A rapid screening tool for fatigue impact in multiple sclerosis

Daphne Kos, Guy Nagels, Marie B D'Hooghe, Marijke Duportail, Eric Kerckhofs, Daphne Kos, Guy Nagels, Marie B D'Hooghe, Marijke Duportail, Eric Kerckhofs

Abstract

Background: Fatigue is a common complaint in multiple sclerosis (MS) and often interferes with daily functioning. Both clinicians and researchers may need to detect high levels of fatigue impact using a time and effort efficient tool. This study evaluates the psychometric properties of a rapid screening instrument for fatigue impact in multiple sclerosis.

Methods: Three visual analogue scales (VAS) for assessing the impact of fatigue were developed. Sixty two subjects with definite MS (mean age 52 +/- 10.5 years; 29 women) and 24 healthy controls (mean age 52 +/- 14 years; 13 women) completed all VAS scales (range 0-100), the Fatigue Severity Scale (FSS) (range 7-63), the Modified Fatigue Impact Scale (MFIS) (range 0-84) and the Guy's Neurological Disability Scale (GNDS) (range 0-5). All tests were repeated with an interval of maximum three days. To evaluate the reproducibility, intraclass correlations (ICC) were calculated, based on one-way analysis of variance for repeated measurements. Validity was considered by means of correlation coefficients. ROC analysis was used to determine the accuracy of the VAS scales.

Results: The ICC of the VAS scales ranged from 0.68 to 0.69. VAS scales showed low to moderate correlation with FSS, MFIS and GNDS (Kendall's tau 0.23-0.45) and were not related with physical or cognitive performance, or with depression. All VAS scales were able to discriminate between subjects with MS and controls. Twenty five subjects with MS had a Fatigue Severity Scale score of 36 or more and were classified into the "fatigue" group. ROC analysis showed that VAS_1 is most useful to classify subjects in the "fatigue" group. A cut-off value of VAS_1 of 59 displayed 76% sensitivity and 72% specificity. When using the MFIS score of 40 or more to classify the groups, VAS_1 remained the strongest tool, with 81% sensitivity and 77% specificity at a cut-off value of 59.

Conclusion: The VAS for the impact of fatigue on daily life (VAS_1) is a moderately reliable, though valid and useful tool to screen rapidly for fatigue impact in multiple sclerosis. A cut-off value of 59 satisfactorily classifies individuals having severe fatigue with a high impact on daily life. In clinical practice, a more comprehensive assessment of fatigue and the impact on daily life is recommended.

Figures

Figure 1
Figure 1
Visual Analogue Scales for the impact of fatigue.
Figure 2
Figure 2
Difference in VAS_1 scores between first and second assessment.
Figure 3
Figure 3
Difference in VAS_2 scores between first and second assessment.
Figure 4
Figure 4
Difference in VAS_3 scores between first and second assessment.
Figure 5
Figure 5
Distribution of VAS scores in healthy controls and persons with MS. Boxes represent 25–75% of the cases; whiskers are minimum and maximum values, lines: median values, °: outliers, *: extreme values. Differences between groups are statistically significant (Mann Whitney U test, p < 0.0001).
Figure 6
Figure 6
Scores of the VAS scales in subjects with low versus high fatigue (based on FSS). Boxes represent 25–75% of the cases; whiskers are minimum and maximum values, lines: median values, °: outliers. Differences between groups are statistically significant (Mann Whitney U test, p < 0.0001).
Figure 7
Figure 7
Scores of the VAS scales in subjects with low versus high impact of fatigue (based on MFIS). Boxes represent 25–75% of the cases; whiskers are minimum and maximum values, lines: median values, °: outliers. Differences between groups are statistically significant (Mann Whitney U test, p < 0.0001).

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Source: PubMed

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