Prediction of outcome in patients presenting with fatigue in primary care

Abstract

Although fatigue is a common problem presenting to primary care, few prospective studies have examined the contribution of a wide range of prognostic factors. AimTo determine the combination of factors most strongly associated with a favourable or unfavourable course of fatigue, when fatigue is presented as a main symptom in primary care. Design of studyProspective, observational cohort study with a 1-year follow-up. SettingA total of 147 primary care practices in the Netherlands. MethodPatients presenting with fatigue as a main symptom completed questionnaires at baseline, and 1, 4, 8, and 12 months later. The prognostic value of potential predictors was assessed by applying multivariable logistic regression analysis. The outcome was severity of fatigue, defined as a combination of dichotomised scores on several repeated measurements with the Checklist Individual Strength. Separate models were used to predict either a favourable or an unfavourable course of fatigue. ResultsBaseline severity of fatigue and patient expectations of chronicity consistently predicted a poor outcome. Additional factors predicting a chronic course were baseline pain intensity and less social support. Baseline characteristics predicting a fast recovery were: male sex, not providing care for others (for example, for older people), better perceived health, and fewer (serious) prolonged difficulties. Both models had good reliability and discriminative validity (area under the receiver operating characteristic curve after internal validation: 0.78 and 0.79). ConclusionThe identified combination of predictors reflects the multidimensionality of fatigue, with a significant contribution of patient expectations of chronicity in the prediction of a poor prognosis. These negative perceptions are modifiable, and should receive more attention in the initial assessment of patients presenting with fatigue.

Fatigue and Depression in Sick-Listed Chronic Low Back Pain Patients

“…Substantial fatigue is also a predictor of chronic fatigue and CFS [50,51]. Although a lack of CFS screening in the study makes us unable to rule out already existent CFS, the reported substantial fatigue could still represent a risk factor, indicating a need for fatigue screening at an early stage of CLBP.…”

Chronic pain epidemiology – where do lifestyle factors fit in?

“…Anxiety, depression and catastrophising beliefs about pain have been shown to be associated with the presence of chronic pain and with a poor prognosis in people with various pain conditions. [14][15][16][17] The temporal relationship between chronic pain and mental health remains unclear, and it is likely that there is a 'bi-directional aetiology' 18 -pain causing poor mental health and vice versa. In depressed patients, neuroimaging has provided evidence of disturbed prefrontal brain activity and a dysfunction of emotion regulation during experimental pain stimulation.…”

Physical and mental fatigue as predictors of sickness absence among Norwegian nurses

“…Kant et al (2003) proposed an epidemiological framework for the etiology of prolonged fatigue, consisting of individual variables (e.g., health status, life style, coping), private circumstances (e.g., domestic and social factors), and work characteristics (e.g., work content, working conditions, and work relations). High fatigue severity and, to a lesser extent, poor mental health, physical and psychological attributions, and expectations about chronicity have been associated with prolonged fatigue (Nijrolder, van der Horst, & van der Windt, 2008;Nijrolder, van der Windt, & van der Horst, 2009). Loge, Ekeberg, and Kaasa (1998) reported that 22% of Norwegians aged 19-80 years experienced prolonged fatigue.…”