Validation study of the Japanese version of the brief fatigue inventory

Fatigue has been recognized as one of the most distressing symptoms in cancer patients. Concise assessment is essential to managing this symptom. To that end, the Brief Fatigue Inventory (BFI), a 9-item questionnaire, was designed to assess fatigue in cancer patients. The purpose of this study was to examine the validity and reliability of the Japanese version of this scale (BFI-J), when compared with previously validated fatigue instruments. We randomly selected 252 cancer patients and presented them with the BFI-J, along with the Cancer Fatigue Scale; Profile of Mood States fatigue, vigor, and depression subscales; and European Organization for Research and Treatment of Cancer QLQ-C30. Specifically, the reliability and construct, criterion, convergent, and discriminant validity of each instrument were evaluated. Additionally, fatigue severity classification was explored using the BFI-J. The results indicated that the BFI-J is a brief, valid, and feasible measure of fatigue for use with Japanese cancer patients.     

Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients

We herein describe the development and validation of the Cancer Fatigue Scale (CFS) for assessment of fatigue in cancer patients. We designed this scale specifically to reflect the nature of fatigue experienced by cancer patients, by using factor analysis; the CFS is a 15-item scale composed of 3 subscales (physical, affective, and cognitive subscales). Three hundred seven cancer patients participated in the validation phase. Construct validity, confirmed by repeating factor analysis, was good. Convergent validity, confirmed by a correlation between CFS and a visual analogue scale for fatigue, was also shown to be good (r = 0.67, P < 0.001). The CFS had good stability (average test-retest reliability r = 0.69, P < 0.001) and good internal consistency (Cronbach's alpha coefficient for all 15 items = 0.88). The present study indicates that the CFS is a brief, valid, and feasible measure of fatigue for use with cancer patients.     

Assessing cultural appropriateness of three translated cancer-related fatigue instruments

The purpose of this study was to evaluate the cultural appropriateness (ie, semantic equivalence, content equivalence, and conceptual equivalence) of 3 translated fatigue instruments (the Cancer Fatigue Scale, the Fatigue Symptom Inventory, and the Schwartz Cancer Fatigue Scale-revised) by using 2 phases: (a) establishment of semantic and content equivalencies by the rigorous process of translation and back-translation, and (b) evaluation of content equivalence and conceptual equivalence by testing on monolingual subjects with the translated fatigue scales and a questionnaire with fatigue terms list and open-ended questions. Convenience sampling was used to recruit subjects at a chemotherapy treatment center for outpatients in Taiwan. The results indicated that the content in the 3 scales were relevant to the experience of fatigue among Taiwanese from the view of patients, but only the fatigue domains in the Cancer Fatigue Scale-Chinese version was similar to the original construct based on the exploratory factor analysis. However, the results for examining the content equivalencies by the fatigue terms list showed that only 4 items in the list were used to describe fatigue by more than 50% of the patients. Therefore, the contents of the chosen scales might not represent the whole concept of fatigue in Taiwan. Exploration of the content and construct of fatigue in Taiwan and further testing of the translated scales are recommended. In addition, the result in this study is helpful for clinical nurses to understand expressions of fatigue in cancer patients within the Chinese culture but the meaning of fatigue still needs to be further explored.     

Development and psychometric testing of a Chinese version of the Fatigue Scale-Children in Taiwan

Aims. The aim of this study was to develop and evaluate the psychometric properties of a Chinese version of the Fatigue Scale-Children (FS-C-C). Background. Cancer-related fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients during and after their cancer treatment. A reliable and valid instrument to measure fatigue is essential to the successful clinical care of paediatric oncology patients in Taiwan who experience this troubling symptom. Design and methods. A total of 108 paediatric oncology Taiwanese patients who were aged 7–12 years participated in this cross-sectional, instrumentation study. The FS-C was translated into Chinese by using an established translation/back-translation method. The psychometric testing of the FS-C-C included internal consistency, content validity, construct validity, convergent validity, criterion-related validity and known-group validity. Results. The FS-C-C achieved an acceptable internal consistency coefficient. Content validity was moderately high (content validity indices ranged from 83–100%). Confirmatory factor analysis supported the three-factor model as an acceptable model fit (the goodness-of-fit index and adjusted goodness-of-fit index both were greater than 0·9; normed fit index, 0·89; root-mean-square residual, 0·15). Although the results did not support the known-group hypothesis, the convergent validity, concurrent validity and predictive validity of the FS-C-C were supported by significant associations with the PedsQL Multidimensional Fatigue Scale, the Anxious/Depressed subscale of the Child Behaviour Checklist and the generic and disease-specific scores on the Quality of Life for Children with Cancer instrument, respectively. Conclusion. Our newly developed FS-C-C is a reliable and valid instrument for the measurement of cancer-related fatigue intensity in Taiwanese children. Relevance to clinical practice. The FS-C-C could provide useful information to guide clinical practice in assessing and managing cancer-related fatigue in childhood cancer patients in Taiwan.     

I get tired for no reason: a single item screening for cancer-related fatigue.

This study examined the criterion validity and sensitivity and specificity of a single item to rapidly screen patients in ambulatory oncology clinics for cancer-related fatigue. In an effort to expand the utility of the Zung Self-Rating Depression Scale (ZSDS) as a screen for other symptoms, the utility of the single fatigue item was examined. The fatigue item reads "I get tired for no reason" and is rated on a four-point scale ranging from "none or a little of the time" to "most or all of the time." Fifty-two subjects were administered the Zung, the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale, and the Fatigue Symptom Inventory (FSI). The Zung item was highly correlated with the ZSDS (r= 0.63, p < 0.0001) and the FACT-An (r = -0.70, p < 0.0001), as well as to the individual items of the FSI, ranging from 0.41 (p < 0.003) to 0.71 (p < 0.0001). All 10 subjects considered to be depressed based on the ZSDS were also considered to fatigued on the FACT-An. Setting the ZSDS item cutoff point at level 3--"A good part of the time"--yielded a sensitivity of 78.95% and a specificity of 87.88%. It is concluded that a single item can be a fast and accurate way of screening cancer patients for fatigue to trigger additional follow-up, thus expanding the utility of a depression screening tool for problems other than the purely psychiatric.     

Validation of the Chinese version of Multidimensional Fatigue Inventory-20 in Chinese patients with cancer

Goals of work

The purpose of this research is to study the validation of the Chinese version of Multidimensional Fatigue Inventory-20 in measuring fatigue status of the patients with cancer in China.

Materials and methods

The original English version of the Multidimensional Fatigue Inventory-20 was translated into a Chinese version, which was applied to measure the fatigue status of cancer patients prior to commencing chemotherapy and during the last week of chemotherapy, respectively. The reliability and criterion-related validity of the Chinese version of the Multidimensional Fatigue Inventory-20 were assessed by calculating Cronbach's α and Pearson correlation coefficients. The construct validity was analyzed by employing factor analysis.

Main results

There were three dimensions in the Chinese version of the MFI-20, which measures the physical, mental, and spiritual fatigue of patients with cancer. All of the correlation coefficients between EORTC QLQ-C30V3.0 and MFI-20 were statistically significant (P?α coefficient was more than 0.8 and 0.7 for total MFI-20 and for the three dimensions of the Chinese version of the MFI-20, respectively.

Conclusions

The Chinese version of the MFI-20 is a reliable and valid instrument to assess fatigue in Chinese patients with cancer.     

Assessing fatigue in persons with cancer: further validation of the Wu Cancer Fatigue Scale

Cancer-related fatigue (CRF) is a significant clinical symptom. Effective assessment of CRF attributes from the patients' perspective is essential. This study tested the psychometric properties of the Wu Cancer Fatigue Scale (WCFS). A total of 172 outpatients with breast cancer, who were at various stages and on various chemotherapy regimens, and were undergoing treatment at one of three cancer clinics in a Midwest metropolitan area, participated in this study. The participants were instructed to complete four instruments in the following order: the 16-item WCFS, Schwartz Cancer Fatigue Scale (SCFS), Geriatric Depression Scale (GDS), and Cancer-Related Fatigue Distress Scale (CRFDS). Structural equation modeling (LISREL 8.54) supported the one-factor measurement model with nine items remaining. Nonsignificant Satorra-Bentler Scaled Chi-square (27)=32.52, P=0.21, standardized root mean square residual=0.032, nonnormal fit index=0.97, comparative fit index=0.98, and incremental fit index=0.98 indicated a good model fit. Convergent validity with the SCFS was 0.78, concurrent validity with the GDS was 0.60, and predictive validity with the CRFDS was 0.73. Internal consistency reliability was alpha=0.91 for the nine-item scale. The revised WCFS is a reliable and valid instrument that aims to measure the subjective characteristics of CRF from the patients' perspective. It may prove useful in both clinical and research settings.     

Patient-related barriers to fatigue communication: initial validation of the fatigue management barriers questionnaire

Fatigue is a highly prevalent and distressing symptom of cancer and its treatment. However, cancer patients often fail to communicate with their oncologists about fatigue. In this study, we attempted to identify the patient-related barriers to communication about fatigue, as cited by patients. Two hundred patients were sampled across the Community Cancer Care, Inc. (CCC) network of Indiana using the Cancer Behavior Inventory-Brief scale (CBI-B), the Zung Self-Rating Depression Scale (ZSDS), the Functional Assessment of Cancer Inventory-Fatigue scale (FACT-F), and the Fatigue Management Barriers Questionnaire (FMBQ), a questionnaire devised by experts in the field of cancer-related fatigue. There were no significant correlations between the instrument scores and demographic variables. Scores on the instruments did not differ significantly based on whether the patient was from a rural or urban site. One hundred thirty-two patients (66%) reported that they had never spoken to their doctor about fatigue. The most frequently reported reasons for this lack of patient communication about fatigue included the doctor's failure to offer interventions (47%), patients' lack of awareness of effective treatments for fatigue (43%), a desire on the patient's part to treat fatigue without medications (40%), and not wanting to complain to the doctor (28%). Patients reported that medical staff offered a mean of 11.63 recommendations for dealing with fatigue. The FMBQ was found to correlate significantly with self-efficacy (CBI-B, r = -0.20, P < 0.01) and correlate weakly with the number of recommendations made (r = -0.15, P < 0.05). The FMBQ was noted to have acceptable internal consistency (alpha = 0.88) and validity and may prove to be a useful instrument for understanding why patients do not communicate about fatigue. Multiple barriers contribute to why cancer patients do not comment about fatigue but may be overcome if physicians screen and assess for this symptom.     

中文版多维疲乏目录应用于脑卒中患者的信度和效度验证

目的 验证中文版多维疲乏目录（Multidimensional Fatigue Inventory ,MFI-20）应用于脑卒中患者的信度和效度。方法 2019年4月至2020年1月,以收治于上海市2所康复医院的374例脑卒中住院患者作为调查对象,采用自行编制的一般资料调查表、苗雨等修订的中文版MFI-20及中文版疲劳严重程度量表（Fatigue Severity Scale,FSS）对患者进行调查。采用项目分析、相关分析及因子分析等方法对量表的信效度进行检验。结果 MFI-20量表量表总体的Cronbach’s α为0.815,各因子的内部一致性系数为0.714~0.862;共提取出6个公因子,分别为：动力下降、注意力疲劳、躯体性疲劳、活动减少、总体疲劳及精力不足,可累计解释总方差的68.21%。以疲劳严重度量表作为校标,MFI-20与其得分的相关关系数为0.580（P<0.01）。结论 中文版MFI-20用于脑卒中患者具有良好的信度和效度,可较好反应患者的脑卒中后疲劳程度。     

多维疲劳量表应用于肿瘤患者的信度和效度验证

目的 评价多维疲劳量表的信效度.方法 将多维疲劳量表(MFI-20)译成中文版,通过174例肿瘤患者进行信效度测量.结果 量表含3个公因子共20个条目,为心理疲劳、躯体疲劳、精神疲劳,共解释总方差的56.21％;疲劳量表总得分与生命质量量表总得分的相关系数为-0.647;整体量表内部一致性为0.867,公因子的内部一致性分别为0.755、0.782、0.613.结论 MFI-20具有很好的效度及高度的内在一致性.     

Brazilian Version of Cancer Fatigue Scale: Validation of the Brazilian Version of Cancer Fatigue Scale in Patients With Breast Cancer

ContextScales to assess the fatigue in patients with cancer may help the clinical decision-making process.ObjectivesThe objective of this study was to cross-culturally adapt and determine the validity of the Brazilian version of Cancer Fatigue Scale.MethodsTranslation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred fifty-one women with breast cancer participated in the validity phase and they filled out the Brazilian version of another instruments (Piper Fatigue Scale Revised, Beck Depression Inventory, Verbal Numerical Rating Scale, and Karnofsky Performance Scale). The measurement properties of reliability, internal consistency, and validity were measured.ResultsThe few discrepancies identified in the back-translation were solved by consensus, and the Cancer Fatigue Scale was successfully translated and cross-culturally adapted. The Brazilian version of Cancer Fatigue Scale showed good stability (test-retest reliability intraclass correlation coefficient = 0.95, 95% CI = 0.94–0.97 and interexaminer reliability intraclass correlation coefficient = 0.98, 95% CI = 0.97–0.99) and good internal consistency (Cronbach's alpha >0.70 for the three subscales/domains). The high correlation was found with Piper Fatigue Scale (r = 0.643) and Beck Depression Inventory (r = 0.509) in terms of validity. However, a reasonable correlation was found with Verbal Numerical Rating Scale (r = 0.302) and Karnofsky Performance Scale (r = −0.324).ConclusionHere, we validated the Cancer Fatigue Scale in breast cancer Brazilian women meaning its use for the identification and evaluation of cancer-related fatigue in patients with breast cancer.     

The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures

Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980–2007. Criteria for judging the “ideal” measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.     

Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients

This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.     

The Fatigue Symptom Inventory: a systematic review of its psychometric properties

Purpose  

Fatigue is one of the most common symptoms experienced by persons with chronic illness, including cancer. The effective management of fatigue hinges in part on the accuracy and reliability of its measurement. The purpose of this study was to review and characterize the use of the 14-item Fatigue Symptom Inventory (FSI) in published studies and to evaluate the available evidence for its psychometric properties.     

Validation study of the Chinese version of the Brief Fatigue Inventory (BFI-C)

A cross-sectional study was conducted among 249 Chinese cancer patients with multiple diagnoses to validate a Chinese version of the Brief Fatigue Inventory (BFI-C). Cronbach's coefficient alpha was 0.92 for fatigue severity items and 0.90 for fatigue interference items. Construct validity was explored by principal factor analysis and suggested a two-factor solution: fatigue severity and fatigue interference. Internal consistency reliability was excellent. Convergent validity was examined by correlating the BFI-C with 2 subscales and 2 component scores of the MOS 36-Item Short-Form Health Survey (coefficients ranged between -0.44 and -0.71, P<0.001). Known-group validity was examined by comparing fatigue severity in patients having different scores on the Eastern Cooperative Oncology Group Performance Status Scale. Approximately 60% of patients experienced moderate to severe fatigue (4 or greater on the 0-10 scale of the BFI-C "fatigue worst" item). The BFI-C is a valid, reliable instrument to measure the severity and impact of cancer-related fatigue among Chinese patients.     

Comparison of SF-36 vitality scale and Fatigue Symptom Inventory in assessing cancer-related fatigue

Purpose  

Cancer-related fatigue (CRF) is an important symptom in clinical practice and research. The best way to measure it, however, remains unsettled. The SF-36 vitality scale, a general measure of energy/fatigue, is a frequently cited measure. With only four items, however, its ability to adequately represent multiple CRF facets has been questioned. The 13-item Fatigue Symptom Inventory (FSI) was developed to assess multidimensional aspects of CRF. Our objectives were to assess the convergent validity and to compare the sensitivity to change of the two scales.     

正念干预对乳腺癌患者癌因性疲乏干预效果的Meta分析

目的：系统评价正念干预对乳腺癌患者癌因性疲乏干预效果。方法：在Web of Science、PubMed、Cochrane Library、Embase、中国生物医学文献数据库(CBM)、维普、万方和中国知网(CNKI)数据库中检索乳腺癌患者正念干预癌因性疲乏的相关随机对照试验。主要结局指标是癌因性疲乏量表。根据最终文献筛选结果依据Cochrane手册质量评价,由综述管理器软件(RevMan,版本5.4)进行Meta分析。结果 文献检索确定了8篇文献,包括1042名受试者。Meta分析结果表明,实施正念干预后,干预组患者的癌因性疲乏水平低于对照组［均数差(MD)=-0.91,95%CI(-1.33,-0.49),P＜0.0001］。结论: 现有证据表明,基于①癌因性疲乏量表(CFS)②Piper疲乏修订量表(PFS-R)③疲乏症状量表(FSI)为研究工具相关文献中正念干预有助于改善乳腺癌患者的癌因性疲乏。     

Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool

The objective was to validate the use of the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria for fatigue (P-ICD10) through comparison with the Functional Assessment of Cancer Therapy Fatigue (FACT-F) subscale and three visual analogue scale (VAS) qualities in cancer patients thought to be fatigued. Fatigue was assessed in 834 cancer patients at three clinical centres in Belgium, using P-ICD10, FACT-F, and VAS to assess: level of energy (VAS1), quality of life (VAS2), and ability to perform daily activities (VAS3). Of the 834 interviewed cancer patients, 54% were classified as fatigued by the P-ICD10 criteria. Internal consistency of P-ICD10 was very good (alpha coefficient 0.82). The principal component analysis corroborated good internal consistency with all variables included in the first component; a second component was used to identify psychological fatigue (concentration and short-term memory disabilities). An abridged set of screening tools based on the first three general symptoms of the P-ICD10 is proposed with 100% specificity and 86% specificity, respectively. There was a marked decrease in FACT-F and VAS1 scores in patients diagnosed as fatigued by the P-ICD10 (mean±SD, FACT-F 20±9 vs 39±8, VAS1 34±21 vs 61±21). A logistic regression model between P-ICD10 criteria diagnosis and FACT-F (VAS1) identified a score of 34 (61) on the FACT-F scale as a proposed cut-off point for the diagnosis of fatigue. The ICD-10 criteria can be recommended as a diagnostic tool, whereas the FACT-F scale and the level of energy 100-mm VAS assess the intensity of fatigue, and are more suitable for follow-up of cancer-related fatigue.Professor Evers passed away suddenly. The authors will always remember his enthusiastic collaboration, wise counsel, and powerful vision.This work was supported by an unrestricted grant from Janssen-Cilag Belgium.     

Applicability,validity, and reliability of the Piper Fatigue Scale in postpolio patients

OBJECTIVE: To identify a scale that is potentially applicable for measuring the fatigue in postpolio patients and to evaluate its validity and reliability in this population. DESIGN: Interview survey of 64 individuals with postpolio syndrome and 25 healthy controls of similar age range, with retest in a subset of postpolio patients. The sample was recruited from a postpolio support group, a postpolio clinic, and the general community. Subjects completed the Piper Fatigue Scale, the Beck Depression Inventory, and the Chalder Fatigue Questionnaire during the interview. RESULTS: Face and content validity of the Piper Fatigue Scale was established by a team of experts and by a group of postpolio patients. The postpolio subjects had significantly higher Piper Fatigue Scale scores than the healthy control subjects (P < 0.001), demonstrating extreme groups validity. Convergent validity was shown with a strong positive correlation between Piper Fatigue Scale scores and Chalder Fatigue Questionnaire scores (r = 0.80). Reliability was also demonstrated with the Piper Fatigue Scale's high internal consistency (alpha = 0.98) and strong test-retest agreement (intraclass correlation coefficient = 0.98). CONCLUSIONS: The Piper Fatigue Scale is a valid and reliable tool for measuring postpolio fatigue. This scale may be useful in other studies of postpolio fatigue, including those gauging the effectiveness of various treatments for this fatigue.