Self-report assessment of fatigue in multiple sclerosis: a critical evaluation

SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.status: publishe

A rapid screening tool for fatigue impact in multiple sclerosis

© 2006 Kos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Assessing life balance of European people with multiple sclerosis: A multicenter clinimetric study within the RIMS network

Background: Life balance is defined as “a satisfying pattern of daily activity that is healthful, meaningful, and sustainable to an individual within the context of his or her current life circumstances”. To assess life balance, the self-report instrument Life Balance Inventory (LBI) has been developed in the US. The aim of this study was to evaluate cross-cultural, construct validity and test-retest reliability of translated versions of the LBI in people with multiple sclerosis (MS) within different European cultures (Dutch, Flemish, Slovenian, and Spanish). Method: The LBI was translated according to the principles of forward/backward translation and the cultural adaption process of patient-reported outcomes and evaluated in people with MS in each country/language area. LBI (score range 1–3; higher scores refer to better balance) was registered twice with an interval of 7 days to evaluate test-retest reliability using Intraclass Correlation Coefficients (ICCs) and Bland Altman analyses. To evaluate construct validity, Pearson correlations of the LBI with quality of life, fatigue, depression and self-efficacy were explored. Results: The total sample (n = 313, 50 ± 11 years of age, MS duration 13 ± 8 years) consisted of five subsamples: Dutch (n = 81, 74% women, 54 ± 9.6 years of age), Flemish 1 (n = 42, 57% women, 49 ± 12 years), Flemish 2 (n = 105, 63% women, 50 ± 10.6 years), Slovenian (n = 48, 79% women, 44 ± 11.2 years) and Spanish (n = 37, 62% women, 47 ± 9.0 years). Baseline total LBI scores differed between subsamples (F(4, 312)=7.19, p < 0.001). ICC [95% CI] of total LBI was 0.88 [0.83–0.92] (Flemish 2), 0.65 [0.39–0.82] (Flemish 1), 0.55 [0.37–0.69] (Dutch), 0.45 [0.15–0.67] (Spanish) and 0.35 [0.07–0.59] (Slovenian). Systematic error was present in one sample; no proportional bias occurred. Correlations ranged from 0.05 to 0.55 for quality of life and self-efficacy, from −0.50 to 0.05 for fatigue and from −0.44 to −0.28 for depression, not fully supporting the hypotheses. Conclusion: The study results provide limited support for test-retest reliability, cross-cultural and construct validity of the LBI in different European subsamples. Although LBI may serve as a supportive tool in goalsetting in rehabilitation, the current version of LBI is not recommended for (international) research purposes

The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial

Purpose to evaluate the effectiveness of an individual self-management occupational therapy intervention program (SMOoTh) versus relaxation on the performance of and satisfaction with relevant daily activities in individuals with multiple sclerosis (MS)-related fatigue. in a single-blind randomized-controlled trial, 31 patients with MS (SMOoTh: n=17, relaxation: n=14) were randomly allocated to three individual sessions focusing on pacing, prioritizing, ergonomics, and self-management (SMOoTh) or on stress management and relaxation (relaxation). Outcomes (blind assessor): Canadian Occupational Performance Measure (COPM) (primary), Modified Fatigue Impact Scale, Checklist Individual Strength and Short-Form Health Measure. COPM improved in the SMOoTh and relaxation group after the intervention and 3 months later (COPM performance: F=13.1, P=0.001 and COPM satisfaction: F=10.4, P=0.001); nonsignificant group differences showed a trend in favor of SMOoTh. Modified Fatigue Impact Scale, Checklist Individual Strength, and most of the Short-Form Health Measure subscales did not change. Clinically relevant changes in COPM performance scores were found in 71 and 27% of patients in the SMOoTh versus the relaxation group. Both interventions seem to be feasible approaches to improve performance of and satisfaction with relevant daily activities in people with MS, with a sustained effect after 3 months. Neither program altered change fatigue (impact) or quality of life. Future studies with larger sample sizes are needed.status: publishe

Life balance of European people with MS: RIMS multicenter psychometric study

Introduction: A balanced person is able to spread time (and energy) optimally across the different life domains. Especially in people with multiple sclerosis (MS) the ability to self-steer an optimal balance in daily activity may be compromised. Objective: To evaluate cross-cultural, construct validity and test-retest reliability, of the translated versions of the Life Balance Inventory (LBI) in people with MS within different European cultures (Danish, French, Spanish, Slovenian, Dutch and Flemish). Method: The LBI was translated according to the principles of translation and cultural adaption process of patient-reported outcomes and evaluated in people with MS in each country/language area. To evaluate construct validity, correlations of the LBI with quality of life, fatigue, depression and self-efficacy are explored. LBI (score range 1-3; higher scores refer to better balance) is registered twice to evaluate test-retest reliability. Results: Complete data collection will be finalized in April 2018. Preliminary results are available of the Dutch (n=81, 74% women, 55±9.6 years), Flemish (n=155, 60% women, 50±11.3 years) and Slovenian (n=48, 78% women, 44±11.2 years) samples. Total LBI scores of Flemish version (2.31 ± 0.4) differed significantly from Dutch version (2.47 ± 0.3) (p=0.02) and Slovenian version (2.47 ± 0.3) (p=0.001). ICC [95% CI] of total LBI was 0.90 [0.86 – 0.93] (Flemish), 0.71 [0.54-0.82] (Dutch) and 0.50 [0.08-0.73] (Slovenian). Correlations ranged from 0.178 to 0.487 in the total sample, not fully confirming a priori hypotheses. Conclusion: The Dutch, Slovenian and Flemish LBI show interesting results which will be further explored in the other languages to make conclusions about the usefulness of the LBI for clinical practice and international research.status: publishe

International research collaboration: case study of the European life balance project team

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