Real-Time Assessment of Fatigue in Patients With Multiple Sclerosis: How Does It Relate to Commonly Used Self-Report Fatigue Questionnaires?

Akker, Lizanne Eva van den; Blikman, Lyan Jm; Hoekstra, Trynke; Munster, Erik van; Verschuren, Olaf; Visser‐Meily, Anne; Kwakkel, Gert; Groot, Vincent de; Beckerman, Heleen; Malekzadeh, Arjan; Looijmans, Milou; Sanches, Sarita A.; Dekker, Joost; Collette, Emma H.; Oosten, Bob W. van; Teunissen, Charlotte E.; Blankenstein, M.A.; Eijssen, Isaline; Rietberg, Marc B.; Heine, Martin; Visser-Meily, Johanna M A; Port, Ingrid G. L. van de; Lindeman, Eline; Meeteren, Jetty van; Bussmann, J.B.J.; Stam, Henk J.; Hintzen, Rogier Q.; Hacking, Hub G.A.; Hoogervorst, Erwin L.J.; Frequin, S.T.F.M.; Knoop, Hans; Jong, Brigit A. de; Bleijenberg, Gijs; Laat, F. A. J. de; Verhulsdonck, Marion C; Munster, E. T. L. van; Oosterwijk, Cor; Aarts, G. J.

doi:10.1016/j.apmr.2016.04.019

Cited by 22 publications

(30 citation statements)

References 28 publications

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“…Consistent with previous research 32,34,35 , these data show that in ambulatory people with MS, symptoms are not static, but are experienced dynamically. Fatigue emerged as the most variable symptom, with a high ratio of within- to between-person variability, and the greatest change from wake to bed time.…”

Section: Discussionsupporting

confidence: 91%

“…Different fatigue patterns by age may be due to increased use of planning and activity pacing 70 in older individuals, to account for greater fatigability 71 . These findings are consistent with a previous study suggesting significant individual differences in diurnal fatigue patterns 34 and suggest a need to further explore individual differences in the experiences of symptoms, and identification of prototypical symptom profiles, which could offer the ability to tailor treatments based on a person’s “symptom phenotype”. These data have implications for energy conservation, a common behavioral strategy based on the premise that people need to “budget” energy, suggesting that that clinicians should consider individual differences by age and sex in daily fatigue and the potential that pacing may be naturally occurring, especially in older persons with MS 72 .…”

Section: Discussionsupporting

confidence: 90%

“…In this study, we examined within-person variability and diurnal patterns in pain, fatigue, depressed mood, and cognitive function over 7 days. Based on previous findings 32,34,35 , we hypothesized that fatigue and depressed mood would demonstrate relatively higher levels of within-person variability compared to other symptoms and that all symptoms would exhibit a diurnal increase in severity throughout the day. We explored whether age, sex, MS subtype, MS duration, work status, and education level were related to different diurnal symptom patterns.…”

mentioning

confidence: 99%

“…Studies that examined daily symptoms in MS have shown significant within-person variability in fatigue and depressed mood, with less variability for pain intensity 32,33 , significant individual differences in diurnal fluctuations in fatigue 34 , and significant daily fatigue fluctuations that are more related to physical exertion in those with compared to those without MS 35 . While these studies provide initial evidence as to daily symptom variability in MS, they are somewhat limited by small sample sizes 32,33,35 and a focus on fatigue 33,34 . Greater understanding of the variability of MS symptoms could provide insight into how symptoms are experienced in daily life, inform approaches to measuring symptoms, and optimize behavioral and pharmacological treatments for symptoms in MS.…”

mentioning

confidence: 99%

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Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Kratz

Murphy

Braley

2017

Archives of Physical Medicine and Rehabilitation

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Objective To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS). Design Repeated-measures observational study of seven consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data. Setting General community. Participants Ambulatory adults (N=107) with MS recruited through [Masked] and surrounding community. Interventions Not applicable. Main Outcome Measure(s) EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0–10 scale, collected five times a day for seven days. Results Cognitive function and depressed mood exhibited more stable within-person patterns compared to pain and fatigue, which varied considerably within-person. All symptoms increased in intensity across the day (all p<0.02) with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7PM for men (wake-bed B=1.04, p=0.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared to younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake-3pm B=0.04, p=0.01; wake-7pm B=0.03, p=0.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared to those with bachelor-level degrees in the evening (wake-7pm B=−0.47, p=0.02; wake-bed B=−.45, p=0.04). Conclusions Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms –fatigue and pain in particular - vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Kratz

Murphy

Braley

2017

Archives of Physical Medicine and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…In our study we assessed quality of life by the Multiple Sclerosis Impact Scale (MSIS-29) questionnaire [11]; depression by Hamilton Rating Scale for Depression (HRSD) [12]; cognitive status by Brief Neuropsychological Examination (ENB) questionnaire [13]; chronic fatigue by Fatigue Severity Scale (FSS) questionnaire [14], disability by Functional Independence Measure (FIM) scale [15], activities for daily living (ADLs) by Barthel Index [16] ; gait balance by Tinetti scale [17].…”

Section: Methodsmentioning

confidence: 99%