Psychometric Property of Fatigue Severity Scale and Correlation With Depression and Quality of Life in Cirrhotics

Abstract

-Background -Fatigue is a common complaint in cirrhotic patients and may be considered a debilitating symptom with negative impact on quality of life. Research on its etiology and treatment has been hampered by the lack of relevant and reproducible measures of fatigue. Objective -To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in cirrhotic patients and to correlate with depressive symptomatology and quality of life. Methods -Cross-sectional study with a convenience sample of 106 cirrhotic patients, aged between 18 and 70 years, both genders, literate, pre and post liver transplantation in outpatient follow-up. Internal consistency, reproducibility, discriminant validity, criterion validity, construct validity, responsiveness criterion, depressive symptomatology and quality of life were evaluated through questionnaires between January and October 2015. Results -The mean age was 54.75±9.9 years, 65.1% male and 32.1% of the sample had cirrhosis due to hepatitis C virus. The mean FSS score was 4.74±1.64. Cronbach's alpha was 0.93, and the Intraclass Correlation Coefficient was 0.905 (95% CI: 0.813-0.952). For discriminant validity, FSS differentiated scores from different groups (P=0.009) and presented a correlation with the Modified Fatigue Impact Scale (r=0.606, P=0.002). FSS correlated significantly and positively with depressive symptomatology and correlated negatively with the SF-36 domains for construct validity. For responsiveness, no significant changes were observed in the fatigue scores in the pre and post-liver transplantation periods (P=0.327). Conclusion -FSS showed good psychometric performance in the evaluation of fatigue in patients with cirrhosis. Fatigue presented a strong correlation with depressive symptomatology and quality of life.

Responsiveness of the Italian version of the Pediatric Quality of Life Multidimensional Fatigue Scale in adult inpatients with obesity

“…Multiple shared aetiologies between depression and fatigue have been proposed including systemic inflammation, mitochondrial dysfunction, oxidative stress, autoimmune abnormalities, hypothalamic-pituitary axis dysfunction, and structural and functional brain changes 41 , 42 . Strong associations between fatigue and depression have been found previously using the PedsQL-MFS 16 and the FSS (e.g., 43 ) although the original validation study emphasized its independence from depression 31 . Depression and fatigue are overlapping but distinct aspects of quality of life which are adversely affected by obesity, responsive to treatment, and important outcomes to consider in evaluating obesity intervention.…”

Association Between Fatigue and Exercise Capacity in Patients With Chronic Liver Disease Awaiting Liver Transplantation

“…According to van den Berg-Emons et al (23) , this complaint remain for up to one year after liver transplantation. It is important to emphasize that fatigue can be difficult to measure and several questionnaires have been developed and tested in ESLD patients (3,15) . In this study we adopted the FSS, a validated fatigue scale known to provide reliable results in this setting (3) .…”

“…It is important to emphasize that fatigue can be difficult to measure and several questionnaires have been developed and tested in ESLD patients (3,15) . In this study we adopted the FSS, a validated fatigue scale known to provide reliable results in this setting (3) . The present study confirmed an inverse correlation of 6MST and FSS in this patient population, indicating that the higher the degree of fatigue, the lower the exercise test.…”

“…Using a reliable fatigue scale and a validated questionnaire is an important issue for both clinicians and researchers. The Fatigue Severity Scale (FSS) has well-documented psychometric properties and may be used to evaluate fatigue in cirrhotic patients (3) .…”

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

“…[222] Fatigue has been associated with disease severity, ascites, encephalopathy, level of physical activity, poor sleep quality, decreased quality of life, mood disturbance, anxiety, depression, and job performance in cirrhosis and with age, sex, diet, mental status, and personality type in general populations. [220,[223][224][225][226][227][228] The evaluation of fatigue should include a comprehensive assessment of other potential contributing factors, such as hypothyroidism, depression, adrenal insufficiency, anemia, vitamin deficiency, and medication side effects (e.g., beta-blockers). [222,226,229,230] Nonpharmacological management of fatigue includes education, recommendations about energy-conserving and -restoring activities, and referral to physical and occupational therapy.…”