Motor,behavioural, and cognitive correlates of fatigue in early,de novo Parkinson disease patients

IntroductionFatigue is one of the most common and disabling non-motor symptoms in Parkinson's disease (PD). The objective of this study was to determine prevalence and motor, behavioural, and cognitive correlates of distressing fatigue in early, de novo PD patients.MethodsEighty-one consecutive de novo PD patients (64% men; mean age 65.73 ± 8.26 years) underwent a comprehensive examination, including Parkinson's disease Fatigue Scale (PFS), Epworth Sleepiness Scale (ESS), Parkinson's Disease Sleep Scale (PDSS), Beck Depression Inventory (BDI), Parkinson's Anxiety Scale (PAS), and Apathy Evaluation Scale (AES). Moreover, all patients underwent a detailed neuropsychological evaluation exploring attention and working memory, executive functions, memory, visuospatial abilities and language. Score of patients with or without distressing fatigue (defined as a PFS score ≥ 8) were compared by Student's t-test or Pearson's chi-square test. Logistic regression analyses were performed to search for motor and non-motor features independently associated with presence of distressing fatigue.ResultsTwelve (15%) patients presented distressing fatigue. Logistic regression identified sleepiness (p = 0.04), “episodic anxiety” subscale of PAS (p = 0.005), and “cognitive apathy” subscale of AES (p = 0.017) as the main factors associated with distressing fatigue. No significant association was found between diagnosis of Mild Cognitive Impairment and distressing fatigue (p = 0.745).ConclusionIn a sample of consecutive de novo PD patients, distressing fatigue is associated with episodic anxiety, cognitive apathy and sleepiness, but not with cognitive impairment. Our findings suggest possible shared pathogenic mechanisms underlying these non-motor symptoms and foster development of early combined therapeutic approaches.     

Validation of the Flinders Fatigue Scale as a measure of daytime fatigue

Study objectivesTo clinically validate the Flinders Fatigue Scale (FFS) as a brief measure of daytime fatigue, and to derive cut-off scores to classify fatigue severity.MethodThe FFS was administered to 439 adult volunteers from the general population, 292 adults with insomnia, 132 adults with Obstructive Sleep Apnoea (OSA) and 66 adults with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), together with the Fatigue Severity Scale (FSS) and the Epworth Sleepiness Scale (ESS).ResultsA factor analysis revealed a single factor solution for the seven-item scale (67% of total variance), although a better fit was obtained for a modified six-item version (75% of total variance). Group FFS scores varied in accordance with theorised fatigue levels, with CFS/ME and insomnia samples reporting significantly higher fatigue than OSA and volunteer samples. Good convergent validity was established with the FSS for volunteer (r = 0.67) and CFS/ME samples (r = 0.61). Excellent discriminant validity with the ESS was observed for the insomnia (r = −0.08) and CFS/ME groups (r = 0.03), while a small-to-moderate correlation was found within the volunteer sample (r = 0.29). Cut-off scores were identified to categorise borderline (13–15), moderate (16–20) and severe (≥21) fatigue.ConclusionsThe FFS is a reliable and valid instrument to quantify subjective daytime fatigue. Sensitivity and specificity analyses indicate scores that best discriminate insomniacs and CFS/ME populations from a non-clinical population. However, it is proposed that the data can also be used to indicate the severity of fatigue by reference to these first two groups.     

阻塞性睡眠呼吸暂停低通气综合征对 职业人群工作状态的影响

摘要：目的通过对比病例组与对照组白日嗜睡、疲劳和工作倦怠的得分,研究阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）对白日嗜睡、疲劳和工作倦怠的影响,探讨OSAHS患者个体特征、PSG相关结果与嗜睡、疲劳及工作倦怠程度的关系。方法选取2016 年3月~2016 年12月在四川大学华西第四医院睡眠中心就诊并经多导睡眠监测确诊的63例OSAHS患者作为病例组,同期从本院体检中心中选73例不打鼾的健康人群作为对照组,应用Epworth嗜睡量表(ESS)、疲劳量表 14（fatigue scale,FS 14）、Maslach工作倦怠问卷对两组患者进行评估,采用独立样本t检验比较组间差异,并采用多元线性回归分析进行多因素分析。结果病例组和对照组在ESS得分、FS 14脑力疲劳、FS 14体力疲劳、工作倦怠中的情绪衰竭得分有明显差异,在工作倦怠中的情感疏远、个体成就感得分没有差异。OSAHS患者的情绪衰竭的回归分析发现,OSAHS患者的情绪衰竭受学历、职业、躯体疲劳、BMI、MAI的影响。结论OSAHS对白日嗜睡和疲劳能产生影响,而OSAHS对工作倦怠的影响还需要进一步的研究证实,防治工作倦怠,不仅要针对OSAHS进行治疗,还要考虑疲劳的影响。     

The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial

Background

Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential.

Objectives

The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients.

Design

A quasi-experimental clinical trial.

Setting

Two hemodialysis units in a medical center in northern Taiwan.

Method

The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks.

Result

Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects.

Conclusions

Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation.

Implication for nursing practice

Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.     

Symptom experience in patients with primary brain tumours: A longitudinal exploratory study

PurposeThis study was undertaken to further understand the symptom experience and the impact of symptoms in daily life in people treated for brain tumours.MethodsA qualitative prospective longitudinal design was used with 9 people who were interviewed over 4 time points (soon after diagnosis, 3 months, 6 months and 12-months post-diagnosis), providing 21 interviews in total.ResultsKey issues for these participants were ongoing fatigue, memory loss and inability to drive. Fatalistic views about the outcomes of their disease were the norm. Participants made adjustments to their lives to accommodate their functional limitations. These included making home alterations, introducing regular exercise to their lives and using complementary therapies. Their expectations did not always match with the reality of the situation, which made several participants angry and dissatisfied with health care professionals.ConclusionsIssues of quality of life are paramount in this group of poor prognosis patients, therefore, health professionals should provide preparatory information to patients on what to expect from the illness and its treatments. Health professionals should also assist patients to manage debilitating symptoms such as fatigue and cognitive impairment.     

护士疲劳状况与领悟社会支持的调查分析

目的 通过对护士疲劳状况与领悟社会支持的调查,了解护士疲劳状况及所获领悟社会支持程度的现状,并对影响因素做初步的回归分析,为进一步预防护士慢性疲劳的发生提供参考.方法 采用疲劳评定量表(FAI)、疲劳量表(FS-14)和领悟社会支持量表(PSSS)对济宁市的200名女性护士进行问卷调查,收回有效问卷191份,有效回收率为95.5%,对所得结果进行统计分析.结果 护士中有疲劳者占69.11%,有疲劳的护士较无疲劳者4因子得分均显著提高;护士的躯体疲劳、脑力疲劳程度均大于一般健康人群;护士所获社会支持得分较高;对年龄、工作时间等各因素进行回归分析后显示:工作紧张程度、脑力疲劳、体力疲劳等显著加剧了疲劳严重程度.结论 护士为疲劳的高危人群,其中工作紧张程度为主要的影响因素;对护士进行社会支持与关怀,及保证充足的睡眠,增加护士人数,良好的工作环境等能有效减轻疲劳状况.     

Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS)

STUDY OBJECTIVE: To examine the prevalence of and risk factors for fatigue and sleep disturbance among adult survivors of childhood cancer. DESIGN: Retrospective cohort of childhood cancer survivors. SETTING: Twenty-six academic institutions treating childhood cancer. PARTICIPANTS: Two thousand six hundred forty-five survivors of childhood acute lymphocytic leukemia, central nervous system tumors, Hodgkin lymphoma, soft-tissue sarcomas, or bone tumors diagnosed before age 21, surviving at least 5 years from diagnosis, and a 500-sibling comparison group. MEASUREMENTS: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale. RESULTS: Significant differences were found between survivors and siblings on the Functional Assessment of Chronic Illness Therapy-Fatigue (40.8 vs 42.0, P < 0.02), Pittsburgh Sleep Quality Index (6.1 vs 5.5, P < 0.004), and Epworth Sleepiness Scale (6.2 vs 5.4, P < 0.001). Nineteen percent of survivors were in the most fatigued range, 16.7% reported disrupted sleep, and 14% increased daytime sleepiness. Survivors with a history of radiation therapy were more likely to be fatigued (odds ratio 1.7, 95% confidence interval 1.3-2.3), yet without significantly different mean scores. Female sex, congestive heart failure, pulmonary fibrosis, depression, and being unmarried significantly predicted more fatigue, whereas obesity and an infant in the house predicted more daytime sleepiness. Similar sociodemographic predictors were also identified among the siblings. CONCLUSION: Because of the large sample size, we detected more objectively reported fatigue, sleep disturbance, and daytime sleepiness among adult survivors of childhood cancer. However, the clinical significance of these differences is questionable. Predictors of fatigue and poor sleep were similar in both survivors and the siblings.     

Validation of the Fatigue Severity Scale in a Swiss Cohort

Background:

Fatigue is highly prevalent and has a negative impact on quality of life and performance in a variety of disorders. The 9-item Fatigue Severity Scale (FSS) is one of the most commonly used self-report questionnaires to measure fatigue, but has only been validated in small sample-sized studies and in single disorders.

Objective:

To validate the FSS in healthy subjects and different disorders known to be commonly associated with fatigue.

Material and Methods:

The FSS was administered to 454 healthy subjects, 188 patients with multiple sclerosis (MS), 235 patients with recent ischemic stroke, and 429 patients with sleep-wake disorders including narcolepsy with cataplexy (n = 22), restless legs syndrome (RLS) (n = 79), sleep apnea (n = 108), insomnia (n = 62), parasomnia (n = 25), excessive daytime sleepiness/hypersomnia of other origin (n = 84), and other sleep-wake disorders (n = 49).

Results:

FSS scores were 4.66 ± 1.64 (mean ± SD) in patients with MS, 3.90 ± 1.85 in patients after ischemic stroke, and 4.34 ± 1.64 in patients with sleep-wake disorders. Compared to patients, values were significantly lower in healthy subjects (3.00 ± 1.08, P < 0.01). Scores did not correlate with gender, age, or education. Item analysis showed an excellent internal consistency and reliability (Cronbach α = 0.93). Test-retest variability was assessed in 104 healthy subjects, showing stable values over time (2.94 ± 0.90 vs. 2.90 ± 0.74; P = 0.27).

Conclusions:

This first validation of a fatigue scale in a large sample size demonstrates that the FSS is a simple and reliable instrument to assess and quantify fatigue for clinical and research purposes.

Citation:

Valko PO; Bassetti CL; Bloch KE; Held U; Baumann CR. Validation of the fatigue severity scale in a swiss cohort. SLEEP 2008;31(11):1601–1607.     

Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients

OBJECTIVE: This study describes the experiences of fatigue and pain in incurable cancer patients and the treatment they receive. METHODS: Patients were recruited via medical specialists from hospitals in the South and Southwest of the Netherlands. Hundred and twenty-five incurable cancer patients filled out a written questionnaire and were also interviewed at home. RESULTS: Ninety percent reported to suffer from fatigue and 48% had pain. Forty-five percent had discussed fatigue with a healthcare professional and 55% had discussed pain. Fifteen percent reported to receive medical treatment for their fatigue and 29% received pain treatment. Treatment for fatigue and pain treatment had been recently adjusted in 4% of the patients with fatigue complaints and 21% of the patients with pain complaints. CONCLUSION: Although fatigue is a more common problem than pain in patients with incurable cancer, less attention in the care is paid to fatigue and its treatment than to pain. PRACTICE IMPLICATIONS: Fatigue deserves more attention in the care policy for incurable cancer patients and more research should be focused on interventions to address fatigue in this group of cancer patients.