ContentList volumes - List articles in this issue
Usefulness of multiple dimensions of fatigue in fibromyalgia
OBJECTIVES: To explore in which contexts ratings of multiple dimensions of fatigue are useful in fibromyalgia, and to compare multidimensional fatigue between women with fibromyalgia and healthy women.
DESIGN: A cross-sectional study.
Subjects and methods: The Multidimensional Fatigue Inventory (MFI-20), comprising 5 subscales of fatigue, was compared with the 1-dimensional subscale of fatigue from the Fibromyalgia Impact Questionnaire (FIQ) in 133 women with fibromyalgia (mean age 46 years; standard deviation 8.6), in association with socio-demographic and health-related aspects and analyses of explanatory variables of severe fatigue. The patients were also compared with 158 healthy women (mean age 45 years; standard deviation 9.1) for scores on MFI-20 and FIQ fatigue.
RESULTS: The MFI-20 was associated with employment, physical activity and walking capacity (rs = –0.27 to –0.36), while FIQ fatigue was not. MFI-20 and FIQ fatigue were equally associated with pain, sleep, depression and anxiety (rs = 0.32–0.63). Regression analyses showed that the MFI-20 increased the explained variance (R2) for the models of pain intensity, sleep, depression and anxiety, by between 7 and 29 percentage points, compared with if FIQ fatigue alone was included in the models. Women with fibromyalgia rated their fatigue higher than healthy women for all subscales of the MFI-20 and the FIQ fatigue (p < 0.001).
CONCLUSION: Dimensions of fatigue, assessed by the MFI-20, appear to be valuable in studies of employment, pain intensity, sleep, distress and physical function in women with fibromyalgia. The patients reported higher levels on all fatigue dimensions in comparison with healthy women.
Anna Ericsson, Tomas Bremell, Kaisa Mannerkorpi
Dept of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Göteborg, Sweden. E-mail: email@example.com
References2. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38: 19–28.
3. Gran JT. The epidemiology of chronic generalized musculoskeletal pain. Best Pract Res Clin Rheumatol 2003; 17: 547–561.
4. Clauw DJ. Fibromyalgia: update on mechanisms and management. J Clin Rheumatol 2007; 13: 102–109.
5. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, et al. Family study of fibromyalgia. Arthritis Rheum 2004; 50: 944–952.
6. Kosek E, Ekholm J, Hansson P. Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 1996; 68: 375–383.
7. Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008; 67: 536–541.
8. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol 1996; 23: 1407–1417.
9. White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol 1999; 26: 1577–1585.
10. White KP, Speechley M, Harth M, Ostbye T. Comparing self-reported function and work disability in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: the London Fibromyalgia Epidemiology Study. Arthritis Rheum 1999; 42: 76–83.
11. Rutledge DN, Jones K, Jones CJ. Predicting high physical function in people with fibromyalgia. J Nurs Scholarsh 2007; 39: 319–324.
12. Nicassio PM, Moxham EG, Schuman CE, Gevirtz RN. The contribution of pain, reported sleep quality, and depressive symptoms to fatigue in fibromyalgia. Pain 2002; 100: 271–279.
13. Choy EH, Arnold LM, Clauw DJ, Crofford LJ, Glass JM, Simon LS, et al. Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome. J Rheumatol 2009; 36: 2330–2334.
14. Guymer EK, Clauw DJ. Treatment of fatigue in fibromyalgia. Rheum Dis Clin North Am 2002; 28: 367–378.
15. Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315–325.
16. Watt T, Groenvold M, Bjorner JB, Noerholm V, Rasmussen NA, Bech P. Fatigue in the Danish general population. Influence of sociodemographic factors and disease. J Epidemiol Community Health 2000; 54: 827–833.
17. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991; 18: 728–733.
18. Arnold LM, Clauw D, Wang F, Ahl J, Gaynor PJ, Wohlreich MM. Flexible dosed duloxetine in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled trial. J Rheumatol 2010; 37: 2578–2586.
19. Mannerkorpi K, Nordeman L, Ericsson A, Arndorw M. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. J Rehabil Med 2009; 41: 751–760.
20. d’Elia HF, Rehnberg E, Kvist G, Ericsson A, Konttinen Y, Mannerkorpi K. Fatigue and blood pressure in primary Sjogren’s syndrome. Scand J Rheumatol 2008; 37: 284–292.
21. Rupp I, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos GA. Impact of fatigue on health-related quality of life in rheumatoid arthritis. Arthritis Rheum 2004; 51: 578–585.
22. Furst CJ, Ahsberg E. Dimensions of fatigue during radiotherapy. An application of the Multidimensional Fatigue Inventory. Support Care Cancer 2001; 9: 355–360.
23. Ericsson A, Mannerkorpi K. Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20. Disabil Rehabil 2007; 29: 1665–1670.
24. Hedin PJ, Hamne M, Burckhardt CS, Engstrom-Laurent A. The Fibromyalgia Impact Questionnaire, a Swedish translation of a new tool for evaluation of the fibromyalgia patient. Scand J Rheumatol 1995; 24: 69–75.
25. Bergman S. Psychosocial aspects of chronic widespread pain and fibromyalgia. Disabil Rehabil 2005; 27: 675–683.
26. Akerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund, G. Sleep disturbances, work stress and work hours: a cross-sectional study. J Psychosom Res 2002; 53: 741–748.
27. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.
28. Mannerkorpi K, Hernelid C. Leisure Time Physical Activity Instrument and Physical Activity at Home and Work Instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia. Disabil Rehabil 2005; 27: 695–701.
29. Mannerkorpi K, Svantesson U, Carlsson J, Ekdahl C. Tests of functional limitations in fibromyalgia syndrome: a reliability study. Arthritis Care Res 1999; 12: 193–199.
30. Colton T. Statistics in medicine. 1st edn. Boston: Little, Brown and Co.; 1974.
31. Altman D. Practical statistics for medical research. London: Chapman & Hall/CRC; 1999.
32. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.
33. Hosmer D, Lemeshow S. Applied logistic regression. 2nd edn. New Jersey: John Wiley & Sons, Inc.; 2000.
34. Henriksson CM, Liedberg GM, Gerdle B. Women with fibromyalgia: work and rehabilitation. Disabil Rehabil 2005; 27: 685–694.
35. , , , , , . Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Chapter 6. PublicHealth 2012; 40: 121–134.
36. Nicklin J, Cramp F, Kirwan J, Greenwood R, Urban M, Hewlett S. Measuring fatigue in rheumatoid arthritis: a cross-sectional study to evaluate the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional questionnaire, visual analog scales, and numerical rating scales. Arthritis Care Res (Hoboken) 2010; 62: 1559–1568.
View at PubMed