Fatigue
Sehle A, Mündermann A, Starrost K, et al. Objective assessment of motor fatigue in multiple sclerosis using kinematic gait analysis: a pilot study. J Neuroeng Rehabil. 2011; 26;8:59.
The aim of this study was to develop a method for the objective assessment of motor fatigue using kinematic gait analysis based on treadmill walking and an infrared-guided system. It concluded that changes in gait patterns following a physical exertion test in patients with MS suffering from motor fatigue can be measured objectively. These changes in gait patterns can be described using the motor fatigue index and represent an objective measure to assess motor fatigue in MS patients.
Catalan M, De Michiel A, Bratina A, et al. Treatment of fatigue in multiple sclerosis patients: a neurocognitive approach. Rehabil Res Pract. 2011; 2011:670537
The objective of the study was to treat fatigue in patients with multiple sclerosis by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery.
Huisinga JM, Filipi ML, Schmid KK, et al. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis? Arch Phys Med Rehabil. 2011; 92(10):1594-601.
This study aimed to evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics. It concluded that subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.
Dodd KJ, Taylor NF, Shields N, et al. Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial. Mult Scler. 2011; 17(11):1362-74.
Progressive resistance training is a relatively safe intervention that can have short-term effects on reducing physical fatigue, increasing muscle endurance and can lead to small improvements in muscle strength and quality of life in people with relapsing-remitting MS. However, no improvements in walking performance were observed and benefits do not appear to persist if training is completely stopped.
Rietberg MB, van Wegen EE, Uitdehaag BM, et al. The association between perceived fatigue and actual level of physical activity in multiple sclerosis. Mult Scler. 2011; 17(10):1231-7.
The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS. It concluded that there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.
Finlayson M, Preissner K, Cho C, et al. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler. 2011; 17(9):1130-40.
This study aimed to test the efficacy and effectiveness of a group-based, teleconference-delivered fatigue management program for people with MS. The results offer strong support for the viability of teleconference-delivered fatigue management education.
Andreasen AK, Stenager E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Mult Scler. 2011; 17(9):1041-54.
This paper aimed to determine the effect of exercise therapy on MS fatigue by systematically reviewing the literature.
Gold SM, Krüger S, Ziegler KJ, et al. Endocrine and immune substrates of depressive symptoms and fatigue in multiple sclerosis patients with comorbid major depression. Neurol Neurosurg Psychiatry. 2011;82(7):814-8
Depression and fatigue frequently co-occur and partially overlap in MS but their underlying biological substrates are unclear. This study supports a role for HPA axis hyperactivity in major depression in MS. In addition, inflammatory and neuroendocrine factors may differentially mediate fatigue and depressive symptoms.
Cook KF, Molton IR, Jensen MP. Fatigue and aging with a disability. Arch Phys Med Rehabil. 2011;92(7):1126-33.
The study assessed fatigue and age in a sample of individuals with spinal cord injury, postpolio syndrome, multiple sclerosis and muscular dystrophy. It found that individuals with disabilities are not only at greater risk of experiencing fatigue but this risk, relative to normative values, increases with age.
Kaminska M, Kimoff RJ, Schwartzman K, et al. Sleep disorders and fatigue in multiple sclerosis: evidence for association and interaction. J Neurol Sci. 2011; 302(1-2):7-13.
The current knowledge on sleep disturbances in MS and the relationship to fatigue is reviewed. Data from neuroimaging studies and studies of molecular consequences of sleep disorders in the general population, with particular attention to sleep-disordered breathing (SDB), are briefly reviewed. Potential biologic interactions with MS are discussed in this context.
Skurvydas A, Brazaitis M, Andrejeva J, et al. The effect of multiple sclerosis and gender on central and peripheral fatigue during 2-min MVC. Clin Neurophysiol. 2011; 122(4):767-76.
The aim of this study was to evaluate the effect of secondary progressive MS disease on central and peripheral fatigue in women and men during continuous 2-min maximal voluntary contractions (MVC) of the quadriceps muscle. They found that MS increased central fatigue and diminished peripheral fatigue significantly during 2-min MVC; however, only peripheral fatigue was significantly greater in healthy men than in healthy women.
Besharat MA, Pourhosein R, Rostami R, et al. Perfectionism and fatigue in multiple sclerosis. Psychol Health. 2011; 26(4):419-32.
120 people with MS were compared with 120 healthy individuals to explore whether differences exist between the two groups with respect to perfectionistic characteristics and to investigate whether dimensions of positive and negative perfectionism are related to the symptomatology of fatigue. The results revealed that the MS group reported lower levels of positive perfectionism and higher levels of negative perfectionism as well as depressive symptoms than the control group. Perfectionism was also significantly related to fatigue symptoms in both groups. These findings suggest that the fatigue symptoms are strongly associated with perfectionistic characteristics.
Motl RW, McAuley E, Wynn D, et al. Effects of change in fatigue and depression on physical activity over time in relapsing-remitting multiple sclerosis. Psychol Health Med 2011; 16(1):1-11.
This prospective, observational study examined the effects of change in the symptoms of fatigue and depression on physical activity over 6 months in persons with RRMS. The findings support the importance of fatigue and depression for predicting longitudinal changes in physical activity in adults with RRMS.
Smedal T, Beiske AG, Glad SB, et al. Fatigue in multiple sclerosis: associations with health-related quality of life and physical performance. Eur J Neurol 2011; 18(1):114-20.
Fatigue at baseline was associated with health-related quality of life (HRQoL) but not with the physical performance tests. Change in fatigue was correlated with change in HRQoL, but not with changes in physical performance. All measures were improved after treatment. While improvements in fatigue and HRQoL were lost at follow-up, improvements in physical performance tests were maintained for at least 6 months.
Melanson M, Grossberndt A, Klowak M, et al. Fatigue and cognition in patients with relapsing multiple sclerosis treated with interferon beta. Int J Neurosci 2010 Oct; 120(10):631-40.
The effects of interferon beta on fatigue and cognitive deficits were assessed in 50 patients with relapsing multiple sclerosis. The data suggest that interferon beta may reduce fatigue and cognitive deficits in patients with relapsing multiple sclerosis.
Krupp LB, Serafin DJ, Christodoulou C. Multiple sclerosis-associated fatigue. Expert Rev Neurother 2010; 10(9):1437-47.
Reviews the scales used to measure fatigue, treatments and clinical trials and highlights the need for further work.
Weinges-Evers N, Brandt AU, Bock M, et al. Correlation of self-assessed fatigue and alertness in multiple sclerosis. Mult Scler 2010; 16(9):1134-40.
Aimed at evaluating a battery of neuropsychological tests regarding their capacity to objectify self-reported fatigue. The alertness subtest of the Test of Attentional Performance may offer an objective method of evaluating self-reported fatigue, and may therefore, in addition to the Fatigue Severity Scale, be a suitable tool for the assessment of MS patients complaining of fatigue.
Peuckmann-Post V, Elsner F, Krumm N, et al. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database of Systematic Reviews 2010; (11): CD 006788
Aimed at identifying substances that alleviate fatigue in advanced disease including multiple sclerosis. A total of 22 studies were identified for analysis. However, based on the limited evidence, the authors could not recommend a specific drug for the treatment of fatigue in palliative care, although amantadine in multiple sclerosis showed a superior effect.
Merkelbach S, Schulz H, Kölmel HW, et al. Fatigue, sleepiness, and physical activity in patients with multiple sclerosis. J Neurol 2010; 1-6. Article in Press.
Study compared fatigue and sleepiness in MS, and their relationship to physical activity. Eighty patients with MS rated the extent of experienced fatigue and sleepiness. While fatigue correlated significantly with age, disease severity, and disease duration, this was not the case for sleepiness.
Bamer AM, Johnson KL, Amtmann DA, et al. Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis. Clin Epid 2010; 2(1):99-106.
473 people with MS involved in an ongoing self-report survey study were asked to report on use of over-the-counter and prescription sleep medications. Results suggested that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population.
Braley TJ, Chervin RD. Fatigue in multiple sclerosis: Mechanisms, evaluation, and treatment. Sleep 2010; 33(8):1061-1067.
Review examines, the most commonly proposed primary and secondary mechanisms of fatigue in MS, tools for assessment of fatigue in this setting, and available treatment approaches to a most common and challenging problem.
Twomey F, Robinson K. Pilot study of participating in a fatigue management programme for clients with multiple sclerosis. Disabil Rehabil 2010; 32(10):791-800.
Examined the experience of participating in a community-based fatigue management programme for people with multiple sclerosis (MS). Participants' experience of the community-based fatigue management programme was described in positive terms with unanticipated benefits and outcomes described.
Brown JN, Howard CA, Kemp DW. Modafinil for the treatment of multiple sclerosis-related fatigue. Ann Pharmacother 2010; 44(6):1098-1103.
Reviews the efficacy and safety of off-label use of modafinil in the treatment of multiple sclerosis (MS)-related fatigue. Based on the available data, use of modafinil for the treatment of MS-related fatigue has demonstrated benefit in all uncontrolled studies but has conflicting results from 2 controlled studies. Modafinil is a reasonable therapeutic option in this patient population, although larger, long-term, randomized controlled studies are necessary to further elucidate the appropriate dose of modafinil, its effects on MS-related fatigue, and adverse effects associated with its use.
Hugos CL, Copperman LF, Fuller BE, et al. Clinical trial of a formal group fatigue program in multiple sclerosis. Mult Scler 2010; 16(6):724-732.
Take Control is a novel program to teach fatigue management to people with multiple sclerosis (MS) following recommendations in the Fatigue and Multiple Sclerosis guideline. Across all visits, fatigue was significantly lower and self-efficacy was significantly higher for the take control group compared with the waiting list group. This pilot study demonstrated significant effects in fatigue and self-efficacy among subjects taking the Fatigue: Take Control program, suggesting that this comprehensive program based on the Fatigue and Multiple Sclerosis guideline may be beneficial in MS.
Velikonja O, Čurić K, Ožura A, et al. Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis. Clin Neurola Neurosurg 2010; 112(7):597-601.
Investigates the effects of sports climbing (SC) and yoga on spasticity, cognitive impairment, mood change and fatigue in MS patients. Concludes that yoga and SC might improve some of the MS symptoms and should be considered in the future as possible complementary treatments.
Mills RJ, Young CA, Pallant JF, et al. Development of a patient reported outcome scale for fatigue in multiple sclerosis: The Neurological Fatigue Index (NFI-MS). Health Qual Life Out 2010; 8 art no: 22.
Examines the reliability and validity of a new scale for MS fatigue, the Neurological Fatigue Index (NFI-MS). A simple 10-item Summary scale, together with scales measuring the physical and cognitive components of fatigue, were validated for MS fatigue.
Thomas S, Thomas PW, Nock A, et al. Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis. Pat Edu Couns 2010; 78(2):240-249.
An evidence-based fatigue management intervention was been developed and preliminary findings look promising. The next phase will examine whether the programme transfers satisfactorily to other centres and collect data in preparation for a randomised controlled trial (RCT).
Blaney BE, Lowe-Strong A. The impact of fatigue on communication in multiple sclerosis: the insider's perspective. Disabil Rehabil 2009; 31(3): 170-180.
Study investigated the relationship between fatigue and communication in people with MS. In-depth interviews with 10 people with MS were used to gain insight into the lived experience of the interaction between MS fatigue and communication. An increase in the severity of communication symptoms and the onset of new communications symptoms when experiencing fatigue were reported as well as a range of strategies employed to manage fatigue and communication changes.
Hadjimichael O, Vollmer T, Oleen-Burkey, MK. Fatigue characteristics in multiple sclerosis: The North American Research Committee on Multiple Sclerosis (NARCOMS) survey. Health Qual Life Outcomes 2008; 6 art no: 100.
People with MS enrolled in the North American Research Committee on Multiple Sclerosis (NARCOMS) patient registry are invited to complete follow-up surveys every six months. One of the surveys was designed to focus on the severity and impact of fatigue. Article discusses survey findings
Fragoso YD, Santana DLB, Pinto RC. The positive effects of a physical activity program for multiple sclerosis patients with fatigue. NeuroRehabilitation 2008; 23 (2): 153-157.
Article describes the development and delivery of a physical activity program for MS patients consisting of a 20-week series of gradual stretching, resistance and aerobic exercises, adapted to the individual clinical condition of each patient. The results showed significant improvement in cardio-circulatory parameters, as well as a significant decrease in scores on the fatigue scale.
Van Kessel K, Moss-Morris R, Willoughby E, et al. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med 2008; 70 (2): 205-213.
Study assessed the efficacy of cognitive behaviour therapy (CBT) as a treatment for multiple sclerosis (MS) fatigue. 72 patients with MS fatigue were randomly assigned to eight weekly sessions of CBT or relaxation training (RT). The primary outcome was the Fatigue Scale. Secondary outcomes included measures of stress, mood, and fatigue-related impairment. Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT.
Holberg C, Finlayson M. Factors influencing the use of energy conservation strategies by persons with multiple sclerosis. Am J Occup Ther 2007; 61(1): 96-107.
8 people who had attended a telephone energy conservation course were interviewed. Three themes directly affected use of energy conservation strategies: 1) experience with MS, 2) sense of self, 3) environmental factors, and is thus dependent on a range of inter-related contextual factors
Matuska K, Mathiowetz V, Finlayson M. Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue. Am J Occup Ther 2007; 61(1): 62-69
123 participants completed a survey about their use of energy conservation strategies. All strategies were newly used by at least half of all participants and rate as effective. Rest and delegation were used most and seen as most effective, followed by changing priorities and standards
Mathiowetz VG, Finlayson ML, Matuska KM, Chen HY, Luo P. Randomised controlled trial of an energy conservation course for persons with multiple sclerosis. Mult Scler 2005;11(5): 592-601.
169 people were randomised to either immediate intervention or control group of delayed therapy. Results showed significant effects on physical and social measures on the Fatigue Impact Scale, reducing fatigue impact and increasing self-efficacy and some measures of quality of life.
Lamb AL, Finlayson M, Mathiowetz V, Chen HY. The outcomes of using self-study modules in energy conservation education for people with multiple sclerosis. Clin Rehabil 2005;19(5):475-81.
Compared self-study modules on fatigue management with attending an energy conservation class. No significant differences were found between the groups, using a range of outcome measures.
Vanage SM, Gilbertson KK, Mathiowetz V. Effects of an energy conservation course on fatigue impact for persons with progressive multiple sclerosis. Am J Occup Ther 2003;57(3):315-23.
37 people with progressive MS took part in an energy conservation course over 8 weeks, compared with 8 weeks of traditional treatment, as a control. Results from the energy conservation course reduced fatigue impact on a range of outcome measures, and the improvement continued over a period following completion of the course.
Mathiowetz V, Matuska KM, Murphy ME. Efficacy of an energy conservation course for persons with multiple sclerosis. Arch Phys Med Rehabil 2001;82(4):449-56.
54 people with MS received six 2 hour sessions of energy conservation course taught by occupational therapists. Participants reported improvements in fatigue management, increased self-efficacy and improved quality of life, using a range of outcome measures.