoms is unavailable. Here, we report the development and initial psychometric properties of the Fatigue and Altered Cognition Scale (the FACs), a measure of self-reported central fatigue and brain fog. Traumatic brain injury (TBI) was chosen to model and develop the FACs due to research team expertise and established links between TBI and the symptom complex. Potential items were generated by researchers and clinicians with experience treating these symptoms, drawing from relevant literature and review of patient responses to measures from past and current TBI studies. The 20 candidate items for the FACs-ten each to assess altered cognition (i.e., brain fog) and central fatigue-were formatted on an electronic visual analogue response scale (eVAS) via an online survey. Demographic information and history of TBI were obtained. A total of 519 participants consented and provided usable data (average age = 40.23 years; 73% female), 204 of whom self-reported a history of TBI (75% reported mild TBI). Internal consistency and reliability values were calculated. Confirmatory factor analysis (CFA) examined the presumed two-factor structure of the FACs and a one-factor solution for comparison. A measurement invariance test of the two latent constructs (altered cognition, fatigue) among participants with and without TBI was conducted. All items demonstrated normal distribution. Cronbach's alpha coefficients indicated good internal consistency for both factors (α's = .95). Omega reliability values were favorable (α's = .95). CFA supported the presumed two-factor model and item loadings which outperformed the one-factor model. Measurement invariance found the two-factor structure was consistent between the two groups. Implications of these findings, study limitations, and potential use of the FACs in clinical research and practice are discussed.
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Affiliation(s)
- Timothy R. Elliott
- Department of Educational Psychology, Texas A&M University, College Station, Texas, United States of America
| | - Yu-Yu Hsiao
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Kathleen Randolph
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Randall J. Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Melinda Sheffield-Moore
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Richard B. Pyles
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Brent E. Masel
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Tamara Wexler
- Department of Rehabilitation Medicine, New York University Langone Health, New York, NY, United States of America
| | - Traver J. Wright
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
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