Assessment of Daily and Weekly Fatigue Among African American Cancer Survivors Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial. Psychometric testing of fatigue instruments for use with cancer patients. Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. Effects of Tai Chi Exercise on Cancer-Related Fatigue in Patients With Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy: A Randomized Controlled Trial. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. A randomized, placebo-controlled, double-blinded trial of duloxetine in the treatment of general fatigue in patients with chronic fatigue syndrome. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. A pilot study exploring the effects of a 12-week t'ai chi intervention on somatic symptoms of depression in patients with heart failure. Exactly what does the Hamilton Depression Rating Scale measure? Randomized phase III clinical trial of five different arms of treatment for patients with cancer cachexia: interim results. Assessing fibromyalgia-related fatigue: content validity and psychometric performance of the Fatigue Visual Analog Scale in adult patients with fibromyalgia. Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy. Impact of Different Exercise Programs on Severe Fatigue in Patients Undergoing Anticancer Treatment-A Randomized Controlled Trial. Improvement in multiple dimensions of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design. A six-month double-blind, placebo-controlled, randomized clinical trial of duloxetine for the treatment of fibromyalgia Validation of the Functional Assessment of Chronic Illness Therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis. Using Modafinil to Treat Fatigue in Parkinson Disease: A Double-Blind, Placebo-Controlled Pilot Study A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.
This investigation evaluates two common measures of cancer-related fatigue , one multidimensional/retrospective and one unidimensional/same day . Fifty-two African American survivors of diverse cancers completed  fatigue visual analogue scales once daily , and the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) once weekly , for four weeks . Zero-order correlations showed retrospective fatigue was significantly related to average , peak , and most recent same-day fatigue . Multilevel r and om coefficient modeling showed unidimensional fatigue shared the most variance with the MFSI-SF 's General subscale for three weeks , and with the Vigor subscale for one week . Research ers and clinicians may wish to prioritize multidimensional measures when assessing cancer-related fatigue , if appropriate In this paper the psychometric properties of the multidimensional fatigue inventory ( MFI-20 ) are established further in cancer patients . The MFI is a 20-item self-report instrument design ed to measure fatigue . It covers the following dimensions : general fatigue , physical fatigue , reduced activity , reduced motivation and mental fatigue . The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy .  The dimensional structure was assessed using confirmatory factor analyses ( Lisrel 's unweighted least-squares method ) . The hypothesised five-factor model appeared to fit the data in both sample s ( adjusted goodness of fit ; AGFI : 0.97 and 0.98 ) . Internal consistency of the separate scales was good in both the Dutch and Scottish sample s with Cronbach 's alpha coefficients ranging from 0.79 to 0.93 . Construct validity was assessed by correlating the MFI-20 to activities of daily living , anxiety and depression . Significant relations were assumed . Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist . Results support the validity of the MFI-20 . The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust CONTEXT Tai Chi is a traditional Chinese health-promoting exercise . It has been shown to enhance mental health and improve psychological condition . OBJECTIVES We aim ed to assess the effectiveness of Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy . METHODS We conducted a r and omized trial of Tai Chi exercise as compared with low-impact exercise as a control intervention . Exercises were practice d every other day , a one-hour session for 12 weeks for each of the study groups . The primary end point was a change in total score of the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . Secondary end points were changes in five subscale scores of the MFSI-SF . All assessment s were repeated at three time points , T0 : before first course of chemotherapy ; T1 : before third course of chemotherapy ; and T2 : at the end of the fourth course of chemotherapy . RESULTS Between January 2012 and December 2014 , 96 patients were enrolled in this trial . At six and 12 weeks , the Tai Chi group had a lower MFSI-SF total score compared with the control group ( 59.5 ± 11.3 vs. 66.8 ± 11.9 , P < 0.05 ; 53.3 ± 11.8 vs. 59.3 ± 12.2 , P < 0.05 ) . At six weeks , the Tai Chi group had lower MFSI-SF general subscale scores ( 18.1 ± 4.6 vs. 20.4 ± 4.5 , P < 0.05 ) and physical subscale scores ( 17.5 ± 4.4 vs. 19.1 ± 4.5 , P < 0.05 ) , and higher MFSI-SF vigor subscale scores ( 14.5 ± 3.3 vs. 11.6 ± 3.4 , P < 0.05 ) , compared with the control group . But no significant differences were found in emotional subscale ( 20.2 ± 3.6 vs. 20.0 ± 3.5 , P > 0.05 ) and mental subscale ( 18.2 ± 4.0 vs. 18.9 ± 3.9 , P > 0.05 ) scores between the Tai Chi group and the control group . At 12 weeks , the MFSI-SF subscale scores showed the same trends as at six weeks . CONCLUSION Tai Chi is an effective intervention for managing cancer-related fatigue in patients with lung cancer undergoing chemotherapy , especially for decreasing general fatigue and physical fatigue , and increasing vigor BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF PURPOSE To evaluate yoga 's impact on inflammation , mood , and fatigue . PATIENTS AND METHODS A r and omized controlled 3-month trial was conducted with two post-treatment assessment s of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control . The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 ( IL-6 ) , tumor necrosis factor alpha ( TNF-α ) , and interleukin-1β ( IL-1β ) , and scores on the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) , the vitality scale from the Medical Outcomes Study 36-item Short Form ( SF-36 ) , and the Center for Epidemiological Studies -Depression ( CES-D ) scale . RESULTS Immediately post-treatment , fatigue was not lower ( P > .05 ) but vitality was higher ( P = .01 ) in the yoga group compared with the control group . At 3 months post-treatment , fatigue was lower in the yoga group ( P = .002 ) , vitality was higher ( P = .01 ) , and IL-6 ( P = .027 ) , TNF-α ( P = .027 ) , and IL-1β ( P = .037 ) were lower for yoga participants compared with the control group . Groups did not differ on depression at either time ( P > .2 ) . Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits ( P = .019 ; P < .001 ) , as well as vitality ( P = .016 ; P = .0045 ) , but not depression ( P > .05 ) than simple group assignment ; more frequent practice produced larger changes . At 3 months post-treatment , increasing yoga practice also led to a decrease in IL-6 ( P = .01 ) and IL-1β ( P = .03 ) production but not in TNF-α production ( P > .05 ) . CONCLUSION Chronic inflammation may fuel declines in physical function leading to frailty and disability . If yoga dampens or limits both fatigue and inflammation , then regular practice could have substantial health benefits CONTEXT Tai Chi exercise has been shown to improve cancer-related fatigue ( CRF ) and autonomic nervous system ( ANS ) balance in some cancer patients or survivors ; however , such effects are yet to be verified in nasopharyngeal carcinoma ( NPC ) patients undergoing chemoradiotherapy . OBJECTIVES To explore the effects of Tai Chi exercise on CRF in NPC patients undergoing chemoradiotherapy and then to evaluate ANS information indicated by heart rate variability parameters and their association with CRF . METHODS A r and omized controlled trial of Tai Chi exercise was conducted from January 2014 to August 2015 . Participants in the Tai Chi group practice d Tai Chi a one-hour session , five sessions/week during chemoradiotherapy . Participants in the control group received usual care . The primary end points were scores of the multidimensional fatigue symptom inventory-short form ( MFSI-SF ) . Secondary end points were heart rate variability parameters , including normalized low-frequency ( nLF ) power , normalized high-frequency ( nHF ) power , and the nLF/nHF ratio , and their association with CRF . RESULTS One hundred fourteen patients were recruited in this study , and 83 patients completed the trial . The Tai Chi group and the control group had comparable baseline characteristics . After chemoradiotherapy , the Tai Chi group exhibited lower MFSI-SF total score and three negative subscale ( general , physical , and emotional fatigue ) scores and higher vigor score compared with the control group ( P < 0.01 for all ) . The nLF/nHF ratio was significantly lower in the Tai Chi group compared to the control group after chemoradiotherapy . The MFSI-SF total score was markedly correlated with the nLF/nHF ratio . CONCLUSION Tai Chi exercise is conducive to alleviate  CRF  in NPC patients undergoing chemoradiotherapy . The improvement in ANS balance might fit into the process of Tai Chi for CRF management in this population OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea ( OSA ) ; however , the impact of continuous positive airway pressure ( CPAP ) on fatigue remains unclear . METHODS Fifty-nine men and women with OSA were r and omly assigned to therapeutic or placebo CPAP in a double-blind fashion for a 3-week intervention period . Four outcome measures were assessed : ( 1 ) fatigue/vigor measured with the Multidimensional Fatigue Symptom Inventory -- Short Form ( MFSI-sf ) , the ( 2 ) fatigue and ( 3 ) vigor subscales of the Profile of Mood States -- Short Form ( POMS ) , and ( 4 ) the Epworth Sleepiness Scale ( ESS ) . Data were analyzed using repeated- measures analysis of variance . RESULTS Compared with patients receiving placebo CPAP , those patients treated with therapeutic CPAP showed significant reductions in the apnea-hypopnea index , as well as decreases in both measures of fatigue and increases in vigor ( P values < 0.05 ) . The beneficial effect of therapeutic treatment was most pronounced in patients with high levels of fatigue at study onset . Significant treatment effects in sleepiness scores were not observed in the entire sample ( P > 0.05 ) ; however , in a subset of patients with excessive sleepiness at the onset of treatment , ESS scores were significantly reduced with use of therapeutic CPAP ( P < 0.05 ) . CONCLUSIONS Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA . Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment OBJECTIVE To assess the efficacy and safety of duloxetine in patients with chronic fatigue syndrome . METHODS A 12-week , r and omized , double-blind study was design ed to compare duloxetine 60 - 120 mg/d  ( n = 30 )  with placebo  ( n = 30 ) for efficacy and safety in the treatment of patients with chronic fatigue syndrome . The primary outcome measure was the Multidimensional Fatigue Inventory general fatigue subscale ( range : 4 - 20 , with higher scores indicating greater fatigue ) . Secondary measures were the remaining Multidimensional Fatigue Inventory subscales , Brief Pain Inventory , Medical Outcomes Study Short Form-36 , Hospital Anxiety and Depression Scale , Centers for Disease Control and Prevention Symptom Inventory , Patient Global Impression of Improvement , and Clinical Global Impression of Severity . The primary analysis of efficacy for continuous variables was a longitudinal analysis of the intent-to-treat sample , with treatment-by-time interaction as the measure of effect . RESULTS The improvement in the Multidimensional Fatigue Inventory general fatigue scores for the duloxetine group was not significantly greater than for the placebo group ( P = 0.23 ; estimated difference between groups at week 12 = -1.0 [ 95 % CI : -2.8 , 0.7 ] ) . The duloxetine group was significantly superior to the placebo group on the Multidimensional Fatigue Inventory mental fatigue score , Brief Pain Inventory average pain severity and interference scores , Short Form-36 bodily pain domain , and Clinical Global Impression of Severity score . Duloxetine was generally well tolerated . CONCLUSION The primary efficacy measure of general fatigue did not significantly improve with duloxetine when compared with placebo . Significant improvement in secondary measures of mental fatigue , pain , and global measure of severity suggests that duloxetine may be efficacious for some chronic fatigue syndrome symptom domains , but larger controlled trials are needed to confirm these results STUDY OBJECTIVE Fatigue and sleep disturbances are two of the most common and distressing symptoms of cancer patients . A relationship between the two symptoms was reported in symptom cluster studies ; however , only subjective measurements of sleep were examined and most studies were cross-sectional . In this study of women with breast cancer undergoing chemotherapy  , we explored the longitudinal relationship between fatigue and sleep measured both subjectively and objective ly . DESIGN Prospect i ve study . Data were collected at 7 time points : before ( baseline ) and during the 3 weeks of cycle 1 and cycle 4 chemotherapy . PARTICIPANTS Ninety-seven women with newly diagnosed stage I-III breast cancer who were scheduled to receive at least four 3-week cycles of chemotherapy .  MEASUREMENT AND RESULTS Objective sleep parameters were measured with an Actillume actigraph ( Ambulatory Monitoring Inc. ) . Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index ( PSQI ) . Fatigue was assessed with the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . Fatigue became worse during both cycles of chemotherapy ( P-values < 0.01 ) . Subjective sleep quality was poor at baseline and remained unchanged throughout treatment . Objective nighttime and daytime total sleep time increased compared to baseline during the treatment administration week of both cycles ; daytime total wake time decreased during the treatment week of both cycles and during the last 2 week of cycle 4 . Mixed model results revealed that fatigue was positively associated with total PSQI scores and with objective measures of total nap time , and negatively associated with total wake time during the day ( all P-values < 0.01 ) . CONCLUSION Fatigue was significantly associated with subjective reports of poor sleep and objective measures of daytime sleepiness , but not with nocturnal sleep as measured with actigraphy . This relationship between fatigue and sleep warrants further studies to explore their possible common underlying etiology BACKGROUND Safe , effective interventions to improve cancer-related fatigue ( CRF ) are needed because it remains a prevalent , distressing , and activity-limiting symptom . Based on pilot data , a phase III trial was developed to evaluate the efficacy of American ginseng on CRF . METHODS A multisite , double-blind trial r and omized fatigued cancer survivors to 2000 mg of American ginseng vs a placebo for 8 weeks . The primary endpoint was the general subscale of the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) at 4 weeks . Changes from baseline at 4 and 8 weeks were evaluated between arms by a two-sided , two- sample t test . Toxicities were evaluated by self-report and the National Cancer Institute 's Common Terminology Criteria for Adverse Events ( CTCAE ) provider grading . RESULTS Three hundred sixty-four participants were enrolled from 40 institutions . Changes from baseline in the general subscale of the MFSI-SF were 14.4 ( st and ard deviation [ SD ] = 27.1 ) in the ginseng arm vs 8.2 ( SD = 24.8 ) in the placebo arm at 4 weeks ( P = .07 ) . A statistically significant difference was seen at 8 weeks with a change score of 20 ( SD = 27 ) for the ginseng group and 10.3 ( SD = 26.1 ) for the placebo group ( P = .003 ) . Greater benefit was reported in patients receiving active cancer treatment vs those who had completed treatment . Toxicities per self-report and CTCAE grading did not differ statistically significantly between arms . CONCLUSIONS Data support the benefit of American ginseng , 2000 mg daily , on CRF over an 8-week period . There were no discernible toxicities associated with the treatment . Studies to increase knowledge to guide the role of ginseng to improve CRF are needed BACKGROUND Patients with chronic heart failure ( HF ) and with elevated depression symptoms are at greater risk of morbidity and mortality . Somatic symptoms of depression are particularly prevalent in HF and are related to worse disease prognosis . T'ai chi practice is related to increased emotional well-being in various clinical population s ; however , relatively little is known about t'ai chi 's effects on somatic versus cognitive symptom dimensions of depression in HF . PURPOSE The objective of the study was to measure whether a t'ai chi intervention effectively reduces somatic and /or cognitive symptoms of depression in patients with HF . METHODS Patients with HF were assigned to either t'ai chi training ( n=16 ) or a usual-care group ( n=12 ) . At baseline and after the 12-week intervention period , participants were evaluated for changes in depressive symptoms using Beck Depression Inventory ( BDI ) total scores ( BDI-t ) and subcategorized scores of BDI-somatic ( BDI-s ) and BDI-cognitive ( BDI-c ) , and for symptoms of fatigue using the Multidimensional Fatigue Symptom Inventory-Short Form . RESULTS Patients with HF in the t'ai chi group compared to the  usual-care  group had reduced BDI-s ( p≤0.017 ) , but not BDI-c ( p=0.50 ) scores from pre- to postintervention . Although t'ai chi did not significantly reduce fatigue , changes in physical fatigue ( p≤0.05 ) were independently associated with changes in BDI-t scores . CONCLUSIONS T'ai chi practice  reduced somatic symptoms of depression , which have been linked to worse prognosis in HF . Reductions in fatigue appear to explain some but not all of the reductions in somatic symptoms of depression The purpose of this study is to evaluate empirical criticism of the psychometric properties of the Hamilton Depression Rating Scale ( HDRS ) by undertaking an " internal construct validity " evaluation . Individual symptom responses for the HDRS were obtained from 370 patients meeting Research Diagnostic Criteria for major depression . A multidimensional normal item response theory ( IRT ) model was used to assess the dimensionality of the HDRS and estimate corresponding item parameters which were then expressed as factor loadings and item thresholds . The analysis yielded a five-dimensional solution . The first dimension ( depressed mood , guilt , suicide , work and interests , agitation , psychic anxiety , somatic anxiety , and loss of libido ) appeared to define global depression severity . These results are consistent with other published factor analytic studies and provide further justification for thinking that the  HDRS total score is a weak index of depressive syndrome severity . The findings provide a benchmark by which the adequacy of future results may be judged , because the multidimensional IRT model does not suffer from the statistical limitations that arise when applying traditional factor analytic methods to discrete symptom ratings OBJECTIVE In April 2005 a phase III r and omized study was started to establish which was the most effective and safest treatment of cancer-related anorexia/cachexia syndrome and oxidative stress in improving identified primary endpoints : increase of lean body mass , decrease of resting energy expenditure ( REE ) , increase of total daily physical activity , decrease of interleukin-6 and tumor necrosis factor-alpha , and improvement of fatigue assessed by the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) . METHODS All patients were given as basic treatment polyphenols plus antioxidant agents alpha-lipoic acid , carbocysteine , and vitamins A , C , and E , all orally . Patients were then r and omized to one of the following five arms : 1 ) medroxyprogesterone acetate/megestrol acetate ; 2 ) pharmacologic nutritional support containing eicosapentaenoic acid ; 3 ) L-carnitine ; 4 ) thalidomide ; or 5 ) medroxyprogesterone acetate/megestrol acetate plus pharmacologic nutritional support plus L-carnitine plus thalidomide . Treatment duration was 4 mo . The sample comprised 475 patients . RESULTS By January 2007 , 125 patients , well balanced for all clinical characteristics , were included . No severe side effects were observed . As for efficacy , an interim analysis on 125 patients showed an improvement of at least one primary endpoint in arms 3 , 4 , and 5 , whereas arm 2 showed a significant worsening of lean body mass , REE , and MFSI-SF . Analysis of variance comparing the change of primary endpoints between arms showed a significant improvement of REE in favor of arm 5 versus arm 2 and a significant improvement of MFSI-SF in favor of arms 1 , 3 , and 5 versus arm 2 . A significant inferiority of arm 2 versus arms 3 , 4 , and 5 for the primary endpoints lean body mass , REE , and MFSI-SF was observed on the basis of t test for changes . CONCLUSION The interim results obtained thus far seem to suggest that the most effective treatment for cancer-related anorexia/cachexia syndrome and oxidative stress should be a combination regimen . The study is still in progress and the final results should confirm these data OBJECTIVES To document 1 ) the content validity and 2 ) measure improvements in fatigue , using the  Fatigue Visual Analogue Scale ( VAS ) assessment tool in patients with fibromyalgia . METHODS The relevance and comprehensiveness of the Fatigue VAS were tested through a qualitative analysis of 20 subjects ' verbatim transcripts from semi-structured qualitative interviews . Data from two r and omised , controller trials in fibromyalgia ( n=1121 ) were used to conduct correlation analyses with the  Fatigue and Tiredness  items from the Fibromyalgia Impact Question naire ( FIQ ) and the Short Form-36 Vitality scale . Known-groups and cross classification analyses were conducted to demonstrate the ability to measure improvement in fatigue using the Fatigue VAS . RESULTS All subjects spontaneously reported that fatigue was an important symptom to capture in fibromyalgia . The Fatigue VAS was well understood by most subjects ( n=18/20 ) . High correlations ( Pearson r>0.75 ) and good agreement ( k>0.66 ) were found between the Fatigue VAS and the FIQ tiredness items no. 16 and 17 and SF-36 ™ Vitality scale . In both clinical trials there was a substantial separation of approximately 20 points on the mean change in the Fatigue VAS score between responders ( > 30 % improvement in pain VAS ) and non-responders . CONCLUSIONS Previous studies have confirmed that fatigue is a major component of the fibromyalgia experience . This current study reports that fibromyalgia patients spontaneously rated fatigue as a highly significant feature of their illness , and supports the use of the Fatigue VAS as a valid question naire in fibromyalgia clinical trials BACKGROUND The purpose of this study is to determine the course of fatigue referring to cognitive symptoms ( scale ' mental fatigue ' ) as well as the motivation to start any activity ( scale ' reduced motivation ' ) , as a function of chemotherapy , in breast cancer patients undergoing adjuvant chemotherapy .  PATIENTS AND METHODS In a prospect i ve cohort study a sample of 157 patients with breast cancer was interviewed at the first , third and fifth cycle of adjuvant chemotherapy as well as 4 and 12 weeks after completion of adjuvant chemotherapy . Patients were treated with st and ard adjuvant chemotherapy , either a doxorubicin containing schedule or CMF ( cyclophosphamide , methotrexate and fluorouracil ) . The psychological dimensions of fatigue were measured by the Multidimensional Fatigue Inventory .  A linear multilevel model was used for analysing the courses . RESULTS The course of mental fatigue and motivation were not affected by the type of chemotherapy . The course of mental fatigue and motivation varied , but seemed to be stable during the treatment of chemotherapy . After the completion of chemotherapy , a weak improvement was seen . Relatively many patients experienced depressive symptoms during the study . These symptoms were correlated with both dimensions of fatigue . At all measurements mental fatigue was influenced by type of operation where women with a mastectomy were significantly more mentally fatigued than women that had undergone a lumpectomy , but nevertheless they were significantly more motivated to start any activity . Age , marital status , number of treatments and the interval between the operation and the first treatment of chemotherapy also seemed to be important determinants . CONCLUSIONS An unequivocal pattern of mental fatigue and reduced motivation during as well as after adjuvant chemotherapy was not found . Depressive symptoms were definitely related to these variables . Type of operation had a significant impact on mental fatigue and motivation to start any activity . Health care providers should be aware of the high rate of patients who experience depressive symptoms during and after the treatment of chemotherapy . Further research should include the trajectory preceding adjuvant chemotherapy and a longer study period afterwards . Moreover , the exact influence of the variables ' age ' , ' marital status ' , ' number of treatments ' and ' the interval between the operation and the first treatment of chemotherapy ' on fatigue is unclear and needs further study CONTEXT Physical exercise can alleviate cancer-related fatigue . R and omized controlled trials in patients with advanced cancer are scarce . OBJECTIVES We test the impact of a structured , individual sports program on fatigue in patients with advanced cancer . METHODS Seventy-seven patients were invited to participate in this r and omized controlled trial exploring the effects of physical exercises on fatigue 12 and 24 weeks after baseline . Patients were r and omized into three groups . Group A received treatment as usual , Group B was taught a structured , individual sports program , and Group C received additional ambulatory physiotherapeutical supervision . Primary outcome was general fatigue , secondary outcomes included rate of severe general fatigue , further dimensions of the Multidimensional Fatigue Inventory ( MFI ) , as well as walking distance . RESULTS Mean score of general fatigue as well as other MFI subdimensions differed nonsignificantly between all groups at 12 weeks . However , the mental fatigue score demonstrated a statistically significant difference between the three groups . The rate of severe general fatigue was significantly reduced within Intervention Group C. Significant longitudinal change of MFI-dimension mental fatigue was found and reached the threshold for minimal clinical ly important difference , while all MFI-dimensions increased in Group A. CONCLUSION Our results imply that tumor- patients ' severe general fatigue can be reduced when patients conduct appropriate physical exercise . This study amends previous knowledge , as it describes the impact of outpatient physical exercise on fatigue in a heterogeneous patient cohort with various advanced cancer entities . Furthermore , this trial differentiates between patients with only a self-directed exercise program versus those receiving additional partially professional supervision Introduction Fatigue is one of the most disabling symptoms associated with fibromyalgia that greatly impacts quality of life . Fatigue was assessed as a secondary objective in a 2-phase , 24-week study in out patients with American College of Rheumatology-defined fibromyalgia . Methods Patients were r and omized to duloxetine 60 - 120 mg/d ( N = 263 ) or placebo ( N = 267 ) for the 12-week acute phase . At Week 12 , all placebo-treated patients were switched to double-blind treatment with duloxetine for the extension phase . Fatigue was assessed at baseline and every 4 weeks with the Multidimensional Fatigue Inventory ( MFI ) scales : General Fatigue , Physical Fatigue , Mental Fatigue , Reduced Activity , and Reduced Motivation . Other assessment s that may be associated with fatigue included Brief Pain Inventory ( BPI ) average pain , numerical scales to rate anxiety , depressed mood , bothered by sleep difficulties , and musculoskeletal stiffness . Treatment-emergent fatigue-related events were also assessed . Changes from baseline to Week 12 , and from Week 12 to Week 24 , were analyzed by mixed-effects model repeated measures analysis . Results At Week 12 , duloxetine versus placebo significantly ( all p < .05 ) reduced ratings on each MFI scale , BPI pain , anxiety , depressed mood , and stiffness . Improvement in ratings of being bothered by sleep difficulties was significant only at Weeks 4 and 8 . At Week 24 , mean changes in all measures indicated improvement was maintained for patients who received duloxetine for all 24 weeks ( n = 176 ) . Placebo-treated patients switched to duloxetine ( n = 187 ) had significant within-group improvement in Physical Fatigue ( Weeks 16 , 20 , and 24 ) ; General Fatigue ( Weeks 20 and 24 ) ; Mental Fatigue ( Week 20 ) ; and Reduced Activity ( Weeks 20 and 24 ) . These patients also experienced significant within-group improvement in BPI pain , anxiety , depressed mood , bothered by sleep difficulties , and stiffness . Overall , the most common ( > 5 % incidence ) fatigue-related treatment-emergent adverse events were fatigue , somnolence , and insomnia . Conclusions Treatment with duloxetine significantly improved multiple dimensions of fatigue in patients with fibromyalgia , and improvement was maintained for up to 24 weeks . Trial registration Clinical Trials.gov registry NCT00673452 PURPOSE We aim ed to assess the effectiveness of acupuncture for  cancer-related fatigue ( CRF ) in patients with breast cancer . PATIENTS AND METHODS We conducted a pragmatic , r and omized controlled trial comparing acupuncture with enhanced usual care .  Three hundred two out patients with breast cancer participated . We r and omly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care  ( r and om assignment of 1:3 respectively ) with minimization controlling for baseline general fatigue and maintenance treatment . Treatment was delivered by acupuncturists once a week for 6 weeks through needling three pairs of acupoints . The usual care group received a booklet with information about fatigue and its management . Primary outcome was general fatigue at 6 weeks , measured with the  Multidimensional Fatigue Inventory ( MFI ) . Other measurements included the Hospital Anxiety and Depression Scale , Functional Assessment of Cancer Therapy-General quality -of-life scale , and expectation of acupuncture effect . Analyses were by intention to treat . RESULTS Two hundred forty-six of 302 patients r and omly assigned provided complete data at 6 weeks . The difference in the mean General Fatigue score , between those who received the intervention and those who did not , was -3.11 ( 95 % CI , -3.97 to -2.25 ; P < .001 ) . The intervention also improved all other fatigue aspects measured by MFI , including Physical Fatigue and Mental Fatigue  ( acupuncture effect , -2.36 and -1.94 , respectively ; both at P < .001 ) , anxiety and depression ( acupuncture effect , -1.83 and -2.13 , respectively ; both at P < .001 ) , and quality of life ( Physical Well-Being effect , 3.30 ; Functional Well-Being effect , 3.57 ; both at P < .001 ; Emotional Well-Being effect , 1.93 ; P = .001 ; and Social Functioning Well-Being effect , 1.05 ; P < .05 ) . CONCLUSION Acupuncture is an effective intervention for managing the symptom of CRF and improving patients ' quality of life CONTEXT Given that the etiology of chronic fatigue syndrome ( CFS ) is believed to be multidimensional , interventions generally have been nonspecific and typically produce only mild to moderate effects . In medical practice , treatment for CFS remains largely symptomatic . Preliminary evidence of the efficacy of acupuncture for CFS is available , but the field has lacked high- quality trials . OBJECTIVE The research team conducted the study to determine the efficacy of acupuncture for CFS . DESIGN A two-arm , r and omized , controlled , singleblinded design was adopted . SETTING The study took place in a teaching laboratory at the School of Chinese Medicine at the University of Hong Kong , Hong Kong , China . PARTICIPANTS Recruited through press publicity in Hong Kong , 127 individuals--40 men and 87 women -- participated in the study . Intervention Through careful implementation of sham acupuncture in the control group ( CG ) , the study blinded all participants with regard to their experimental or control status . The treatment regime was 2 sessions/wk for 4 consecutive wk . OUTCOME MEASURES Measures of fatigue ( Chalder 's Fatigue Scale ) , health-related quality of life ( SF-12 ) , and general mental health ( GH Q-12 ) were taken at baseline and upon completion of treatment . RESULTS Ninety-nine participants completed the interventions , with 50 and 49 participants in the experimental group ( EG ) and CG respectively . Repeated measures ANOVA revealed a significant decrease in physical ( F(1,93 ) = 4.327 ; P = .040 ) and mental fatigue ( F(1,96 ) = 10.451 ; P = .002 ) and improvement in the physical component score of SF-12 ( F(1,93 ) = 4.774 ; P = .031 ) . Considerable effects with Cohen 's d were observed in the sham-control group : 0.92 , 0.78 , and 0.38 for the three scores , respectively . These positive effects could have included some therapeutic effects due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects . The EG showed moderate net effect sizes with Cohen 's d : 0.52 , 0.63 , and 0.54 for the three outcome measures , respectively . CONCLUSION Despite considerable positive effects for the CG , the EG demonstrated significant net-effect sizes at a moderate magnitude in physical and mental fatigue and in the physical component of health-related quality of life . The impacts on general mental health outcomes appeared to be smaller Objective : Assess the efficacy of  duloxetine 60/120 mg ( N = 162 ) once daily compared with  placebo ( N = 168 ) in the treatment of patients with fibromyalgia , during six months of treatment . Methods : This was a phase-III , r and omized , double-blind , placebo-controlled , parallel-group study assessing the efficacy and safety of duloxetine . Results : There were no significant differences between treatment groups on the co- primary efficacy outcome measures , change in the Brief Pain Inventory ( BPI ) average pain severity from baseline to endpoint ( P = 0.053 ) and the Patient ’s Global Impressions of Improvement ( PGI-I ) at endpoint ( P = 0.073 ) . Duloxetine-treated patients improved significantly more than placebo-treated patients on the Fibromyalgia Impact Question naire pain score , BPI least pain score and average interference score , Clinical Global Impressions of Severity scale , area under the curve of pain relief , Multidimensional Fatigue Inventory mental fatigue dimension , Beck Depression Inventory-II total score , and 36-item Short Form Health Survey mental component summary and mental health score . Nausea was the most common treatment-emergent adverse event in the duloxetine group . Overall discontinuation rates were similar between groups . Conclusions : Although duloxetine 60/120 mg/day failed to demonstrate significant improvement over placebo on the co- primary outcome measures , in this supportive study , duloxetine demonstrated significant improvement compared with placebo on numerous secondary measures OBJECTIVE This study vali date d a brief measure of fatigue in rheumatoid arthritis ( RA ) , the Functional Assessment of Chronic Illness Therapy ( FACIT ) Fatigue Scale . METHODS The FACIT Fatigue was tested along with measures previously vali date d in RA : the Multidimensional Assessment of Fatigue ( MAF ) and Medical Outcomes Study Short-Form 36 ( SF-36 ) Vitality . The sample included 636 patients with RA enrolled in a 24 week double blind , r and omized clinical trial ( RCT ) of adalimumab versus placebo . RESULTS The FACIT Fatigue showed good internal consistency ( alpha = 0.86 to 0.87 ) , strong association with SF-36 Vitality ( r = 0.73 to 0.84 ) and MAF ( r = -0.84 to -0.88 ) , and the ability to differentiate patients according to clinical change using the American College of Rheumatology ( ACR ) response criteria ( ACR 20/50/70 ) . Psychometric performance of the FACIT Fatigue scale was comparable to that of the other 2 fatigue measures . A minimally important difference in FACIT Fatigue change score of 3 - 4 points was confirmed in a separate sample of 271 patients with RA enrolled in a second double blind RCT of adalimumab versus placebo . CONCLUSION The FACIT Fatigue is a brief , valid measure for monitoring this important symptom and its effects on patients with RA Background : Fatigue is a major nonmotor symptom in Parkinson disease ( PD ) . It is associated with reduced activity and lower quality of life . Objective : To determine if modafinil improves subjective fatigue and physical fatigability in PD . Methods : Nineteen PD patients who reported significant fatigue in the Multidimensional Fatigue Inventory ( MFI ) participated in this 8-week study . Subjects took their regular medications and were r and omly assigned to the treatment group ( 9 subjects , modafinil 100-mg capsule BID ) or placebo group ( 10 subjects ) . We used the MFI to measure subjective fatigue and used finger tapping and intermittent force generation to evaluate physical fatigability . Subjects also completed the Epworth Sleepiness Scale ( ESS ) and the Center of Epidemiological Study -Depression Scale . Results : There were no significant differences at baseline and at 1 month in finger tapping and ESS between the modafinil and placebo groups . At 2 months , the modafinil group had a higher tapping frequency ( P < 0.05 ) , shorter dwell time ( P < 0.05 ) , and less fatigability in finger tapping and tended to have lower ESS scores ( P < 0.12 ) than the placebo group . However , there was no difference between groups over time for any dimension of the MFI . Conclusions : This small study demonstrated that although modafinil may be effective in reducing physical fatigability in PD , it did not improve fatigue symptoms Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment . But even though several authors have tried to conceptualise fatigue , its mechanisms are still poorly understood . The aim of this study was twofold : ( a ) to explore fatigue in cancer patients inductively , and ( b ) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts . A qualitative research strategy was adopted using a grounded-theory approach . The prospect i ve study took place in the oncology department of the Kantonsspital , St. Gallen , Switzerl and , with sample s of 20 cancer patients and 20 healthy individuals .  Unstructured , tape-recorded interviews were conducted to collect data . The transcripts of the interviews were analysed using content analysis and constant comparison . Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical , affective and cognitive expressions of fatigue/tiredness . Physical signs were more frequent than affective and cognitive signs in both groups . In the cancer patients , fatigue involved decreased physical performance , extreme , unusual tiredness , weakness and an unusual need for rest , which was distinctly different for healthy persons . Affective and cognitive distress was also more prominent in cancer patients . Interestingly , the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population . Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon . A step-like theory , explaining the production of fatigue/tiredness was tentatively put forward involving nociception , perception and expression of tiredness . The emerging concepts break tiredness/fatigue into an expression of physical , affective and cognitive tiredness/fatigue . The experience is different between healthy individuals and cancer patients . Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further , controlled studies
The MFSI-SF demonstrated moderate test-retest reliability in a small number of studies .
The MFSI-SF fatigue subscales were positively correlated with measures of distress , depressive , and anxious symptoms .
Purpose Fatigue is a subjective complaint that is believed to be multifactorial in its etiology and multidimensional in its expression .
Fatigue may be experienced by individuals in different dimensions as physical , mental , and emotional tiredness .
The purpose s of this study were to review and characterize the use of the 30-item Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) in published studies and to evaluate the available evidence for its psychometric properties .