Validity and reliability of the Traditional Chinese version of the Multidimensional Fatigue Inventory in general population

<div><p>Background</p><p>Fatigue is a common symptom in the general population and has a substantial effect on individuals’ quality of life. The Multidimensional Fatigue Inventory (MFI) has been widely used to quantify the impact of fatigue, but no Traditional Chinese translation has yet been validated. The goal of this study was to translate the MFI from English into Traditional Chinese (‘the MFI-TC’) and subsequently to examine its validity and reliability.</p><p>Methods</p><p>The study recruited a convenience sample of 123 people from various age groups in Taiwan. The MFI was examined using a two-step process: (1) translation and back-translation of the instrument; and (2) examination of construct validity, convergent validity, internal consistency, test-retest reliability, and measurement error. The validity and reliability of the MFI-TC were assessed by factor analysis, Spearman rho correlation coefficient, Cronbach’s alpha coefficient, intraclass correlation coefficient (ICC), minimal detectable change (MDC), and Bland-Altman analysis. All participants completed the Short-Form-36 Health Survey Taiwan Form (SF-36-T) and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) concurrently to test the convergent validity of the MFI-TC. Test-retest reliability was assessed by readministration of the MFI-TC after a 1-week interval.</p><p>Results</p><p>Factor analysis confirmed the four dimensions of fatigue: general/physical fatigue, reduced activity, reduced motivation, and mental fatigue. A four-factor model was extracted, combining general fatigue and physical fatigue as one factor. The results demonstrated moderate convergent validity when correlating fatigue (MFI-TC) with quality of life (SF-36-T) and sleep disturbances (PSQI) (Spearman's rho = 0.68 and 0.47, respectively). Cronbach’s alpha for the MFI-TC total scale and subscales ranged from 0.73 (mental fatigue subscale) to 0.92 (MFI-TC total scale). ICCs ranged from 0.85 (reduced motivation) to 0.94 (MFI-TC total scale), and the MDC ranged from 2.33 points (mental fatigue) to 9.5 points (MFI-TC total scale). The Bland-Altman analyses showed no significant systematic bias between the repeated assessments.</p><p>Conclusions</p><p>The results support the use of the Traditional Chinese version of the MFI as a comprehensive instrument for measuring specific aspects of fatigue. Clinicians and researchers should consider interpreting general fatigue and physical fatigue as one subscale when measuring fatigue in Traditional Chinese-speaking populations.</p></div

Reliability (internal consistency, test-retest, and measurement error) of the total score and four subscales of the MFI-TC in healthy adults (<i>n</i> = 123).

<p>Reliability (internal consistency, test-retest, and measurement error) of the total score and four subscales of the MFI-TC in healthy adults (<i>n</i> = 123).</p

Correlations between subscales and the total score of the MFI-TC.

<p>Correlations between subscales and the total score of the MFI-TC.</p

Correlations between fatigue, quality of life, and quality of sleep.

<p>Correlations between fatigue, quality of life, and quality of sleep.</p

Bland-Altman plot of the total fatigue score of the MFI-TC.

<p>The plot illustrates the agreement between time 1 and time 2 and identifies possible outliers. Each subject is represented on the graph by conveying the mean value of the 2 assessments (x-axis) and the difference between the 2 assessments (y-axis). The mean difference was the estimated bias, and the standard deviation (SD) of the differences measured the fluctuations around this mean (outliers being above 1.96 SD_diff). The reference lines show the mean difference between time 1 and time 2 (solid line), and the 95% limits of agreement for the mean difference (broken lines).</p

Characteristics of the participants (<i>n =</i> 123).

<p>Characteristics of the participants (<i>n =</i> 123).</p

Factor analysis of the MFI-TC.

<p>Factor analysis of the MFI-TC.</p

The effect of a single session of premotor cTBS600 on motor plasticity.

<p>A single session of premotor cTBS600 significantly reduced the motor plasticity produced by cTBS300 to M1 in healthy subjects (A). In contrast, a single session of premotor cTBS600 only produced marginal effect on motor plasticity in dystonic patients (B). Error bars refer to SEM.</p

Experimental design.

<p>In the main experiment (A), dystonic patients received premotor cTBS600 on five consecutive days. Rest motor threshold (RMT) was assessed at the beginning of the experiment on day 1 and day 5. The amplitude of MEPs, writing tests and SICI/ICF were recorded before and after premotor cTBS600 on day 1 and 5. Motor plasticity assessed by cTBS300 given to M1 was measured more than one week before or one month after the 5-day premotor cTBS600 and 2 hours after premotor cTBS600 on day 5. In a control study (B), only a single session of premotor cTBS600 was given to dystonic and healthy subjects. The amplitude of MEPs was recorded before and after premotor cTBS600. Motor plasticity was assessed more than one week before or one month after premotor cTBS600 and 2 hours after premotor cTBS600. Motor plasticity was assessed by the change in the size of MEP that is induced by cTBS300 given to M1 (C).</p

Demographic data of patients with focal hand dystonia.

<p>No.: the anonymised patient identification numbers in each of the two groups; *: the age at onset of years; #: denote the abnormal posture when writing showed jerky and tremulous dystonic movement; (x): dropped out; (o): hand writing tests only.</p><p>Oxa: oxcarbazepine; Tri: trihexyphenidyl; Clo: clonazepam; Top: topiramate; Cbz: carbamazepine; Pro: propranolol; Bez: benzodiazepam; Bac: baclofen.</p><p>BTX (botulinum toxin A injection): the timing of the last injection before the experiment is 6 month in R-8 and S-1 and >12 months in R-1, R-3, R-4, R-6, R7, R-9 and S-8.</p