A cross-cultural perspective on psychological determinants of chronic fatigue syndrome: A comparison between a portuguese and a dutch patient sample

Background Few studies focus on cross-cultural differences in Chronic fatigue syndrome (CFS). Purpose This study aimed to (1) compare fatigue severity and impairment, somatic complaints, psychological distress, and quality of life (QoL) in a population of Portuguese and Dutch patients; (2) explore the differential contribution of behavioral and cognitive determinants of fatigue severity; and (3) investigate the relation between fatigue severity and somatic complaints on one hand and QoL on the other in both populations. Method Eighty-five female patients from Portugal (Mean age0 47.54) and 167 female CFS patients from The Netherlands (Mean age044.93) participated in the study. All participants were surveyed for demographic and clinical characteristics, fatigue severity, somatic symptoms, psychological distress, (physical and psychological) QoL, physical activity, behavior regulation patterns, and illness representations. Results Cross-cultural differences were found in relation to working status, duration of fatigue symptoms, psychological distress, somatic complaints, and psychological QoL. Although behavioral characteristics and illness representations were significantly associated with fatigue severity in both Portuguese and Dutch patients, there were important differences in the determinants of CFS. Moreover, higher levels of fatigue and severity of other somatic complaints were related to poor QoL. Conclusions These findings show cross-cultural similarities and differences in clinical characteristics and psychological determinants of CFS that are important in view of diagnosis and treatment

Public transport policy in the Netherlands

Dutch public transport as a part of transport policy.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue

<p>Abstract</p> <p>Background</p> <p>Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program.</p> <p>Methods/Design</p> <p>This is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity.</p> <p>Discussion</p> <p>The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.anzctr.org.au/ISRCTN70763996.aspx">ISRCTN70763996</a></p

Illness perceptions mediate the relationship between bowel symptom severity and health-related quality of life in IBS patients

PURPOSE: Irritable bowel syndrome (IBS) is a functional bowel disorder with a large negative impact on HRQOL. The present study examines whether severity of bowel symptoms is directly related to HRQOL, and/or indirectly, mediated by the patients’ illness perceptions. METHODS: Patients were recruited from an IBS support group (N = 123), and data were collected online. HRQOL was measured with the Quality of Life Measure for Persons with IBS and illness perceptions with the brief Illness Perception Questionnaire. Mediation models were tested using the bootstrapping procedure developed by Hayes. RESULTS: Irritable bowel syndrome symptom severity is directly related to total HRQOL and its subscales; after entering the mediator variables (i.e. the patients’ illness perceptions) into the model, this direct association remained only significant for total HRQOL. The relationship between bowel symptom severity and total HRQOL was partially mediated by illness perceptions, and its relationship with each of the HRQOL subscales was fully mediated by the patients’ illness perceptions. Perceived consequences were a mediator of the relationship between bowel symptom severity, total HRQOL as well as its subscales, with the exception of Sexuality. CONCLUSIONS: Bowel symptom severity not only has a direct relationship with HRQOL, but also an indirect relationship via the patients’ cognitive and emotional representations of their illness. In order to better understand this relationship, future research should not only include illness perceptions but also assess cognitive and behavioural coping responses. Clinicians wanting to improve patients’ HRQOL should not only focus on the patients’ symptoms, but also on their illness beliefs and coping responses

Is the MacNew quality of life questionnaire a useful diagnostic and evaluation instrument for cardiac rehabilitation?

Purpose The MacNew health-related quality of life questionnaire is internationally used as a standard for psychosocial assessment in many cardiac rehabilitation centres. This study investigates its discriminating capacity between diagnostic disease categories, sex and age at entry (T1) and at the end (T2) of cardiac rehabilitation as well as the responsiveness of the MacNew during this period. Method Data were used from 6749 cardiac rehabilitation patients at T1 and 1654 at T2. Results Results show that the global MacNew as well as the three (physical, emotional, social) subscales have high internal consistencies, and differentiate well and in the expected direction at T1 between diagnostic groups (heart surgery, myocardial infarction with and without percutaneous coronary intervention, stable angina with and without percutaneous coronary intervention, implantable cardioverter defibrillator, and heart failure patients), sex and age. The MacNew also proves to be an adequate evaluation instrument for cardiac rehabilitation, as all scales are responsive enough to capture changes from T1 to T2. At T2, however, the MacNew seems to lose some of its discriminating power, partly because of ceiling effects. Conclusion It is suggested to complement the use of the MacNew both at T1 and T2 with a brief anxiety and depression measure, which is valid and responsive for different groups of cardiac rehabilitation patients. EurJ Cardiovasc Prev Rehabil 15:516-520) (C) 2008 The European Society of Cardiolog

Efficacy of a randomized controlled self-regulation based physical activity intervention for chronic fatigue: Mediation effects of physical activity progress and self-regulation skills

Dados suplementares referentes a este artigo podem ser encontrados online em: http://dx.doi.org/10.1016/j.jpsychores.2016.12.012.Objective: Examine the medium-term effects of a brief physical activity (PA) self-regulation (SR) based intervention (4-STEPS program) for chronic fatigue, and explore the mediating effects of PA related variables and SR skills. Methods: A two-arm randomized controlled trial (Usual Care vs 4-STEPS) was carried out. The 4-STEPS program consisted of Motivational Interviewing and SR-skills training. Fatigue severity (primary outcome) and impact, PA, health-related quality of life (HrQoL), and somatic and psychological distress were assessed at baseline, post-treatment (12 weeks) and 12 months follow-up. Results: Ninety-one patients (45 intervention and 46 controls) were included. At follow-up, there were significant treatment effects on fatigue severity (g = 0.72) and fatigue impact, leisure-time PA, and physical and psychological HrQoL. No significant effects were found for number of daily steps and somatic and psychological distress. Fatigue severity at follow-up was partially mediated by post-treatment progress on a personal PA goal (effect ratio = 18%). Conclusion: Results suggest that a brief intervention, focusing on the formulation and pursuit of personal PA goals and the use of SR skills, produces sustained benefits for fatigue severity. Despite these promising results, dropout was high and the intervention was not beneficial for all secondary outcomes.Fundação para a Ciência e a Tecnologia (FCT)info:eu-repo/semantics/publishedVersio

Effects of a self-regulation based physical activity program (the “4-STEPS”) for unexplained chronic fatigue : A randomized gontrolled trial

Background: This study aimed at assessing the effects of a self-regulation-based brief physical activity program for patients suffering from unexplained chronic fatigue, the “4- STEPS to control your fatigue program”. Method: A 12-week randomized controlled trial was conducted. Adult patients meeting the CDC criteria for idiopathic chronic fatigue were randomized to either the control condition (standard care) or the intervention condition (4-STEPS). The 4-STEPS was based on self-regulation principles and consisted of motivational interviewing and self-regulation skills training. All patients were assessed at baseline and post-treatment (12 weeks) for fatigue severity (primary outcome) and impact, physical activity (leisure time physical activity, number of daily steps and personal activity goal progress), health-related quality of life, somatic distress and psychological distress (depression and anxiety). Results Ninety-one patients (45 intervention and 46 control patients) received the allocated intervention. At post-treatment, statistical analysis revealed a significant difference for subjective experience of fatigue (4.73 points; g=0.51) in favour of the intervention group. Mixed design ANCOVAs showed a significant effect of the 4-STEPS on fatigue severity, leisure time physical activity, personal activity goal progress and healthrelated quality of life. No significant effects were found for number of daily steps and somatic and psychological distress. Conclusion: The 4-STEPS program has significant beneficial effects at post-treatment. This brief self-regulation-based intervention looks promising for the management of unexplained chronic fatigue.Fundação para a Ciência e Tecnologia (FCT

Psychometric Properties of the Portuguese Version of the Treatment Self-Regulation Questionnaire for Physical Activity (TSRQ - PA)

Aim: The aim of the present study was to analyze the reliability and factorial validity of the Portuguese Version of the Treatment Self-Regulation Questionnaire for physical activity (TSRQ-PA). Method: In this study, 148 healthy adults (Mean age = 44.70, 96.6% women) and 89 chronic fatigue patients (Mean age = 47.39, 97.8% women) filled out questionnaires related to behaviour regulation style (TSRQ – PA) and physical activity. Results: The confirmatory factor analysis adjustment indices of a two-factor structure (Autonomous Regulation scale and Controlled Regulation scale) of the TSRQ-PA were satisfactory and internal consistency estimates were acceptable for both factors. A higher degree of autonomous behaviour regulation was significantly associated with higher levels of physical activity. Conclusion: These findings provide support for the validity and reliability of the TSRQ – PA for measuring behaviour regulation style for engaging in physical activity, in different settings

Low Goal Ownership Predicts Drop-out from a Weight Intervention Study in Overweight Patients with Type 2 Diabetes

# The Author(s) 2009. This article is published with open access at Springerlink.com Background Drop-out is a major problem in weight loss studies. Although previous attrition research has examined some predictors of drop-out, theoretically grounded research on psychological predictors of drop-out from weight interventions has been lacking. Purpose To examine psychological predictors of drop-out from a weight reduction study in diabetes type 2 patients. Method A clinical trial was conducted with 101 overweight/ obese (body mass index&gt;27) diabetes type 2 patients. Patients were randomly assigned to a self-regulation intervention, an active control group, and a passive control group. Psychological, somatic, socio-demographic, and lifestyle variables were examined as predictors of drop-out from baseline to 6monthsfollow-up. Results Multiple logistic regression analysis indicated that low autonomous regulation or low ‘goal ownership ’ was the best predictor of drop-out. Conclusion It is suggested that the assessment of ‘goal ownership ’ prior to a weight reduction intervention could identify patients who are sufficiently motivated to participate. Patients who score low on ‘goal ownership ’ may be offered pretreatment interventions to increase their motivation