Differences in the experience of fatigue in patients and healthy controls: patients' descriptions

[Tom Kindlon]

(Possibly not the most riveting paper for patients but I want to post an e-comment of mine that they didn't put up)

Free full text: http://www.hqlo.com/content/5/1/36

Differences in the experience of fatigue in patients and healthy controls: patients' descriptions

Marieke F Gielissen1*, Hans Knoop1, Petra Servaes1, Joke S Kalkman1, Marcus J Huibers2, Stans Verhagen3 and Gijs Bleijenberg1

* Corresponding author: Marieke F Gielissen m.gielissen@nkcv.umcn.nl

Author Affiliations

1 Expert Centre Chronic Fatigue Nijmegen, Radboud University, Nijmegen Medical Centre, The Netherlands

2 Department of medical, clinical and experimental psychology, Maastricht University, The Netherlands

3 Department of Medical Oncology of the Radboud University Nijmegen Medical Centre, The Netherlands

Health and Quality of Life Outcomes 2007, 5:36 doi:10.1186/1477-7525-5-36

Abstract

Background

The primary objective was to develop an adjective checklist, the Fatigue Quality List (FQL), aimed at assessing different perceptions of fatigue.



Methods

961 participants filled out the FQL (28 adjectives).

A component and confirmatory factor analyses were performed and psychometric properties were evaluated.

Differences on factor scores between different patients' groups were investigated and pre- and post treatment scores were compared in demonstrating change of perceptions after treatment of fatigue.



Results

Four independent factors were found with adequate psychometric properties.
Different perceptions were found between the patients' groups.

Patients who were recovered after treatment for fatigue showed similar scores on the factors as healthy controls.



Conclusion

The FQL appears to be a promising tool in measuring different perceptions of fatigue, which can be especially interesting for clinical practice.

 

[Tom Kindlon]

I sent an e-letter but it has been left in limbo. As it's now over 3 years, I don't expect to hear back, so here it is for what it's worth.

I just checked and I also submitted it in January 2010 also, without getting a reply - this April 2010 e-mail was the second time I tried.

-----Original Message-----
From: editorial@hqlo.com [mailto:editorial@hqlo.com]
Sent: 07 April 2010 8:53
To: Mr Tom Kindlon
Subject: Your comment on Health and Quality of Life Outcomes 2007, 5:36

Dear Mr Kindlon

Thank you for contributing to the discussion of Health and Quality of Life Outcomes 2007, 5:36 <http://www.hqlo.com/content/5/1/36>.

Your comment will be posted as long as it contributes to the topic under discussion and does not breach patients' confidentiality or libel anyone. You will receive a further notification by email when the posting appears on the site or if it is rejected by the moderator.

Your posting will read:

Mr Tom Kindlon, Irish ME/CFS Association - for Information, Support & Research

"Recovery" (from fatigue) does not necessarily mean recovery from CFS (in terms, for example, of activity levels)

Comment:

In this paper, some variant of the word "recovered" is used 12 times, generally to describe some of the Chronic Fatigue Syndrome (CFS) patients who had taken part in a cognitive behaviour therapy (CBT) trial for CFS[1].



Actometer data from this study has recently been released[2]. This paper reported that CBT did not cause an increase in physical activity at the end of treatment. Before CBT, the patients did a mean 67.4 units of activity (standard deviation(SD): 21.8); following CBT, patients did 68.8 units of activity (SD: 25.2). The authors report that a previous study [3] found healthy controls had a mean Actometer score of 91 (S.D.=25). There was also no increase in activity levels in two other CBT trials examined[4,5].



The authors[2] also found that in the three CBT studies, changes in physical activity were not related to changes in fatigue. So "recovery from fatigue" does not necessarily mean recovery from CFS in terms of achieving normal activity levels.



In another Dutch CBT study[6], 37% of patients were said to be recovered from fatigue, where recovery was defined as no longer scoring on any of the 3 negative factors of the Fatigue Quality List (FQL). However when low scores on other questionnaires were also required to fulfil "full recovery", only 23% of the sample were said to be in "full recovery". Note that only subjective measures were used in that definition of full recovery - a return to a normal level of activity, as measured by an actometer, was not required.



Incidentally, a paper has recently been released which also examined language used to describe fatigue by CFS patients and healthy controls[6]. It is slightly different as phrases rather than adjectives were used to describe the fatigue e.g. "Mentally tired after the slightest effort", "Lack the energy to talk to anyone", etc. Factor analyses revealed a five-factor structure for participants with ME/CFS but only a one-factor solution for the control group. The five factors for fatigue in ME/CFS participants were described as: "Post-Exertional", "Wired", "Brain-Fog", "Energy" and "Flu-Like".


References:



[1] Prins JB, Bleijenberg G, Bazelmans E, Elving L, de Boo Th, Severens JL, van der Wilt GJ, Spinhoven Ph, van der Meer JWM: Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial. Lancet 2001, 357:841-847.



[2] Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G. How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010 Jan 5:1 -7. [Epub ahead of print]



[3] van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373&#8211;379.



[4] Knoop H, van der Meer JW, Bleijenberg G (2008). Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial. British Journal of Psychiatry 193, 340-341.



[5] Stulemeijer M, de Jong LW, Fiselier TJ, Hoogveld SW, Bleijenberg G (2005). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 330. Published online : 7 December 2004. doi :10.1136/bmj.38301.587106.63.



[6] Knoop H, Bleijenberg G, Gielissen MFM, Van der Meer JWM, White PD: Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom 2007, 76:171-176.


[7] Jason, L.A., Jessen, T., Porter, N., Boulton, A., Njoku, M.G., &#38; Friedberg, F. Examining types of fatigue among individuals with ME/CFS. Disability Studies Quarterly, 2009, 29, 3. Full text at: http://www.dsq-sds.org/article/view/938/1113


Competing interests:

No competing interests

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Regards

Health and Quality of Life Outcomes