A Qualitative Metasynthesis of the Experience of Fatigue Across Five Chronic Conditions

Abstract

Context. Fatigue is a symptom reported by patients with a variety of chronic conditions. However, it is unclear whether fatigue is similar across conditions. Better understanding its nature could provide important clues regarding the mechanisms underlying fatigue and aid in developing more effective therapeutic interventions to decrease fatigue and improve quality of life. Objectives. To better understand the nature of fatigue, we performed a qualitative metasynthesis exploring patients' experiences of fatigue across five chronic noninfectious conditions: heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease. Methods. We identified 34 qualitative studies written in the last 10 years describing fatigue in patients with one of the aforementioned conditions using three databases (Embase, PubMed, and CINAHL). Studies with patient quotes describing fatigue were synthesized, integrated, and interpreted. Results. Across conditions, patients consistently described fatigue as persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsened over time. Four common themes emerged: running out of batteries, a bad life, associated symptoms (e.g., sleep disturbance, impaired cognition, and depression), and feeling misunderstood by others, with a fear of not being believed or being perceived negatively. Conclusion. In adults with heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease, we found that fatigue was characterized by severe energy depletion, which had negative impacts on patients' lives and caused associated symptoms that exacerbated fatigue. Yet, fatigue is commonly misunderstood and inadequately acknowledged.

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews

“…Toye et al [180] described how patients with chronic pain tended to perceive their life as "impoverished and confined" and as being in a "constant battle against their body". Similarly, our findings identified a risk of isolation for some patients because of the burden of symptoms [41,50,56,74], the physical limitations as a consequence of disease progression [35,42,43,49,51,52,54,55,61,72,73] and complications [62,63,78,[102][103][104], and the impact of perceived or experienced stigma [37,41,81,88,89,91,100]. One overview of qualitative reviews also explored patients' and caregivers' experiences of care with chronic diseases and included two of our selected diseases (HF and COPD) [181].…”

“…Most patients with obesity perceived themselves as having poor fitness and low confidence in their physical capability [ 61 ]. In COPD and HF, fatigue was a common symptom with a negative impact on patient quality of life [ 35 ]. In these patients, damaged lung function, declines in cognitive status, and effects of symptoms and treatments interrupted patients’ previous functioning and increased dependency [ 42 , 43 , 49 , 51 , 52 , 55 , 72 , 73 ].…”

“…We included 148 reviews, distributed as follows: T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one chronic disease (n = 5 [3.4%]). Three included both COPD and HF [34][35][36], one included both T2DM and COPD [37], and one included COPD, HF, and T2DM [38] (Table 1…”

Passive transfer of fibromyalgia symptoms from patients to mice

“…IgG from patients reduces locomotor activity in mice. Fatigue, a feeling of excessive mental or physical weariness and weakness, is one of the key symptoms of FMS (38), but also of a wide range of other chronic diseases (39). FMS patients often display reduced levels of physical activity (40), with a loss of physical fitness as a consequence (41).…”

Fatigue in patients with chronic disease: results from the population-based Lifelines Cohort Study

“…Parkinson’s disease (PD) 3 , chronic heart failure (CHF) 4 , chronic obstructive pulmonary disease (COPD) 5 , type I diabetes mellitus (T1DM) 6 , rheumatoid arthritis (RA) 7 , and inflammatory bowel disease 8 . Fatigue is associated with functional impairment and often reported by patients to be one of the most burdensome and challenging aspects of their disease 9 , 10 . Thus far, fatigue is mostly studied in the context of a single chronic condition.…”