Differential Diagnosis and Management of Fatigue in Multiple Sclerosis: Considerations for the Nurse

Costello, Kathleen; Harris, Colleen

doi:10.1097/01376517-200306000-00003

Cited by 22 publications

(22 citation statements)

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“…18 Sutherland et al also reported that relaxation education resulted in a decrease in fatigue levels in MS patients. 17 It is reported in the literature that carefully and regularly applied exercise is one of the methods used in coping with fatigue 8,30 ; PMRT used as one of the nonpharmacological approaches to control fatigue in patients with MS yielded positive results, 7,31 and 5-20-minute PMRT sessions were as effective as 1 hour of sleep in preserving individuals' physical energy. 32 A statistically significant difference was found between the global sleep quality ( p < 0.001) score averages and the score averages the patients obtained from subjective sleep quality ( p < 0.001), sleep latency ( p < 0.001), sleep duration ( p < 0.05), sleep efficiency ( p < 0.05), sleep disorder ( p < 0.001), and daytime dysfunction ( p < 0.001) areas of sleep quality scale after PMRT.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis

Dayapoğlu

Tan²

2012

The Journal of Alternative and Complementary Medicine

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Background and objectives: Fatigue and sleep problems are very commonly observed in patients with multiple sclerosis (MS). The Progressive Muscle Relaxation Technique (PMRT), used as one of the alternative methods in recent years, is reported to have benefits such as facilitating sleep and reducing sensitivity against fatigue. This research was conducted to investigate the effect of PMRT on fatigue and sleep quality in patients with MS. Setting and design: This research was performed as a single-group pretest/post-test pretrial model. The research was conducted between March 2008 and December 2009 in the neurology polyclinic. Materials and methods: The study was conducted with 32 patients who met the research criteria and agreed to participate in the study. A Personal Information Form was used as a data collection tool, Fatigue Severity Scale was used for measuring fatigue, and the Pittsburgh Sleep Quality Index was used for evaluating the sleep quality. PMRT was applied to the sample group once a day for 6 weeks. Statistical analysis: Percentage, paired t-test, and Pearson's correlation analysis were used in the assessment of data. Results: It was determined that PMRT decreased patients' fatigue level and improved their sleep quality, and this difference was observed to be statistically significant. Moreover, patients' fatigue level increased as their sleep quality decreased. Conclusions: This study supports the effect of PMRT on fatigue and sleep quality in patients with MS, and it is recommended that further studies be conducted on this subject in the future.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis

Dayapoğlu

Tan²

2012

The Journal of Alternative and Complementary Medicine

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“…MS-fatigue differs from tiredness experienced by healthy people in both severity and impact. It can have a profound impact on individuals’ lives; limiting or preventing participation in everyday activities, work, leisure and social pursuits; and reducing psychological well-being 3. It is one of the key precipitants of early retirement4 and its ‘invisible’ nature can make it difficult for others to understand 5.…”

Section: Introductionmentioning

confidence: 99%

A pragmatic parallel arm multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based fatigue management programme (FACETS) for people with multiple sclerosis

Thomas

Kersten

et al. 2013

J Neurol Neurosurg Psychiatry

109

104

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BackgroundFatigue is a common and troubling symptom for people with multiple sclerosis (MS).AimTo evaluate the effectiveness and cost-effectiveness of a six-session group-based programme for managing MS-fatigue (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle (FACETS)).MethodsThree-centre parallel arm randomised controlled trial with economic evaluation. Patients with MS and significant fatigue were randomised to FACETS plus current local practice (FACETS) or current local practice alone (CLP), using concealed computer-generated randomisation. Participant blinding was not possible. Primary outcomes were fatigue severity (Fatigue Assessment Instrument), self-efficacy (Multiple Sclerosis-Fatigue Self-Efficacy) and disease-specific quality of life (Multiple Sclerosis Impact Scale (MSIS-29)) at 1 and 4 months postintervention (follow-up 1 and 2). Quality adjusted life years (QALYs) were calculated (EuroQoL 5-Dimensions questionnaire and the Short-form 6-Dimensions questionnaire).ResultsBetween May 2008 and November 2009, 164 patients were randomised; primary outcome data were available for 146 (89%). Statistically significant differences favour the intervention group on fatigue self-efficacy at follow-up 1 (mean difference (MD) 9, 95% CI (4 to 14), standardised effect size (SES) 0.54, p=0.001) and follow-up 2 (MD 6, 95% CI (0 to 12), SES 0.36, p=0.05) and fatigue severity at follow-up 2 (MD −0.36, 95% CI (−0.63 to −0.08), SES −0.35, p=0.01) but no differences for MSIS-29 or QALYs. No adverse events reported. Estimated cost per person for FACETS is £453; findings suggest an incremental cost-effectiveness ratio of £2157 per additional person with a clinically significant improvement in fatigue.ConclusionsFACETS is effective in reducing fatigue severity and increasing fatigue self-efficacy. However, it is difficult to assess the additional cost in terms of cost-effectiveness (ie, cost per QALY) as improvements in fatigue are not reflected in the QALY outcomes, with no significant differences between FACETS and CLP. The strengths of this trial are its pragmatic nature and high external validity.Trial registration:Current Controlled Trials ISRCTN76517470.

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“…The pathophysiology of MS-fatigue is poorly understood but is likely to be multifactorial making it a complex and challenging symptom to manage and treat 10. It has a profound impact on all spheres of daily life; limiting or preventing participation in work, leisure and social activities and reducing psychological well-being 11. It is the primary reason why people with MS give up work or reduce their hours 12.…”

Section: Introductionmentioning

confidence: 99%

“…10 It has a profound impact on all spheres of daily life; limiting or preventing participation in work, leisure and social activities and reducing psychological well-being. 11 It is the primary reason why people with MS give up work or reduce their hours. 12 Currently diagnosis of MS is based on the revised McDonald criteria.…”

Section: Introductionmentioning

confidence: 99%

Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

et al. 2015

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ObjectivesTo explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme,Fatigue:ApplyingCognitive behavioural andEnergy effectivenessTechniques to lifeStyle (‘FACETS’). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life.DesignA questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS.ParticipantsAll had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions.MethodsParticipants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme.Results82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants’ comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management.ConclusionsIndividuals’ comments highlighted the complex, multifaceted nature of fatigue management. Revising expectations and a greater acceptance of fatigue were important shifts following the programme. Findings support the relevance of a cognitive behavioural approach for fatigue management. Booster sessions might be a useful addition to the FACETS programme.Trial registration numberCurrent controlled trialsISRCTN76517470; Results.

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Differential Diagnosis and Management of Fatigue in Multiple Sclerosis: Considerations for the Nurse

Cited by 22 publications

References 0 publications

Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis

Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis

A pragmatic parallel arm multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based fatigue management programme (FACETS) for people with multiple sclerosis

Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

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