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Development of a Fatigue Scale
Abstract
A self-rating scale was developed to measure the severity of fatigue. Two-hundred and seventy-four new registrations on a general practice list completed a 14-item fatigue scale. In addition, 100 consecutive attenders to a general practice completed the fatigue scale and the fatigue item of the revised Clinical Interview Schedule (CIS-R). These were compared by the application of Relative Operating Characteristic (ROC) analysis. Tests of internal consistency and principal components analyses were performed on both sets of data. The scale was found to be both reliable and valid. There was a high degree of internal consistency, and the principal components analysis supported the notion of a two-factor solution (physical and mental fatigue). The validation coefficients for the fatigue scale, using an arbitrary cut off score of 3/4 and the item on the CIS-R were: sensitivity 75.5 and specificity 74.5.
... With regards to the post-acute disease stage, data was collected at least 6 months after the diagnostic laboratory test, through the application of a structured questionnaire, developed exclusively for this study. The questionnaire was based on clinical protocols for the management of post-COVID syndrome, by the Brazilian Ministry of Health and the health department of Belo Horizonte (13,14), as well as on previously validated tools, including Generalized Anxiety Disorder-7 (GAD-7) (15), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) (16), Patient Health Questionnaire-9 (PHQ-9) (17), Chalder's Fatigue Scale (18,19), New York Health Association's functional scale (20), and Charlson's comorbidity index (21). ...
... The constructs used to assess cognitive functions, namely memory problems, concentration problems, difficulties for thinking clearly and word finding difficulties, were obtained from the Chalder Fatigue Scale (18,19). This is a previously validated instrument widely applied to measure physical and mental fatigue in patients with chronic fatigue syndrome (18,19). ...
... The constructs used to assess cognitive functions, namely memory problems, concentration problems, difficulties for thinking clearly and word finding difficulties, were obtained from the Chalder Fatigue Scale (18,19). This is a previously validated instrument widely applied to measure physical and mental fatigue in patients with chronic fatigue syndrome (18,19). Emerging literature has linked post-COVID cognitive symptoms to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in which the Chalder Fatigue Scale is frequently used (22). ...
Introduction
Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people.
Objective
To evaluate the incidence of post-acute COVID-19 cognitive symptoms, as well as the associated risk factors.
Methods
Retrospective cohort, including outpatients with laboratory-confirmed COVID-19 and who were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding the persistence of COVID-19 symptoms after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly.
Results
From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25–46] vs. 30 [IQR 24–42] years-old, p = 0.042) with a higher prevalence in the female sex (80.5% vs. 62.2%, p < 0.001) when compared to those who did not present cognitive symptoms, as well as a lower prevalence of smoking (8.7% vs. 16.2%, p = 0.024). Furthermore, patients with persistent cognitive symptoms were more likely to have been infected during the second wave of COVID-19 rather than the third (31.0% vs. 21.3%, p = 0.014). Patients who needed to seek in-person care during the acute phase of the disease were more likely to report post-acute cognitive symptoms (21.5% vs. 9.3%, p < 0,001). In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41–3.57), fatigue (OR 2.33, CI 95% 1.19–4.56), depression (OR 5.37, CI 95% 2.19–13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30–3.81).
Conclusion
In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.
... The assessment included a standardized medical assessment, symptom surveys, biological sampling, and function testing. In this paper, results from a composite questionnaire containing validated inventories including the Chalder Fatigue Questionnaire [21], the De Paul Symptom Questionnaire [22], the Pediatric Quality of life Inventory (PedsQL) [23], the Hospital Anxiety and Depression Scale [24] and a modified COVID-19 symptom inventory [25] were used to chart fatigue, post-exertional malaise, quality of life, depression/anxiety symptoms and infectious/respiratory/cognitive symptoms respectively [19,20]. ...
... Of note, SARS-CoV-2 negative participants were subject to testing of nasopharyngeal secretion and serology for SARS-CoV-2; both were confirmed to be negative. The sample selection for this sub study was based on reported fatigue, the hallmark symptom of PCC and PIFS, which was recorded using the Chalder Fatigue Questionnaire (CFQ) [21]. Selection based on CFQ numerical scores allowed for better contrast between the experimental groups with regards to symptom intensity and frequency, with higher scores pointing to higher symptom burden. ...
... Furthermore, forty SARS-CoV-2 negative participants were included as controls. The uninfected controls included twenty participants that did not report fatigue and did not adhere to PCC/PIFS case definitions, as well as twenty participants that were identified as fatigue-cases by the Chalder Fatigue Questionnaire (bimodal CFQ ≥ 4) [21]. Thus, the experiment included four groups: SARS-COV-2 positive cases with fatigue (SARS + F +), SARS-COV-2 positive cases without fatigue (SARS + F-), and SARS-COV-2 negative cases with fatigue (SARS-F +) and without fatigue (SARS-F-) (Fig. 1). ...
Background
Post COVID-19 condition (PCC) is a complication of SARS-COV-2 infection and can lead to long-term disability.
Methods
The present study was designed to analyse the gene expression patterns of PCC through bulk RNA sequencing of whole blood and to explore the potential molecular mechanisms of PCC. Whole blood was collected from 80 participants enrolled in a prospective cohort study following SARS-CoV-2 infected and non-infected individuals for 6 months after recruitment and was used for bulk RNA sequencing. Identification of differentially expressed genes (DEG), pathway enrichment and immune cell deconvolution was performed to explore potential biological pathways involved in PCC.
Results
We have found 13 differentially expressed genes associated with PCC. Enriched pathways were related to interferon-signalling and anti-viral immune processes.
Conclusion
The PCC transcriptome is characterized by a modest overexpression of interferon-stimulated genes, pointing to a subtle ongoing inflammatory response.
... Fatigue: Chalder Fatigue Questionnaire (CFQ). The CFQ is an 11-item questionnaire that measures fatigue, encompassing both physical and mental aspects 61 . Each question offers four response options, ranging from "Less than usual" (0) to "Much more than usual" (3). ...
... The total score ranges from 0 to 11, with scores of 4 or above indicating severe fatigue 62 . The CFQ has been established as a reliable and valid measure 61 and has been validated in Norwegian 63 . In this cohort, Cronbach's alpha was 0.87. ...
Pain, a widespread challenge affecting daily life, is closely linked with psychological and social factors. While pain clearly influences daily function in those affected, the complete extent of its impact is not fully understood. Given the close connection between pain and psychosocial factors, a deeper exploration of these aspects is needed. In this study, we aim to examine the associations between psychosocial factors, pain intensity, and pain-related disability among patients with chronic pain. We used data on 4285 patients from the Oslo University Hospital Pain Registry, and investigated pain-related disability, pain intensity, pain catastrophizing, psychological distress, perceived injustice, insomnia, fatigue, and self-efficacy. We found significant associations between all psychosocial variables and pain-related disability, even after adjusting for demographic factors. In the multiple regression model, sleep problems and pain intensity were identified as primary contributors, alongside psychological distress, and fatigue. Combined, these factors accounted for 26.5% of the variability in pain-related disability, with insomnia and pain intensity exhibiting the strongest associations. While the direction of causation remains unclear, our findings emphasize the potential of interventions aimed at targeting psychosocial factors. Considering the strong link between psychosocial factors and pain-related disability, interventions targeting these factors—particularly insomnia—could reduce disability and enhance quality of life in those who suffer.
... Since fatigue is a subjective symptom, the assessment of fatigue severity is a key factor for both patients and physicians [11]. To date, in order to objectify the severity of fatigue among CFS patients, an abundance of questionnaires and assessment tools have been developed, such as the Chalder Fatigue Questionnaire (CFQ), Multidimensional Fatigue Inventory (MFI), and Fatigue Impact Scale (FIS) [12][13][14]. Nevertheless, for many healthcare professionals including general practitioners who care for patients with ME/CFS, the difficult process of assessing exact fatigue-related status including, in particular, the severity of fatigue is a clinical challenge due to the lack of standardized global information [15]. ...
... Among the 60 RCTs finally selected, 6 types of assessment tools were adopted, such as CFQ, CIS, and MFI (Table 1). Each tool has the unique characteristics in terms of questionaries and scoring scales, likely CFQ consisting of 11 questionnaires giving a maximum score of 33 points [13] and MFI consisting of 20 questionnaires giving a maximum score of 100 points [22]. In this study, for easy and intuitive presentation of fatigue severity, we converted the baseline fatigue scores derived from different tools in each RCT to a maximum score of 100 points and conducted meta-analysis. ...
Background
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating illness medically unexplained, affecting approximately 1% of the global population. Due to the subjective complaint, assessing the exact severity of fatigue is a clinical challenge, thus, this study aimed to produce comprehensive features of fatigue severity in ME/CFS patients.
Methods
We systematically extracted the data for fatigue levels of participants in randomized controlled trials (RCTs) targeting ME/CFS from PubMed, Cochrane Library, Web of Science, and CINAHL throughout January 31, 2024. We normalized each different measurement to a maximum 100-point scale and performed a meta-analysis to assess fatigue severity by subgroups of age, fatigue domain, intervention, case definition, and assessment tool, respectively.
Results
Among the total of 497 relevant studies, 60 RCTs finally met our eligibility criteria, which included a total of 7088 ME/CFS patients (males 1815, females 4532, and no information 741). The fatigue severity of the whole 7,088 patients was 77.9 (95% CI 74.7–81.0), showing 77.7 (95% CI 74.3–81.0) from 54 RCTs in 6,706 adults and 79.6 (95% CI 69.8–89.3) from 6 RCTs in 382 adolescents. Regarding the domain of fatigue, ‘cognitive’ (74.2, 95% CI 65.4–83.0) and ‘physical’ fatigue (74.3, 95% CI 68.3–80.3) were a little higher than ‘mental’ fatigue (70.1, 95% CI 64.4–75.8). The ME/CFS participants for non-pharmacological intervention (79.1, 95% CI 75.2–83.0) showed a higher fatigue level than those for pharmacological intervention (75.5, 95% CI 70.0–81.0). The fatigue levels of ME/CFS patients varied according to diagnostic criteria and assessment tools adapted in RCTs, likely from 54.2 by ICC (International Consensus Criteria) to 83.6 by Canadian criteria and 54.2 by MFS (Mental Fatigue Scale) to 88.6 by CIS (Checklist Individual Strength), respectively.
Conclusions
This systematic review firstly produced comprehensive features of fatigue severity in patients with ME/CFS. Our data will provide insights for clinicians in diagnosis, therapeutic assessment, and patient management, as well as for researchers in fatigue-related investigations.
... Physical and mental fatigue was assessed using the 14-item Chalder Fatigue Scale (CFS; [4]). This is rated dichotomously using 0 (no) and 1 (yes). ...
... The GAD-7 (α = 0.906) and CFQ (α = 0.941) were also found to have excellent internal consistency, whereas the PHQ-9 (α = 0.874) was considered to be good. The CFS was explored using both the 14-item and 11-item versions (see [4]). It was interesting to find that the 14-item version yielded better internal consistency for measuring fatigue in this ataxia sample (α = 0.815) compared to using 11-items (α = 0.762). ...
Introduction
It has been increasingly recognised that the impact of Ataxia extends beyond physical and motor symptomology. However, it is less known whether self-reported non-motor and ataxia symptom severity varies across ataxias of differing aetiology, which would have important implications for providing more targeted treatment.
Aim
This study aimed to investigate the impact of ataxia aetiology (hereditary, acquired or idiopathic) on self-reported depression, anxiety, fatigue, cognitive deficits, and ataxia symptom severity. Comparisons were also made between the ataxia sample as a whole and a neurologically healthy control group.
Method
Responses were collected using a cross-sectional online survey to recruit a national UK sample of people with ataxia.
Results
The study recruited 110 participants with ataxia (hereditary = 51, acquired = 16, idiopathic = 43) and 32 healthy controls. No significant differences were found across study variables for different causes of ataxia. However, participants with ataxia did report significantly higher levels of depression, anxiety, fatigue, cognitive deficits, and ataxia symptom severity compared to healthy controls.
Conclusion
This study found that participants with ataxia self-reported increased non-motor symptoms compared to healthy controls, which was a generally homogenous experience across different causes of ataxia. There was also considerable comorbidity of symptoms which requires further exploration. This study highlights the need for early assessment and intervention to address these non-motor symptoms in ataxia populations.
... Participants fulfilling the diagnostic criteria for an FSS (i.e., FM, CFS, IBS) or BDS according to self-reported symptom questionnaires, were identified with the BDS Checklist by Budtz-Lilly et al [24], which assesses characteristic clusters of bothersome symptoms present within the last 12 months. Cases with FM were identified according to criteria by White et al [25], CFS according to criteria by Chalder et al [26], and IBS according to criteria by Kay et al [27]. ...
... Interviews were conducted by trained experienced primary care physicians over the telephone. Based on the interviews, diagnoses of FM [25], CFS [26], IBS [27], and BDS [2] were established. ...
... It has consistently fared extremely well against other longer complex tools. [12][13][14] COVID-19 disease has claimed many lives in the last 2-3 years. Post-COVID-19 syndrome is an evolving symptomatology requiring more exploration with an indication toward autonomic/small-fiber dysfunction. ...
... It is a 11-item scale further divided into two components: one that measures physical fatigue (questions 1-7) and one that measures the mental fatigue (questions 8-11). [12,13] Statistical analysis ...
BACKGROUND
The pandemic, coronavirus disease 2019 (COVID-19) has led to a heavy toll on the human health. The aim of this study was to determine the influence of body fat distribution, evolving long-term effect on autonomic function, and its correlation with Chalder Fatigue Severity Score in post-COVID-19-recovered individuals of Indian ethnicity.
MATERIALS AND METHOD
A case–control study was conducted in the Department of Physiology on 31 cases and 29 age- and gender-matched controls. Cardiovascular evaluation including heart rate variability (HRV), galvanic skin response (GSR), body fat analysis, and Chalder Fatigue Severity Score was performed on the study participants. The continuous variables of basal anthropometric parameters, GSR values, HRV indices, and body fat parameters are expressed as mean and standard deviation (SD).
RESULTS
Diastolic blood pressure (DBP) was significantly increased among cases ( P = 0.04). GSR (average) for cases is higher when compared to controls and was borderline significant ( P = 0.05). There were no statistically significant differences in the HRV parameters. Cases showed significantly higher body fat distribution as compared to the control group indicating increased susceptibility of the obese population to COVID-19. Chalder’s post-COVID-19 Fatigue Severity Score of cases showed a negative correlation with LF:HF and RMSSD but it was not statistically significant.
CONCLUSION
In our study, we conclude that there was a significant increase in DBP and GSR (average) with significantly higher visceral fat percentage, body fat percentage, subcutaneous fat percentage, skeletal muscle percentage, and trunk fat percentage in cases as compared to the control group suggestive of higher propensity of obese individuals suffering from COVID-19 and resulting in dysautonomia as compared to the controls.
... The Fatigue Scale-14 (FS-14) was developed by Trudie Chalder in 1992 as a tool to assess the severity of fatigue symptoms [25]. This scale comprises 14 questions related to fatigue, to which subjects respond either with a yes or no, depending on how well the question aligns with their actual situation. ...
... The Cronbach's α coefficient ranged from 0.88 to 0.90, demonstrating good reliability [14]. Furthermore, the correlation coefficient between individual item scores and the total score ranged from 0.369 to 0.690 (P < 0.01), indicating satisfactory validity [25]. In a study involving Chinese doctors and anesthesiologists, the Cronbach's α coefficient for FS-14 was measured to be 0.844 and 0.73, respectively, suggesting high recognition of the scale within the Chinese medical community and its applicability to all Chinese individuals [26]. ...
Objective
This survey aims to comprehensively understand occupational burnout among pre-hospital emergency medical personnel and explore associated risk factors.
Methods
A cross-sectional online survey using a census method was conducted between 15 July, 2023, and ends on 14 August, 2023, in Chengdu, SiChuan province, China. The questionnaire included general demographic information, the Maslach Burnout Inventory-General Survey (MBI-GS) with 15 items, and the Fatigue Scale-14 (FS-14) with 14 items. Univariate analysis was conducted on all variables, followed by multivariate logistic regression models to examine the associations between occupational burnout and the risk factors.
Results
A total of 2,299 participants,99.57% completed the survey effectively The participants were from 166 medical institutions in Chengdu, comprising 1,420 nurses (61.50%) and 889 clinical doctors (38.50%). A total of 33.36% participants experienced burnout, predominantly mild (30.27%), followed by moderate (2.78%) and severe (0.3%). Physicians, higher fatigue scores, age, work experience appeared to be related to burnout. Logistic regression models revealed that individuals aged over 50 were less prone to experience burnout compared to medical staff aged 18–30 (OR: 0.269, 95% CI: 0.115–0.627, p = 0.002). Physicians were more prone to experience burnout compared to nursing staff (OR: 0.690, 95% CI: 0.531–0.898, p = 0.006). Those with 0–5 years of experience were more prone to experience burnout compared to those with 6–10 years or over 15 years of experience (OR: 0.734, 95% CI: 0.547–0.986, p = 0.040; OR: 0.559, 95% CI: 0.339–0.924, p = 0.023). Additionally, for each 1-point increase in the fatigue score, the likelihood of burnout in medical staff increased by 1.367 times (OR: 1.367, 95% CI: 1.323–1.412, p < 0.0001).
Conclusion
Pre-hospital emergency medical personnel demonstrate a notable prevalence of mild job burnout. These results provide a groundwork for future focus on the various stages of job burnout within pre-hospital emergency staff, alerting hospital and departmental managers to promptly address the mental well-being of their personnel and intervene as needed.
... To date, fatigue has primarily been measured using self-report questionnaires (for example, the Chalder Fatigue Scale [11]) and passive physiological recording methods (electroencephalographic and cardiac activity measures, and video capture of facial expressions or behavioural signals such as yawning; e.g., [12][13][14]). Whilst questionnaire measures benefit from the validity of probing different subjective aspects of fatigue, they usually concern relatively long timescales (often the last two weeks), and represent a relatively high burden for users under repeated administration (even in brief formats, such as ecological momentary assessment, [15]). ...
Background. Shift work, or working outside of normal circadian cycles, is associated with both experience of fatigue and poorer long-term physical and mental health. However, current methods for assessing fatigue present several barriers to building understanding of how these risks develop over time within individuals.
Objective. Here, we explore the potential of momentary speech activity-based fatigue measurement in a large, multi-lingual cohort of shift workers, using an intensive longitudinal study design (twice-daily measurement over two weeks in N=1,197 individuals from six different countries).
Methods. Paralinguistic speech features were used to predict different aspects of acute and chronic fatigue at each study time-point, with performance assessed in unseen (held-out) data. Results are reported both across the dataset as a whole, and for user-specific prediction models.
Findings. In the cross-sectional analysis, good (close to or exceeding current state-of-the-art) performance was achieved for both current sleep deprivation and self-reported sleepiness levels. The within-user analysis revealed robust increases in performance, yielding the ability to detect more subjective aspects of fatigue such as pervasive physical and mental exhaustion.
Conclusions. These findings offer preliminary support for the utility of using brief momentary speech samples as a low-burden, acceptable, and reliable measure of different aspects of fatigue in high-risk populations such as shift workers.
Clinical Implications. Developing brief, accessible measures of different dimensions of fatigue is an important step towards building understanding of how risks for poorer health outcomes develop over time within individuals exposed to significant circadian disruption.
... Respondents rated their experiences on a 4-point scale ("less than usual" to "much more than usual"). Two scoring systems, Likert scoring (0-1-2-3, total score 0-33) and bimodal scoring (0-0-1-1, total score 0-11), are commonly employed, with the latter allowing for categorization of fatigue caseness based on a cut-off score of 4 points or more [7]. Bimodal scoring was used to calculate fatigue prevalence in the study population and Likert scoring for all subsequent investigations on factors associated with fatigue. ...
Fatigue is commonly associated with myasthenia gravis (MG), but factors contributing to fatigue development in MG are incompletely understood. This nationwide cross-sectional registry study included 1464 patients diagnosed with autoimmune MG, recruited between February 2019 and April 2023. Frequency and severity of fatigue was assessed at study inclusion using the patient-reported Chalder Fatigue Questionnaire (CFQ). Frequency of fatigue was 59%. Fatigue severity strongly correlated with both patient-reported and physician-assessed MG outcome measures (MG-ADL, MG-QoL15, QMG and MGFA classes) and was associated with a history of myasthenic exacerbation and/or myasthenic crises and a delay in diagnosis of more than 1 year after symptom onset. Fatigue was more prevalent in women and coincided with symptoms of depression, anxiety, and sleep dissatisfaction. Differences in fatigue severity were observed between antibody (ab) subgroups, with highest fatigue severity in LRP4-ab-positive patients and lowest fatigue severity in AChR-ab-positive patients. Fatigue is a frequent and clinically highly relevant symptom of MG. Early diagnosis and prevention of MG crises may limit the long-term burden of fatigue in patients with MG.
... Chalder Fatigue Questionnaire (CFQ-PL). This questionnaire was developed to measure the severity of fatigue among adults in clinical and research settings (Cella & Chalder, 2010;Chalder et al., 1993). It consists of 11 items reflecting a multidimensional view of fatigue, covering decreased mental and physical endurance, fatigability and problems with cognitive functioning connected with increased levels of tiredness. ...
Background
Cancer-related fatigue is a complex syndrome and the most frequently reported complaint, especially during treatment. Sometimes a large discrepancy in patient fatigue estimations between the patients themselves and medical staff is observed. The main goal of this study was to compare fatigue from the patients’ and the medical staff’s perspectives.
Participants and procedure
The methods used included author-designed surveys for both the patient (questions about fatigue, intensity, causes and influence on life constructed mostly in the form of numerical rating scales) and the medical staff (the same questions on the perception of the patient’s fatigue), the Chalder Fatigue Questionnaire, and the EORTC QLQ-C30. The study involved 51 cancer patients during chemotherapy treatment.
Results
For 63% of the subjects, there was convergence of fatigue assessments made by patients and staff. Differences were visible in the staff’s and patients’ assessment of the intensity of fatigue experienced by the patients. The simple question “Are you fatigued (yes or no)?” corresponded to all questionnaires and scales in the case of patients. The equivalent question to the staff, “Is the patient fatigued (yes or no)?”, corresponded only to the patients’ current assessment of fatigue and with no other score on the questionnaire or scale that the patients filled out about their fatigue. Also, patients identified more causes of fatigue and staff overestimated the influence of chemotherapy on fatigue. Of the patient subjects, 51.4% did not know of any ways to cope with fatigue, and most of them talked about it only to family and friends.
Conclusions
Despite existing recommendations on the need to screen and educate patients in this matter, the issue of fatigue still re-quires attention.
... After completing the RMR and DXA measurement, the players were given breakfast and instructed to complete an electronic questionnaire administered on a portable tablet (iPad pro, Apple, California, USA). All individuals completed a survey consisting of several questionnaires which included the LEAF-Q (Melin et al., 2014), the EDE-Q 11 (Friborg et al., 2013), the Bergen Insomnia Scale (BIS) (Pallesen et al., 2008), the Chalder Fatigue Scale (Chalder et al., 1993), the 12item General Health Questionnaire (Jackson, 2007), as well as an adapted version of the OSTRCQ (Clarsen et al., 2020). Further, customized questions regarding diet and energy intake (EI) on match, training, and rest days were administered as well as questions specifically inquiring about history of stress fractures. ...
A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross‐sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n = 27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed.
... The Bell Score is a widely used and concise tool used to assess the functional impairment of patients with ME/CFS [45], with 100% indicating normal health and 0% bedriddenness. The Chalder Fatigue Scale (CFQ) evaluates 14 items to measure the impact and severity of fatigue's physical and mental aspects [61]. The Composite Autonomic Symptom Score 31 (COMPASS-31) is a concise instrument to assess autonomic nervous system dysfunction. ...
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystemic disease characterized by a complex, incompletely understood etiology. Methods: To facilitate future clinical and translational research, a multicenter German ME/CFS registry (MECFS-R) was established to collect comprehensive, longitudinal, clinical, epidemiological, and laboratory data from adults, adolescents, and children in a web-based multilayer-secured database. Results: Here, we present the research protocol and first results of a pilot cohort of 174 ME/CFS patients diagnosed at two specialized tertiary fatigue centers, including 130 (74.7%) adults (mean age 38.4; SD 12.6) and 43 (25.3%) pediatric patients (mean age 15.5; SD 4.2). A viral trigger was identified in 160/174 (92.0%) cases, with SARS-CoV-2 in almost half of them. Patients exhibited severe functional and social impairment, as reflected by a median Bell Score of 30.0 (IQR 30.0 to 40.0) and a poor health-related quality of life assessed with the Short Form-36 health survey, resulting in a mean score of 40.4 (SD 20.6) for physical function and 59.1 (SD 18.8) for mental health. Conclusions: The MECFS-R provides important clinical information on ME/CFS to research and healthcare institutions. Paired with a multicenter biobank, it facilitates research on pathogenesis, diagnostic markers, and treatment options. Trial registration: ClinicalTrials.gov NCT05778006.
... Although there is no gold standard for the NUTRITION IN CLINICAL PRACTICE | 13 measurement of fatigue, the most widely used tool for both clinical and community settings is the Chalder Fatigue Scale, also known as the Fatigue Questionnaire, which includes 11 items divided into two categories: physical and mental symptoms. 187,188 On the other hand, a simple visual analog scale may be used for a quick assessment of physical or mental energy by asking "How would you describe your physical (or mental) energy at the moment, from 0 being 'I have no energy at all' to 100 being 'I am full of energy'?" 189 Another outcome of interest is mental health, such as anxiety and depression risk, which has been associated with lower diet quality and food insecurity. 190,191 A commonly used brief scale for assessing the risk for anxiety and depression combines two questions from the Patient Health Questionnaire and two questions from the Generalized Anxiety Disorder Scale to create the Patient Health Questionnaire 4. 192 For the general population, Löwe et al 193 suggest a cutoff point of ≥6 as "yellow flag" and ≥9 as "red flag" for the risk of depression or anxiety and should be further investigated. ...
In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non–weight‐related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.
... Considering the numerous approaches to detect fatigue that have already been made and employed, tools for quantifying fatigue are not a novel idea [51]. For instance, as suggested by Chalder et al. [52,53], subjective questionnaires were created in the early 1990s to measure physical exhaustion in the general population. Subsequently, similar attempts were made with the same objective. ...
... Higher scores indicate a higher level of chronic fatigue. 32,33 For all participants, psychiatric symptoms included depression symptoms measured by the Patient Health Questionnaire-9 (PHQ-9), 34 anxiety symptoms measured by the Generalized Anxiety Disorder-7 (GAD-7), 35 insomnia symptoms measured by the Insomnia Severity Index (ISI), 36 and PTSD symptoms measured by the PTSD checklist for DSM-5 (PCL-5). 37 The total scores of these scales were interpreted as follows: PHQ-9, normal (0-4), mild (5-9), moderate to severe (10-27) depression symptoms; GAD-7, normal (0-4), mild (5-9), moderate to severe (10-21) anxiety symptoms; ISI, normal (0-7), subthreshold (8)(9)(10)(11)(12)(13)(14), moderate to severe (15-28) insomnia symptoms. ...
Background
A variety of symptoms, particularly cognitive, psychiatric and neurological symptoms, may persist for a long time among individuals recovering from COVID-19. However, the underlying mechanism of these brain abnormalities remains unclear. This study aimed to investigate the long-term neuroimaging effects of COVID-19 infection on brain functional activities using resting-state functional magnetic resonance imaging (rs-fMRI).
Methods
Fifty-two survivors 27 months after infection (mild-moderate group: 25 participants, severe-critical: 27 participants), from our previous community participants, along with 35 healthy controls, were recruited to undergo fMRI scans and comprehensive cognitive function measurements. Participants were evaluated by subjective assessment of Cognitive Failures Questionnaire-14 (CFQ-14) and Fatigue Scale-14 (FS-14), and objective assessment of Montreal Cognitive Assessment (MoCA), N-back, and Simple Reaction Time (SRT). Each had rs-fMRI at 3T. Measures such as the amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) were calculated.
Findings
Compared with healthy controls, survivors of mild-moderate acute symptoms group and severe-critical group had a significantly higher score of cognitive complains involving cognitive failure and mental fatigue. However, there was no difference of cognitive complaints between two groups of COVID-19 survivors. The performance of three groups was similar on the score of MoCA, N-back and SRT. The rs-fMRI results showed that COVID-19 survivors exhibited significantly increased ALFF values in the left putamen (PUT.L), right inferior temporal gyrus (ITG.R) and right pallidum (PAL.R), while decreased ALFF values were observed in the right superior parietal gyrus (SPG.R) and left superior temporal gyrus (STG.L). Additionally, decreased ReHo values in the right precentral gyrus (PreCG.R), left postcentral gyrus (PoCG.L), left calcarine fissure and surrounding cortex (CAL.L) and left superior temporal gyrus (STG.L). Furthermore, significant negative correlations between the ReHo values in the STG.L, and CFQ-14 and mental fatigue were found.
Interpretation
This long-term study suggests that individuals recovering from COVID-19 continue to experience cognitive complaints, psychiatric and neurological symptoms, and brain functional alteration. The rs-fMRI results indicated that the changes in brain function in regions such as the putamen, temporal lobe, and superior parietal gyrus may contribute to cognitive complaints in individuals with long COVID even after 2-year infection.
Funding
The National Programs for Brain Science and Brain-like Intelligence Technology of China, the 10.13039/501100001809National Natural Science Foundation of China, 10.13039/501100004826Natural Science Foundation of Beijing Municipality of China, and the 10.13039/501100012166National Key Research and Development Program of China.
... Fatigue Questionnaire (CFS; [27]). The scale consists of 11 items and is scored on a 4-point Likert scale (0 = less than usual, 1 = no more than usual, 2 = more than usual, 3 = much more than usual and a bimodal scale where 0 and 1 yields 0 on bimodal score and 3 and 4 yields 1 in bimodal score. ...
Background
A concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up.
Methods
This was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up.
Results
Validated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up.
Conclusions
The concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up.
Trial registration
ClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.
... Following our previous methodologies, fatigue was assessed using the Chalder Fatigue Scale (CFQ-11) [17,145]. Patients reported their general condition over the past 3 days, with scores ranging from 0 to 3 via the Likert scoring system, enabling calculation of a global score (max 33) and subscales for physical (0-21) and psychological fatigue (0-12) [146,147]. ...
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has introduced the medical community to the phenomenon of long COVID, a condition characterized by persistent symptoms following the resolution of the acute phase of infection. Among the myriad of symptoms reported by long COVID sufferers, chronic fatigue, cognitive disturbances, and exercise intolerance are predominant, suggesting systemic alterations beyond the initial viral pathology. Emerging evidence has pointed to mitochondrial dysfunction as a potential underpinning mechanism contributing to the persistence and diversity of long COVID symptoms. This review aims to synthesize current findings related to mitochondrial dysfunction in long COVID, exploring its implications for cellular energy deficits, oxidative stress, immune dysregulation, metabolic disturbances, and endothelial dysfunction. Through a comprehensive analysis of the literature, we highlight the significance of mitochondrial health in the pathophysiology of long COVID, drawing parallels with similar clinical syndromes linked to post-infectious states in other diseases where mitochondrial impairment has been implicated. We discuss potential therapeutic strategies targeting mitochondrial function, including pharmacological interventions, lifestyle modifications, exercise, and dietary approaches, and emphasize the need for further research and collaborative efforts to advance our understanding and management of long COVID. This review underscores the critical role of mitochondrial dysfunction in long COVID and calls for a multidisciplinary approach to address the gaps in our knowledge and treatment options for those affected by this condition.
... Psychological, wellbeing, musculoskeletal and sleep measures Questionnaires were completed online using Qualtrics (Qualtrics, London, UK). Measures included the Chalder Fatigue Scale [40], Schwarzer and Renner Physical Exercise Self-Efficacy Scale (adapted to assess self-efficacy related to sitting less) [41], Generalised Self-Efficacy Scale [42], Cohen Perceived Stress Scale [43], Positive and Negative Affect Schedule [44], World Health Organization Five Well-Being Index [45], WHOQOL-BREF quality of life [46], Pittsburgh Sleep Quality Index [47] and Standardised Nordic Questionnaire to assess musculoskeletal symptoms [48]. ...
Background
Reducing and breaking up sitting is recommended for optimal management of Type 2 diabetes mellitus (T2DM). Yet, there is limited evidence of interventions targeting these outcomes in individuals with this condition. The primary aim of this study was to assess the feasibility and acceptability of delivering and evaluating a tailored online intervention to reduce and break up sitting in adults with T2DM.
Methods
A mixed-methods two-arm randomised controlled feasibility trial was conducted in ambulatory adults with T2DM who were randomised 1:1 to the REgulate your SItting Time (RESIT) intervention or usual care control group. The intervention included online education, self-monitoring and prompt tools (wearable devices, smartphone apps, computer apps) and health coaching. Feasibility outcomes were recruitment, attrition, data completion rates and intervention acceptability. Measurements of device-assessed sitting (intended primary outcome for definitive trial), standing and stepping, and physical function, psychosocial health and wellbeing were taken at baseline, 3 months and 6 months. Individual semi-structured interviews were conducted at six-months (post intervention) to explore acceptability, feasibility and experiences of the trial and intervention using the Framework Method.
Results
Seventy participants aged 55 ± 11 years were recruited. Recruitment rate (proportion of eligible participants enrolled into the study) was 67% and participant retention rate at 6 months was 93% (n = 5 withdrawals). Data completion rates for daily sitting were 100% at baseline and ranged from 83 to 91% at 3 months and 6 months. Descriptive analysis demonstrated potential for the intervention to reduce device-measured sitting, which was 30.9 ± 87.2 and 22.2 ± 82.5 min/day lower in the intervention group at 3 and 6 months, respectively, compared with baseline. In the control group, sitting was 4.4 ± 99.5 and 23.7 ± 85.2 min/day lower at 3 and 6 months, respectively. Qualitative analysis identified three themes: reasons for participating in the trial, acceptability of study procedures, and the delivery and experience of taking part in the RESIT intervention. Overall, the measurement visits and intervention were acceptable to participants.
Conclusions
This study demonstrated the feasibility and acceptability of the RESIT intervention and evaluation methods, supporting a future definitive trial. If RESIT is found to be clinically effective, this could lead to changes in diabetes healthcare with a focus on reducing sitting.
Trial registration
The trial was registered with ISRCTN (number ISRCTN14832389).
... (2) Questionnaire-based detection of personal fatigue levels [14] involves the use of common fatigue assessment scales, including the Karolinska sleepiness scale (KSS) [15], Stanford sleepiness scale (SSS) [16], Fatigue Scale-14 [17], and National Aeronautics and Space Administration task load index [18]. Subjects complete a questionnaire, calculate the score after finishing it, and gauge their fatigue status based on the obtained score. ...
Air traffic controller fatigue has become a significant concern for flight safety. With the sharp rise in global air traffic, it is imperative to assess controller fatigue, as it directly impacts the safety and efficiency of air traffic control operations. Our study introduces a non-intrusive method to detect fatigue by analyzing the facial and vocal characteristics of air traffic controllers. Initially, we developed fast and accurate schemes for facial feature extraction, which allowed us to measure the “percentage of eyelid closures” and yawn frequency from video recordings. Subsequently, we extracted several vocal features from audio recordings, including average fundamental frequency, short-time average magnitude, short-time zero-crossing rate, harmonic-to-noise ratio, jitter, shimmer, loudness, and Mel-frequency cepstrum coefficient. We then created temporal sequences of these facial and vocal features to feed into a bi-directional long short-term memory gated recurrent unit network. This data, combined with the Stanford Sleepiness Scale, facilitated the identification and precise prediction of controller fatigue levels. Our experimental findings validate the effectiveness of the proposed detection method, which demonstrated a recognition accuracy rate of 95.12% on the test audio and video datasets.
... Higher scores suggest greater severity of fatigue [33]. The Chalder Fatigue Questionnaire was designed to characterize fatigue in general population [34,35]. It consists of 11 items for which a total score is obtained and is composed of two domains-physical fatigue and mental fatigue. ...
Fatigue is a common non-motor symptom in Parkinson’s disease (PD), but even so, it may still be underdiagnosed or misdiagnosed in current practice due to its non-specific manifestations. The aims of this study were to investigate the prevalence of fatigue in PD patients compared to healthy controls and to identify the main characteristics and associations of fatigue with other non-motor symptoms and the impact of fatigue on sleep disturbances in Parkinson’s disease. Materials and methods: case–control study in which 131 PD patients and 131 age- and sex-matched controls were enrolled. Main characteristics of fatigue, sleep, and other non-motor symptoms were assessed using specific validated questionnaires. Results: According to the Chalder fatigue scale, fatigue is more prevalent in PD patients (38.16%) compared to healthy controls (26.71%). Fatigue was identified in 46.54% of the PD patients using the Parkinson’s Fatigue Scale (PFS-16). PD patients with fatigue presented a worse motor status, more sleep disturbances (insomnia, daytime sleepiness), a broader spectrum of non-motor symptoms (pain, anxiety, urinary disturbances), worse cognitive performances, a lower level of happiness, and worse quality of life compared to PD patients without fatigue. Conclusion: Fatigue is a common symptom of PD and needs to be assessed, considering its consequences on quality of life. Sleep disturbances have a great influence over fatigue in PD patients.
... They also debated the strengths and limitations of different fatigue-specific outcome measures, each of which had been developed and validated in a different condition, with varying emphasis on cognitive fatigue, physical fatigue, effect on daily life, and motivation. These instruments included the Modified Fatigue Impact Scale; Fatigue Severity Scale [102]; Fatigue Assessment Scale; Functional Assessment Chronic Illness Therapy-Fatigue (FACIT-F) [103]; Work and Social Adjustment Scale [104]; Chalder Fatigue Scale [105]; Visual Analogue Scale-Fatigue [106]; and the EQ5D [87]. In one clinic Greenhalgh et al. ...
Background
Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called “postcode lottery” of care. The original aim of this study—to examine the nature of quality in long covid care and reduce unwarranted variation in services—evolved to focus on examining the reasons why standardizing care was so challenging in this condition.
Methods
In 2021–2023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge.
Results
Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through idiographic (case-based) reasoning, in which practitioners build lessons from the particular to the general. This contrasts with the nomothetic reasoning implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients).
Conclusion
Not all variation in long covid services is unwarranted. Largely because long covid’s manifestations are so varied and comorbidities common, generic “evidence-based” standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients’ unique needs.
Study registration
NCT05057260, ISRCTN15022307.
... The Chalder Instrument for fatigue analysis is a tool developed to assess the severity of fatigue in clinical and research contexts. Originally proposed by Chalder et al. in [12] the questionnaire was designed to measure fatigue in patients with Chronic Fatigue Syndrome (CFS) and has been widely used in various studies on fatigue and related conditions. The instrument consists of an 11-item scale in which participants report how often they experience different symptoms of fatigue. ...
We present here a brief review of what has been published about fatigue, highlighting its multifactorial nature and the lack of objective markers that make it difficult to establish a consensus on measurement methods and present the Computerized Evaluation of Work Readiness (FOCOS/Prontos System), aiming to assess the correlation between the computerized assessment performance and signs of fatigue, using the Chalder instrument. The study applied the Chalder Fatigue Scale to 552 employees of a Brazilian mining company, with a final sample consisting of 334 individuals divided into a 'clinical group' (G1) with signs of fatigue and a 'control group' (G0) without fatigue. The study aimed to analyze readiness profiles between the clinical and control groups using statistical tests like the Mann-Whitney U-test and Welch's t-test, with significance set at p-value <0.05. Results showed significant differences in daily readiness, cognitive impacts, and risky behaviors before and after self-reporting fatigue. The Prontos System demonstrated predictive value for fatigue-related risks and accident prevention measures, highlighting its role in enhancing workplace safety and productivity. The study highlights the importance of daily and continuous fatigue assessment using the FOCOS/Prontos System to track signs of fatigue, as well as productivity. The system's multidimensional approach enriches fatigue prediction and classification accuracy. Integrating instruments enhances fatigue management, allowing for proactive intervention based on temporal analysis of readiness parameters and behaviors associated with fatigue. The study emphasizes the complexity of fatigue and its correlation with accidents, advocating for ongoing monitoring as a preventive and performance optimization strategy, thus promoting a safer and healthier work environment.
... Chalder Fatigue Questionnaire (CFQ): It was created by Chalder et al., in 1993, this 11-item questionnaire, validated for the Brazilian primary care setting, measures both psychological and physical fatigue experienced over the past 6 months. Scoring is based on a 4-point Likert scale, ranging from 0 (less than usual) to 3 (much more than usual), the cut-off score for fatigue diagnosis is 22 [10]. 9-item Primary Health Questionnaire (PHQ): This was translated and validated by AlHadi et al., it gauges depression symptoms over the last 2 weeks. ...
Background Fatigue Syndrome (FS) is described as extreme exhaustion following ordinary activities. Sleep deprivation, the use of antidepressants, autoimmune illnesses, and anemia are also risk factors for FS. Symptoms of FS include headache, dizziness, and dyspnea, among others. Objective: This study focused on assessing the prevalence of fatigue syndrome (FS) and its association with depression and anxiety, among the medical students in Saudi Arabia. Methodology In this cross-sectional investigation conducted in 2023, 740 medical students participated. Data were gathered using an online survey, which encompassed four key sections: Sociodemographic details, the 11-item Chalder Fatigue Questionnaire (CFQ), the 9-item Primary Health Questionnaire (PHQ) assessing depression, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Analyses were performed by the use of SPSS version 25. Results A total of 740 students were surveyed, 417 (56.4%) satisfied the diagnostic requirements for fatigue syndrome (FS), with most of them being females. Furthermore, 234 (31.2%) and 296 (40.8%) of the participants reported having significant anxiety symptoms and depressive symptoms, respectively. FS was positively correlated with symptoms of anxiety and depression (P
... Fatigue was assessed by one item from The Subjective Well-Being Scale in YH1 and 3 [28], and one item from the Chalder Fatigue Scale (CFS) [29] in YH4. We dichotomized the response options into "Strong/fit" and "Tired/worn out". ...
In recent decades, increases in mental health problems in adolescents have been reported from several large population-based surveys. This raises questions about changes in underlying risk and protective factors that can inform future intervention strategies. Population data were collected from 1995 to 2019 in three waves of the Young-HUNT studies in Norway to map decennial trends in the prevalence of established risk factors for, and their associations with, adolescent mental health problems. All adolescents (aged 13–19 years) attending lower and upper secondary school in the county of Trøndelag were invited, representing three historical cohorts of 25,245 unique adolescents. Mental health problems (HSCL-5) and established mental health risk factors were self-reported. Using a generalized linear model and linear regression, we calculated changes in relative and absolute differences between risk factors and mental health problems. Overall, the prevalence of established risk factors for mental health problems in adolescence increased markedly between 1995 and 2019, especially in girls. Prominent increases were observed for fatigue, bullying, musculoskeletal pain and migraine, loneliness, and overweight. Furthermore, with the exception of excess alcohol use and family economy, associations between each risk factor and adolescent mental health problems strengthened over the same time span in girls, but less among boys. Our findings suggest that several modifiable risk factors for poor mental health in adolescence are increasing, especially among girls, and should be targeted in community, school, and in clinical settings.
... Further details will be presented in the forthcoming statistical analysis plan. [32] which is composed of 11 items, each of which is answered using a 4-point Likert scale ranging from 0 (less than usual) to 3 (much more than usual). The maximum score is therefore 33, and a higher score is associated with a worse health state 7. Measuring independent physical activity (frequency of occurrences, and duration in minutes) using an modified version of the Godin leisure score index questionnaire [33] 8. ...
Background
Two million people in the UK are living with or beyond cancer and a third of them report poor quality of life (QoL) due to problems such as fatigue, fear of cancer recurrence, and concerns about returning to work. We aimed to develop and evaluate an intervention based on acceptance and commitment therapy (ACT), suited to address the concerns of cancer survivors and in improving their QoL. We also recognise the importance of exercise and vocational activity on QoL and therefore will integrate options for physical activity and return to work/vocational support, thus ACT Plus (+).
Methods
We will conduct a multi-centre, pragmatic, theory driven, randomised controlled trial. We will assess whether ACT+ including usual aftercare (intervention) is more effective and cost-effective than usual aftercare alone (control). The primary outcome is QoL of participants living with or beyond cancer measured using the Functional Assessment of Cancer Therapy: General scale (FACT-G) at 52 weeks. We will recruit 344 participants identified from secondary care sites who have completed hospital-based treatment for cancer with curative intent, with low QoL (determined by the FACT-G) and randomise with an allocation ratio of 1:1 to the intervention or control. The intervention (ACT+) will be delivered by NHS Talking Therapies, specialist services, and cancer charities. The intervention consists of up to eight sessions at weekly or fortnightly intervals using different modalities of delivery to suit individual needs, i.e. face-to-face sessions, over the phone or skype.
Discussion
To date, there have been no robust trials reporting both clinical and cost-effectiveness of an ACT based intervention for people with low QoL after curative cancer treatment in the UK. We will provide high quality evidence of the effectiveness and cost-effectiveness of adding ACT+ to usual aftercare provided by the NHS. If shown to be effective and cost-effective then commissioners, providers and cancer charities will know how to improve QoL in cancer survivors and their families.
Trial registration
ISRCTN: ISRCTN67900293. Registered on 09 December 2019.
All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1.
... Recent epidemiological studies have highlighted a high prevalence of CFS, particularly among adults (Johnston, Brenu, Staines, & Marshall-Gradisnik, 2013) and predominantly affecting women (Faro et al., 2016). While there is no universal tool for assessing CFS patients comprehensively (Bergner et al., 1976), specific questionnaires, such as the Chalder Fatigue Questionnaire (CFQ), are frequently used to assess the severity of symptomatic fatigue (Chalder et al., 1993), which has been shown to reliably discriminate between clinical and nonclinical conditions (Cella & Chalder, 2010), and the Multidimensional Fatigue Inventory (MFI-20) for comprehensive fatigue assessment (Shahid, Wilkinson, Marcu, & Shapiro, 2012). Additionally, various interventions have been proposed for managing CFS symptoms, including Cognitive Behavioral Therapy -CBT, Graded Exercise Therapy -GET, Adaptive Pacing Therapy -APT, Specialist Medical Care -SMC, and Graded Exercise Self-help -GES. ...
Purpose: Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) is a complex condition with debilitating symptoms that significantly impact individuals, particularly those in the working population. This study aims to investigate the effectiveness of Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) along with additional methods such as Graded Exercise Self-help (GES), Adaptive Pacing Therapy (APT), and Specialist Medical Care (SMC), in managing Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) among the working population. Methods: A systematic analysis of five randomized controlled trials conducted between 2013 and 2023, encompassing GET, CBT, APT, SMC, and GES was performed using PubMed. Results: The selected studies consistently demonstrate that GET positively impacts physical functioning and reduces fatigue levels in working individuals with CFS. Additionally, CBT proves valuable, emphasizing the importance of addressing the mental aspects of CFS in occupational contexts. Conclusion: This review underscores the need for further research, advocating for direct assessment methods like biomarkers to enhance our understanding of CFS and improve treatment outcomes. These insights are crucial for healthcare practitioners, researchers, and policymakers navigating the complexities of CFS within the workplace. Emphasizing the integration of psychological interventions with physical therapies is essential for a comprehensive approach to managing CFS among the working population.
... In fact, the guidance emphasises the lack of data regarding Long COVID in CYP. In this regard, it speaks to the Campbell and Carnevale "Ethical Processes" model, in that it advises healthcare providers as well as assessment clinics to gather data through questionnaires given to young patients and their families at three months and six months post-COVID (Goodman, 1997), EQ-5D-Y (Fitriana et al., 2021) 11-item Chalder Fatigue Questionnaire (CFQ) (Chalder et al., 1993) -speci cally, the stated aim of the guidance is to assess the impact of COVID-19 on CYP and their families, keeping in mind the wide range of symptoms, organ impairment, alternate diagnosis for symptoms, and effect on social life due to symptoms (NICE, 2020: Table 1: policy/guideline 5). This need to focus on inclusiveness, accountability as well as the key topics of concern factoring into the responsiveness of policy with regards to CYP was also mentioned in a recent paper focusing on topics of concern about the experiences of CYP as described by healthcare workers on social media. ...
There is still much unknown about the long-term consequences of COVID-19, otherwise known as post-acute sequelae of COVID (PASC). The challenge of defining the manifestation of Long COVID in children and young people (CYP) was specifically identified as a research subject by the National Institute for Health and care Research (NIHR). The lack of data relating to this age group and the impact the symptoms of PASC may have on the well-being and development of children have made research on this topic especially pressing. This healthcare policy study focuses on the applicability of Thompson et al.'s and Campbell and Carnevale’s frameworks in understanding the formulation and implementation of Long COVID healthcare policies. The analysis uses the ‘LISTEN’ method, applying a mixed method analysis of policy data and social media discourse analysis. Overall, the findings of this review of Long COVID policy guidelines for CYP and adults between 2020 and 2022, highlight increased public concern around the ethical aspects of policy-making, with high focus on Accountability and Responsiveness. The review concludes with several policy recommendations such as enhancing accountability through regular audits, promoting inclusiveness by incorporating CYP perspectives, ensuring transparency via regular updates, and maintaining equity in policy impact. Clinical policies should provide clear guidelines for healthcare providers, support mental health services for CYP and healthcare workers, and clarify school policies regarding Long COVID. Policymakers should also consider a health equity perspective in their Long COVID recovery policies.
... The Chalder Fatigue Scale was developed by Chalder et al. (1993). It is a 14-item scale addressing the symptoms of physical fatigue (items one to eight) and mental fatigue (items 9-14). ...
Main Points • The results showed that nomophobia, netlessphobia, and sleepiness predicted fatigue. • Nomophobia and netlessphobia predicted sleepiness. • Nomophobia and netlessphobia explained 18% and 30% of the total variance, respectively. Abstract This study investigated the predictive effects of nomophobia, netlessphobia, and sleepiness on fatigue. The sample consisted of 907 students from a public university. Data were collected using Demographical Information Form, the Fırat Netlessphobia Scale, the Fırat Nomophobia Scale, the Epworth Sleepiness Scale, and the Chalder Fatigue Scale. Therefore, structural equation modeling was used to identify factors affecting fatigue. The structural equation modeling was performed using the Analysis of Moment Structures. The results showed that nomophobia, netlessphobia, and sleepiness predicted fatigue, explaining 31% of the total variance. Nomophobia and netlessphobia predicted sleepiness, with nomophobia and netlessphobia explaining 18% and 30% of the total variance, respectively.
... In 76 female participants (age 25-35 years), Depression Scale, Anxiety Scale, and Stress Scale were assessed using Anxiety Stress Scale (DASS-21) [11], Insomnia Scale was assessed using the Athens Insomnia Scale [12], Positive/Negative Mood Scales were assessed using the Positive and Negative Affect Schedule score [13], and Fatigue Scale was assessed using the Chalder Fatigue Scale [14] before and after the application's use. For the Chalder Fatigue Scale, a high-fatigue subgroup was created with an initial score of 15 or higher, a value indicating the possibility of chronic fatigue syndrome [15]. ...
We developed an easy-to-use smartphone-based stress care system that employs simultaneous vibratory sensations and synchronized music. In this study, we evaluated the usefulness of this technology and discussed its potential for societal implementation.
This prospective study was conducted in three phases in Tokyo. Phase 1 tested the application’s efficacy in stress management following one month of use using subjective surveys assessing depression, anxiety, stress, insomnia, mood, and fatigue. Phase 2 assessed the effect of one month of application on internal stress markers (salivary cortisol, IgA, and oxytocin levels). Phase 3 assessed the application’s perceived efficacy and potential for social integration using a questionnaire survey administered after one week of use.
Significant improvements were observed in all subjective stress markers and salivary cortisol levels one month after application. Sixty-seven percent of the participants reported perceiving their therapy as effective in relaxing both their body and mind, while 46% felt that it contributed to improved sleep after one week of application use. Additionally, 73% of participants expressed a positive intention to continue with therapy.
The smartphone-based stress care application offers an individualized experience through both tactile and auditory stimulation, demonstrating its potential for widespread societal implementation of stress management.
Background
Findings from studies assessing Long Covid in children and young people (CYP) need to be assessed in light of their methodological limitations. For example, if non-response and/or attrition over time systematically differ by sub-groups of CYP, findings could be biased and any generalisation limited. The present study aimed to (i) construct survey weights for the Children and young people with Long Covid (CLoCk) study, and (ii) apply them to published CLoCk findings showing the prevalence of shortness of breath and tiredness increased over time from baseline to 12-months post-baseline in both SARS-CoV-2 Positive and Negative CYP.
Methods
Logistic regression models were fitted to compute the probability of (i) Responding given envisioned to take part, (ii) Responding timely given responded, and (iii) (Re)infection given timely response. Response, timely response and (re)infection weights were generated as the reciprocal of the corresponding probability, with an overall ‘envisioned population’ survey weight derived as the product of these weights. Survey weights were trimmed, and an interactive tool developed to re-calibrate target population survey weights to the general population using data from the 2021 UK Census.
Results
Flexible survey weights for the CLoCk study were successfully developed. In the illustrative example, re-weighted results (when accounting for selection in response, attrition, and (re)infection) were consistent with published findings.
Conclusions
Flexible survey weights to address potential bias and selection issues were created for and used in the CLoCk study. Previously reported prospective findings from CLoCk are generalisable to the wider population of CYP in England. This study highlights the importance of considering selection into a sample and attrition over time when considering generalisability of findings.
Our study aims to delineate the phenotypes of chronic neuropsychiatric symptoms among adult subjects recovering from their first COVID that occurred more than one year ago. We also aim to explore the clinical and socioeconomic risk factors of having a high loading of chronic neuropsychiatric symptoms. We recruited a post-COVID group who suffered from their first pre-Omicron COVID more than a year ago, and a control group who had never had COVID. The subjects completed app-based questionnaires on demographic, socioeconomic and health status, a COVID symptoms checklist, mental and sleep health measures, and neurocognitive tests. The post-COVID group has a statistically significantly higher level of fatigue compared to the control group (p < 0.001). Among the post-COVID group, the lack of any COVID vaccination before the first COVID and a higher level of material deprivation before the COVID pandemic predicts a higher load of chronic post-COVID neuropsychiatric symptoms. Partial correlation network analysis suggests that the chronic post-COVID neuropsychiatric symptoms can be clustered into two major (cognitive complaints -fatigue and anxiety-depression) and one minor (headache-dizziness) cluster. A higher level of material deprivation predicts a higher number of symptoms in both major clusters, but the lack of any COVID vaccination before the first COVID only predicts a higher number of symptoms in the cognitive complaints-fatigue cluster. Our result suggests heterogeneity among chronic post-COVID neuropsychiatric symptoms, which are associated with the complex interplay of biological and socioeconomic factors.
This chapter describes the proposed MFA framework, going over the requirements of such systems and detailing their implementation for the actual framework, including hardware and software integration. This chapter also approaches the experimental setup applied in all case studies, which will be discussed in the following chapters.
Background
There is no known effective pharmacological therapy for long COVID, which is characterized by wide-ranging, multisystemic, fluctuating, or relapsing symptoms in a large proportion of survivors of acute COVID. This randomized controlled trial aims to assess the safety and efficacy of an anti-inflammatory agent colchicine, to reduce symptoms among those at high risk of developing long COVID.
Methods
This multi-centre, parallel arm, 1:1 individual randomized, placebo-controlled, double-blind superiority trial will enrol 350 individuals with persistent post-COVID symptoms. Participants will be randomized to either colchicine 0.5 mg once daily (< 70 kg) or twice daily (≥ 70 kg) or matched placebo for 26 weeks and will be followed up until 52 weeks after randomization. The primary trial objective is to demonstrate the superiority of colchicine over a placebo in improving distance walked in 6 min at 52 weeks from baseline. The secondary objectives are to assess the efficacy of colchicine compared to placebo with respect to lung function, inflammatory markers, constitutional symptoms, and mental health state. In a sub-sample of 100 participants, cardiac biomarkers of myocardial injury and myocardial oedema using MRI will be compared.
Discussion
Persistent inflammatory response following SARS-CoV-19 is one of the postulated pathophysiological mechanisms of long COVID. Colchicine, a low-cost anti-inflammatory agent, acts via multiple inflammatory pathways and has an established safety profile. This trial will generate evidence for an important health priority that can rapidly translate into practice.
Trial registration
This clinical trial has been registered prospectively on www.clinicaltrials.gov with registration CTRI/2021/11/038234 dated November 24, 2021.
This longitudinal study aimed to identify factors that influence migraines in Korean women nurses using data from the Korea Nurses’ Health Study. Among those who participated in Survey 1 (2013–2014) and the follow-up survey (2015–2019), we selected 2605 participants for Cox proportional hazard regression analysis, 521 participants who were newly diagnosed with migraine and 2084 controls using a 1:4 incidence density sampling approach. Consuming coffee (≥ 3 cups: RR = 1.666; 95% CI = 1.175–2.362, < 3 cups: RR = 1.439; 95% CI = 1.053–1.966), being obese (BMI ≥ 25: RR = 1.341, 95% CI = 1.003–1.793), and engaging in vigorous physical activity (RR = 1.010; 95% CI = 1.000–1.019) increased the risk of developing a migraine. Nurses with an annual salary greater than $3500 were less likely to develop migraines (RR = 0.786, 95% CI = 0.631–0.979). The results imply that lifestyle factors, such as the amount of coffee consumption, BMI level, and degree of physical activity could be considered when formulating treatment plans for women who have newly developed migraines.
Objective. The assessment of mental fatigue (MF) and attention span in educational and healthcare settings frequently relies on subjective scales or methods such as induced-task interruption tools. However, these approaches are deficient in real-time evaluation and dynamic definitions. To address this gap, this paper proposes a Continuous Quantitative Scale (CQS) that allows for the natural and real-time measurement of MF based on group-synchronized electroencephalogram (EEG) data. Approach. In this study, computational psychophysiology was used to measure MF scores during a realistic class. Our methodology continuously monitored participants’ psychological states without interrupting their regular routines, providing an objective evaluation. By analyzing multi-subject brain-computer interface (mBCI) data with a collaborative computing approach, the group-synchronized data were obtained from 10 healthy participants to assess MF levels. Each participant wore an EEG headset for only 10 min of preparation before performing a sustained task for 80 min. Main results. Our findings indicate that a lecture duration of 18.9 min is most effective, while a duration of 43.1 min leads to heightened MF levels. By focusing on the group-level simultaneous data analysis, the effects of individual variability were mitigated and the efficiency of cognitive computing was improved. From the perspective of a neurocomputational measure, these results confirm previous research. Significance. The proposed CQS provides a reliable, objective, memory- and emotion-free approach to the assessment of MF and attention span. These findings have significant implications not only for education, but also for the study of group cognitive mechanisms and for improving the quality of mental healthcare.
Background
Health has effects on children’s academic performance. Qi deficiency is generally used to assess an individual’s health in the Chinese traditional medicine theory. This study explores the effects of qi deficiency on children’s academic performance and examines whether mental fatigue mediates these effects.
Methods
A total of 550 students aged 10–13 in fifth-grade were surveyed in a big primary school in Sichuan Province in November 2023 using paper-pencil-based questionnaires. Qi deficiency and mental fatigue were assessed, and exam scores in Chinese and Mathematics were recorded. Pearson’s correlation and linear regression analyses were used to test the mediation model and hypotheses.
Results
The fifth-grade students had mild qi deficiency (M = 2.09) and a mild state of mental fatigue (M = 2.38) on a five-point Likert scale. The average exam scores in Mathematics and Chinese were 70.07 and 74.44 points out of 100, respectively. Qi deficiency was associated with Mathematics scores (r = −0.37, p < 0.01) and Chinese scores (r = −0.30, p < 0.01), and mental fatigue (r = 0.47, p < 0.01). Furthermore, mental fatigue was associated with Mathematics scores (r = −0.46, p < 0.01) and Chinese scores (r = −0.34, p < 0.01). Linear regression analyses showed that qi deficiency significantly predicted Mathematics scores (β = −0.26, p < 0.01), Chinese scores (β = −0.19, p < 0.01), and mental fatigue (β = 0.41, p < 0.01). When qi deficiency was controlled for, mental fatigue significantly predicted Mathematics scores (β = −0.28, p < 0.01) and Chinese scores (β = −0.17, p < 0.01).
Conclusion
The mediation model and hypotheses were well supported, indicating that mental fatigue mediated the influence of qi deficiency on academic performance of fifth-grade students. Furthermore, the mediation effect of mental fatigue on Mathematics scores was a little stronger than that on Chinese scores.
The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people’s daily function. Depression and sociodemographic variables were significant predictors of fatigue.
Zusammenfassung
Myalgische Enzephalomyelitis/Chronisches Fatigue-Syndrom (ME/CFS) ist eine schwere, chronische Multisystemerkrankung, die je nach Ausprägung zu erheblichen körperlichen und kognitiven Einschränkungen, zum Verlust der Arbeitsfähigkeit bis hin zur Pflegebedürftigkeit einschließlich künstlicher Ernährung und in sehr schweren Fällen sogar zum Tod führen kann. Das Ziel dieses D-A-CH-Konsensusstatements ist es, 1) den aktuellen Wissensstand zu ME/CFS zusammenzufassen, 2) in der Diagnostik die kanadischen Konsensuskriterien (CCC) als klinische Kriterien mit Fokus auf das Leitsymptom post-exertionelle Malaise (PEM) hervorzuheben und 3) vor allem im Hinblick auf Diagnostik und Therapie einen Überblick über aktuelle Optionen und mögliche zukünftige Entwicklungen aufzuzeigen. Das D-A-CH-Konsensusstatement soll Ärzt:innen, Therapeut:innen und Gutachter:innen dabei unterstützen, Patient:innen mit Verdacht auf ME/CFS mittels adäquater Anamnese und klinisch-physikalischen Untersuchungen sowie der empfohlenen klinischen CCC zu diagnostizieren und dabei die präsentierten Fragebögen sowie die weiteren Untersuchungsmethoden zu nutzen. Der Überblick über die zwei Säulen der Therapie bei ME/CFS, Pacing und die symptomlindernden Therapieoptionen sollen nicht nur Ärzt:innen und Therapeut:innen zur Orientierung dienen, sondern auch Entscheidungsträger:innen aus der Gesundheitspolitik und den Versicherungen darin unterstützen, welche Therapieoptionen bereits zu diesem Zeitpunkt bei der Indikation „ME/CFS“ von diesen erstattbar sein sollten.
Background
Chronic fatigue syndrome (CFS) is a long-term and complex chronic disease that seriously affects the physical and mental health and quality of life of patients. Massage, as one of the methods in traditional Chinese medicine, can treat both symptoms and root causes and is widely used to treat CFS. The main purpose is to systematically evaluate the impact of massage therapy on the efficacy and safety of CFS patients, providing a reference for clinical practice.
Methods
By searching for literature published in PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, VIP Database, and China National Knowledge Infrastructure Database until November 2023, randomized controlled trial studies were selected according to the established inclusion and exclusion criteria. The Cochrane system evaluation manual was used to evaluate the quality of the included studies, and RevMan5.4 software was used for meta-analysis.
Results
32 randomized controlled trials were included, with a total of 2594 CFS patients. Meta-analysis showed that the total score of the fatigue scale (FS-14) in the treatment group, MD = −1.59, 95% CI (−1.84, −1.34), P < .00001; Physical fatigue score, MD = −1.30, 95% CI (−1.60, −1.00), P < .00001; Mental fatigue score, MD = −0.84, 95% CI (−0.99, −0.72), P < .0001]; Effective rate [RR = 1.23, 95% CI (1.19,1.28), P < .00001]; all indicators were superior to the control group, Only one study reported adverse reactions, including local swelling, skin bruising, and nausea.
Conclusion
Our research findings suggest that massage therapy has a significant therapeutic effect on CFS, avoiding adverse reactions and improving fatigue symptoms. Therefore, massage therapy for chronic fatigue syndrome should be further promoted and applied.
Nucleotides (NTs), important biomolecules involved in numerous cellular processes, have been proposed as potential candidates for anti-aging interventions. However, whether nucleotides can act as an anti-aging supplement in older adults remains unclear. TALENTs is a randomized, double-blinded, placebo-controlled trial that evaluates the efficacy and safety of NTs as an anti-aging supplement in older adults by exploring the effects of NTs on multiple dimensions of aging in a rigorous scientific setting. Eligible community-dwelling adults aged 60–70 years were randomly assigned equally to two groups: nucleotides intervention group and placebo control group. Comprehensive geriatric health assessments were performed at baseline, 2-months, and 4-months of the intervention. Biological specimens were collected and stored for age-related biomarker testing and multi-omics sequencing. The primary outcome was the change from baseline to 4 months on leukocyte telomere length and DNA methylation age. The secondary aims were the changes in possible mechanisms underlying aging processes (immunity, inflammatory profile, oxidative stress, gene stability, endocrine, metabolism, and cardiovascular function). Other outcomes were changes in physical function, body composition and geriatric health assessment (including sleep quality, cognitive function, fatigue, frailty, and psychology). In the RCT, 301 participants were assessed for eligibility and 122 were enrolled. Participants averaged 65.65 years of age, and were predominately female (67.21%). All baseline characteristics were well-balanced between groups, as expected due to randomization. The majority of participants were pre-frailty and had at least one chronic condition. The mean scores for physical activity, psychological, fatigue and quality of life were within the normal range. However, nearly half of the participants still had room for improvement in cognitive level and sleep quality. This TALENTs trial will represent one of the most comprehensive experimental clinical trials in which supplements are administered to elderly participants. The findings of this study will contribute to our understanding of the anti-aging effects of NTs and provide insights into their potential applications in geriatric healthcare.
Aim:
The diagnoses of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are highly associated with fatigue and pain, respectively. Physiologically and clinically an effect of thyroid status on fatigue and pain is expected. There may be clinically relevant differences in thyroid hormone axes though within values of reference in both patients with normal thyroid hormones, or in patients with well-regulated thyroid disease. These potential differences are explored in this study.
Materials and methods:
In the present study, female patients with CFS (n = 49) and FM (n = 58) as well as female healthy controls (n = 53) were included. We explored plasma levels of TSH and FT4 between the groups using Kruskall-Wallis, and the relation between fatigue score and levels of TSH and FT4 by means of Spearman's rho.
Results:
There were no group differences between CFS patients, FM patients, and healthy controls in levels of TSH and FT4.
Conclusion:
As one might clinically and physiologically expect an association between thyroid function and fatigue, which may be associated with clinical disorders such as CFS and FM, we suggest future studies to examine the field further by exploring the influence of thyroid receptors and responses of the thyroid hormone cascade.
Video conferencing solutions have become a primary tool to sustain general operations during crises or disasters, and their usage is increasingly widespread even under normal circumstances. This study aims to examine the psychometric properties of the Turkish version of the Zoom Exhaustion and Fatigue Scale (ZEFS) and obtain a cut-off score from the scale to distinguish the state of feeling mentally exhausted and fatigued. The study was conducted with 270 university students. Participants completed an information form, the ZEFS, and the Chalder Fatigue Scale (CFS). In confirmatory factor analysis, the 5-factor structure in the original form of the scale was achieved. Significant correlations were found between ZEFS and CFS scores, with ZEFS scores predicting CFS scores. Significant results were found among video conferencing evaluation, attendance numbers, health complaints, and ZEFS variables. In the ROC analysis, the mean cut-off score was found to be 1.96. According to the cut-off score, total CFS score, number of video conferencing attendances, perceived burden, and enjoyment differed. Cronbach's alpha coefficient was .95 for the entire scale, ranging from .87 to .92 for its subscales. The results indicate that the Turkish version of ZEFS is a psychometrically adequate measurement tool for assessing and distinguishing exhaustion and fatigue caused by the increasing use of video conferencing in the digital age.
Zusammenfassung
Ziel Die Post-COVID-Sprechstunde (PCS) wird im Rahmen eines umfassenden Behandlungsangebotes der gesetzlichen Unfallversicherung für Post-COVID-Patient*innen durchgeführt, um individuelle Empfehlungen für die weitere Versorgung festzulegen. Ziel der Untersuchung war die Erfassung der Hauptsymptome sowie die damit verbundenen Einschränkungen der sozialen und beruflichen Teilhabe, um Konsequenzen für die ambulante Rehabilitation abzuleiten.
Methodik Neben einer ärztlichen Untersuchung sowie einem psychologischen Konsil wurden zahlreiche Assessments zur Evaluation des biopsychosozialen Gesundheitszustands durchgeführt. 373 weibliche (82,2%) und 81 männliche Patient*innen im Alter zwischen 40 und 60 Jahren aus den Berufen der Gesundheits- und Pflegedienste, der Erziehung und Pädagogik nahmen seit April 2021 an der PCS teil.
Ergebnisse Nahezu alle untersuchten Patient*innen (98,2%) gaben Fatigue als Kardinalsymptom ihrer Post-COVID-Beschwerden an, in über 73% der Fälle in Kombination mit subjektiv erlebten Einschränkungen der Hirnleistungsfähigkeit. Die Dauer der Symptomatik persistierte dabei sowohl bei den weiblichen als auch männlichen Versicherten durchschnittlich seit 14–15 Monaten. Somit sind über 85% der Gesamtstichprobe als Fälle chronischer Erschöpfung (Fatigue Skala) einzustufen. Die Schwere der Fatigue beeinflusst zudem proportional die Lebensqualität (SF-36), Gefühle von Angst und Depression (HADS), die psychische Widerstandskraft (RS-13) sowie motorische Parameter wie die maximale Greifkraft und die Ausdauerleistungsfähigkeit. 54,3% der Versicherten erhielten zudem eine psychische Verdachtsdiagnose und 38,1% die Empfehlung zu einer weiterführenden neuropsychologischen Diagnostik.
Schlussfolgerung Zur weiteren Behandlung des Leitsymptoms der chronischen Fatigue ist eine multimodale und interdisziplinäre ambulante Rehabilitation zu empfehlen, die sich an der Behandlung der Diagnose des Chronischen Fatiguesyndroms (ME/CFS) und somit insbesondere an einem psychoedukativen und weniger an einem kurativen Therapieansatz orientieren und Nachsorgestrategien berücksichtigen sollte. Gesicherte psychische Störungen und neuropsychologische Defizite sind begleitend zu behandeln.
Fifty patients fulfilling operational criteria for the chronic fatigue syndrome (CFS), and who had been ill for a mean of five years, were offered cognitive behaviour therapy in an open trial. Those fulfilling operational criteria for depressive illness were also offered tricyclic antidepressants. The rationale was that a distinction be drawn between factors that precipitate the illness and those that perpetuate it. Among the latter are cognitive factors such as the belief that physical symptoms always imply tissue damage, and behavioural factors such as persistent avoidance of activities associated with an increase in symptoms. Therapy led to substantial improvements in overall disability, fatigue, somatic and psychiatric symptoms. The principal problems encountered were a high refusal rate and difficulties in treating affective disorders. Outcome depended more on the strength of the initial attribution of symptoms to exclusively physical causes, and was not influenced by length of illness. These results suggest that current views on both treatment and prognosis in CFS are unnecessarily pessimistic. It is also suggested that advice currently offered to chronic patients, to avoid physical and mental activity, is counterproductive.
A visual analogue scale to evaluate fatigue severity (VAS-F) was developed and tested in a sample of 75 healthy individuals and a sample of 57 patients undergoing medical evaluation for sleep disorders. The scale consists of 18 items related to fatigue and energy, has simple instructions, and is completed with minimal time and effort. The VAS-F compares favorably with the Stanford Sleepiness Scale and the Profile of Mood States, and its internal consistency reliabilities are high. Healthy subjects demonstrated significant differences between their evening and morning scores on the VAS-F, while sleep-disordered patients did not.
To determine the prevalence and associations of symptoms of fatigue.
Questionnaire survey.
London general practice.
611 General practice attenders.
Scores on a fatigue questionnaire and reasons given for fatigue.
10.2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome.
Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress.
Patients (n = 47) presenting to a neurological centre with unexplained chronic "postviral" fatigue (CFS) were studied prospectively. Controls were patients with peripheral fatiguing neuromuscular diseases and inpatients with major depression in a psychiatric hospital. Seventy-two percent of the CFS patients were cases of psychiatric disorder, using criteria that excluded fatigue as a symptom, compared with 36% of the neuromuscular group. There was no difference in subjective complaints of physical fatigue between all groups. Mental fatigue and fatigability was equally common in CFS and affective patients, but only occurred in those neuromuscular patients who were also cases of psychiatric disorder. Overall, the CFS patients more closely resembled the affective than the neuromuscular patients. Attribution of symptoms to physical rather than psychological causes was the principal difference between matched CFS and psychiatric controls. The symptoms of "postviral" fatigue had little ability to discriminate between CFS and affective disorder. The fatigue in CFS appeared central in origin, suggesting it is not primarily a neuromuscular illness. The implications for research and treatment of chronic fatigue are discussed.
Fatigue is a prominent disabling symptom in a variety of medical and neurologic disorders. To facilitate research in this area, we developed a fatigue severity scale, subjected it to tests of internal consistency and validity, and used it to compare fatigue in two chronic conditions: systemic lupus erythematosus and multiple sclerosis. Administration of the fatigue severity scale to 25 patients with multiple sclerosis, 29 patients with systemic lupus erythematosus, and 20 healthy adults revealed that the fatigue severity scale was internally consistent, correlated well with visual analogue measures, clearly differentiated controls from patients, and could detect clinically predicted changes in fatigue over time. Fatigue had a greater deleterious impact on daily living in patients with multiple sclerosis and systemic lupus erythematosus compared with controls. The results further showed that fatigue was largely independent of self-reported depressive symptoms and that several characteristics could differentiate fatigue that accompanies multiple sclerosis from fatigue that accompanies systemic lupus erythematosus. This study demonstrates (1) the clinical and research applications of a scale that measures fatigue severity and (2) helps to identify features that distinguish fatigue between two chronic medical disorders.
8 SS 19-23 YR. OLD PERFORMED AN EXERCISE DURING 11 MIN. ON A BICYCLE ERGOMETER ON 13 DAYS IN SUCCESSION. NOT BEING AWARE OF THE SYSTEMATIC DAILY VARIATIONS IN THE SLOPE OF THE WORK LOAD, ALL SS SHOWED SIGNIFICANT CORRELATIONS BETWEEN SUBJECTIVE FEELINGS OF GENERAL PHYSICAL FATIGUE-AS EXPRESSED ON DIFFERENT KINDS OF RATING SCALES-AND SLOPE OF WORK LOAD. REGRESSION EQUATIONS SATISFACTORILY DESCRIBE LINEAR RELATIONSHIPS BETWEEN LOAD AND FATIGUE. FACTOR ANALYSIS SUGGESTS A FACTOR "INCREASING FATIGUE," AND A FACTOR "DECREASING FITNESS."
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of
all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between
two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence
and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should
be so divided before using the formula. The index
[`(r)]ij\bar r_{ij}
, derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches.
Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability
of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial
group-factor clusters within a subtest. Scalability is not a requisite.
73 fatigued and 45 unfatigued members of the British Army completed a 16-item adjective checklist, derived from the Nowlis Mood Adjective Checklist. The items had been selected to provide a subjective measure of fatigue. Although the scores could differentiate between the two groups, they did not correlate with an objective measure of fatigue. Significant relationships were found between EPQ-scores and the checklist scores, suggesting that extraverts denied feeling fatigued while neurotics exaggerated their fatigue. Susceptibility to effects of social desirability, as measured by the lie-scale, was also found to decrease self-rated fatigue.
The prevalence of physical symptoms among a sample of patients registered at a health centre is described as recorded from home interviews. The number of physical symptoms per person is then correlated with personal characteristics and environmental factors, using computer programmes.
SYNOPSIS
Many of the standardized interviews currently used in psychiatry require the interviewer to use expert psychiatric judgements in deciding upon the presence or absence of psychopathology. However, when case definitions are standardized it is customary for clinical judgements to be replaced with rules. The Clinical Interview Schedule was therefore revised, in order to increase standardization, and to make it suitable for use by ‘lay’ interviewers in assessing minor psychiatric disorder in community, general hospital, occupational and primary care research.
Two reliability studies of the revised Clinical Interview Schedule (CIS-R) were conducted in primary health care clinics in London and Santiago, Chile. Both studies compared psychiatrically trained interviewer(s) with lay interviewer(s). Estimates of the reliability of the CIS-R compared favourably with the results of studies of other standardized interviews. In addition, the lay interviewers were as reliable as the psychiatrists and did not show any bias in their use of the CIS-R. Confirmatory factor analysis models were also used to estimate the reliabilities of the CIS-R and self-administered questionnaires and indicated that traditional measures of reliability are probably overestimates.
Oxidative metabolism is the major source of energy for muscle activity, and maximal oxygen uptake (V̇O2max), the product of maximal cardiac output and maximal arteriovenous oxygen difference, indicates individual capacity for oxidative
metabolism and performance of exercise by the large muscles. Strength, a function of muscle cross-sectional area, motor-unit
recruitment, and neuromuscular coordination, is the ability to develop force in a single, brief, maximal effort voluntary
contraction of rested muscle. Weakness is a diminished ability of rested muscle to exert maximal force. Fatigue is a loss
of maximal force-generating capacity that develops during muscular activity, likely originates within muscle itself, and persists
until muscle is fully recovered. Individual perception of motor effort can be determined with standardized rating scales.
These concepts are discussed in detail, their relevance to the pathophysiology of exercise in chronic' fatigue syndrome is
analyzed, and a general strategy of exercise evaluation pertinent to chronic fatigue syndrome is presented.
An epidemiological study was undertaken to provide the first reported estimate of the point prevalence of chronic fatigue syndrome in an Australian community. After a pilot study in a separate location, the population of the Richmond Valley, New South Wales, was sampled using a structured case-finding technique, which included notification from local medical practitioners, the use of a screening questionnaire and standardised interviews conducted by a physician and psychiatrist. In addition, investigations were performed to exclude alternative diagnoses and to assess cell-mediated immunity. Forty-two patients with chronic fatigue syndrome, with a female:male ratio of 1.3:1.0, were detected in a population of 114,000. The mean age at onset of symptoms was 28.6 years (SD, 12.3 years), and the median duration of symptoms from onset to sampling date was 30 months. The social status of the patients was distributed in accordance with that of the remainder of the population sampled, with no bias towards the middle or upper social classes. The disorder was causing considerable incapacity, with 43% of patients unable to attend school or work. The conservative estimate from this study suggests a prevalence on June 30 1988 of 37.1 cases per 100,000 (95% confidence interval [CI], 26.8-50.2). Chronic fatigue syndrome is an important disorder in this Australian community that affects young individuals from all social classes and causes considerable ill health and disability.
Symptoms by age and sex were studied in two population studies from Gothenburg, Sweden. In general, men and women showed the same age-related pattern. The prevalence of the following symptoms increased with age--sleeping disturbances, pain in the joints, pain in the legs, breathlessness, and impaired hearing. Six symptoms decreased with age--general fatigue, abdominal pain, nausea, diarrhoea, cough, and headache. A group of symptoms showed a curvilinear shape with a peak at the age of 50. In general, women presented more symptoms than men. This was especially true for symptoms of depression and tension. A possible explanation is that women are more attentive to their internal state. A more probable explanation, supported by our study, is that the mental symptoms are related to the woman's situation in life with double work (responsible for both work and family).
This article describes an easily administered Visual Analogue Scale (VAS) technique that can be used to detect changes in mood and subjective activation. The method yields two summary measures: Global Vigor (GV) and Global Affect (GA), each ranging in value from 0 to 100. The instrument was administered about six times per day in 38 healthy control and 6 depressed patients participating in temporal isolation studies. This yielded a total of 5,734 control subject sessions and 575 patient sessions. For both groups, frequency distributions of GV and GA were shown to be approximately Gaussian, and evidence was obtained suggesting that the instrument was being completed properly. On average, depressives were about 0.6 standard deviations lower than controls in GV and about 1.5 standard deviations lower in GA, confirming the validity of the scales. Measures of GV in controls were shown to be sensitive to both jet lag and diurnal variation, thus confirming the reliability and validity of GV in these situations. In two studies involving more than 50 days of voluntary seclusion, measures of GA were found to show an almost monotonic decline, tracking the decline in mood and confirming the reliability and validity of GA in that situation.
A visual analogue scale to measure global vigour and affect
MONK T. A visual analogue scale to measure global vigour and affect. Psychiat Res 1989; 27:
89-99.
Fatigue: The measurement of a multidimensional concept. Unpublished raw data
- Piper Bf
- Lindsey Am
- Dodd Aj
PIPER BF, LINDSEY AM, DODD AJ. Fatigue: The measurement
of a multidimensional
concept.
Unpublished
raw data. 1984.
Development of ameasure of symptoms in chronic fatigue syndrome: The profile of fatigue related symptoms
- C Ray
- Wrc Weir
- S Phillips
- S Cullen
Symptoms by age and sex
TIBBL~N G, BENGSTSSON C, FURUNER B, LAPIDUS L. Symptoms by age and sex. Stand J Primary
Hlth Care 1990; 8: 9-17.
A Technique for the development of attitude scales
- Likert