SHORT REPORTS

A longitudinal study of variations in and predictors of fatigue in multiple sclerosis

S Johansson¹, C Ytterberg¹, J Hillert², L Widén Holmqvist¹, L von Koch¹

¹ Division of Neurology, Department of Clinical Neuroscience, and Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
² Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden

Correspondence to:
Dr S Johansson, Division of Neurology R54, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden; sverker.johansson{at}ki.se

Objectives: To describe variations in fatigue over the course of 2 years in a sample of persons with multiple sclerosis (MS), and to investigate the predictive value of the following variables on variations in fatigue: sex, age, sense of coherence, living with a partner, living with children, work status, immunomodulatory treatment, mood, disease severity, disease course, time since diagnosis and time.

Methods: Every 6 months, 219 outpatients at an MS specialist clinic were assessed using the Fatigue Severity Scale (FSS). Predictive values were explored with Generalised Estimating Equation employing proportional odds models; FSS scores were categorised as non-fatigue, borderline fatigue or fatigue.

Results: FSS scores varied significantly (p = 0.02); 54% changed FSS category one or several times, 27% were persistently fatigued and 19% persistently non-fatigued. Independent predictors of increased fatigue were depressive symptoms, weak/moderate sense of coherence, living with a partner and not working. Furthermore, moderate disease severity predicted increase when combined with >10 years since diagnosis or a progressive course. Independent predictors of decreased fatigue were no depressive symptoms, strong sense of coherence, living alone and working. Moreover, mild and severe disease predicted a decrease when combined with >10 years since diagnosis, and mild severity combined with a progressive course.

Conclusion: Mood, sense of coherence and living with a partner were independent predictors of fatigue in persons with MS. In addition to monitoring disease related variables, health related services should apply a broad range of approaches and repeatedly assess fatigue in persons with MS, to provide preventive care and appropriate interventions.

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This article has been cited by other articles:

• Morrow, S., Weinstock-Guttman, B, Munschauer, F., Hojnacki, D, Benedict, R. (2009). Subjective fatigue is not associated with cognitive impairment in multiple sclerosis: cross-sectional and longitudinal analysis. Mult Scler 15: 998-1005 [Abstract]  
• Johansson, S, Ytterberg, C, Gottberg, K, Widen Holmqvist, L, von Koch, L (2009). Use of health services in people with multiple sclerosis with and without fatigue. Mult Scler 15: 88-95 [Abstract]