Fatigue in multiple sclerosis:: a comparison of different rating scales and correlation to clinical parameters
Fatigue in multiple sclerosis:: a comparison of different rating scales and correlation to clinical parameters
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DOI：
10.1191/1352458502ms839oa
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发表时间：
2002-12-01
影响因子：
5.8
通讯作者：
Toyka, K
中科院分区：
文献类型：
--
作者：
Flachenecker, P;Kümpfel, T;Toyka, K
目的：疲劳是多发性硬化（MS）患者最常见的致残症状之一，但定义不清。为了更清楚地描述疲劳的频率和类型，我们首先比较了连续MS患者中广泛使用的四种疲劳量表。其次，为了进一步阐明疲劳的本质，我们调查了疲劳与身体残疾、病程、免疫治疗和抑郁症的关系。患者和方法：在2000年2月至9月期间，151名连续的MS患者进入我们的门诊部，（94例复发缓解型，50例继发性进展型和7例原发性进展型患者，平均年龄29.0 ± 7.3岁，平均疾病持续时间9.9 ± 6.7年，中位EDSS 3.5）填写标准化问卷，包括四个疲劳量表-疲劳严重程度量表（FSS），MS特异性FSS（MFSS），改良疲劳影响量表（MFIS），视觉疼痛评分（VAS）。当患者在调查问卷中陈述疲劳：1）是他们三种最致残的症状之一，2）每天或大部分时间发生，3）限制他们在家中或工作中的活动时，他们被纳入“MS相关疲劳组”（MS-F）。不符合这些标准的患者被归类为“MS相关非疲劳组”（MS-NF）。采用贝克抑郁量表（BDI）测量抑郁程度。结果如下：虽然所有的尺度都显示出MS-F和MS-NF之间的显着差异，这些尺度之间的相关性，最好的中度（相关系数范围从0.06到0.56）。最具区分力的量表是FSS和MRS，显示MS-F和MS-NF组的第10和第90个量表没有重叠，临界值分别为4.6和38。在填写BDI的148例患者中，有24例（16%）存在抑郁（BDI大于或等于18）。FSS与身体残疾（r = 0.33，p < 0.0001）和BDI（r = 0.41，p < 0.0001）显著相关，但与年龄、病程、临床活动和β-干扰素治疗无关。然而，在多变量分析中，只有BDI独立预测疲劳。结论.疲劳和抑郁症的关联表明，可能存在共同的潜在机制，或者通过因果关系相互依赖，需要进一步调查。疲劳是一种多维症状，因此，可用的测试测量和衡量疲劳的不同方面，这一事实最好地解释了各种疲劳量表之间的弱相关性。我们的研究结果强调了更准确定义疲劳的必要性，以及开发更有效的工具，如果这些工具用于评估治疗的话。
Objectives: Fatigue is one of the most common, yet poorly defined, disabling symptoms in patients with multiple sclerosis (MS). To delineate more dearly the frequency and type of fatigue, we first compared four widely used fatigue scales in consecutive MS patients. Secondly, to further clarify the nature of fatigue, we investigated its relation to physical disability, course of the disease, immunotherapy, and depression. Patients and Methods: Between February and September 2000, 151 consecutive MS patients entering our outpatient clink (94 relapsing-remitting, 50 secondary progressive, and 7 primary progressive patients, mean age 29.0 +/- 7.3 years, mean disease duration 9.9 +/- 6.7 years, median EDSS 3.5) filled in a standardized questionnaire including four fatigue scales - Fatigue Severity Scale (FSS), MS-specific FSS (MFSS), Modified Fatigue Impact Scale (MFIS), and Visual Analogue Scale (VAS). Patients were included in the 'MS-related fatigue group' (MS-F) when they stated in the questionnaire that fatigue: 1) is one of their three most disabling symptoms, 2) occurs daily or on most of the days, and 3) limits their activities at home or at work Patients fulfilling none of these criteria were classified as 'MS-retated nonfatigue group' (MS-NF). Depression was measured by Beck's Depression Inventory (BDI). Results: Although all scales showed significant differences between MS-F and MS-NF, correlation between these scales was, at best moderate (correlation coefficients ranging from 0.06 to 0.56). The most discriminative scales were FSS and MRS, showing no overlap of the 10th and 90th percentiles for the MS-F and MS-NF groups, with cut-off values of 4.6 and 38, respectively. Depression (BDI greater than or equal to 18) was present in 24 of 148 patients who filled in the BDI (16%). FSS was significantly correlated with physical disability (r = 0.33, p < 0.0001) and BDI (r = 0.41, p < 0.0001), but not with age, disease duration, clinical activity, and treatment with interferon-beta. In multivariate analysis, however, only BDI independently predicted fatigue. Conclusions. The association of fatigue and depression suggests that there might be either common underlying mechanisms or interdependence by a cause-and-effect relationship that requires further investigation. The weak correlation within various fatigue scales is best explained by the fact that fatigue is a multidimensional symptom and, therefore, the available tests measure and weight different aspects of fatigue. Our findings underline the necessity for a more exact definition of fatigue and the development of more valid tools if these are to be used to evaluate treatments.