Heightened effort discounting is a common feature of both apathy and fatigue

Apathy and fatigue have distinct aetiologies, yet can manifest in phenotypically similar ways. In particular, each can give rise to diminished goal-directed behaviour, which is often cited as a key characteristic of both traits. An important issue therefore is whether currently available approaches are capable of distinguishing between them. Here, we examined the relationship between commonly administered inventories of apathy and fatigue, and a measure of goal-directed activity that assesses the motivation to engage in effortful behaviour. 103 healthy adults completed self-report inventories on apathy (the Dimensional Apathy Scale), and fatigue (the Multidimensional Fatigue Inventory, and/or Modified Fatigue Impact Scale). In addition, all participants performed an effort discounting task, in which they made choices about their willingness to engage in physically effortful activity. Importantly, self-report ratings of apathy and fatigue were strongly correlated, suggesting that these inventories were insensitive to the fundamental differences between the two traits. Furthermore, greater effort discounting was strongly associated with higher ratings across all inventories, suggesting that a common feature of both traits is a lower motivation to engage in effortful behaviour. These results have significant implications for the assessment of both apathy and fatigue, particularly in clinical groups in which they commonly co-exist.

A multisite randomized controlled trial of two group education programs for fatigue in multiple sclerosis: Very long term (5–6 year) follow-up at one site

Background A multicomponent group MS fatigue self-management program reduced fatigue impact compared to a rigorous control 12 months after enrollment. Objectives Assess and compare changes between groups in fatigue impact and behavior changes implemented 5–6 years after enrollment. Methods The Modified Fatigue Impact Scale (MFIS) and a behavior change questionnaire were administered 5–6 years after enrollment. Results There were no significant changes in mean MFIS scores within or between groups from baseline to 5–6 years later. Behavior changes were of similar frequency in both groups. Conclusion Fatigue impact was stable and behavior changes were similar between groups 5–6 years after a fatigue self-management program.

Early Outpatient Tele-rehabilitation Improves Functional Outcomes in Patients Following Hospitalization for COVID-19: A Case Series

Introduction: This study assesses the impact of early outpatient telerehabilitation on patients following hospitalization for COVID-19. To date, there have not been studies assessing this type of program, despite significant documentation of functional deficits that would benefit from outpatient rehabilitation services. Objective: To determine whether outcomes support the utilization of an early outpatient telerehabilitation based protocol. Design: Retrospective analysis, nonrandomized controlled trial. Setting: Academic healthcare center, secondary care. Patients: All patients discharged following hospitalization with COVID-19 between April and September of 2020 (n=50) were contacted to participate; 26 accepted, 19 completed the rehabilitation protocol. Inclusion criteria were: patient diagnosed with and hospitalized for COVID-19, patient willing to participate in study. Interventions: Patients were seen for 2-4 visits of physical therapy where they were assessed, screened to assess need for mental health, occupational therapy, and speech therapy services and placed into predetermined activity tolerance categories with corresponding exercises given. Main Outcome Measures: Outcome measures assessed were Borg Rating of Perceived Exertion (RPE) on selected tasks, 30 Second Sit to Stand Test, Daily Fatigue Impact Scale score, Resting Respiratory Rate, activity tolerance (based on averaging severity levels of previously identified functional scale scores), and patient-rated feelings of dyspnea on exertion. Results: Statistically significant improvements were found in resting respiratory rate (p<0.05), 30 Second Sit to Stand score (p<0.001), Daily Fatigue Impact Scale score (p<0.05), Borg RPE (p<0.05), and overall severity rating (p<0.01). Patient-rated dyspnea was not significantly different from first to last visit. Conclusions: 2-4 visits of telerehabilitation provided soon after hospital discharge resulted in significant improvements in functional outcome measures. This supports the utilization of outpatient rehabilitation following hospitalization for COVID-19 as well as the use of telerehabilitation to provide these services.

Evaluation of the Unidimensional Fatigue Impact Scale (U-FIS) in Crohn's Disease: The Importance of Local Item Dependency

Background and PurposeThe Unidimensional Fatigue Impact Scale (U-FIS) was developed for use in a multiple sclerosis population. The aim was to determine whether the U-FIS is a valid tool for measuring the impact of fatigue in Crohn's disease (CD).MethodCD patients completed the U-FIS as part of a validation study of the Crohn's Life Impact Questionnaire (CLIQ). Data were analyzed according to Rasch measurement theory (RMT).ResultsTwo hundred sixty-one completed U-FIS questionnaires were available for analysis. After rescoring the items to resolve disordered thresholds, all 22 items showed acceptable RMT fit. However, there was considerable local item dependency (LID).ConclusionThe U-FIS did not provide unidimensional measurement in a sample of CD patients due to high levels of LID. Combining the three FIS outcomes into a single measure was not justified.

The Effect of an Educational Program on Fatigue Level Among Multiple Sclerosis Patients

Background: Multiple sclerosis is a chronic disease that affect all aspects of the patients’ life causing multiple progressive symptoms; most common fatigue which leads to dependency of patients on their family for carrying out their daily routine activities. Aim: The present study aims at evaluating the effect of an educational program on fatigue level among multiple sclerosis patients. Design: A quasi-experimental one-group pretest-posttest was used. Setting: the study was conducted in multiple sclerosis outpatient clinic in El-Kasr El-Eini University Hospital. Sample: A convenient sample of (250) multiple sclerosis patients. Tools: Two tools were used: first tool was Structured MS patient dietary knowledge questionnaire, second tool was The Arabic Version of Modified Fatigue Impact Scale. Results: Showed a highly statistical negative correlation between dietary knowledge and cognitive, psychosocial fatigue among MS patients in pre, post and 3 months after implementation of the program. Conclusions: The results of this study indicated that MS patients' dietary knowledge improved after application of the educational program as well as there was a decline in MS patients' fatigue level with statically significance differences between pre, post and 3 months after application of the program. Recommendation: Dissemination of dietary knowledge program among other multiple sclerosis patients. Keywords: Multiple sclerosis patients, dietary knowledge, fatigue

Fatigue as a symptom of neurological diseases

Objective. The aim of the work was to study the fatigue syndrome in various organic brain diseases. Materials and methods. Patients in the recovery period of hemispheric stroke, with Parkinson's disease and multiple sclerosis were examined. Along with the clinical one, there was conducted a study using the asthenia questionnaire MFI-20, FIS (Fatigue Impact Scale), FSS (Fatigue Severity Scale). Results. It has been established that patients with various diseases of the central nervous system have a syndrome of fatigue, which is a nosogenic one, that is, a consequence of organic brain damage.

Diagnosis of sleepiness, fatigue and depression in patients with myasthenia gravis

Introduction. Examination of excessive daytime sleepiness, fatigue and depression in patients with myasthenia gravis is important for differential diagnosis of other disorders, and adds to a comprehensive clinical assessment.Objective. The aim is a comprehensive assessment of sleepiness, fatigue and depression and evaluation of the impact of autoimmune comorbidity on these symptoms in myasthenia gravis patients, using newly validated Russian versions of international questionnaires. The present article aims at familiarizing a wider Russian-speaking audience of specialists in the field of neuromuscular disease and sleep medicine with the main findings of our previously published work.Materials and methods. The study included 73 patients with MG and 230 control subjects. For sleepiness, fatigue and depression evaluation were used: Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS) (cognitive / physical / psychosocial subscales), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI) (cognitive-affective and somatic domains), Spielberger–Khanin State Trait Anxiety Inventory (STAI).Results. The Fatigue Severity Scale and Fatigue Impact Scale showed good psychometric properties and can be used to identify distinct aspects of fatigue in patients with myasthenia gravis. The studied patient cohort revealed clinically significant fatigue (69.9 %), excessive daytime sleepiness (15.1 %), moderate to severe depression (20.5 %), a high level of personal (64.4 %) and situational anxiety (27.4 %). Among 13 patients with myasthenia gravis and additional autoimmune comorbidity, there were no significant differences in the severity of sleepiness, fatigue and depression compared with the main group.Conclusion. The use of self-reported scale of sleepiness, fatigue and depression combined with careful clinical-neurological characterization adds to a more comprehensive view of the patient. The identification of sleepiness, fatigue and depression can guide therapeutic decisions and contributes to a better patient care. The presence of concomitant autoimmune pathology in patients with myasthenia gravis does not seem to increase the severity of sleepiness, fatigue and depression.

Effects of Massage Therapy on Multiple Sclerosis: a Case Report

Background: Multiple Sclerosis (MS) is characterized by degeneration of the myelin sheath of an axon resulting in decreased transmission of nerve impulses. It is an autoimmune disease with periods of exacerbation and remission. Types of MS include relapsing-remitting, acute progressive, chronic progressive attack-remitting, and benign. Symptoms vary from patient to patient. Common symptoms include fatigue, spasticity, swelling, and altered gait. MS is commonly treated with medications that help relieve symptoms and prolong disease progression. Massage Therapy (MT), specifically Swedish techniques, have been effective in treating MS. Objective: To examine the effects of MT on mobility, fatigue, and edema in a patient with MS. Methods: An MT student from MacEwan University’s 2,200-hour Massage Therapy program administered five MT treatments over a six-week period to a 58-year-old female diagnosed with MS 11 years earlier. She presented with symptoms of decreased mobility, fatigue, and left ankle edema. Assessment included active and passive range of motion (ROM), myotomes, dermatomes, reflexes, and orthopedic tests. Goals for the treatment sessions were to increase mobility, decrease fatigue, and decrease edema. Assessment measures included the Timed-Up-and-Go (TUG) test for mobility, the Modified Fatigue Impact Scale (MFIS) to measure fatigue, and Figure-8 ankle measurement to measure edema. Techniques used included Swedish massage, passive ROM, manual lymphatic drainage (MLD), and home-care exercises. Results: Little change was noted in mobility. The patient’s fatigue level and left ankle edema decreased. Conclusion: The results suggest that MT is effective in reducing fatigue and edema in a patient with MS. Future studies are needed to evaluate the correlation between mobility and massage.