Towards personalized assessment of fatigue perpetuating factors in patients with chronic fatigue syndrome using ecological momentary assessment:A pilot study

OBJECTIVE: This study aimed to explore the associations between cognitions, behaviours and affects and fatigue in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and their relation to reduction of fatigue after cognitive behaviour therapy (CBT). METHODS: In CFS/ME patients, 22 behaviours, cognitions and affects, potentially perpetuating fatigue were registered 5 times a day using ecological momentary assessment (EMA) and an actigraphy. Simultaneous Components Analysis (SCA) was used to identify components of perpetuation, that were tested for their associations with fatigue in multilevel vector autoregressive (VAR) modelling. Fatigue severity was measured pre- and posttreatment with the Checklist Individual Strength. The relationship between perpetuation (the strength and direction of the possible associations between fatigue and the components) and therapy outcome was investigated. RESULTS: 58 patients met inclusion criteria (m age = 36.5; 65.5% female) and data of 50 patients were analysed in the multilevel analysis. Two perpetuating components were found: "psychological discomfort" and "activity". For the total group, both perpetuating components did not predict fatigue on a following time-point. For individual patients the strength and direction of the associations varied. None of the associations between perpetuating components and fatigue significantly predicted treatment outcome. CONCLUSION: Results suggest that there is heterogeneity in perpetuation of fatigue in CFS/ME. Investigating fatigue and perpetuators on an individual rather than group level could lead to new insights

Short fatigue questionnaire: Screening for severe fatigue.

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Short fatigue questionnaire: Screening for severe fatigue.

Objective. To determine psychometric properties, a cut-off score for severe fatigue and normative data for the 4-item Short Fatigue Questionnaire (SFQ) derived from the multi-dimensional fatigue questionnaire Checklist Individual Strength (CIS). Methods. Data of previous studies investigating the prevalence of fatigue in ten chronic conditions (n = 2985) and the general population (n = 2288) was used to determine the internal consistency (Cronbach's alpha) of the SFQ, its relation with other fatigue measures (EORTC QLQ-30 fatigue subscale and digital fatigue diary), a cut-off score for severe fatigue (ROC analysis) and to examine whether the four SFQ items truly measure the same construct. Norms were calculated for ten patient groups and the Dutch general population. Results. Cronbach's alpha of the SFQ were excellent in almost all groups. Pearson's correlations between the SFQ and the EORTC-QLQ-C30 fatigue subscale and a fatigue diary were respectively 0.76 and 0.68. ROC analysis showed an area under the curve of 0.982 (95% CI: 0.979–0.985) and cut-off score of 18 was suggested which showed a good sensitivity (0.984) and specificity (0.826) as well as excellent values for the positive and negative prediction values within all groups using the CIS as golden standard. Factor analysis showed a one factor solution (Eigenvalue: 3.095) with factor loadings of all items on the factor being greater than 0.87. Conclusion. The SFQ is an easy to use, reliable and valid instrument to screen for severe fatigue in clinical routine and research