No abstract

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

Although fatigue is recognized as a symptom of MS, there have been insufficient methods for evaluating this symptom. We administered the Fatigue Impact Scale to 85 MS patients and 20 hypertensive patients. Neurologic impairment, mental health, and general health status were also assessed. MS patients reported significantly higher fatigue impact than hypertensive patients. Most MS patients reported fatigue as either their worst (14%), or one of their worst (55%) symptoms. Disease classification and neurologic impairment had little bearing on Fatigue Impact Scale scores in the MS sample. The best predictive models for mental health and general health status in the MS sample both included the Fatigue Impact Scale as a significant factor. This study demonstrates that: 1) fatigue is a very prevalent and severe problem in MS, 2) fatigue impact cannot be predicted by clinical measures of neurologic impairment, 3) fatigue has a significant effect on the mental health and general health status of MS patients.Resume: L'impact de la fatigue chez les patients atteints de sclerose en plaques. Bien qu'il soit reconnu que la fatigue est un des symptomes de la sclerose en plaques, il n'existe pas de methode satisfaisante pour evaluer ce symtome. 85 patients souffrant de la sclerose en plaques et a 20 patients souffrant d'hypertension ont et£ evalues au moyen de l'echelle de l'impact de la fatigue (Fatigue Impact Scale). Nous avons egalement evalue la deterioration neurologique, la same mentale et la sante en general. Les patients souffrant de la sclerose en plaques ont indique' que l'impact de la fatigue etait superieur de facon significative a celui decrit par les patients souffrant d'hypertension. La majorite des patients souffrant de la sclerose en plaques ont indique que la fatigue etait soit leur pire probleme (14%), soit l'un des plus severes (55%). La classification de la maladie ainsi que la severite de la deterioration neurologique etaient peu reliees a la fatigue, telle qu'evaluee par l'echelle de l'impact de la fatigue, chez les patients souffrant de la sclerose en plaques. Les resultats du l'echelle de l'impact de la fatigue constituaient un facteur significatif dans l'elaboration de modeles predisant le mieux la sante mentale et la sante en general. Cette 6tude demontre que: 1) la fatigue est un probleme frequent et grave dont souffrent ceux qui sont atteints de la sclerose en plaques, 2) l'impact de la fatigue ne peut etre pr6dit par les mesures de la deterioration neurologique, 3) la fatigue a un effet significatif sur la sante mentale et sur la sante en general des patients souffrant de la sclerose en plaques.Can. J. Neurol. Sci. 1994; 21: 9-14 Fatigue is recognized as a disabling symptom of Multiple Sclerosis (MS) but measurement of this symptom has proven difficult and ratings of fatigue are typically not included in the routine quantitative evaluation of neurologic impairment.

ABSTRACT. Objectives. More than 85% of children born today with chronic medical conditions will live to adulthood, and many should transfer from pediatric to adult health care. The numbers of adults with congenital heart defects (CHDs) are increasing rapidly. Current guidelines recommend that just over half of adult CHD patients should be seen every 12 to 24 months by a cardiologist with specific CHD expertise at a regional CHD center, because they are at risk for serious complications (eg, reoperation and/or arrhythmias) and premature mortality. The present study aimed to determine the percent of young adults with CHDs who successfully transferred from pediatric to adult care and examine correlates of successful transfer.Design. Cross-sectional study with prevalence data from an entire cohort.Setting and Patients. All patients (n ‫؍‬ 360) aged 19 to 21 years with complex CHDs who, according to current practice guidelines, should be seen annually at a specialized adult CHD center were identified from the database of the cardiology program at the Hospital for Sick Children in Toronto, Canada, a pediatric tertiary care center. Of these patients, 234 completed measures about health beliefs, health behaviors, and medical care since age 18 years.Main Outcome Measure. All 15 specialized adult CHD centers in Canada formed the Canadian Adult Congenital Heart (CACH) Network. Attendance for at least 1 follow-up appointment at a CACH center before the age of 22 years was ascertained for all eligible patients. Attendance at a CACH center provides a clear criterion for successful transfer.Results. In the total cohort, 47% (95% confidence interval [CI]: 42-52) had transferred successfully to adult care. There was no difference in rates of successful transfer between patients consenting to complete questionnaires (48%) and those who declined (47%). More than one quarter (27%) of the patients reported having had no cardiac appointments since 18 years.In Conclusions. This is the first study to document the percent of young adults with a chronic illness who successfully transfer to adult care in a timely manner. Patients were from an entire birth cohort from the largest pediatric cardiac center in Canada, and outcome data were obtained on all eligible patients. Similar data should be obtained for other chronic illnesses. There is need for considerable improvement in the numbers of young adults with CHDs who successfully transfer to adult care. At-risk adolescents with CHDs should begin the transition process before their teens, should be educated in the importance of antibiotic prophylaxis, should be contacted if a follow-up appointment is missed, and should be directed to a specific CHD cardiologist or program, with the planned timing being stated explicitly.Adult care needs to be discussed in the pediatric setting, and patients must acquire appropriate beliefs about adult care well before transfer. Developmentally appropriate, staged discussions involving the patient, with and without parents, throughout adolescence may help pa...