Associations between fatigue impact and lifestyle factors in people with multiple sclerosis – The Danish MS hospitals rehabilitation study

Abstract

Background:The lack of medical treatment options to reduce fatigue in patients with multiple sclerosis (MS) emphasize the importance of identifying potential non-pharmacological modifiable factors, as this may help advance current treatment strategies. The aim of this study was to identify potential modifiable lifestyle factors as well as patient-and disease-related characteristics, that are associated with fatigue in a large sample of clinically well-characterized patients with MS.Methods: This study was a secondary analysis of a pragmatic randomized controlled trial of inpatient multidisciplinary rehabilitation in Denmark. MS patients aged 18 to 65 years and with a disease severity score ≤ 7.5 according to the Expanded Disability Status Scale participated. Data on patient-and disease-related characteristics, fatigue impact (Modified Fatigue Impact Scale (MFIS)), and on lifestyle factors (tobacco smoking, alcohol intake, and physical activity), were collected at baseline.A linear mixed model was used to compare MFIS total, physical, cognitive, and psychosocial scores across subgroups of selected characteristics. Regression analyses were used to examine associations between lifestyle factors and MFIS total, physical, cognitive, and psychosocial scores.Results: In the sample of 417 MS patients, median age was 51 years, 69% were female, median time since diagnosis was 8 years, with 41% having relapsing remitting MS.Higher MFIS total scores were observed in MS patients with shorter time since diagnosis, being a tobacco smoker, and not undertaking regular physical activity. Somewhat similar findings were observed for MFIS subscores (physical, cognitive, psychosocial), especially MFIS physical scores.In the multivariate analyses, physical activity was significantly associated with fatigue impact on total, physical and psychosocial functioning. Tobacco smoking was significantly associated with fatigue impact on psychosocial functioning. Alcohol intake was not associated with fatigue impact. None of the lifestyle factors were associated with fatigue impact on cognitive functioning. In the adjusted models time since diagnosis was significantly associated with fatigue impact on total, physical and cognitive functioning, as was disease severity with fatigue impact on physical and cognitive functioning.Conclusion: Physical activity showed the most pronounced associations with fatigue impact on physical and psychosocial functioning, while the impact on cognitive functioning showed a trend. Tobacco smoking contributed significantly to impact on psychosocial functioning, while alcohol intake did not contribute to fatigue impact. Introducing or supporting maintenance of physical activity/exercise and cessation of tobacco smoking seems to be a useful approach for rehabilitation services to help patients with MS manage fatigue.

Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis

“…The pooled overall effect size for early retirement was 17.2% (95% CI 14.6–20.2; I 2 = 99.13). In three (4.5%) studies from 2006, 2018, and 2021, the prevalence of early retirement was over 50% [ 74 , 122 , 174 ]. In the most recent studies, the subjects’ sample largely comprised patients who attended rehabilitation clinics or were of advanced age.…”

“…32, 120, 122, 123], Denmark (four, 6.0%) [73][74][75][76], Australia (three, 4.5%) [108,109,175], Belgium (three, 4.5%) [35,79,80], Holland (three, 4.5%) [61,63,176], Italy (three, 4.5%) [111 -113], Ireland (two, 3.0%) [47,48], Spain (two, 3.0%) [8, 28], Sweden (two, 3.0%) [90,91], Switzerland (two, 3.0%) [66,67], Argentina (one, 1.5%) [46], Austria (one, 1.5%) [39], Brazil (one, 1.5%) [55], the Czech Republic (one, 1.5%) [40], France (one, 1.5%) [85], Greece (one, 1.5%) [41], Hungary (one, 1.5%) [42], Iran (one, 1.5%) [59], Israel (one, 1.5%) [49], Russia (one, 1.5%) [45], Norway (one, 1.5%) [65], and Portugal (one, 1.5%) [44]. One (1.5%) study was multinational [170].…”

“…three (2.0%) studies each. Most of the data on the estimates of the prevalence comes from Canada (four, 2.6%)[69][70][71][72], Denmark (five, 3.3%)[73][74][75][76][77], Belgium (five, 3.3%)[35,[78][79][80][81], France (five, 3.3%)[82][83][84][85][86], Spain (five, 3.3%) [8,28,33,87,88], Sweden (seven, 4.6%)[89- 95], Germany (eight, 5.3%)[96][97][98][99][100][101][102][103], Australia (eight, 5.9%)[38,[104][105][106][107][108][109][110], Italy (nine, 5.9%)[111][112][113][114][115][116][117][118][119], United Kingdom (nine, 5.9%)[29,32,…”

Fatigue in multiple sclerosis is associated with socioeconomic factors

“…Current smoking was independently associated with fatigue in the regression model in which disability pension, anxiety and depression was not included, but not when these variables were included. In a Danish study, the researchers examined the impact of different lifestyle factors on MS fatigue, including smoking, alcohol habits and physical activity (Johansson et al, 2021). They found that physical activity reduced the impact of fatigue, and that smoking had a negative effect, while alcohol intake was not associated with fatigue.…”

Multimethodological validation of the modified fatigue impact scale in a Danish population of people with Multiple Sclerosis

“…Specifically, the MFIS is a three-factor composite scale evaluating and quantifying the trait level of experienced fatigue impact on physical (9 items), cognitive (10 items) and psychosocial functioning (2 items). The MFIS is an acknowledged outcome measure in clinical trials, and despite being widely used in the Danish MS community (Taul-Madsen et al, 2020;Johansson et al, 2021;Oervik et al, 2017;Riemenschneider et al, 2021;Callesen et al, 2020), the Danish translation of the questionnaire has not yet been validated. Moreover, previous validation studies of other translations of the MFIS scale have reached different conclusions regarding the validity of the MFIS.…”