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FATIGUE QUESTIONNAIRE

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information

General Description

Purpose

To assess the severity of fatigue in general practice settings.

Content

Seven items related to physical symptoms of fatigue (e.g., Do you feel weak? Do you need to rest more?). Four items related to mental symptoms of fatigue (e.g., Do you have difficulty concentrating? How is your memory?).

Developer/contact information

Chalder T, Berelowitz G, Pawlikowska T, Watta L, Wessely S, Wright D, Wallace EP. Trudie Chalder: Academic Department of Psychological Medicine, King's College School of Medicine and Dentistry & Institute of Psychiatry, 103 Denmark Hill London SE5 8AZ, UK. E-mail: .

Versions

Has been translated into other languages but author of questionnaire does not maintain a list of these translations.

Number of items in scale

11 items.

Subscales

Total score most often used, but 2 scores, one for physical fatigue (items 1–7) and one for mental fatigue (items 8–11) may be used.

Populations
Developmental/target

Adults 18–45 years seen in general practice settings (1).

Other uses

Chronic Fatigue Syndrome (2,3), Gulf War syndrome (4), postinfectious fatigue (5), general population (6,7).

WHO ICF Components

Participation restriction.

Administration

Method

Paper and pencil questionnaire.

Training

No special training required.

Time to administer/complete

Probably 2–5 minutes.

Equipment needed

Pencil.

Cost/availability

No cost. Questions published in original Chalder et al (1) article in Appendix on page 153. Items 5,12, and 14 were eliminated from the 14-item fatigue scale printed in the Appendix leaving 11 items for the final version. Copy available at the Arthritis Care & Research Web site at http://www.interscience.wiley.com/jpages/0004-3591:1/suppmat/index.html.

Scoring

Responses
Scale

Scoring using a bimodal response system or a Likert score with weights assigned to each response choice. Likert or bimodal rating scales with 4 response options. For the Likert Scale: better than usual = 0, no more than usual = 1, worse than usual = 2, much worse than usual = 3. For the bimodal scale: better than usual = 0, no more than usual = 0, worse than usual = 1, much worse than usual = 1. Sum all items for a total score.

Score range

Range is 0–11 for bimodal response format; 0–33 for Likert Scale.

Interpretation of scores

Higher score indicates more fatigue.

Method of scoring

Sum responses for total score.

Time to score

Less than 5 minutes.

Training to score

None.

Training to interpret

None.

Norms available

In a community sample of 15,283 women and men, ages 18–45 years, 18.3% had substantial fatigue (bimodal score = 4 or lasting 6 weeks or longer) (6).

Psychometric Information

Reliability
Internal consistency

Cronbach's alpha (α) for the 11-item scale was 0.89. The α for the physical fatigue subscale was 0.85 and for the mental fatigue subscale was 0.82 (1).

Validity
Construct

Principal component analysis of a 14-item scale supported a 2- dimensional solution of 1) physical fatigue and 2) mental fatigue. Three items were eliminated leaving 11 items (1).

Discriminant

Relative Operating Characteristic analysis was used to define a cut-off score on the Fatigue Questionnaire to discriminate between cases and non-cases (1).

Sensitivity/responsiveness to change

Fifteen of 18 children ages 11–18 years with Chronic Fatigue Syndrome improved their fatigue scores after an intervention of family cognitive behavioral therapy (2).

Comments and Critique

Measures severity of physical and mental fatigue. Use has been primarily with persons with Chronic Fatigue Syndrome. One strength is that in addition to a total score, separate scores can be calculated for physical and mental fatigue.

References

1.(Original) Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al. Development of a Fatigue Scale. J Psychosomatic Res 1993;37:147–53.

2.Chalder T, Tong J, Deary V. Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study. Arch Dis Child 2002;86:95–7.

3.Deale A, Husain K, Chalder T, Wessely S. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Am J Psychiatry 2001;12:2038–42.

4.Chalder T, Hotopf C, Unwin C, Hull L. Ismail A, Wessely S. Prevalence of Gulf war veterans who believe they have Gulf War syndrome: questionnaire study. BMJ 2001;323:473–6.

5.Wessely S, Chalder T, Hirsch S, Pawlikowska T, Wallace P, Wright DJM. Postinfectious fatigue: prospective cohort study in primary care. Lancet 1995;345:1333–8.

6.Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJM, Wessely SC. Population based study of fatigue and psychological distress. BMJ 1994;308:763–6.

7.Chalder T, Power MJ, Wessely S. Chronic fatigue in the community: a question of attribution. Psychol Med 1996;26:791–800.

FATIGUE SEVERITY SCALE (FSS)

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information

General Description

Purpose

To measure fatigue severity in a manner that facilitates research in the experience of fatigue in a variety of medical and neurologic disorders (1).

Content

Nine statements concerning respondent's fatigue, e.g., how fatigue affects motivation, exercise, physical functioning, carrying out duties, interfering with work, family, or social life.

Developer/contact information

Developers were Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. Contact Lauren B. Krupp, Department of Neurology, School of Medicine, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY 11794-8121.

Versions

An expanded 29-item version (2). Translated into German.

Number of items in scale

There are 9 items.

Subscales

None.

Populations
Developmental/target

Adults with multiple sclerosis (MS), systemic lupus erythematosus (SLE).

Other uses

Systemic lupus erythematosus (3–5), fibromyalgia (6), Lyme Borreliosis (7), multiple sclerosis (8), post-polio (9), amyotrophic lateral sclerosis (10), cancer (11), brain injury (12), Parkinson's disease (13), insomnia (14), sleep apnea (15).

WHO ICF Components

Participation restriction

Administration

Method

Paper and pencil questionnaire.

Training

No special training required.

Time to administer/complete

Not stated, but probably 2–3 minutes.

Equipment needed

Pencil.

Cost, availability

No cost, questionnaire published in original article (1) in Table 2 on page 1122. Copy available at the Arthritis Care & Research Web site at http://www.medal.org/adocs/docs_ch1/doc_ch1.05.html .

Table  . Summary Table of Fatigue Measures*
Measure/scaleContentMeasure outputsNo. of itemsResponse formatMethod of administrationTime for administrationValidated populationsPsychometric properties
ReliabilityValidityResponsiveness
  • *

    SLE = systemic lupus erythematosus; ALS = amylotrophic lateral sclerosis; RA = rheumatoid arthritis; HIV = human immunodeficiency virus; ADLs = activities of daily living; SF = Short Form; OA = osteoarthritis.

Fatigue QuestionnaireMeasure of fatigue severityTotal score or separate subscale scores for physical and mental fatigue. Higher score equals  more severe fatigue7 items measure physical symptoms of fatigue 4 items measure  mental  symptoms of  fatigueLikert scale (0–3): 0 = better  than usual 1 = no more  than usual 2 = worse  than usual 3 = much  worse than  usual Bimodal  responses  the same  but scoring  is (0,0,1,1).Self-administered<5 minutesAdults with chronic fatigue syndrome, Gulf War syndrome, postinfectious fatigue, general population.Excellent internal consistencyGoodGood but more data needed on responsiveness
Fatigue Severity ScaleNegative statements about how fatigue affects functioning related to motivation, exercise, physical functioning, carrying out duties, interference with work, family, or social lifeMean score: Higher score = more  severe fatigue.9 itemsLikert Scale 1 = Strongly  Disagree 7 = Strongly  AgreeSelf-administered<5 minutesAdults with SLE, fibromyalgia, Lyme Borreliosis, chronic fatigue syndrome, post-polio, ALS, multiple sclerosis cancer, brain injury, Parkinson's disease, insomnia, Guillaine-Barre Syndrome, sleep apnea, brain injury.Excellent internal consistency and stability.ExcellentGood but more data needed on responsiveness
Multi-dimensional Assessment of FatigueMeasures four dimensions of fatigue: severity, distress, timing, interference in ADLs.Global Fatigue Index (GFI) (1–50). Item 16 is omitted in calculating GFI.Severity, 2 items; Distress, 1 item; Interference with  ADLs, 11  items; Timing, 2 items.Numerical rating scale of 1–10 for items 1–14 Categorical  response  for items  15 and 16.Self-administered5 minutesRA, HIV-positive adults, multiple sclerosis, coronary heart disease, women, oncology mixed cancer diagnosis, rural oncology.Excellent internal consistency Fair - good  stabilityExcellent convergent and divergent validityGood
SF-36-Version 1 Vitality (Energy/Fatigue) Subscale Total score is transformed to a 0–100 scale so score can be compared to norms.4 items6-point Likert 1–6 scaleSelf-administered or interview.< 1 minute for 4-item subscaleAdults with OA, hip replacement, RA, Sjogren's Syndrome. SF-36 widely used in  numerous ill or well  populations.Excellent internal consistency.GoodGood

Scoring

Responses
Scale

Scale is a 7-point Likert scale where 1 = Strongly Disagree and 7 = Strongly Agree. Sum responses and divide by number of items for scale score.

Score range

Range is 1–7.

Interpretation of scores

Higher score indicates more severe fatigue.

Method of scoring

Calculate a mean score by hand or computer.

Time to score

1–2 minutes.

Training to score

No special training.

Training to interpret

None.

Norms available

Mean 2.3 (SD ± 0.7) in normal healthy adults (1).

Psychometric Information

Reliability

Cronbach's Alpha: 0.89 for SLE subjects (n = 28), 0.81 for MS subjects (n = 25), 0.88 for normal healthy adults (n = 20), and 0.88 for total sample of 74 subjects (1).

Test-retest

(2 time points separated by 5–33 weeks) showed no significant changes in FSS scores when no clinical change was expected (r = 0.84) (1).

Validity
Construct

Factor analysis identified one factor when tested in a sample of 131 rural patients with cancer (16). Discriminant function analysis: 98% of MS subjects correctly classified and 90% of SLE subjects correctly classified versus normal controls (1).

Concurrent

Correlation of FSS with visual analog scale (n = 74) was r = 0.68; P < 0.001 (1). Vitality scores, measured by the Rand Index of Vitality, were inversely correlated with Fatigue Severity Scores supporting divergent validity (17).

Sensitivity/responsiveness to change

Clinical improvement after treatment was associated with reduction in FSS score t(7) = 2.16; P < 0.01 (1).

Comments and Critique

In rheumatology, this questionnaire has been used to measure fatigue in patients with SLE and fibromyalgia. Items are related to the consequences of fatigue. The original construct validity was tested with small numbers of subjects (1). However, a subsequent factor analysis conducted by Winstead-Fry (16) of data from 131 rural cancer patients all 9 items loaded on 1 factor supporting construct validity.

References

1.(Original) (Original) Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The Fatigue Severity Scale: application to patients with multiple sclerosis and systemic lupus erythematosis. Arch Neurol 1989;46:1121–3.

2.Schwartz JE, Jandorf L, Krupp, LB. The measurement of fatigue: a new instrument. J Psychosom Res 1993;37:753–62.

3.Austin JS, Maisiak RS, Macrina DM, Heck LW. Health outcome improvements in patients with systemic lupus erythematosus using two telephone counseling interventions. Arthritis Care Res 1996;9:391–9.

4.Krupp LB, LaRocca NG, Muir J, Steinberg AD. A study of fatigue in systemic lupus erythematosus. J Rheumatol 1990;17:1450–2.

5.Ramsey-Goldman R, Schilling EM, Dunlop D, Langman C, Greenland P, Thomas RJ, et al. A pilot study on the effects of exercise in patients with systemic lupus erythematosis. Arthritis Care Res 2000;13:262–9.

6.Alexander RW, Bradley LA, Alarcón GS, Trianna-Alexander M, Aaron LA, Alberts KR, et al. Sexual and physical abuse in women with fibromyagia: association with outpatient health care utilization and pain medication usage. Arthritis Care Res 1998;11:102–15.

7.Ravdin LD, Hilton E, Primeau M, Clements C, Barr WB. Memory functioning in lyme borreliosis. J Clin Psychol 1996;57;282–6.

8.Giovannoni G, Thompson AJ, Miller DH, Thompson EJ. Fatigue is not associated with raised inflammatory markers in multiple sclerosis. Neurology 2001;57:676–81.

9.Packer TL, Martins I, Krefting L, Brouwer B. Post-polio sequelae: activity and post-polio fatigue. Orthopedics 1991;14:1223–6.

10.Drory VE, Goltsman E, Reznik JG, Mosek A, Korczyn AD. The value of muscle exercise in patients with amyotrophic lateral sclerosis. J Neurol Sci 2001;191:133–7.

11.Stone P, Hardy J, Huddart R, Hern RA, Richards M. Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer 2000;36:1134–41.

12.La Chapelle DL, Finlayson MAJ. An evaluation of fatigue in patients with brain injury and healthy controls. Brain Inj 1998;12:649–59.

13.Shulman LM, Taback RL, Bean J, Weiner WJ. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord 2001;16:507–10.

14.Means MK, Lichstein KL, Epperson MT, Johnson CT. Relaxation therapy for insomnia: nighttime and day time effects. Behav Res Ther 2000;38:665–78.

15.Aguillard RN, Riedel BW, Lichstein K, Grieve FG, Johnson CT, Noe SL. Daytime functioning in obstructive sleep apnea patients: exercise tolerance, subjective fatigue, and sleepiness. Appl Psychophysiol Biofeedback 1998;23:207–17.

16.Winstead-Fry P. Psychometric assessment of four fatigue scales with a sample of rural cancer patients. J Nurs Meas 1998;6:111–22.

Additional Reference

Krupp LB, Coyle, PK, Doscher C, Miller A, Cross AH, Jandorf L, Halper J, Johnson B, Morgante L, Grimson R. Fatigue therapy in multiple sclerosis: Results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology 1995;45:1956-61.

Additional Reference

Taylor RR, Jason LA, Torres A. Fatigue rating scales: an empirical comparison. Psycol Med 2000;30:849-56.

MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information

General Description

Purpose

The MAF was originally developed to measure self-reported fatigue in adults with rheumatoid arthritis (RA) (1) but subsequently has been used to measure fatigue in adults with other chronic conditions. The MAF is a revision of the Piper Fatigue Scale that was developed and tested with oncology patients (2).

Content

The MAF is a self-administered questionnaire to measure 4 dimensions of self-reported fatigue: degree and severity, amount of distress it causes, its timing (how often it occurs and if it changed over the past week), and the degree to which fatigue interferes with activities of daily living (e.g., household chores, cooking, bathing, dressing, working, socializing, sexual activity, leisure/recreational, shopping, walking, other exercising). Respondents are asked to reflect on their experience of fatigue for the past week. A Global Fatigue Index (GFI) is calculated.

Developer/contact information

Basia Belza, PhD, RN, Department of Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA 98195-7266. Website for MAF users: http://www.son.washington.edu/research/maf/users-guide.asp.

Versions

Originally developed in English. Numerous language versions are available from the MAPI Research Institute (Lyon, France) such as Spanish for Mexico, Spanish for the United States, and Portuguese for Brazil. To gain access to and information about a translated version contact MAPI at their website at www.mapi-research-inst.com.

Number of items in scale

The MAF consists of 16 items. Only 15 items are used to calculate the GFI.

Subscales

Although dimensions are not intended as subscales for descriptive purposes some researchers have reported mean scores for severity (items 1,2), distress (item 3), degree of interference in activities of daily living (items 4–14), and timing (items 15,16).

Populations
Developmental/target

Adults with rheumatoid arthritis.

Other uses

Healthy adults (control) compared with adults with RA (3), adults with RA (4,5); recent onset synovitis (6); RA/anemia (7); adults with a chronic disease (human immunodeficiency virus [HIV]–positive adults [8], HIV-positive adults receiving interleukin-2 treatment &lsqbr;9&rsqbr;); oncology mixed cancer (10); breast cancer chemotherapy (11); chronic obstructive pulmonary disease (12); Multiple sclerosis (13); coronary heart disease (14); breast-feeding women (15), postpartum women (16); rural oncology (17).

WHO ICF Components

Activity limitation, participation restriction.

Administration

Method

Self-administered questionnaire.

Training

No special training.

Time to administer/complete

Author states less than 5 minutes.

Equipment needed

Paper and pencil.

Cost/availability

Permission to use the MAF is obtained by completing the permission form accessed from a website: http://www.son.washington.edu/research/maf/users-guide.asp. There is no charge for individual use of the MAF. Colleagues in industry who would like to use the MAF may be charged a nominal fee.

Scoring

Responses
Scale

Numerical rating scale (1–10) for items 1, and 4–14 (1 = not at all, 10 = a great deal), item 2 (1 = mild to 10 = severe), item 3 (1 = no distress, 10 = a great deal of distress), Categorical response (1–4) for Timing items 15 and 16.

Score range

For GFI, score range is 1–50 (1 = no fatigue, 50 = severe fatigue).

Interpretation of scores

Higher scores indicate more severe fatigue, fatigue distress, or interference with activities of daily living.

Method of scoring

To calculate the GFI, convert item 15 to a 0–10 scale by multiplying each score by 2.5 and then sum items 1,2, and 3, average of items 4–14, and newly scored item 15. Item 16 is not included in the GFI. Do not assign a score to items if respondent indicated they “do not do any activity for reasons other than fatigue.” If respondents select no fatigue on 1, assign a zero to items 2–16. Mean scores for Severity, Interference in ADLs, and Timing can also be calculated.

Time to score

5 minutes.

Training to score

No special training needed.

Training to interpret

No special training needed.

Norms available

Mean GFI in RA patients (n = 51) was 29.2, 28.1, and 26.1 at 3 time periods 6–8 weeks apart. Age- and sex-matched healthy controls (n = 46) had a mean GFI of 17, 16.5, and 15.8 at the 3 time periods (3).

Pychometric Information

Reliability
Numerical rating scale

Cronbach's alpha for GFI = 0.93 (n = 77), stability correlation ranged from a high of 0.73 for controls at Time 1 to a low of 0.47 for controls at Time 3 (3). Testing of the MAF-GFI with 210 cancer patients confirmed excellent internal consistency (Cronbach's alpha = 0.88) and stability (n = 37), r = 0.87 (10). Excellent internal consistency of the MAF-GFI also was supported in a study of 183 HIV-positive men with a Cronbach's alpha = 0.96 (8).

Validity
Construct

Original factor analysis of data from adult RA patients supported a 1-factor solution (1). Two factor analyses of the MAF scores of subjects with cancer (10,17) did not support a one-factor solution (fatigue). However, Bormann et al (8) found that 15 items loaded on one factor (level of fatigue) in a non-rotated factor analysis.

Concurrent

Correlated with the POMS fatigue subscale (r = 0.84, P = 0.01) (1). Meek et al (10) also found moderately high correlations of the MAF-GFI with selected POMS subscales (10).

Divergent

Negative correlation with POMS vigor subscale (r = −0.62) (3). Divergent validity was supported by an inverse relationship of the MAF-GFI with the Short Form-36 vitality scale (r = −0.80; P < 0.001) (8).

Sensitivity/responsiveness to change

GFI scores indicated less fatigue in adult RA patients with anemia of chronic disease after treatment of their anemia (7). Global Fatigue Index increased significantly from baseline to posttest measures for mothers of infants on apnea monitors (16). Meek et al (10) found the MAF responsive to changes in fatigue after radiation or chemotherapy. GFI increased in HIV-infected men after treatment with Interleukin-2 and returned to baseline at 1-month post-treatment (9).

Comments and Critique

The original version of the MAF used a visual analog scale response format. The response format was changed to a numerical rating scale and tested in 50 adults with RA and 26 age- and sex-matched controls. The mean fatigue level in adults with RA was higher compared to healthy controls. The change in response format did not change the excellent internal consistency of the MAF (3). In clinic settings where a brief assessment of amount of fatigue is preferred, the 2-item MAF-severity or a 1-item visual analog scale, Rhoten Fatigue Scale (18), can be used. However, these latter two scales measure only the amount of fatigue and the 1-item Rhoten Scale cannot be assessed for internal consistency. The strength of the MAF is that it measures 4 dimensions of fatigue thus providing data for a fuller description of fatigue in the population of interest.

References

1.(Original) Tack (Belza) B. Dimensions and correlates of fatigue in older adults with rheumatoid arthritis [dissertation]. San Francisco: University of California, San Francisco, School of Nursing; 1991.

2.Piper B, Lindsey A, Dodd M, Ferketich S, Paul S, Weller S. The development of an instrument to measure the subjective dimension of fatigue. In Funk S, Tornquist E, Champagne M, Wiese R, editors. Key aspects of comfort: management of pain, fatigue, and nausea. New York: Springer; 1989. p. 199–207.

3.Belza B. Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol 1995;22:639–43.

4.Neuberger G, Press AN, Lindsley HB, Hinton R, Cagle PE, Carlson K, et al. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Res Nurs Health 1997;20:195–204.

5.Belza B, Henke C, Yelin EH, Epstein WV, Gilliss CL. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res 1993;42:93–9.

6.Gerber L, El-Gabalawy H, Arayssi T, Furst G, Yarboro C, Schumacher HR. Polyarticular arthritis, independent of rheumatoid factor, is associated with poor functional outcome in recent onset inflammatory synovitis. J Back Musculoskeletal Rehabil 2000;14:105—9.

7.Kaltwasser JP, Kessler U, Gottschalk R, Stucki G, Möller B. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 2001;28:2430–6.

8.Bormann J, Shively M, Smith T, Gifford A. Measurement of fatigue in HIV-positive adults: reliability and validity of the Global Fatigue Index. J Assoc Nurses AIDS Care 2001;12:75–83.

9.Grady C, Anderson R, Chase GA. Fatigue in HIV-infected men receiving investigational interleukin-2. Nurs Res 1998;47:227–34. 10. Meek PM, Nail LM, Barsevick A, Schwartz AL, Stephen S, Whitmer K, et al. Psychometric testing of fatigue instruments for use with cancer patients. Nurs Res 2000;49:181–190.

10.Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Matteson S, Rakita D, et al. Temporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment. Support Care Cancer 2002;10:329–36.

11.Belza B, Steele BG, Hunziker J, Lakshminaryan S, Holt L, Buchner DM. Correlates of physical activity in chronic obstructive pulmonary disease. Nurs Res 2001;50:195–202.

12.Schwartz CE, Coulthard-Morris L, Zeng Q. Psychosocial correlates of fatigue in multiple sclerosis. Arch Phys Med Rehabil 1996;77:165–70.

13.Sullivan MD, LaCroix AZ, Spertus JA, Hecht J. Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. Am J Cardiol 2000;86:1135–38.

14.Wambach KA. Maternal fatigue in breastfeeding primiparae during the first nine weeks postpartum. J Hum Lactation 1998;14:219–29.

15.Williams PD, Press A, Williams AR, Piamjariyakul U, Keeter LM, Schultz J, et al. Fatigue in mothers of infants discharged to the home on apnea monitors. App Nurs Res 1999;12:69–77.

16.Winstead-Fry P. Psychometric assessment of four fatigue scales with a sample of rural cancer patients. J Nurs Meas 1998;6:111–22.

17.Rhoten D. Fatigue and the postsurgical patient. In: Norris CM, editor. Concept clarification in nursing. Rockville (MD): Aspen; 1982; p. 277–300.

SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information

General Description

Purpose

To assess vitality (energy level and fatigue). Subscale of a general health survey designed for use in clinical practice and research, health policy evaluation and general population surveys (1).

Content

Vitality Subscale score is determined by responses to 4 items: Did you feel full of life? Did you have a lot of energy? Did you feel worn out? Did you feel tired?

Developer/contact information

Developers: John E. Ware, Jr, PhD and Cathy Donald Sherbourne, PhD. Contact information: John E. Ward, Jr, PhD, Health Institute NEMC-Box 345, 750 Washington Street, Boston, MA 02111. Website is http://www.sf-36.com/.

Versions

SF-36 Version 1.0, SF-36 Version 2.0, SF-12 and SF-8. The SF-8 and SF-12 have only 1 item to assess energy/fatigue. There is a SF-36 Version 2.0 with new scoring book that was released in Fall, 2002.

Number of items in subscale

There are 4 items.

Subscales

4 items in Energy/Fatigue Subscale on SF-36.

Populations
Developmental/target

14 years of age and older.

Other uses

The SF-36 has been widely used in numerous ill or healthy populations to assess health status. In rheumatology, it has been used mainly in adults with osteoarthritis (OA) or hip replacement for OA. Also has been used in studies of adults with RA or Sjogren's syndrome (See selected examples on reference list).

WHO ICF Components

Activity limitation.

Administration

Method

Self-administered questionnaire (14 years or older). Computerized administration or administration by an interviewer.

Training

None for Vitality subscale.

Time to administer/complete

For subscale less than one minute.

Equipment needed

Pencil.

Cost/availability

No charge to academic institutions or persons with academic appointments. Charge to commercial institutions. Scoring Manual for SF-36 Version 1 is $108 and can be ordered from the SF-36 website. Questionnaires can be printed from the website.

Scoring

Responses
Scale

Likert 1–6 response format for SF-36 Version 1 where 1 = All of the time, 6 = None of the time.

Score range

Range is 4–24 for subscale, transformed score 0–100.

Interpretation of scores

Higher score indicates higher vitality (greater energy, lower fatigue), lower score indicates lower vitality (less energy, greater fatigue).

Method of scoring

Two positive energy items: “Did you feel full of pep?” and “Did you have lots of energy?” must be reverse-scored. Sum values for a total raw score. Transform each raw scale score to a 0–100 scale using the following formula: Transformed Scale = (Actual raw score - lowest possible raw score) ÷ (Possible raw score range) × 100. It is recommended that respondents must answer 50% of the items in the scale for the score to be calculated.

Time to score

1–2 minutes.

Training to score

Inform scorer about recoding of 2 positive energy items.

Training to interpret

No.

Norms available

SF-12 version-2, SF-36 version-2 and SF-8 surveys have up-to-date general US population norms for both the standard (4-week recall) and acute (1-week recall) forms.The norm data are available in the scoring manual that must be purchased. In one study, normal female control subjects (n = 126) had a vitality transformed score of 60 (2).

Psychometric Information

Reliability

For Vitality subscale Cronbach's alpha= 0.87 (n = 3,445) (3).

Validity
SF-36 Version 1.0

Construct validity supported by factor analysis (4). Vitality subscale had a relative validity of 0.67 in discriminating between patients with minor versus serious medical conditions, but poor discriminant validity in distinguishing patients with serious medical conditions from psychiatric patients.

Sensitivity/responsiveness to change

SF-36 Vitality subscale increased following treatment of anemia of chronic disease in patients with rheumatoid arthritis (5). SF-36 Vitality subscale scores improved in osteoarthritis patients after hip replacement surgery (6) and following treatment of early rheumatoid arthritis with etanercept or methotrexate (7).

Comments and Critique

In 2002, a literature search identified 148 references in which the Vitality Subscale, as part of the SF-36, was measured in studies of patients with arthritis. Most of these studies were with patients with osteoarthritis. Fewer studies were found with patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. According to the SF-36 website, the SF-36 version 1, SF-12 version 1 and SF-8 have been translated into more than 40 different languages. The 1 vitality item on the SF-8 and SF-12 needs further testing in patients with rheumatic disorders to establish its responsiveness for that population (8). The SF-36 Vitality (energy/fatigue) subscale is short (4 items) and has strong psychometric data supporting its reliability and validity.

References

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information
  • 1
    (Original) Ware JE, Sherbourne, CD. The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection. Med Care 1992; 30: 47383.
  • 2
    Tensing EK, Solovieva SA, Tervahartiala T, Nordstrom DC, Laine M, et al. Fatigue and health profile in sicca syndrome of Sjogren's and non-Sjogren's syndrome origin. Clin Exp Rheumatol 2001: 19: 3136.
  • 3
    McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32: 4066.
  • 4
    McHorney CA, Ware JE, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31: 24763.
  • 5
    Kaltwasser JP, Kessler U, Gottschalk R, Stucki G, Möller, B. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 2001; 28: 24306.
  • 6
    Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtena BG, et al. A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage 2001: 9: 13746.
  • 7
    Kosinski M, Kujawski SC, Martin R, Wanke LA, Buatti MC, Ware JE, et al. Health-related quality of life in early rheumatoid arthritis: Impact of disease and treatment response. Am J Manag Care 2002; 8: 23140.
  • 8
    Ghandhi SK, Salmon JW, Zhao SZ, Lambert BL, Gore PR, Conrad K. Psychometric evaluation of the 12-item short-form health survey (SF-12) in osteoarthritis and rheumatoid arthritis clinical trials. Clin Ther 2001; 23: 10801.

Supporting Information

  1. Top of page
  2. FATIGUE QUESTIONNAIRE
  3. FATIGUE SEVERITY SCALE (FSS)
  4. MULTIDIMENSIONAL ASSESSMENT OF FATIGUE (MAF) Scale
  5. SHORT FORM-36 (SF-36) VITALITY SUBSCALE OF THE SHORT FORM HEALTH SURVEY
  6. References
  7. Supporting Information
FilenameFormatSizeDescription
suppmat_175.pdf49KSupporting Information file suppmat_175.pdf

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