A longitudinal study of variations in and predictors of fatigue in multiple sclerosis
- 1Division 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
- 2Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Dr S Johansson, Division of Neurology R54, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden; sverker.johansson{at}ki.se
- Received 22 March 2007
- Revised 22 September 2007
- Accepted 3 October 2007
Abstract
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.
Footnotes
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Funding: An unrestricted grant from Biogen Idec supported data collection. The study was funded by grants from the Centre for Health Care Sciences, the Health Care Sciences Postgraduate School, Karolinska Institutet; the Swedish Association of Persons with Neurological Disabilities; and the Swedish Research Council.
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Competing interests: None.
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Ethics approval: The ethics committee of Karolinska Institutet approved the study.
