Profiles Characterize Fatigue in Patients With MS

Fatigue profiles for patients with multiple sclerosis (MS) are based on severity of fatigues and not on various dimensions, according to a study recently published in Scientific Reports.

Patients with MS sometimes experience disabling fatigue that manifests in physical, cognitive, and psychosocial exhaustion. The root cause of the symptom can be attributed to several factors, including the disease’s process in a patient’s central nervous system and by inflammatory processes associated with immune activation. Additional primary fatigue sources include demyelination, axonal loss, or neuroendocrine disturbance.

Currently, there are over 250 ways to measure fatigue according to the study researchers. “A clear distinction between different fatigue profiles that show the involvement of a certain domain (eg, cognitive fatigue or physical activity-induced fatigue) would create opportunities for patient-tailored fatigue treatments,” they said.

The researchers set out to determine whether fatigue profiles for patients with MS are based on the various dimensions of fatigue and to see if there is “a single, common, unidimensional factor model of perceived fatigue in patients with MS.”

To do so, 264 patients with severe primary MS completed 4 self-reported fatigue questionnaires: the Checklist of Individual Strength, the Modified Fatigue Impact Scale, the Fatigue Severity Scale, and the SF36 vitality. In order to identify patients with similar fatigue characteristics, a cluster analysis was conducted on the questionnaire results. In addition, all 54 items included in the questionnaires were tested for unidimensionality via an exploratory factor analysis.

“Fatigue profiles mainly distinguished patients based on the severity of their score on all domains,” the researchers said. “The multiple dimensions of fatigue had no influence on cluster formation.”

Based on these findings, the researchers concluded fatigue profile solutions are not helpful when it comes to targeting optimal fatigue interventions among patients with MS.

“Developing fatigue profiles might help reduce the number of measurement instruments and might facilitate decision making on which instruments should be used and which qualify as redundant,” the researchers said.

They continued, “a patient’s fatigue profile might facilitate clinical decision making with regard to the content and specificity of treatment.”

The researchers also noted that no study has shown that dimension-specific treatment of fatigue leads to better outcomes and 1 fatigue sub-scale is sufficient in classifying the symptom.

“In terms of clinical practice this means that there is as yet no reason to measure multidimensional aspects of fatigue in primary fatigued patients with MS.”

Reference

Beckerman H, Eijssen ICJM, van Meeteren J, Verhulsdonck MC, de Groot V. Fatigue profiles in patients with multiple sclerosis are based on severity of fatigue and not on dimensions of fatigue [published online March 5, 2020]. Sci Rep. doi: 10.1038/s41598-020-61076-1.