A Comparison of Fatigue Scales in Postpoliomyelitis Syndrome

doi:10.1016/j.apmr.2006.06.009

Archives of Physical Medicine and Rehabilitation

Volume 87, Issue 9, September 2006, Pages 1213-1217

Presented in part to the American Academy of Neurology, April 2005, Miami, FL.

https://doi.org/10.1016/j.apmr.2006.06.009 Get rights and content

Abstract

Vasconcelos Jr OM, Prokhorenko OA, Kelley KF, Vo AH, Olsen CH, Dalakas MC, Halstead LS, Jabbari B, Campbell WW. A comparison of fatigue scales in postpoliomyelitis syndrome.

Objective

To examine the applicability and validity of traditional fatigue questionnaires in postpoliomyelitis syndrome (PPS) patients with disabling fatigue.

Design

Cross-sectional study. PPS and disabling fatigue were ascertained according to published criteria. Descriptiveness was determined using the McNemar test, and interscale z-score agreement was estimated with Pearson’s coefficients.

Setting

PPS clinic.

Participants

Fifty-six survivors of poliomyelitis: 39 met criteria for PPS, 25 of whom met criteria for disabling fatigue.

Interventions

Not applicable.

Main Outcome Measures

The Fatigue Severity Scale (FSS), visual analog scale (VAS) for fatigue, and Fatigue Impact Scale (FIS).

Results

Twenty-four patients scored 50% or higher on the scale range for FSS, compared with 19 patients for VAS for fatigue (P=.042), and 7 patients for FIS (P<.001). Scores for patients with disabling fatigue averaged 81.5%, 62%, and 40.9% of the scale range for FSS, VAS for fatigue, and FIS, respectively. Agreement was moderate between the FSS and VAS for fatigue (r=.45, P=.02), but low between FSS and FIS (r=.29, P=.15), and FIS and VAS for fatigue (r=.20, P=.33). Two sample t tests showed significant differences between those with disabling fatigue and those without, based on FSS scores (t=3.8, P<.001), but not for VAS for fatigue or FIS scores.

Conclusions

FSS was the most descriptive of the instruments tested. Scores generated by the scales were not interchangeable. Of the 3 scales, FFS seemed to be the most informative for the clinical assessment of fatigue in patients with PPS.

Section snippets

Research Participants

We conducted this study under a protocol approved by the local institutional review board. Following the subject’s consent, we carried out a detailed clinical evaluation to confirm the diagnosis of PPS, to discern the presence or absence of disabling fatigue, and to exclude confounders. We ascertained PPS according to a slightly modified version of the diagnostic criteria recommended by the International March of Dimes¹⁶: (1) unequivocal remote history of paralytic poliomyelitis followed by

Results

In total, 56 patients (22 men, 34 women) were recruited as part of a larger outpatient study in a metropolitan area. Age varied from 31 to 88 years (median, 59y; mean, 59.9y). Of the 56 patients, 39 fulfilled the adopted diagnostic criteria for PPS, and 25 of the 39 also had disabling fatigue according to definition. Mean age at acute poliovirus infection was 6.4 years, (median, 5y; range, 9mo to 23y). Time from acute infection to maximal recovery was 1 to 26 years (median, 4y; mean, 7y). Among

Discussion

As shown, FSS was the strongest predictor of severe fatigue in the study sample. Our results indicated that scores on the FSS most closely agreed with the intensity of self-reported fatigue. All but 1 patient meeting the definition for disabling fatigue scored 50% or higher on the scale range for FSS. Our finding, however, should be taken with caution because of the strong resemblance between 2 of the 3 statements characterizing disabling fatigue and items 7 and 8 on the FSS form. The

Conclusions

In patients with PPS, fatigue is an incapacitating symptom for which a plethora of conventional pharmacologic therapies have been tested and failed. A major road block in clinical research in PPS continues to be the lack of specific and sensitive measure tools. Among the traditional questionnaires tested in this investigation, the FSS seemed to be the most informative for the clinical assessment of PPS patients suffering from fatigue. However, the adequacy of FSS for longitudinal monitoring of

Acknowledgments

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the Department of Defense.

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Approach to Fatigue and Energy Conservation
2021, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
The smallest detectable change was 1.5 for the FSS, 2.0 for the PPL fatigue item, and 1.9 for the SFQ. Vasconcelos and colleagues17 compared the FFS, Fatigue Impact Scale, and Visual Analogue Scale (VAS) for fatigue in 56 subjects with 39 of those fitting the criteria for PPS. Of the 3 scales, the FSS was the strongest predictor of severe fatigue with moderate correlation to the VAS.
A randomized controlled trial of coenzyme Q<inf>10</inf> for fatigue in the late-onset sequelae of poliomyelitis
2015, Complementary Therapies in Medicine
Citation Excerpt :
The FSS comprises nine items in a seven-point scale with higher scores in the range of 1–7 indicating higher levels of fatigue.14 Vasconcelos et al.18 compared the applicability and validity of the FSS, visual analog scale and the fatigue impact scale for the measurement of fatigue in PPS and concluded that the FSS was the strongest predictor of severe fatigue and most closely agreed with the intensity of self-reported fatigue in PPS. Since then, Rasch analysis has confirmed the validity of eight of the nine items of the FSS (the exception being item 1 on motivation) as a measure of the severity and impact of physical symptoms of fatigue in polio survivors.19
To determine if coenzyme Q₁₀ alleviates fatigue in the late-onset sequelae of poliomyelitis.
Parallel-group, randomized, placebo-controlled trial.
Coenzyme Q₁₀ has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue.
Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded.
Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q₁₀ or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome.
Of 103 participants, 54 were assigned to receive coenzyme Q₁₀ and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q₁₀ was safe and well-tolerated.
A daily dose of 100 mg coenzyme Q₁₀ for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis.
The registration number for the clinical trial is ACTRN 12612000552886.
Fatigue in advanced kidney disease
2014, Kidney International
Citation Excerpt :
The intensity of fatigue is measured in millimeters from the low (left) end of the scale with, again, a higher score indicating an increased level of fatigue. Studies have suggested that the descriptiveness of the visual analog scale to evaluate fatigue severity is considerably lower compared with other measures.23 Furthermore, the scale might fail to differentiate between sleepiness and fatigue.24
Fatigue is commonly experienced in patients with advanced kidney disease and associated with poor outcomes. The prevalence of fatigue ranges from 42% to as high as 89% according to treatment modality and the measurement instruments used. This paper reviews studies examining sociodemographic, biological, and psychological factors associated with fatigue in advanced kidney disease. The association between fatigue and psychological factors, such as depression and anxiety, behavioral factors, such as sleep and nutrition, and cytokines, such as IL-6 and CRP corroborates the view of fatigue as a multidimensional and multifactorial problem. Although depression and fatigue are related, the relationship is typically moderate in size, thus fatigue should not simply be seen as a symptom of distress. Accordingly, it is important for treatment plans to address the complex etiology of fatigue through pharmacological and nonpharmacological interventions. To date, results of nonpharmacological interventions are promising, with physical exercise and cognitive-behavioral therapy showing beneficial results. Work conducted in other patient populations highlights the importance of cognitions and behaviors in the prediction and maintenance of fatigue. Such work could be applied to advanced kidney disease allowing a model of fatigue to be developed from which to base suitable interventions in this setting.
Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia
2010, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Citation Excerpt :
VAS are commonly used measurement tools for quantifying a participant's perception of symptoms, such as pain, dyspnea, nausea, and fatigue, in research studies. Use of the VAS for symptom measurement has been extensively studied for pain measurement and fatigue in a variety of patient populations and situations, and the scale has been found to be a valid and reliable measure for symptom perception (Anton, Miller, & Townson, 2008; Bausewein, Booth, & Higginson, 2008; Bijur, Silver, & Gallagher, 2001; Bricker & Lavendre, 2002; Good et al., 2001; Hewlett, Hehir, & Kirwan, 2007; Mattsson, Möller, Lundberg, Gard, & Boström, 2008; Mayberry et al., 1999a; Myles & Urquhart, 2005; Vasconcelos et al., 2006; Winkelman, Norman, Maloni, & Kless, 2008). Documentation of the onset of the second stage of labor, onset of active pushing, and delivery times were recorded at the time of occurrence in the computerized, medical record documentation system, and on the data collection sheet.
To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue.
Randomized clinical trial.
Labor and delivery unit of a not‐for‐profit community hospital.
Convenience sample of nulliparous laboring women with epidural anesthesia.
Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation.
The length of pushing, total length of the second stage, and maternal fatigue.
A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05).
We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group.
Aging and sequelae of poliomyelitis
2010, Annals of Physical and Rehabilitation Medicine
We estimate that there are about 50,000 persons who survived poliomyelitis in their childhood in France (mean age estimated between 50 and 65 years). After a few decades of stability, 30 to 65% of individuals who had been infected and recovered from polio begin to experience new signs and symptoms.
Review of the literature on Pubmed with the following keywords “Poliomyelitis” and “Post-Polio Syndrome (PPS)”.
These new signs and symptoms are characterized by muscular atrophy (decreased muscle mass), muscle weakness and fatigue, muscle and/or joint pain. All these symptoms lead to significant changes in mobility with falls and inability to carry on with daily life activities. There are several intricate causes. The normal aging process and weight gain are regularly blamed. Respiratory disorders and sleep disorders must be looked for: respiratory insufficiency, sleep-related breathing disorders such as sleep apnea, restless legs syndrome. Orthopedics complications are quite common: soft-tissue pathologies of the upper limbs, degenerative pathologies of the large joints or spinal cord, fall-related fractures. Finally, the onset of an authentic PPS is possible.
The therapeutic care of this late functional deterioration requires regular monitoring check-ups in order to implement preventive measures and appropriate treatment. This therapeutic care must be multidisciplinary as physical rehabilitation; orthotics and technical aids are all essential.
On estime à 50 000 le nombre d’anciens poliomyélitiques en France (moyenne d’âge évaluée entre 50 et 65 ans). Après plusieurs dizaines d’années de stabilité, 30 à 65 % des anciens poliomyélitiques décrivent une dégradation tardive.
Revue de la littérature sur PubMed à partir des mots clés « Poliomyélitis » et « Post-Polio Syndrome (PPS) ».
Cette dégradation tardive associe asthénie, faiblesse et fatigabilité musculaire, douleurs musculaires et/ou articulaires, fonte musculaire. Le tout entraîne une diminution des capacités de marche, des chutes, une perte d’autonomie… Les causes sont souvent intriquées. Les phénomènes de vieillissement et la prise de poids sont régulièrement en cause. Les troubles respiratoires et les troubles du sommeil doivent être recherchés : insuffisance respiratoire, syndrome des apnées du sommeil (SAS), syndrome des jambes sans repos. Les complications orthopédiques sont courantes : pathologies abarticulaires des membres supérieurs, pathologies dégénératives des grosses articulations ou du rachis, fractures secondaires à des chutes. Enfin, la survenue d’un authentique syndrome post-poliomyélitique (SPP) est possible.
La prise en charge de cette dégradation secondaire nécessite des bilans réguliers afin de mettre en place des mesures préventives et curatives. Elle doit être multidisciplinaire. La rééducation, l’appareillage et les aides techniques ont une place importante.
Measuring Fatigue in Persons With Spinal Cord Injury
2008, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
The VAS-F is a simple 1-item question of self-reported fatigue similar to a VAS for pain. Variants of the VAS-F have been widely used in fatigue research and practice.5,15,28 We used a VAS-F with anchors of “no fatigue” and “extreme fatigue.”
Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.
To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).
A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.
A tertiary spinal cord rehabilitation facility.
Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.
Not applicable.
The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).
Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74–.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.
The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.

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Supported by the Department of Defense (Health Affairs grant no. MDA 905-01-007).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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Original articleA Comparison of Fatigue Scales in Postpoliomyelitis Syndrome

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Research Participants

Results

Discussion

Conclusions

Acknowledgments

Am J Med

Arch Phys Med Rehabil

Arch Phys Med Rehabil

A case of progressive muscular atrophy occurring in a man who had acute poliomyelitis nineteen years previously with a review of the literature bearing upon the relations of infantile spinal paralysis to the spinal disease of later life

Univ Pa Med Bull

Fatigue and multiple sclerosisevidence-based management strategies for fatigue in multiple sclerosis

Administration of recombinant human leukocyte alpha 2-interferon in patients with amyotrophic lateral sclerosis

Arch Neurol

Post-polio fatigue treated with amantadine [letter]

Arch Neurol

Postpolio syndrome—response to deprenyl (selegiline)

Int J Neurosci

A double-blind, placebo-controlled trial of amantadine for the treatment of fatigue in patients with the post-polio syndrome

Ann N Y Acad Sci

An open trial of pyridostigmine in post-poliomyelitis syndrome

Can J Neurol Sci

Effect of human growth hormone on muscle function in post-polio syndrome

Ann N Y Acad Sci

A double-blind, placebo-controlled trial of high-dose prednisone for the treatment of post-poliomyelitis syndrome

Ann N Y Acad Sci

Bromocriptine in the treatment of post-polio fatiguea pilot study with implications for the pathophysiology of fatigue

Am J Phys Med Rehabil

Original article
A Comparison of Fatigue Scales in Postpoliomyelitis Syndrome