The development and validation of the Unidimensional Fatigue Impact Scale (U-FIS)

Abstract

Background: The multidimensional assessment of fatigue is complicated by the interrelation of its multiple causes and effects.

Objective: The purpose of the research was to develop a unidimensional assessment of fatigue (U-FIS).

Methods: Data collected with the Fatigue Impact Scale (FIS) were subjected to Rasch analysis to identify potential problems with the scale. Additional items for the U-FIS were generated from interviews with UK MS patients. The U-FIS was tested for face and content validity in patient interviews and included in a validation survey to determine dimensionality (Rasch model), reliability and validity.

Results: The original FIS was not unidimensional when subscale items were combined. The modification of the FIS and addition of a number of items allowed the development of a 22-item unidimensional scale (U-FIS) that was reliable (Cronbach Alpha = 0.96; test-retest = 0.86,) and valid given correlations with the Nottingham Health Profile and ability to distinguish between MS severity groups. There was no significant difference in U-FIS scores according to MS type.

Conclusion: It is valid to conceptualize the functional impact of fatigue as unidimensional. The U-FIS is a reliable and valid questionnaire that will allow the measurement of this construct in clinical studies.

Keywords

fatigue multiple sclerosis questionnaire Rasch analysis U-FIS unidimensional

Get full access to this article

View all access options for this article.

References

Multiple Sclerosis Society UK. Symptom management survey multiple sclerosis, UK: Multiple Sclerosis Society , 1997.

Freal JE , Kraft GH , Coryell JK Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 1984; 65: 135-138.

Multiple Sclerosis Council for Clinical Practice Guidelines. Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis, Washington DC: Paralyzed Veterans of America, 1998.

Krupp LB , Alvarez LA , LaRocca NG , Scheinberg LC Fatigue in multiple sclerosis. Arch Neurol 1988; 45: 435-437.

Fisk JD , Ritvo PG , Ross L. , Haase DA , Marrie TJ , Schlech WF Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis 1994; 18(Suppl. 1): S79-S83.

Diamond BJ , Johnson SK , Kaufman M. , Graves L. Relationships between information processing, depression, fatigue and cognition in multiple sclerosis. Arch Clin Neuropsychol 2008; 23: 189-199.

Bakshi R. , Shaikh ZA , Miletich RS , et al. Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler 2002 ; 6: 181-185.

Amato MP , Ponziani G. , Rossi F. , Liedl CL , Stefanile C. , Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler 2001; 7: 340-344.

Kos D. , Kerckhofs E. , Nagels G. , D’hooghe MB , Ilsbroukx S. Origin of fatigue in multiple sclerosis: review of the literature . Neurorehabil Neural Repair 2008; 22: 91-100.

10.

Mills RJ , Young CA A medical definition of fatigue in multiple sclerosis. QJM 2008; 101: 49-60.

11.

Aaronson LS , Teel CS , Cassmeyer V. , et al. Defining and measuring fatigue. Image J Nurs Sch 1999 ; 31: 45-50.

12.

Schwid SR , Covington M. , Segal BM , Goodman AD Fatigue in multiple sclerosis: current understanding and future directions . J Rehabil Res Dev 2002; 39: 211-224.

13.

Trojan DA , Arnold D. , Collet JP , et al. Fatigue in multiple sclerosis: association with disease-related, behavioural and psychosocial factors. Mult Scler 2007; 13: 985-995.

14.

Penner IK , Bechtel N. , Raselli C. , et al. Fatigue in multiple sclerosis: relation to depression, physical impairment, personality and action control. Mult Scler 2007; 13: 1161-1167.

15.

Mainero C. , Faroni J. , Gasperini C. , et al. Fatigue and magnetic resonance imaging activity in multiple sclerosis. J Neurol 1999; 246: 454-458.

16.

Zivadinov R. , Bakshi R. Central nervous system atrophy and clinical status in multiple sclerosis. J Neuroimaging 2004; 14(Suppl. 3): 27S-35S.

17.

Sheean GL , Murray NM , Rothwell JC , Miller DH , Thompson AJ An electrophysiological study of the mechanism of fatigue in multiple sclerosis . Brain 1997; 120(Pt 2): 299-315.

18.

Chipchase SY , Lincoln NB , Radford KA Measuring fatigue in people with multiple sclerosis. Disabil Rehabil 2003; 25: 778-784.

19.

Bailey A. , Channon S. , Beaumont JG The relationship between subjective fatigue and cognitive fatigue in advanced multiple sclerosis. Mult Scler 2007; 13: 73-80.

20.

Krupp LB , LaRocca NG , Muir-Nash J. , Steinberg AD The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-1123.

21.

Schwartz JE , Jandorf L. , Krupp LB The measurement of fatigue: a new instrument . J Psychosom Res 1993; 37: 753-762.

22.

Smets EM , Garssen B. , Bonke B. , De Haes JC The Multi dimensional Fatigue Inventory (MFI) psychometric qual ities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315-325.

23.

Mathiowetz V. Test-retest reliability and convergent validity of the Fatigue Impact Scale for persons with multiple sclerosis. Am J Occup Ther 2003; 57: 389-395.

24.

Mathiowetz VG , Finlayson ML , Matuska KM , Chen HY , Luo P. Randomized controlled trial of an energy conservation course for persons with multiple sclerosis . Mult Scler 2005; 11: 592-601.

25.

Cutter NC , Scott DD , Johnson JC , Whiteneck G. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil 2000 ; 81: 164-169.

26.

Marcellin F. , Preau M. , Ravaux I. , Dellamonica P. , Spire B. , Carrieri MP Self-reported fatigue and depressive symptoms as main indicators of the quality of life (QOL) of patients living with HIV and Hepatitis C: implications for clinical management and future research . HIV Clin Trials 2007; 8: 320-327.

27.

Theander K. , Cliffordson C. , Torstensson O. , Jakobsson P. , Unosson M. Fatigue Impact Scale: Its validation in patients with chronic obstructive pulmonary disease . Psychol Health Med 2007; 12: 470-484.

28.

Choi-Kwon S. , Han SW , Kwon SU , Kim JS Poststroke fatigue: characteristics and related factors. Cerebrovasc Dis 2005; 19: 84-90.

29.

Fisk JD , Brown MGB , Sketris IS , Metz LM , Murray TJ , Stadnyk K. Comparison of health utility measures for the evaluation of multiple sclerosis treatments. J Neurol Neurosurg Psychiatry 2005; 76: 58-63.

30.

Rasch G. Probabilistic Models for Some Intelligence and Attainment Tests. Copenhagen: Danish Institute for Educational Research ; 1960. (Expanded edition; Chicago: The University of Chicago Press; 1980).

31.

Tennant A. , McKenna SP , Hagell P. Application of Rasch analysis in the development and application of quality of life instruments. Value Health 2004; 7(Suppl. 1): S22-S26.

32.

Wright BD Comparing Rasch measurement and factor analysis. Struct Equation Model 1996; 3: 3-24.

33.

Waugh RF , Chapman ES

An analysis of dimensionality using factor analysis (true-score theory) and Rasch measurement: what is the difference? Which method is better?

J Appl Meas 2005; 6: 80-99.

34.

Pallant JF , Tennant A. An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS). Br J Clin Psychol 2007; 46: 1-18.

35.

Meads DM , Bentall RP Rasch analysis and item reduction of the Hypomanic Personality Scale . Pers Individ Dif 2008; 44: 1772-1783.

36.

Holland PW , Wainer H (eds). Differential Item Functioning. New Jersey: Lawrence Erlbaum Associates, 1993.

37.

Hunt SM , McKenna SP , McEwen J. , Williams J. , Papp E. The Nottingham Health Profile: subjective health status and medical consultations . Soc Sci Med [A] 1981; 15: 221-229.

38.

Zigmond AS , Snaith RP The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370.

39.

Chang CH , Cella D. , Clarke S. , Heinemann AW , Von Roenn JH , Harvey R.

Should symptoms be scaled for intensity, frequency, or both?

Palliat Support Care 2003; 1: 51-60.

40.

McGorry RW , Webster BS , Snook SH , Hsiang SM Accuracy of pain recall in chronic and recurrent low back pain. J Occup Rehabil 1999; 9: 169-178.

41.

Zifko UA Management of fatigue in patients with multiple sclerosis. Drugs 2004; 64: 1295-1304.

42.

Lai JS , Crane PK , Cella D. Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue. Qual Life Res 2006 ; 15: 1179-1190.

43.

Hagell P. , Höglund A. , Reimer J. , et al. Measuring fatigue in Parkinson’s disease: a psychometric study of two brief generic fatigue questionnaires. J Pain Symptom Manage 2006; 32: 420-432.

44.

Attarian HP , Brown KM , Duntley SP , Carter JD , Cross AH The Relationship of Sleep Disturbances and Fatigue in Multiple Sclerosis. Arch Neurol 2004; 61: 525-528.

45.

Chwastiak LA , Gibbons LE , Ehde DM , et al. Fatigue and psychiatric illness in a large community sample of persons with multiple sclerosis . J Psychosom Res 2005; 59: 291-298.

46.

Colosimo C. , Millefiorini E. , Grasso MG , et al. Fatigue in MS is associated with specific clinical features. Acta Neurol Scand 1995; 92: 353-355.

47.

Kroencke DC , Lynch SG , Denney DR Fatigue in multiple sclerosis: relationship to depression, disability, and disease pattern. Mult Scler 2000; 6: 131-136.

48.

Pittion-Vouyovitch S. , Debouverie M. , Guillemin F. , Vandenberghe N. , Anxionnat R. , Vespignani H. Fatigue in multiple sclerosis is related to disability, depression and quality of life . J Neurol Sci 2006; 243: 39-45.