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PubMed2003

Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population.

BACKGROUND: Scant research has adequately addressed the impact of chronic fatigue syndrome on patients' daily activities and quality of life. Enumerating specific problems related to quality of life in chronic fatigue syndrome patients can help us to better understand and manage this illness. This study addresses issues of functional status in persons with chronic fatigue syndrome and other fatiguing illnesses in a population based sample, which can be generalized to all persons with chronic fatigue. METHODS: We conducted a random telephone survey in Wichita, Kansas to identify persons with chronic fatigue syndrome and other fatiguing illnesses. Respondents reporting severe fatigue of at least 1 month's duration and randomly selected non-fatigued respondents were asked to participate in a detailed telephone interview. Participants were asked about symptoms, medical and psychiatric illnesses, and about physical, social, and recreational functioning. Those meeting the 1994 chronic fatigue syndrome case definition, as determined on the basis of their telephone responses, were invited for clinical evaluation to confirm a diagnosis of chronic fatigue syndrome. For this analysis, we evaluated unemployment due to fatigue, number of hours per week spent on work, chores, and other activities (currently and prior to the onset of fatigue), and energy level. RESULTS: There was no difference between persons with chronic fatigue syndrome and persons with a chronic fatigue syndrome-like illness that could be explained by a medical or psychiatric condition for any of the outcomes we measured except for unemployment due to fatigue (15% vs. 40%, P <.01). Persons with chronic fatigue syndrome and other fatiguing illnesses had substantially less energy and spent less time on hobbies, schooling, or volunteer work than did non-fatigued controls (P <.01). CONCLUSIONS: Persons with chronic fatigue syndrome are as impaired as persons whose fatigue could be explained by a medical or psychiatric condition, and they have less energy than non-fatigued controls.

Activities of Daily Living↗
PubMed2002

Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis.

OBJECTIVES: To investigate whether the single-item fatigue question of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Fatigue Inventory (MFI) are appropriate instruments to measure fatigue in ankylosing spondylitis (AS); to identify factors that influence fatigue in AS; and to assess how fatigue in all its aspects is associated with quality of life in AS. METHODS: A total of 812 patients with AS were included. Patients completed questionnaires on disease activity (BASDAI), functional ability (Bath Ankylosing Spondylitis Functional Index [BASFI]), global well-being (Bath Ankylosing Spondylitis Global Score [BAS-G]), overall perceived health (EuroQoL visual analog scale), and quality of life (Ankylosing Spondylitis Quality of Life questionnaire, and Short Form 36 [SF-36]). Patients were dichotomized into a F+ group (fatigue = major symptom) if the BASDAI fatigue score was > 5.0 and a F- group (fatigue = minor symptom) if the fatigue score was < 5.0. Reproducibility was assessed with intraclass correlation coefficients, and responsiveness was calculated according to 3 different methods. Logistic regression analysis was used to determine which factors were associated with fatigue. Multiple regression analysis was used to investigate whether fatigue contributes in explaining quality of life. RESULTS: Fifty-three percent of the patients were assigned to the F+ group. They scored significantly worse compared with the F- group with respect to each dimension of the MFI and to all other questionnaires studied (all P < 0.001). The BASDAI fatigue question, as well as each separate dimension of the MFI, showed moderate to good reproducibility (0.57-0.75) and responsiveness (0.23-0.96). Fatigue was, in the opinion of the patients, highly associated with pain (70% of patients) and stiffness (54% of patients). Logistic regression analysis showed that scores on BASDAI, BASFI, BAS-G, and mental health status (SF-36) were independently associated with fatigue (R(2) = 0.52). Multiple regression analysis showed that scores on the BASDAI fatigue question were significantly associated with quality of life. With the 5 MFI dimensions as explanatory variables, different aspects of fatigue were associated with different domains of quality of life. CONCLUSIONS: Fatigue as a major symptom of AS can effectively be measured with either a single-item question on the intensity of fatigue or with the MFI. The MFI, however, provides more insight into specific dimensions of fatigue. Fatigue appears to be associated with the level of disease activity, functional ability, global well-being, and mental health status. In addition, fatigue negatively influences different aspects of quality of life.

Adult↗
PubMed2003

The prevalence and correlates of fatigue in older cancer patients.

PURPOSE: to assess the prevalence and correlates of fatigue in cancer patients aged 60 and older during outpatient treatment with chemotherapy or pamidronate. PATIENT AND METHODS: seventy-seven consecutive cancer patients with different tumors age 60+ served by the senior adult oncology program of the H. Lee Moffitt Cancer Center, were enrolled in the study. Inclusion criteria were: (1) age >-60 years; (2) histological diagnosis of malignancy; (3) no major psychiatric or neurological disorder that could interfere with the competition of the measures; (4) ability to understand and to speak English. Assessment included cognition, function, depression and fatigue. The instruments included geriatric depression scale, mini mental state examination and fatigue symptom inventory. The study used a cross-sectional design. RESULTS: Fifty-six patients (72.7%) reported fatigue at the time of the assessment; seventy-six patients (99%) in the past week. Forty patients (52%) rated their average fatigue as greater than 5. Forty-two patients (54%) reported that they felt fatigue all seven days, for any part of the day in the week before the assessment. Sixty five (84%) patients rated fatigue as interfering with their general level of activity. The fatigue disruptiveness was higher for women than for man (P<0.007). Marital status and educational level were not significantly related to fatigue severity or fatigue disruptiveness (P> or =0.33). A significant positive correlation between depressive symptoms and fatigue severity (r = 0.29, P<0.01) was recorded. Depression was also significantly related to fatigue disruptiveness (r = 0.44, P<0.01). Cognitive status was not correlated with fatigue severity or fatigue disruptiveness. A negative correlation between haemoglobin level and fatigue severity (r = -0.30, P<0.01) and between haemoglobin level and fatigue disruptiveness (r = -0.28, P<0.01) was found. Having had medical care or counselling in the past for anxiety and depression was positively correlated with fatigue disruptiveness (r = 0.29, P<0.01). CONCLUSION: Fatigue is a common symptom of older cancer patients treated with antineoplastic medical treatment. Female patient showed higher fatigue disruptiveness than male. In this study a positive correlation between depression and fatigue, and a negative correlation between haemoglobin and fatigue, were recorded.

Age Factors↗
PubMed2002

Mild versus severe fatigue in polio survivors: special characteristics.

In studies conducted on polio survivors with late effects of poliomyelitis, new fatigue is frequently reported. The main purpose of the present study was to examine the characteristics of polio survivors reporting severe fatigue versus those reporting mild or no fatigue. From a survey among 276 representative Norwegian polio survivors, we recruited all patients with mild/no fatigue and those with severe fatigue, without other diseases than poliomyelitis. Out of 276 polio survivors, 43 reported mild, 113 moderate and 118 severe fatigue (2 were missing). Only 12 with mild fatigue, 21 with moderate and 14 with severe fatigue had no other diseases and health problems related to fatigue. Six of these patients with mild/no and 9 with severe fatigue, and 16 healthy persons participated in the study. The subjects were assessed with the Fatigue Questionnaire, Fatigue Severity Scale, Visual Analog Scale for pain and fatigue, SCL-90-R, cognitive tests, event-related brain potentials (ERPs), blood and urine parameters, spirometry, exercise and muscle strength tests, 24-hour pulse registration, Sunnaas ADL-index and the Rivermead Mobility Index. The group with severe fatigue had significantly more elevated scores on SCL-90-R, measuring obsessive-compulsive behaviour, depression and anxiety than both the mild fatigue group and the controls. They also had higher scores on the somatization scale than the control group. No other test results showed significant differences between the mild/no and the severe fatigue polio groups. The present results give no support to the hypothesis of "brain fatigue in polio survivors, assessed by cognitive tests or ERPs. Moreover, the physical test results did not correspond to perceived fatigue. Thus, the only characteristics distinguishing polio survivors with severe fatigue from those with mild/no fatigue in this study were psychological characteristics. However, a larger group of polio survivors suffer from additional diseases, and such diseases should be ruled out during a comprehensive rehabilitation program.

Activities of Daily Living↗
PubMed2000

Fatigue in the Danish general population. Influence of sociodemographic factors and disease.

OBJECTIVE: To measure the levels of fatigue in the general population, and to examine how disease and sociodemographic factors influence fatigue. DESIGN: Cross sectional questionnaire study in the Danish general population. SUBJECTS: A random, age stratified sample of 1608 people aged 20-77 with an equal gender distribution (response rate 67%). MAIN OUTCOME MEASURES: Five fatigue scales from the questionnaire Multidimensional Fatigue Inventory: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation and Mental Fatigue. RESULTS: Fatigue scores were skewed towards absence of fatigue. The General Fatigue and Physical Fatigue scales showed the highest fatigue levels while the Reduced Motivation scale showed lowest levels. Gender differences in fatigue scores were small, but the variability among women was higher-that is, more women had high scores. A multiple linear regression analysis showed that respondents of low social status and respondents with a depression had high fatigue scores on all scales, independent of other factors. Chronic somatic disease had an independent direct effect on Mental Fatigue, but for the rest of the scales, the effect of somatic disease depended on age, gender and/or whether the person was living alone. For example, General and Physical Fatigue decreased with age among healthy people, whereas scores on these scales increased with age among those with a somatic disease. CONCLUSIONS: Physical and mental diseases play essential parts for the level of fatigue and as modulators of the associations between sociodemographic factors and fatigue. These interactions should be taken into account in future research on fatigue and sociodemographic factors and when data from clinical studies are compared with normative data from the general population.

Adult↗
PubMedDate not supplied

The natural history of concurrent sick building syndrome and chronic fatigue syndrome.

An outbreak of chronic fatigue syndrome linked with sick building syndrome was recently described as a new association. Whether chronic fatigue syndrome acquired in this setting tends to remit or, as sporadic cases often do, persist, is unknown. To clarify the natural history of chronic fatigue syndrome in association with sick building syndrome the 23 individuals involved in the outbreak were interviewed four years after the onset. In the previous interview one year after the onset of symptoms, 15 (including 5 with chronic fatigue syndrome and 10 with idiopathic chronic fatigue) of the 23 noted fatigue. Three years later 10 of the 15 were "fatigue free" or "much improved". Five were only "some better", "the same", or "worse". Three of the five people previously diagnosed with chronic fatigue syndrome were "much improved" (two) or "fatigue free" (one). The remaining two were seriously impaired, homebound and unable to work. The 10 individuals with substantially improved fatigue (three of the five with chronic fatigue syndrome and seven of the 10 with idiopathic chronic fatigue) were more likely to have noted improvement in nasal and sinus symptoms, sore throats, headaches, and tender cervical lymph nodes when compared to those with a lingering significant fatigue (p < 0.001). Upper respiratory symptoms and headaches improved in those with reduced fatigue but remained problematic in those with persisting significant fatigue. We conclude that the fatigue related to sick building syndrome, including chronic fatigue syndrome, is significantly more likely to improve than fatigue identified in sporadic cases of chronic fatigue syndrome.

Fatigue Syndrome, Chronic↗
PubMedDate not supplied

Daily fatigue patterns and effect of exercise in women with breast cancer.

OBJECTIVES: Cancer treatment-related fatigue is a common and disruptive side effect of chemotherapy. Exercise is an intervention proposed to reduce fatigue in cancer patients. The purpose of this study was to describe the patterns of daily fatigue in women with breast cancer who did and did not exercise while receiving the first three cycles of adjuvant chemotherapy. MATERIALS AND METHODS: Women received instruction to follow an 8-week home-based exercise program and to maintain daily exercise and fatigue diaries. Functional ability (12-minute walk) was measured pretest and post-test. RESULTS: Several distinct patterns of fatigue emerged. The most common pattern of fatigue after chemotherapy demonstrated a sharp rise in fatigue. However, several women demonstrated a chaotic pattern with erratic and wide swings in their fatigue throughout the entire study period. Women who adopted exercise experienced fewer days of high fatigue levels and more days of low levels of fatigue for both average and worst levels of fatigue. Women who did not exercise experienced more bad days (high fatigue) and fewer good days (low fatigue). CONCLUSIONS: Exercise appears to reduce the levels of average and worst fatigue and may help women recognize their pattern of fatigue. Exercise may reduce the intensity of fatigue by reorganizing women's interpretation of fatigue. Routine clinical assessment and education about fatigue by health professionals can help patients to understand their pattern of fatigue and may help them to manage the symptom.

Activities of Daily Living↗
PubMed2002

Clinical relevance of fatigue levels in cancer patients at a Veterans Administration Medical Center.

BACKGROUND: The correlation of fatigue levels with functional interference, symptom distress, and quality of life may help determine clinically significant fatigue levels. METHODS: One hundred eighty consecutive patients with cancer completed the Functional Assessment of Cancer Therapy (FACT) General and Fatigue subscales (FACT-G and FACT-F, respectively), the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), the Depression Scale (Zung), and the Brief Fatigue Inventory (BFI). The Karnofsky performance status (KPS) was determined for each patient. Multivariate analyses of variance were performed to compare fatigue models with different cut-off points to categorize fatigue levels. Cox proportional hazards analysis was performed to assess the association between fatigue severity and survival. RESULTS: Increased fatigue levels were associated with greater symptom distress and decreased quality of life. A model with usual fatigue cut-off points of 0 (no fatigue), 1-2 (mild fatigue), 3-6 (moderate fatigue), and 7-10 (severe fatigue) was optimal in relation to functional interference items (Wilks lambda, 0.36; F = 11.61; P < 0.0001), symptom distress scores (Wilks lambda, 0.52; F = 10.41; P < 0.0001), and quality-of-life scores (Wilks lambda, 0.50; F = 0.50; P < 0.0001). Fatigue severity predicted survival in univariate analysis (chi-square test, 25.42; P < 0.0001). The KPS, stage of disease, and number of symptoms independently predicted survival in patients with fatigue. CONCLUSIONS: Clinically relevant fatigue levels are correlated with symptom and quality-of-life measurements. Patients with a usual fatigue severity > 3 or a worst fatigue severity > 4 on a 1-10 scale may require further assessment.

Adult↗
PubMed2000

Fatigue effects in the cat gastrocnemius during frequency-modulated efferent stimulation.

Effects of low- and high-frequency fatigue were studied on muscle dynamics in isometric conditions of the cat gastrocnemius. Fatiguing sessions consisted of 25-28 repetitions of the standard tests that included an 18-s interval of continuous frequency-modulated stimulation preceded and followed by single stimuli evoking twitch contractions. The rate of the continuous part was changed in accordance with a symmetrical double-trapezoidal signal, including three successive phases of constant rate at 10, 40 and 10s(-1); between these phases, each lasting for 4s, the rate changed linearly within a 2-s interval. The following modes of muscle activation were applied: (i) stimulation of single filaments constituting approximately one-fifth to one-seventh of the total cross-section of the L(7) and S(1) ventral roots; (ii) the distributed stimulation of five similar filaments; and (iii) direct stimulation of muscle through bipolar wire electrodes. A relative drop in tension, the fatigue index, expressed as the ratio at the end of a fatigue session over its value at the beginning of the test, was used to quantify fatigue effects. The fatigue indices during low-rate stimulation were 0.56+/-0.03 (mean+/-S.D.) at the first phase and 0. 64+/-0.02 at the third phase, while during high-rate stimulation this parameter was only 0.32+/-0.02. The high-rate stimulation noticeably increased the mean tension during low-rate stimulation; the ratio between the reactions at the third and the first phases could be as much as two to three times greater than that at the beginning of the fatigue session. It was demonstrated that the potentiation was connected with after-effects of the rate-tension hysteresis. The hysteresis decreased with fatigue, the fatigue index for the rate-tension loop areas ranging from 0.39 to 0.52 (0.45+/-0. 05, mean+/-S.D.). The fatigue processes developed more quickly and intensively in the previously fatigued muscles: the obtained fatigue indices were 0.73+/-0.05 and 0.70+/-0.10 at the first and third phases, and 0.62+/-0.06 (mean+/-S.D.) at the second phase of stimulation, respectively. In the cases of distributed and direct stimulation applied to muscles in a fresh state, fatigue dynamics did not differ significantly from those observed during single-filament stimulation. In experiments with distributed stimulation applied to previously fatigued muscles, a powerful depression of the high-rate components was registered in several cases, which seemed to be connected with depressive effects at the level of nerve-muscle synaptic transmission. The effects of low- and high-frequency fatigue were studied in isometric conditions of muscle contraction. In addition to the well-known differentiation between low- and high-frequency fatigue effects, the complex pattern of efferent stimulation used allowed us to identify additional fatigue-related changes in the rate-tension hysteresis. This hysteresis seems to be one of the possible mechanisms directed to compensate for low-frequency fatigue in the muscle contraction.

Animals↗
PubMed1998

Fatigue and radiotherapy: (A) experience in patients undergoing treatment.

Cancer patients undergoing radiotherapy frequently report fatigue. However, knowledge of the importance of fatigue for these patients and of the factors associated with their fatigue is limited. The aim of the current investigation was to gain more insight into fatigue as related to radiotherapy by answering the following questions. First, how is the experience of fatigue best described? Secondly, to what extent is fatigue related to sociodemographic, medical (including treatment), physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue after completion of radiotherapy? Patients with different types of cancer receiving radiotherapy with curative intent (n = 250) were interviewed before and within 2 weeks of completion of radiotherapy. During treatment, patients rated their fatigue at 2-weekly intervals. Results indicate a gradual increase in fatigue over the period of radiotherapy and a decrease after completion of treatment. Fatigue scores obtained after radiotherapy were only slightly, although significantly, higher than pretreatment scores. After treatment, 46% of the patients reported fatigue among the three symptoms that caused them most distress. Significant associations were found between post-treatment fatigue and diagnosis, physical distress, functional disability, quality of sleep, psychological distress and depression. No association was found between fatigue and treatment or personality characteristics. Multivariate regression analysis demonstrated that the intensity of pretreatment fatigue was the best predictor of fatigue after treatment. In view of this finding, a regression analysis was performed to gain more insight into the variables predicting pretreatment fatigue. The degree of functional disability and impaired quality of sleep were found to explain 38% of the variance in fatigue before starting radiotherapy. Fatigue in disease-free patients 9 months after treatment is described in paper (B) in this issue.

Fatigue↗
PubMed2000

Patient factors related to the presentation of fatigue complaints: results from a women's general health care practice.

The aim of this study was to examine which patient-related factors predicted: (1) fatigue, (2) the intention to discuss fatigue and (3) the actual discussion of fatigue during consultation with a GP in a women's general health care practice. Patients were asked to complete two questionnaires: one before and one after consultation. The patient-related factors included: social-demographic characteristics; fatigue characteristics; absence of cognitive representations of fatigue; nature of the requests for consultation; and other complaints. Some 74% of the 155 respondents reported fatigue. Compared to the patients that were not fatigued, the fatigued patients were more frequently employed outside the home, had higher levels of general fatigue, and a higher need for emotional support from their doctor. A minority (12%) intended to discuss fatigue during consultation. Of the respondents returning the second questionnaire (n = 107), 22% reported actually discussing their fatigue with the GP while only 11% had intended to do so. In addition to the intention to discuss fatigue during consultation, the following variables related to actually discussing fatigue: living alone, caring for young children, higher levels of general fatigue, absence of cognitions with regard to the duration of the fatigue, and greater psychological, neurological, digestive, and/or musculoskeletal problems as the reason for consultation. Fatigue was found to be the single reason for consultation in only one case. It is concluded that fatigue does not constitute a serious problem for most patients and that discussion of fatigue with the GP tends to depend on the occurrence of other psychological or physical problems and the patient's social context.

Adolescent↗
PubMed2006

Fatigue is a major problem after liver transplantation.

Fatigue is often experienced after liver transplantation. The aim of this cross-sectional study was to assess the severity of fatigue in liver transplant recipients. In addition, the nature of fatigue and factors that may be associated with severity of fatigue after liver transplantation were explored. Ninety-six patients up to 15 years after liver transplantation were included. Severity of fatigue and nature of fatigue were assessed with the Fatigue Severity Scale (FSS) and the Multidimensional Fatigue Inventory, respectively. Furthermore, age, gender, indication for transplantation, time since transplantation, immunosuppressive medication, self-experienced disability, and health-related quality of life (HRQoL) were assessed as potential associated factors. Sixty-six percent of all patients was fatigued (FSS > or = 4.0) and 44% of all patients was severely fatigued (FSS > or = 5.1). Patients experienced physical fatigue and had reduced activity rather than mental fatigue and reduced motivation. Age, gender, self-experienced disabilities, and HRQoL were correlated with severity of fatigue. Results of the study indicate that fatigue is a major problem in patients after liver transplantation and no indications were found that complaints of fatigue improve over time. Liver transplant recipients experience physical fatigue and reduced activity rather than mental fatigue and reduced motivation. These findings have implications for the development of interventions needed to rehabilitate persons after liver transplantation.

Fatigue↗
PubMedDate not supplied

Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome.

OBJECTIVES: To identify the prevalence, psychiatric comorbidity, illness behavior, and outcome of patients with a presenting complaint of fatigue in a primary care setting. METHODS: 686 patients attending two family medicine clinics on a self-initiated visit completed structured interviews for presenting complaints, self-report measures of symptoms and hypochondriasis, and the Diagnostic Interview Schedule (DIS). Fatigue was identified as a primary or secondary complaint from patient reports and questionnaires completed by physicians. RESULTS: Of the 686 patients, 93 (13.6%) presented with a complaint of fatigue. Fatigue was the major reason for consultation of 46 patients (6.7%). Patients with fatigue were more likely to be working full or part time and to be French Canadian, but did not differ from the other clinic patients on any other sociodemographic characteristic or in health care utilization. Patients with fatigue received a lifetime diagnosis of depression or anxiety disorder more frequently than did other clinic patients (45.2% vs. 28.2%). Current psychiatric diagnoses, as indicted by the DIS, were limited to major depression, diagnosed for 16 (17.2%) fatigue patients. Patients with fatigue reported more medically unexplained physical symptoms, greater perceived stress, more pathologic symptom attributions, and greater worries about having emotional problems than did other patients. However, only those fatigue patients with coexisting depressive symptoms differed significantly from nonfatigue patients. Patients with fatigue lasting six months or longer compared with patients with more recent fatigue had lower family incomes and greater hypochondriacal worry. Duration of fatigue was not related to rate of current or lifetime psychiatric disorder. One half to two thirds of fatigue patients were still fatigued one year later. CONCLUSIONS: In a primary care setting, only those fatigue patients who have coexisting psychological distress exhibit patterns of abnormal illness cognition and behavior. Regardless of the physical illnesses associated with fatigue, psychiatric disorders and somatic amplification may contribute to complaints of fatigue in less than 50% of cases presented to primary care.

Adolescent↗
PubMed2004

Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up.

PURPOSE: The aim of this study was to evaluate fatigue 2.5 years after adjuvant radiation therapy (RT) in patients with localized breast cancer and to assess its relation to pre- and immediate post-treatment fatigue values. The association of fatigue with psychological distress and functional impairment was analyzed as well as pretreatment predictors for chronic fatigue. METHODS: Of a set of 41 patients whose fatigue was evaluated during adjuvant radiation therapy, 38 patients alive and free of cancer at 2.5 years (t2) after RT were assessed in this study. Patients received the Fatigue Assessment Questionnaire (FAQ), a visual analog scale on fatigue intensity (VAS-F) as well as on cancer-related distress (VAS-D), the Hospital Anxiety and Depression Scale (HADS), and three questions of the Short-Form 36-Item Health Survey (SF-36) per mail. All 38 patients returned their questionnaires. The values were compared to pretreatment (t0) and immediate post-treatment levels (2 months after RT, t1). RESULTS: There was no significant difference between chronic fatigue levels at 2.5 years after RT and pretreatment values. When compared to immediate post-treatment levels the FAQ global score and the HADS anxiety score displayed a significant increase. Cancer-related distress correlated closely with fatigue scores. Patients with functional impairment had slightly higher fatigue values. Age or hormonal therapy were not associated with chronic fatigue levels. Pretreatment fatigue and pretreatment HADS anxiety and depression scores were good predictors of fatigue at 2.5 years after RT explaining 60% (FAQ) and 49% (VAS-F) of its variance. CONCLUSIONS: Fatigue 2.5 years after RT did not increase above baseline levels before RT in conservatively operated breast cancer patients. Chronic fatigue correlated closely with psychological distress. Patients with pretreatment elevated fatigue, anxiety or depression levels are at risk for chronic fatigue.

Adult↗
PubMed1998

Fatigue and radiotherapy: (B) experience in patients 9 months following treatment.

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.

Aged↗
PubMed2005

Establishment of a protocol to test fatigue of the trunk muscles.

BACKGROUND: Muscle fatigue has high relevance in human performance yet little research has evaluated how it should be assessed. OBJECTIVE: To perform a pilot study to identify suitable methods of generating and assessing fatigue of the trunk flexor and extensor muscles. METHODS: Sixteen university rugby players (mean (SEM) age 21.9 (0.2) years) were recruited and subjected to four protocols (A, B, C, D), separated by a week to allow recovery, with peak torque being recorded during each test: A, isokinetic measurements before and after fatigue, with a 10 repetition isokinetic fatigue period; B, isokinetic measurements before and after fatigue with a 45 second isometric fatigue period; C, isometric measurements before and after fatigue with a 10 repetition isokinetic fatigue period; D, isometric measurements before and after fatigue with a 45 second isometric fatigue period. All were conducted during flexion and extension of the trunk on the Cybex Norm Isokinetic Dynamometer trunk flexion-extension unit. RESULTS: All subjects completed all four protocols. Fatigue induction appeared more effective in flexion than extension. Significant differences in mean peak torque before and after fatigue were seen in protocols A, B, and D in flexion and only in protocol D for extension. In flexion, protocol D produced the greatest fatigue, peak torque being 16.2% less after than before fatigue, suggesting greatest sensitivity. CONCLUSIONS: Protocol D, which incorporates isometric testing and fatigue protocols, appears to be able to produce fatigue most effectively, and therefore may provide the most valid assessment of fatigue in the trunk flexor and extensor muscles.

Adult↗
PubMed2005

Four year follow up of fatigue in a geographically defined primary biliary cirrhosis patient cohort.

BACKGROUND AND AIMS: Fatigue is the commonest symptom described by patients in most populations with the autoimmune liver disease primary biliary cirrhosis (PBC), and appears to be unrelated to liver disease severity. At present, it is unclear how the fatigue experienced by patients (only characterised to date in cross sectional studies) evolves over time. In this study, we set out to address how fatigue had changed over four years of follow up in a geographically defined cohort of PBC patients who participated in an earlier cross sectional study of fatigue impact. METHODS: Participants in the original 2000 study who were still alive in 2004 were asked to complete the same fatigue assessment tool (fatigue impact score, FIS). In those who had died between 2000 and 2004, medical notes, death certificates, and primary care records were reviewed. RESULTS: A total of 108 of the original cohort of 136 patients were alive at the time of the follow up study, 99 of whom (92%) participated in the follow up study. With the exception of four patients who underwent transplantation between 2000 and 2004, all of whom showed significant improvement in fatigue severity as assessed by FIS, fatigue severity was unchanged over four years of follow up. Among the 28 patients who died during the follow up period, survival was significantly lower in patients who were fatigued at the 2000 baseline (FIS above the median for the whole PBC population (40/160); log rank test, p = 0.006 v non-fatigued patients at baseline). Increased fatigue severity was independently associated with decreased survival on multivariate analysis. Fatigued PBC subjects were significantly more likely to have suffered a cardiac death than non-fatigued patients. CONCLUSIONS: The fatigue phenotype appears to be highly stable in PBC. The presence of fatigue in PBC is independently associated with a significantly increased risk of death in general, and cardiac death in particular. Factors underpinning fatigue in PBC, and the mechanisms whereby fatigue is associated with increased mortality, warrant further study.

Adult↗
PubMed2001

Reflex and intrinsic changes induced by fatigue of human elbow extensor muscles.

Fatigue-induced changes in intrinsic and reflex properties of human elbow extensor muscles and the underlying mechanisms for fatigue compensation were investigated. The elbow joint was perturbed using small-amplitude and pseudorandom movement patterns while subjects maintained steady levels of mean joint extension torque. Intrinsic and reflex properties were identified simultaneously using a nonlinear delay differential equation model. Intrinsic joint properties were characterized by measures of joint stiffness, viscous damping, and limb inertia and reflex properties characterized by measures of dynamic and static reflex gains. Fatigue was induced using 15 min of intermittent voluntary isometric (submaximal) exercise, and a rest period of 10 min was taken to allow the fatigued muscles to recover from acute fatigue effects. Identical experimental and data analysis procedures were used before and after fatigue. Our findings were that after fatigue, joint stiffness was significantly reduced at higher torque levels, presumably reflecting the reduced force-generating capacity of fatigued muscles. Conversely, joint viscosity was increased after fatigue potentially because of the reduced crossbridge detachment rate and prolonged relaxation associated with intracellular acidosis accompanying fatigue. Static stretch reflex gain decreased significantly at higher torque levels after fatigue, indicating that the isometric fatiguing exercise might be associated with a preferential change in properties of spindle chain fibers and bag(2) fibers. For matched pre- and postfatigue torque levels, dynamic reflexes contributed relatively more torque after fatigue, displaying higher dynamic reflex gains and larger dynamic electromyographic responses elicited by the controlled small-amplitude position perturbations. These changes appear to counteract the fatigue-induced reductions in joint stiffness and static reflex gain. The compensatory responses could be partly due to the effects of increasing the number of active motoneurons innervating the fatiguing muscles. This shift in operating point gave rise to significant compensation for the loss of contractile force. The compensation could also be due to fusimotor adjustment, which could make the dynamic reflex gain much less sensitive to fatigue than intrinsic stiffness. In short, the reduced contribution from intrinsic stiffness to joint torque was compensated by increased contribution from dynamic stretch reflexes after fatigue.

Adult↗