Fatigue symptoms are reported by a majority of patients with multiple sclerosis (MS). Reliable assessment, however, is a demanding issue as the symptoms are experienced subjectively and as objective assessment strategies are missing. The objective of this study was to develop and validate a new tool, the Fatigue Scale for Motor and Cognitive Functions (FSMC), for the assessment of MS-related cognitive and motor fatigue. A total of 309 MS patients and 147 healthy controls were included into the validation study. The FSMC was tested against several external criteria (e.g. cognition, motivation, personality and other fatigue scales). The item-analysis and validation procedure showed that the FSMC is highly sensitive and specific in detecting fatigued MS patients, that both subscales significantly differentiated between patients and controls (p < 0.01), and that internal consistency (Cronbach's alpha alpha > 0.91) as well as test-retest reliability (r > 0.80) were high. Cut-off values were determined to classify patients as mildly, moderately or severely fatigued. In conclusion, the FSMC is a new scale that has undergone validation based on a large sample of patients and that provides differential quantification and graduation of cognitive and motor fatigue.

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PurposeCustomer satisfaction and image are important factors for service companies because of their impact on loyalty. Although much research has looked at the relationship of both of these factors individually, little is known about them when they are considered together. Furthermore, experience with the service or product has largely been neglected in this line of research. This paper aims to undertake a first step to fill this gap.Design/methodology/approachThis research, with data from one of Europe's most modern night‐train companies, employs structural equation modelling to test the proposed hypotheses.FindingsDifferentiating new customers from experienced ones, the results show that for new customers satisfaction is crucial whereas image plays a much smaller role in terms of loyalty. For experienced customers, however, the importance of satisfaction decreases whereas the impact of image increases.Research limitations/implicationsSatisfaction and image were both measured by a single item. Although they show high face validity, the findings should be replicated using a multiple‐item approach. Future research should also consider distinguishing between transaction‐specific satisfaction and cumulative satisfaction.Practical implicationsThis paper concludes that customers' experience plays a decisive role in predicting loyalty. Managers should therefore be aware of the level of their customers' experience and may even consider developing different retention programmes tailored to the level of customers' experience.Originality/valueThis research proposes an integrative model of satisfaction, image, and loyalty, and analyses the impact of experience within this model. It is pioneering work that empirically investigates the relationships between these constructs.

Although fatigue is one of the most common symptoms of multiple sclerosis, it is yet poorly understood and therefore difficult to manage. To clarify the nature of fatigue we investigated its relationship to depression, physical impairment, personality and action control and compared these variables between a sample of 41 MS patients and 41 healthy controls. Physical impairment was assessed by the EDSS and all other dimensions, using questionnaires. Stepwise linear regression analyses revealed that physical impairment was related to physical fatigue in MS patients. Depression was the main factor influencing fatigue among both, MS patients and controls. What clearly differentiated the two groups was the correlation between fatigue and action control. Decreased levels of action control imply attentional and motivational deficits and were only found in fatigued MS patients. Our study indicates that motivational disturbances might be specific for MS related fatigue.

Purpose: Evaluation of two different training schedules of a computer based working memory training (BrainStim) in patients with multiple sclerosis (MS). Method: Forty-five MS outpatients were allocated to two different training groups and a control group without training. Patients with treatment received 16 training sessions scheduled either as a high intensity training (4 times per week for 4 weeks) or as a distributed training (2 times per week for 8 weeks). A neuropsychological test battery including self-report measures was applied at baseline and at retest. The baseline assessment was performed twice at an interval of two weeks to control for possible learning effects. Results: In the outcome measures training for both intervention groups led to significantly improved fatigue symptoms as well as working memory -, and mental speed performances. Log files recorded during training showed a similar increase in levels of difficulty for both intervention groups as training progressed. No effects were found on short term memory, quality of life or depression. Conclusions: Since comparable improvements were observed in both training groups, BrainStim can be applied as a therapeutic intervention adjusted to the personal agenda of MS patients.