A validity and reliability study of the Turkish Checklist Individual Strength (CIS) questionnaire in musculoskeletal physical therapy patients

The effect of perceived social support on fatigue in mothers having twin infants: the mediating role of sleep quality

The aim of this study is to investigate the mediating role of sleep quality in the relationship between multidimensional perceived social support and fatigue among mothers of twin infants. One hundred and six (106) twin mothers participated in this cross-sectional study, who completed the Descriptive Information Form, Multidimensional Scale of Perceived Social Support, Pittsburgh Sleep Quality Index, and Checklist Individual Strength. The scale score averages of the mothers in the study are as follows: social support, 61.41 ± 23.86; fatigue, 77.64 ± 28.68; and sleep quality, 8.26 ± 2.38. According to the path model, perceived social support has a negative effect on poor sleep quality (p = .001, Beta = -0.411), and poor sleep quality has a positive effect on fatigue (p = .001, Beta = 0.335). Sleep quality also mediates the effect of multidimensional perceived social support on mothers' fatigue levels (p = .001, Beta = -0.138). The study results suggest that the perceived social support and fatigue levels of twin mothers are moderate, while their sleep quality is poor. Therefore, mothers of twin infants may benefit from increased social support to alleviate fatigue and enhance sleep quality.

Reliability and Validity of the Turkish Version of the Vanderbilt Fatigue Scale for Adults

PURPOSE

Listening-related fatigue (LRF) is a prominent topic of research interest. The purpose of this study is to investigate the reliability and validity of the Turkish version of the 40-item Vanderbilt Fatigue Scale for Adults (TR-VFS-A-40).

METHOD

This study included 317 adults with no hearing loss and 260 adults with hearing loss in the study group, totaling 577 adults aged 18-75 years. While 31 adults in the study group did not use any hearing technology, there were 96 hearing aid users and 123 cochlear implant (CI) users. A subset of 80 CI users completed the TR-VFS-A-40 a second time, 2 weeks later, to assess test-retest reliability. Intraclass correlation coefficients were used to assess test-retest reliability. Cronbach's alpha was used to evaluate internal consistency. To examine construct validity, a confirmatory factor analysis (CFA) was performed. For concurrent validity analysis, the Checklist Individual Strength (CIS) and TR-VFS-A-40 scores were analyzed using the Spearman correlation test.

RESULTS

Cronbach's alpha values were excellent for the total scale of .987 and the cognitive, emotional, physical, and social subscales (.953, .954, .955, and .946, respectively). Analyses of concurrent validity revealed strong and significant correlations between CIS and TR-VFS-A-40 scores, indicating a good concurrent validity. The CFA determined that the construct validity of the TR-VFS-A-40 was satisfactory.

CONCLUSION

The TR-VFS-A-40 is a valid and reliable measure of LRF.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25457752.

The comparison of functional status and health-related parameters in ovarian cancer survivors with healthy controls

PURPOSE

The primary purpose of this study was to evaluate functional status and health-related parameters in ovarian cancer (OC) survivors and to compare these parameters with healthy controls. The secondary purpose of this study was to compare these parameters in early and advanced OC survivors.

METHODS

Thirty-two OC survivors (n = 15 early stage; n = 17 advanced stage) with no evidence/suspicion of cancer recurrence after completing adjuvant local and systemic treatments for at least 12 months and 32 healthy controls were recruited for functional- and health-related assessments. Participants were assessed using the following methods of measuring the following: 6-min walk test (6MWT) for functional exercise capacity, 30-s chair stand test (30 s-CST) for functional fitness and muscle endurance, a handheld dynamometer for peripheral muscle strength, and a handheld dynamometer for lower extremity strength, Medical Micro RPM for respiratory muscle strength, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity level, and Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, Checklist Individual Strength (CIS) for fatigue, Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression level, and the World Health Organization-Five Well-Being Index (WHO-5) for generic quality of life.

RESULTS

All OC survivors underwent surgery and chemotherapy, and only 9.4% received radiotherapy in addition to chemotherapy. The median recurrence-free period post-completion of adjuvant treatments was 24.00 (12.00-75.00) months. OC survivors had lower 6MWT (m) (p < 0.001, r = 1.50), peripheral muscle strength (p = 0.005, r = 0.72), knee extension (p < 0.001, r = 1.54), and respiratory muscle strength (maximal inspiratory pressure) (p < 0.001, r = 1.90) (maximal expiratory pressure) (p < 0.001, r = 1.68) compared to healthy controls. HADS-A (p = 0.005, r = 0.75) and CIS scores (p = 0.025, r = 0.59) were also higher in the OC survivors. Early-stage OC survivors had better 6MWT (m) than advanced-stage OC survivors (p = 0.005, r = 1.83). Peripheral muscle strength was lower in advanced-stage OC survivors (p = 0.013, r = 0.92). FACT/GOG-NTX scores were higher in early-stage OC survivors (p < 0.001, r = 1.42). No significant differences were observed between early- and advanced-stage OC survivors in other measures (p < 0.05).

CONCLUSION

The findings suggest functional status, and health-related parameters are negatively affected in OC survivors. Additionally, higher levels of fatigue, neuropathy anxiety, and depression were reported in advanced OC survivors.

Has COVID-19 really affected the physical and mental health of university students? One-year follow-up results after the pandemic declaration

BACKGROUND

The COVID-19 pandemic affected the whole world and various isolation measures were applied during this period. One of the groups that were physically and mentally affected by this period was students.

OBJECTIVE

To investigate the effects of the COVID-19 pandemic on the physical activity (PA) level, attitudes and behaviors related to PA, smoking, perceived stress, and fatigue of university students one-year after the declaration of the pandemic.

METHODS

A total of 102 students (79F/23M, 20.68±1.81 years) who were evaluated face to face with International Physical Activity Questionnaire-Short Form (IPAQ-SF), Cognitive Behavioral Physical Activity Questionnaire (CBPAQ), Perceived Stress Scale (PSS), and Turkish Checklist Individual Strength (CIS-T) Questionnaire before the declaration of the pandemic, were evaluated online with the same questionnaires one-year after the declaration of the pandemic.

RESULTS

Although there was no difference in terms of other variables, there was a statistically significant difference in the CBPAQ outcome expectation subscale (p = 0.04). The ΔPSS and ΔCIS-T total had a statistically significant effect on the ΔCBPAQ total (p = 0.003 and p = 0.007), ΔPSS and ΔCIS-T total were independent predictors of ΔCBPAQ total (Δ: before-one year after the declaration of the pandemic).

CONCLUSION

University students had positive attitudes and behaviors related to PA and they increased their PA levels, although not significantly, compared to before the declaration of the pandemic. Perceived stress and fatigue may have an effect on attitudes and behaviors related to PA and PA levels. It is thought that university students continue their routines despite the many limitations of the pandemic.

Dental Implant Corrosion Products May Accumulate in the Human Body

BACKGROUND

Corrosion products resulting from the degradation of the dental implant surface due to biological fluids and infection may accumulate in the body and lead to clinical consequences.

PURPOSE

The primary aim of this study is to measure the accumulation of dental implant corrosion products in the human body and the secondary aim is to estimate the association between corrosion products and fatigue.

STUDY DESIGN, SETTING, SAMPLE

This study was designed as a prospective cross-sectional and was conducted with patients presenting at to the Department of Oral and Maxillofacial Surgery. The study included patients with Grade IV dental implants made of pure titanium (Ti) at the bone level and Grade V abutments composed of Ti, aluminum (Al), and vanadium (V). Individuals possessing different metallic implants and those prone to metal exposure were not included in the study. Blood and hair samples were procured from each participant and subsequently analyzed.

PREDICTOR VARIABLES

The predictor variable is implant exposure, and it was divided into 3 groups; Group I, patients with healthy dental implants; Group II, patients with peri-implantitis; Control Group, individuals without dental implants.

MAIN OUTCOME VARIABLES

The primary outcome variables are Al, Ti, V levels in blood and hair samples and the secondary outcome variable is the fatigue questionnaire score.

COVARIATES

Age and gender, along with the dental implant number and duration of exposure within the study groups, are utilized as covariates.

ANALYSES

Groups were compared using the Kruskal-Wallis and Mann-Whitney U-tests. Spearman's correlation coefficient determined relationships between groups, signifying significance with P values <.05.

RESULTS

The sample consisted of 30 patients aged 18 to 68, with 53% being female and 47% male. The differences among the 3 groups in the median values of blood Ti, V; hair Al, Ti, V; and fatigue questionnaire scores were not statistically significant (P > .05). However, the median blood Al value was statistically higher in Group II (P < .05).

CONCLUSIONS AND RELEVANCE

While the presence of healthy dental implants may not affect the accumulation of Al, Ti, and V within the body, patients with peri-implantitis exhibited elevated blood Al levels, possibly due to infection influencing the corrosion process.

Predictors of the 6-min walk test in patients with ovarian cancer

PURPOSE

To identify the predictors of the 6-min walk test (6MWT) and investigate the relationship between 6MWT, performance status, functional mobility, fatigue, quality of life, neuropathy, physical activity level, and peripheral muscle strength in patients with ovarian cancer (OC).

METHODS

Twenty-four patients diagnosed with stage II-III ovarian cancer were included in the study. Patients were assessed using the following measurement methods: 6MWT for walking capacity, Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, an armband physical activity monitor for physical activity level, Checklist Individual Strength (CIS) for fatigue, Functional Cancer Treatment Evaluation with Quality of Life-Extreme (FACT-O) for quality of life, Functional Evaluation of Cancer Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, a hand-held dynamometer for peripheral muscle strength, and 30-s chair-stand test for functional mobility.

RESULTS

The mean 6MWT distance was 578.48 ± 115.33 meters. 6MWT distance correlated with ECOG-PS score (r = -0.438, p = 0.032), handgrip strength (r = 0.452, p= 0030), METs (r = 0.414, p = 0.044) 30s-CST (r= 0.417, p= 0.043), and neuropathy score (r = 0.417, p = 0.043) significantly. There was no relationship between 6MWT distance and other parameters (p> 0.05). Multiple linear regression analysis demonstrated that performance status was the sole predictor of 6MWT.

CONCLUSION

The walking capacity seems to be associated with performance status, peripheral muscle strength, level of physical activity, functional mobility, and severity of neuropathy in patients with ovarian cancer. Evaluating these may help clinicians to understand factors behind the decreased walking capacity.

Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults

BACKGROUND

Fatigue is emerging as a major public health problem that is highly associated with poor health-related quality of life and disability. Among adults, fatigue has become increasingly common because of workload or lifestyle changes. This study aimed to cross-culturally adapt the Chalder Fatigue Scale (CFS) into Turkish, to investigate its psychometric properties, and to establish normative data in healthy adults by age and gender.

METHODS

The validity of the CFS was tested with a total sample of 476 healthy adults aged 20-40 years (264 males and 212 females) and test-retest/measurement error analyses were performed with 161 participants (94 males and 67 females). The test-retest reliability was examined using the intraclass correlation coefficient (ICC), and internal consistency was determined using Cronbach's α-coefficient. Predictive validity was assessed using the Receiver Operating Characteristic to validate the cut-off value of the CFS for non-fatigued and fatigued participants. Factor analyses and hypothesis testing were conducted to assess construct validity. Hypothesis testing examined convergent and known-group validity by testing 14 predefined hypotheses.

RESULTS

The mean (SD) and median (25-75%) CFS scores were 10.7 (4.9) and 11 (7-14) for the total sample (n = 476). The cut-off point for CFS was set at ≥ 12 with a sensitivity of 65.8% and a specificity of 85.9%. The CFS provided evidence of excellent fit of the two-factor structure (CFI = 0.963, RMSEA = 0.06, SRMR = 0.02). There was evidence of strong internal consistency demonstrated by Cronbach's α = 0.863 and good test-retest reliability by ICC = 0.76. Thirteen out of 14 hypotheses (92.9%) were confirmed and the scale showed low to moderate correlation with other measurement instruments (r = 0.31-0.51).

CONCLUSIONS

The CFS has been shown to be a reliable and valid instrument that can be used in various populations for the assessment of fatigue.

LEVEL OF EVIDENCE

Level II.

Perceived Sleep Quality and Fatigue in a Population of New Mothers: A Cross-Sectional Study Comparing Relationships with Breastfeeding and Bottle Feeding

Introduction: This study, which used a cross-sectional design, was carried out to examine the factors associated with the way mothers fed their infants such as breastfeeding or bottle feeding, and to compare perceived sleep quality and fatigue levels. Method: The study sample consisted of a total of 100 women in the 4th to 16th week postpartum, including 50 women breastfeeding and 50 women bottle feeding their infants. The data of the study were collected in Family Health Centers (FHC) through the face-to-face interview technique using "a Personal Information Form," "the Pittsburgh Sleep Quality Index-PSQI," and "the Checklist Individual Strength-CIS." Results: The mothers' total sleep quality (PSQI) score was found to not differ significantly according to the type of infant feeding. Similarly, total scores for fatigue assessment obtained from the CIS did not differ according to the infant feeding type variable. A significant positive correlation was found between total sleep quality and total fatigue level, and subjective fatigue level. Discussion: The sleep quality and fatigue levels of mothers are independent of the method of feeding their infants. Midwives should plan initiatives with parents to improve maternal sleep quality and reduce fatigue levels and inform parents that breastfeeding is not a factor that reduces sleep quality or increases fatigue. Clinical Trials.gov ID: 1129/5463.

The efficiency of a mixed exercise program on quality of life and fatigue levels in patients with breast cancer

OBJECTIVE

Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors.

METHODS

This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program.

RESULTS

Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p<0.001, p<0.001, p=0.006, p=0.008, and p<0.001, respectively) in the study group. The results also showed that physical health, general health status, and emotional and social health status significantly increased with the exercise program (p<0.001, p<0.001, p=0.004, and p=0.003, respectively).

CONCLUSION

Our results show that a mixed (fitness center and home) 12-week exercise program provides an improvement in general health and reduces the side effects of the treatments and fatigue in patients with breast cancer. For a good prognostic process after medical treatment, exercise can be recommended in every accessible area.

Fatigue: A forgotten symptom of asthma

OBJECTIVE

Fatigue is a common symptom frequently reported in many disorders but little is known about the prevalence of fatigue in asthma. The objective of this study was to determine the prevalence of fatigue in asthmatic patients, the effect of fatigue on asthma quality of life and the relationship between fatigue and anxiety/depression MATERIALS AND METHODS: This prospective cross-sectional study was conducted in Uludağ University Faculty of Medicine, Department of Immunology and Allergic Diseases outpatient clinic from June 2019 to December 2019. Fatigue was assessed using the Checklist Individual Strength-Fatigue (CIS-Fatigue), psychological distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) and quality of life were assessed using the Asthma Quality of Life Questionnaire (AQLQ).

RESULTS

In the present study, a total of 168 patients are included with an average age of 43.8 ± 4.3 years. Nearly 64.8% of patients had controlled asthma and (35.2%) patients had uncontrolled asthma. Fatigue (CIS-Fatigue ≥ 27 points) was detected in 62.6% of patients and associated with asthma-related quality of life, asthma control, dyspnea, depression and anxiety (P < 0.05). However, the degree of lung function impairment and asthma severity were not associated with fatigue.

CONCLUSIONS

Fatigue as a symptom is common in asthmatic patients and correlates with asthma-related quality of life, asthma control, dyspnea, depression and anxiety. Future studies are needed to better understand the physical, psychological, behavioural and systemic factors that precipitate or perpetuate fatigue in asthma.

Turkish reliability and validity study of the medical outcomes study (MOS) sleep scale in patients with obstructive sleep apnea

Background/aim

The purpose of the present study was to evaluate the Turkish reliability and validity of the medical outcomes study (MOS) sleep scale in patients who have obstructive sleep apnea.

Materials and methods

The data of the study were collected from 120 adult patients with obstructive sleep apnea and from 90 healthy individuals between March 04 and May 31, 2019.

Results

The Cronbach’s α internal consistency reliability coefficient of the MOS sleep scale was found as 0.82. The test-retest reliability was acceptable (r = 0.76-0.94). Six factors were identified by the factor analysis. These were the same as those in the original MOS-Sleep. The correlations between the MOS-Sleep and other instruments administered in this study provided evidence for structural validity. A significant relation was determined between MOS sleep scale and obstructive sleep apnea syndrome (OSAS) severity and the healthy group ( P < 0.05). In addition, the Cronbach α internal consistency reliability coefficient of the healthy group in MOS sleep scale was found as 0.78. The items of the six factors that were obtained with the confirmatory factor analysis for the MOS sleep scale of the healthy group were found to be the same as in the original MOS-Sleep.

Conclusion

Turkish MOS sleep scale is a measurement tool that consists of 12 items and 6 subdimensions with adequate validity and reliability indicators.

Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy

The aim of this study were to evaluate pain, care burden, depression level, sleep quality, fatigue and quality of life (QoL) among a group of mothers of children with cerebral palsy (CP) and to compare their results with a group of healthy controls. The study involved 101 mothers who had children with CP and 67 mothers who had a healthy child as the control group. Pain, care burden, depression level, sleep quality, fatigue and QoL of all the participants were evaluated by the numerical rating scale, the Zarit care burden scale (ZCBS), the beck depression inventory (BDI), the Pittsburgh sleep quality index (PSQI), the checklist individual strength (CIS) and the short form-36 (SF-36), respectively. Numerical rating scale value was 3.57 ± 2.96 in the patient group. When the two groups were compared, the CP group showed higher scores for ZCBS, BDI, PSQI, total CIS and SF-36 subscales of general health and vitality whereas the scores for role physical, role emotional, mental health and mental component summary were found to be lower in the patients, compared to the control group. Reducing caregiving burden of the mothers' by other family members and increasing psychosocial supports may help improve the mother's health status.

The assessment of fatigue: Psychometric qualities and norms for the Checklist individual strength

OBJECTIVE

The Checklist Individual Strength (CIS) measures four dimensions of fatigue: Fatigue severity, concentration problems, reduced motivation and activity. On the fatigue severity subscale, a cut-off score of 35 is used. This study 1) investigated the psychometric qualities of the CIS; 2) validated the cut-off score for severe fatigue and 3) provided norms.

METHODS

Representatives of the Dutch general population (n=2288) completed the CIS. The factor structure was investigated using an exploratory factor analysis. Internal consistency and test-retest reliability were determined. Concurrent validity was assessed in two additional samples by correlating the CIS with other fatigue scales (Chalder Fatigue Questionnaire, MOS Short form-36 Vitality subscale, EORTC QLQ-C30 fatigue subscale). To validate the fatigue severity cut-off score, a Receiver Operating Characteristics analysis was performed with patients referred to a chronic fatigue treatment centre (n=5243) and a healthy group (n=1906). Norm scores for CIS subscales were calculated for the general population, patients with chronic fatigue syndrome (CFS; n=1407) and eight groups with other medical conditions (n=1411).

RESULTS

The original four-factor structure of the CIS was replicated. Internal consistency (α=0.84-0.95) and test-retest reliability (r=0.74-0.86) of the subscales were high. Correlations with other fatigue scales were moderate to high. The 35 points cut-off score for severe fatigue is appropriate, but, given the 17% false positive rate, should be adjusted to 40 for research in CFS.

CONCLUSION

The CIS is a valid and reliable tool for the assessment of fatigue, with a validated cut-off score for severe fatigue that can be used in clinical practice.

Improvement of fatigue after vitamin D supplementation in kidney transplant recipients

Low serum levels of vitamin D have been associated with fatigue in both healthy and clinical populations. Our aim was to evaluate the effect of vitamin D supplementation on fatigue in kidney transplant recipients (KTRs). In total, 137 patients after kidney transplant and 119 age- and sex-matched healthy volunteers were recruited. Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured by competitive protein-binding assay. Fatigue was assessed using the subscale fatigue of the Checklist Individual Strength (CIS). Of all KTRs, 60 patients without initial vitamin D3 supplementation were started on vitamin D3 supplementation (cholecalciferol) 800 IU/d, with a follow-up examination after 3.0 to 9.0 months (mean, 6 months). Fatigue was found in 40.1% of KTRs. Serum 25(OH)D levels were inversely and independently associated with CIS scores in KTRs (P = .002). In the 60 patients who received vitamin D3 supplementation, 25(OH)D was overall increased at follow-up with 18.5% (P = .004) and CIS scores improved with 10.0% (P = .007). As vitamin D has beneficial effects on fatigue scores in KTRs, we suggest monitoring this parameter in KTRs and supplementation with vitamin D3 when vitamin D levels are low.

The association between bone mineral density, quality of life, quality of sleep and fatigue

OBJECTIVES

This study was undertaken to examine quality of life (QoL), the quality of sleep and fatigue level in postmenopausal women with osteoporosis (OP) but without fractures, to assess the associations between these parameters and to compare the results with those for subjects who have osteopenia or normal bone mineral density (BMD).

METHODS

In this study, 113 postmenopausal osteoporosis (PMO) subjects without fractures, 172 subjects with osteopenia and 102 subjects with normal BMD were included. The severity of pain, QoL, quality of sleep and fatigue were assessed using the visual analogue scale (VAS), the QoL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), the Pittsburgh Sleep Quality Index (PSQI) and the Checklist of Individual Strength (CIS) questionnaire.

RESULTS

No statistically significant differences between the three groups were found in terms of VAS and QUALEFFO-41 total scores (p > 0.05). On the other hand, PSQI and CIS total scores were significantly different in the PMO and osteopenia groups (P = 0.015 and 0.007, respectively) compared to the group with normal BMD.

CONCLUSIONS

During the follow-up and treatment of women with PMO or osteopenia, QoL, quality of sleep and fatigue should be assessed and incorporated into treatment decisions, even in the absence of fractures.

The checklist individual strength (CIS20-R) in patients with amyotrophic lateral sclerosis - a longitudinal study

OBJECTIVES

Fatigue may be underestimated symptom in amyotrophic lateral sclerosis (ALS). The self-administered checklist individual strength (CIS20-R) was used to measure both physical and mental fatigue in ALS.

MATERIALS AND METHODS

Fatigue was measured in 51 consecutive patients with ALS using the fatigue severity scale (FSS) and the CIS20-R (four dimensions: subjective fatigue experience, concentration, motivation, activity). The questionnaire scores were compared with disease and progression parameters [revised ALS functional rating scale (ALS-FRS-R), MRC sum score, slow vital capacity (slow VC)]. Patients had follow-ups at six and 12 months.

RESULTS

At baseline (mean age: 57.9 years ± 12.3, mean disease duration: 15.8 months ± 12.7) clinical relevant fatigue was seen in 49% in FSS and 40% in CIS20-R. FSS and CIS20-R (except the subscale for concentration) were steadily increasing in the course of the disease. CIS1 (subjective fatigue) but not FSS showed a correlation to the ALS-FRS-R and the progression of the ALS-FRS-R after 12 months. There was a moderate positive correlation between FSS and CIS20-R.

CONCLUSIONS

The CIS20-R is a sensitive tool to detect clinically relevant fatigue in early stages of ALS. Both physical and mental (motivation) dimensions of fatigue steadily increase during the course of the disease in ALS.