Approach to Fatigue

Dukes, Jason; Chakan, Matthew; Mills, Aaron; Marcaurd, Maurice

doi:10.1016/j.mcna.2020.09.007

Cited by 16 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Management of fatigue is generally challenging, and effective treatments are lacking. 13 Transcranial direct current stimulation (tDCS) is a safe, portable, and non-invasive neuromodulation technique. 14 Previous studies have described the positive effects of non-invasive brain stimulation on fatigue associated with other disorders, such as multiple sclerosis, Parkinson’s disease, stroke, or autoimmune disorders.…”

Section: Introductionmentioning

confidence: 99%

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Oliver-Mas

Delgado‐Alonso

Delgado‐Álvarez

et al. 2023

Brain Communications

View full text Add to dashboard Cite

Fatigue is one of the most frequent and disabling symptoms of post-COVID syndrome. In this study, we aimed to assess the effects of transcranial direct current stimulation on fatigue severity in a group of patients with post-COVID syndrome and chronic fatigue. We conducted a double-blind, parallel-group, sham-controlled study to evaluate the short-term effects of anodal transcranial direct current stimulation (2 mA, 20 min/day) on the left dorsolateral prefrontal cortex. The Modified Fatigue Impact Scale score was used as the primary endpoint. Secondary endpoints included cognition (Stroop test), depressive symptoms (Beck Depression Inventory), and quality of life (EuroQol-5D). Patients received eight sessions of transcranial direct current stimulation and were evaluated at baseline, immediately after the last session, and one month later. Forty-seven patients were enrolled (23 in the active treatment group and 24 in the sham treatment group); mean age was 45.66 ± 9.49 years, and 37 (78.72%) were women. The mean progression time since acute infection was 20.68 ± 6.34 months. Active transcranial direct current stimulation was associated with a statistically significant improvement in physical fatigue at the end of treatment and at one month as compared with sham stimulation. No significant effect was detected for cognitive fatigue. In terms of secondary outcomes, active transcranial direct current stimulation was associated with an improvement in depressive symptoms at the end of treatment. The treatment had no effects on quality of life. All the adverse events reported were mild and transient, with no differences between the active stimulation and sham stimulation groups. In conclusion, our results suggest that transcranial direct current stimulation on the dorsolateral prefrontal cortex may improve physical fatigue. Further studies are needed to confirm these findings and optimize stimulation protocols.

show abstract

Section: Introductionmentioning

confidence: 99%

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Oliver-Mas

Delgado‐Alonso

Delgado‐Álvarez

et al. 2023

Brain Communications

View full text Add to dashboard Cite

show abstract

“…The most recent definitions refer to fatigue as a suboptimal psychophysiological condition caused by exertion; this state causes changes that may reduce mental processing or physical activity [ 2 ]. Fatigue is related with alterations in muscle activity, proprioception, and cognitive function [ 3 ], and has been associated with chronic diseases such as hypothyroidism [ 4 ]. It has been reported that up to one-third of patients presenting with fatigue have thyroid disease, predominantly in women [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism

et al. 2023

View full text Add to dashboard Cite

Background: Fatigue is a common symptom in hypothyroidism; however, the effect of levothyroxine on fatigue has been little studied. The aim of this study was to evaluate the effect of levothyroxine on fatigue in Latino patients with primary hypothyroidism, as well as the association of TSH and free T4 (FT4) with the severity and persistence of fatigue. Methods: A prospective study was performed in 92 patients with primary hypothyroidism. Fatigue severity scale (FSS) scores and clinical and biochemical characteristics before and at 6 months of levothyroxine were evaluated. Results: After 6 months of levothyroxine, a reduction in FSS (53 (47–57) vs. 36 (16–38); p = 0.001) and fatigue frequency (45.7% vs. 26.1%; p = 0.008) was evident. Both before and after 6 months of levothyroxine, there was a positive correlation of the FSS score with TSH and a negative correlation with FT4. Persistent fatigue was associated with a pretreatment FSS score (r = 0.75; p = 0.001) and diabetes (r = 0.40; p = 0.001). An FSS > 34 (RR 3.9 (95% CI 1.43–10.73; p = 0.008)), an FSS > 36 (RR 3.23 (95% CI 1.21–8.6; p = 0.019)), and diabetes (RR 5.7 (95% CI 1.25–9.6; p = 0.024)) before treatment were risk factors for persistent fatigue. Conclusions: Levothyroxine improved fatigue in most patients. Diabetes and an FSS score >34 or >36 before treatment were risk factors for persistent fatigue.

show abstract

“…Indeed, PCP often believe that fatigue has no speci c de nition and can be associated with a wide variety of differential diagnoses. [8][9][10] Even more troubling for the physician is that fatigue can indicate a very broad spectrum of potentially life-threatening underlying diseases or conditions of organic, [11][12][13] mental, behavioural, [7,[14][15][16] or lifestyle [7,17] origin. For a summary of potential underlying factors of fatigue, see Fig.…”

Section: Introductionmentioning

confidence: 99%

“…[26] Patient-centred tools have been developed to help differentiate the causes of fatigue at the primary practice level, including the Epworth Sleepiness Scale, the STOP-Bang questionnaire, and the Patient Health Questionnaire-9 (PHQ9). [9] Guidance for primary practitioners is available on how to proceed with the differential diagnosis unexplained fatigue, [17,27] however no tool has been speci cally validated in this setting. The use of non-validated tools may compromise data interpretation, and therefore PCPs could bene t from a patient-centred diagnostic aid that is particularly adapted to their setting.…”

Section: Introductionmentioning

confidence: 99%

Effects of a novel differential diagnosis aid for managing patients with unexplained fatigue in the primary care setting. A prospective randomized, controlled and multicentre pilot study in primary care

Känel,

Neuner-Jehle,

Kressig

et al. 2023

Preprint

View full text Add to dashboard Cite

Objective Unexplained fatigue is a common reason for encounter in the primary care setting, with currently no structured tool available to support diagnosis. This study evaluated the effects of the novel Fatigue Differential Diagnostic Aid (FDDA) in clinical practice. Design This was a prospective, randomized, controlled, multicentre study comparing use of the FDDA vs usual care in patients with unexplained fatigue as the main reason for encounter. Setting and Participants The study included 93 patients seen in the primary care setting (FDDA n=40, usual care n=53) in Switzerland. Outcomes Patient Global Impression of Change (PGIC), patient satisfaction with treatment and fatigue improvement, treatment patterns, number of examinations, number of visits. Results There was no statistically significant group difference for the primary endpoint of PGIC. However, five predefined endpoints met statistical significance: (1) More patients were very satisfied with treatment management in the FDDA group at both 1 month (FDDA 56.8% vs usual care 25.6%, p=0.004) and 3 months (FDDA 64.9% vs usual care 31%, p=0.003); (2) patients underwent more examinations at baseline in the FDDA group (median 11.0 for FDDA vs 7.0 for usual care, p=0.002); (3) The FDDA group received a wider range of, and more treatments at 1 month, but less iron replacement therapy (p=0.0233); the FDDA was also associated with (4) a higher total number of visits (median 4.0 vs 3.0, p <0.001), and (5) more patients reporting reduced fatigue after 3 or 6 months (FDDA 97.4% vs usual care 78.4%, p=0.011). Conclusions The FDDA has the potential to improve the management of fatigue. The findings of this study may be relevant to clinical practice because physicians using the FDDA investigated the causes of fatigue more extensively, and more patients reported reduced fatigue. Further studies on diagnostic tools for unexplained fatigue are warranted.

show abstract

Approach to Fatigue

Cited by 16 publications

References 27 publications

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Transcranial direct current stimulation for post-COVID fatigue: a randomized, double-blind, controlled pilot study

Severity of Fatigue and Its Relationship with TSH before and after Levothyroxine Replacement Therapy in Patients with Primary Hypothyroidism

Effects of a novel differential diagnosis aid for managing patients with unexplained fatigue in the primary care setting. A prospective randomized, controlled and multicentre pilot study in primary care

Contact Info

Product

Resources

About