Anna Ericsson

Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20

Objectives. Fibromyalgia (FM) and Chronic Widespread Pain (CWP) are common diseases in primary care and, in addition to the pain they cause, fatigue is a major problem. Fatigue is regarded as a multidimensional concept and instruments assessing fatigue should therefore cover several different dimensions. The Multidimensional Fatigue Inventory (MFI-20) measures five different dimensions of fatigue. The aim of the study was to investigate the test-retest reliability and convergent construct validity of the Swedish version of the MFI-20 in female patients with FM or CWP. Methods. To investigate the convergent construct validity, 166 female patients with FM or CWP completed the Swedish version of the MFI-20 and a Visual Analogue Scale (VAS) measuring global fatigue. Thirty-six of the 166 patients completed the Swedish version of the MFI-20 on two occasions, one day apart to evaluate the test-retest reliability. Results. Spearmans correlation coefficient revealed a significant association between each of the five subscales of the MFI-20 and the VAS for global fatigue. General Fatigue had the highest correlation with the VAS (rs = 0.62, p<0.001), while Reduced Motivation had the lowest (rs = 0.32, p<0.001). The intra-class correlation coefficients (ICC) were satisfactory for all the five subscales of the MFI-20. Conclusion. The results of this study indicate that the Swedish version of the MFI-20 is a reliable tool for assessing the degree of fatigue in patients with FM or CWP. This study also supports the theory that fatigue is a multidimensional concept and different aspects of fatigue should be measured separately.

Fatigue and blood pressure in primary Sjögren's syndrome

Objective: Primary Sjögrens syndrome (SS) is an autoimmune disease characterized by fatigue. Little is known about the genesis of fatigue. Fatigue is thought to represent a multidimensional concept and it is important to be able to measure it confidently. The aims were to evaluate the reliability and validity of the 20‐item Multidimensional Fatigue Inventory (MFI‐20) in SS and to search for factors associated with this disabling symptom. Methods: Forty‐eight women with primary SS completed the MFI‐20 questionnaire. The results were compared with age‐matched women with fibromyalgia (FM) and healthy controls. Convergent construct validity was assessed by correlations to a Visual Analogue Scale (VAS) for global fatigue by Spearmans correlation (rs). Test–retest reliability was analysed by the intraclass correlation coefficient (ICC) in 28 women. Associations between clinical variables and subscales of the MFI‐20 were analysed. Results: The SS women scored significantly higher in all subscales of the MFI‐20 compared to controls but similar to FM. The ICCs were satisfactory, ranging from 0.66 for general fatigue to 0.85 for the total score of MFI‐20. All subscales correlated significantly to VAS for global fatigue, general fatigue showing the highest correlation (rs = 0.70). The estimated number of hours of sleep/day was significantly associated with many of the fatigue dimensions. All five subscales of the MFI‐20 were inversely associated with diastolic blood pressure (BP) and two with systolic BP. Conclusions: The MFI‐20 was found to be a reliable and valid tool for the measurement of fatigue in primary SS. High levels of fatigue were correlated with low BP, suggesting an associated involvement of the autonomic nervous system.

Experience of physical activity in patients with fibromyalgia and chronic widespread pain

Purpose. Patients with fibromyalgia (FM) and chronic widespread pain (CWP) find physical activity troublesome. The purpose was to develop a questionnaire to investigate the experience of physical activity in FM and CWP populations. Method. A questionnaire was developed from a qualitative study. After that, a total of 204 patients with FM or CWP completed the questionnaire. A factor analysis was conducted and the internal consistency was investigated. The relationship between the factors and pain, health status (the Fibromyalgia Impact Questionnaire, FIQ), distress (the Hospital Anxiety and Distress scale, HAD) and leisure time physical activity (the Leisure Time Physical Activity Instrument, LTPAI) was investigated. Results. Five factors were identified: Physical Relaxation (PR), Well-being (WB), Activity Beliefs (AB), Activity-related Symptoms (AS) and Activity Habits (AH). Cronbachs alpha ranged from 0.57 to 0.86. The PR showed a correlation (rho 0.28, p < 0.01) with the FIQ Pain. The AS showed a correlation (rho 0.25, p < 0.01) with the FIQ total score, while the AH showed a correlation with the HAD Depression (0.26, p < 0.01) and with strenuous physical activity (LTPAI) (−0.32, p < 0.01). Conclusion. A new instrument was developed to study the experience of physical activity in persons with long-lasting pain. Five factors were identified using factor analysis, and three of them showed fair associations with FM symptoms, distress or physical activity.

Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial

BackgroundFibromyalgia (FM) affects approximately 1–3xa0% of the general population. Fatigue limits the work ability and social life of patients with FM. A few studies of physical exercise have included measures of fatigue in FM, indicating that exercise can decrease fatigue levels. There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM. The present study is a sub-study of a multicenter randomized controlled trial in women with FM. The purpose of the present sub-study was to examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM, and to investigate predictors of the potential change in fatigue.MethodsA total of 130 women with FM (age 22–64 years) were included in this assessor-blinded randomized controlled multicenter trial examining the effects of person-centered progressive resistance exercise compared with an active control group. The intervention was performed twice a week for 15xa0weeks. Outcomes were five dimensions of fatigue measured with the Multidimensional Fatigue Inventory (MFI-20). Information about background was collected and the women also completed several health-related questionnaires. Multiple linear stepwise regression was used to analyze predictors of change in fatigue in the total population.ResultsA higher improvement was found at the post-treatment examination for change in the resistance exercise group, as compared to change in the active control group in the MFI-20 subscale of physical fatigue (resistance group Δ –1.7, SD 4.3, controls Δ 0.0, SD 2.7, pu2009=u20090.013), with an effect size of 0.33. Sleep efficiency was the strongest predictor of change in the MFI-20 subscale general fatigue (betau2009=u2009−0.54, pu2009=u20090.031, R2u2009=u20090.05). Participating in resistance exercise (betau2009=u20091.90, pu2009=u20090.010) and working fewer hours per week (betau2009=u20090.84, pu2009=u20090.005) were independent significant predictors of change in physical fatigue (R2u2009=u20090.14).ConclusionsPerson-centered progressive resistance exercise improved physical fatigue in women with FM when compared to an active control group.Trial registrationClinicalTrials.gov NCT01226784. Registered 21 October 2010.

How to manage fatigue in fibromyalgia: nonpharmacological options

The aim of this article is to suggest recommendations for the management of fatigue in fibromyalgia (FM) by reviewing and compiling findings of nonpharmacological treatment for fatigue in patients with FM. The management of fatigue in FM should incorporate regular physical exercise maintained for a longer period of time, which contributes to improved general health and facilitates coping with fatigue and other symptoms. The evidence is still low and the effect of exercise on fatigue in FM needs to be further studied. Patients with FM appear to benefit from general sleep hygiene advice and also need to develop individual strategies to manage the complex factors in everyday life that may be related to fatigue.

Effects of exercise on fatigue and physical capacity in men with chronic widespread pain - a pilot study

BackgroundThere is very limited knowledge about the effects of exercise on men with Chronic Widespread Pain (CWP), especially regarding fatigue. We wanted to investigate the effects of resistance exercise compared with pool exercise on multidimensional fatigue, psychological distress and physical capacity in men with CWP.MethodsThirty-four men with CWP, with a mean age of 49 (SD 8, range 26–59) years, were randomised to 12xa0weeks of standardised pool exercise (PE) or resistance exercise (RE). The primary outcome was the Multidimensional Fatigue Inventory (MFI-20). Depression, anxiety, isometric force, pain and health-related quality of life were also assessed.ResultsNo significant differences were found for changes in MFI-20 between the exercise groups. The RE group improved the isometric forces of right shoulder abduction (RE: ∆2.2 SD 1.5xa0N, PE: ∆0.6 SD 1.2xa0N, pu2009=u20090.009), right knee flexion (RE: ∆50, SD 50xa0N, PE: ∆-17, SD 71xa0N, pu2009=u20090.003) and left knee flexion (RE: ∆33 SD 39, PE: ∆-9 SD 52xa0N, pu2009=u20090.017) compared with the PE group. The drop-out rate was 29xa0% in the RE group and 18xa0% in the PE group.ConclusionsBoth a resistance exercise programme and a pool exercise programme improved different dimensions of fatigue in men with CWP. There were no differences in the change in fatigue over time between the exercise groups. Resistance exercise improved isometric strength compared with pool exercise. Because different types of exercise appear to improve different aspects of health, the goals could guide the choice of treatment. Further exercise studies with larger groups are needed to gain more knowledge about the effect of exercise on fatigue in men with CWP.Trial registrationClinicalTrials.gov Identifier NCT01278641. Registration date April 2008.

Psychometric properties of the Stress and Crisis Inventory (SCI-93) in females with fibromyalgia and chronic widespread pain

Abstract Background: Fibromyalgia (FM) and chronic widespread pain (CWP) are commonly associated with symptoms such as fatigue, stiffness, tension, exhaustion and psychological distress. Research on biological markers of the degree of stress symptoms has been conducted for decades. However, biological markers do not offer sufficient information for clinical practice, and thus, validated rating scales are still the best assessment option. The Stress and Crisis Inventory-93 (SCI-93) was designed to assess the severity of symptoms that are primarily related to the autonomous nervous system. Objective: The purpose of this study was to evaluate the psychometric properties of the SCI-93 with regard to known-group validity, internal consistency and test–retest reliability. Methods: The study included 166 women with FM or CWP in addition to 157 age-matched healthy women. The test–retest reliability was investigated in 40 women with FM. Results: A one-factor solution was chosen, which explained 53% of the total variance; Cronbachs alpha was 0.98. The group of patients with FM and CWP showed significantly higher SCI-93 total scores than the healthy reference group (mean = 76.4 ± 24.9 vs. mean = 24.9 ± 21.3; P < 0.001), supporting known-group validity. In the test–retest reliability study, the intra class correlation for the SCI-93 total score was 0.95. Conclusions: The SCI-93 demonstrated satisfactory known-group validity and test–retest reliability. The instrument appears to reflect well the severity of autonomous symptoms.

OP0286-HPR Resistance Exercise Improves Multidimensional Fatigue in Women with Fibromyalgia. A Randomized Controlled Trial

Background Fibromyalgia (FM) affects approximately 1-3% of the general population. Fatigue limits the work ability as well as the social life of patients with FM. A few studies of physical exercise have included measures of fatigue in FM, indicating that exercise can decrease fatigue levels. There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM. Objectives To examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM, and to investigate predictors for the potential change in fatigue. Methods A total of 130 women with FM (age 22-64 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of person-centered progressive resistance exercise compared with an active control group. The intervention was performed twice a week for 15 weeks. Outcomes were five dimensions of fatigue measured with the Multidimensional fatigue inventory (MFI-20). Information about background was gathered collected and the women also completed several health-related questionnaires. Multivariable stepwise regression was used to analyze predictors of change in fatigue in the total population. Results A higher improvement was found at the post-treatment examination for change in the resistance exercise group, as compared to change in the active control group for the MFI-20 subscales General fatigue (Resistance Δ-1.3 SD 3.1, Controls Δ-0.5 SD 2.6, p=0.031), Physical fatigue (Resistance Δ-1.7, SD 4.3, Controls Δ0.0, SD 2.7, p=0.013) and Mental fatigue (Resistance Δ-1.6 SD 3.4, Controls Δ-0.1 SD 2.5, p=0.008). Sleep efficiency was found to be the strongest predictor for change in the MFI-20 subscales General Fatigue (rs = -0.21, p=0.049) and for change in Reduced Motivation (rs = -0.22, p=0.037). Participating in resistance exercise (beta =1.90, p=0.010) and working less hours per week (beta =0.84, p=0.005) was independent significant predictors for change in Physical Fatigue (R2=0.14). Participating in resistance exercise was the strongest predictor for change in Mental Fatigue (p=0.008). Conclusions Person-centered progressive resistance exercise improved multiple dimensions of fatigue in women with FM when compared to an active control group. Participating in resistance exercise, reporting poorer sleep efficiency and working less hours per week at baseline predicted improvement in multidimensional fatigue in women with FM. Disclosure of Interest None declared

AB1097-HPR A Pain School Rehabilitation Program for Patients with Chronic Widespread Pain – A Qualitative Interview Study

Background The prevalence of chronic widespread pain is approximately 10–15% and it is a common problem in primary health care. Being female and older is associated with higher prevalence. Chronic pain is generally associated with low activity level, low work capability, and negative health consequences. Studies of education and exercise have shown effective results for patients with chronic pain. This pain school rehabilitation program “Knowledge for life” has been developed by professionals together with the Swedish Rheumatoid Association for use in primary health care, but is not previously evaluated. Objectives To evaluate the experience of participation in the pain school rehabilitation program Knowledge for life in patients with chronic widespread pain Methods 12 women (age 25–72 years) with chronic widespread pain were included in this qualitative interview study set in primary health care. Semi-structured interviews were held 10 weeks after participating in four weekly group sessions. Interviews were performed by two authors and transcribed verbatim. Data was analyzed through content analysis according to Graneheim and Lundman (1). Analyzes were performed by the first author, but was controlled by co-authors for agreement. Results are presented through themes and categories. Informed consent were signed by all participants. Results The preliminary results are based on four interviews. The analysis resulted in five themes, which are the meaning of the group, positive experience of movement, change of relationship to self, change of relationship to pain, and external circumstances of change. The meaning of the group reflects upon the shared experiences and a sense of belonging deriving from the group discussions. Positive experience of movement describes the participants experiences of physical activity and exercise related to their body, group activities and change of habit and attitude towards movement in general. The participants described a change of relationship to self and change of relationship to pain related to increased knowledge, acceptance, and active strategies. External circumstances to change was also identified describing the leader and setting to be important factors in stimulating change. Conclusions Participation in a pain school rehabilitation program contributed to increased knowledge and awareness about pain and about the self for the patients with chronic widespread pain in the present study. They also reported positive experiences of group sessions and of physical activity and exercise. The program provides a structure of rehabilitation for patients with chronic widespread pain. References Graneheim UH & Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24: 105–112. Disclosure of Interest None declared

THU0611-HPR Male Chronic Widespread Pain – Effects of Exercise. a Pilot Study

Background Chronic Widespread Pain (CWP) is defined as pain in the right and left side of the body, above and below the waist combined with axial pain, for at least 3 months. The prevalence of CWP in general populations is in men between 3% and 9% and in women between 6.5% and 16%. Gender has been suggested to play a role in how patients with CWP respond to pain management programs. There is limited knowledge about the effects of exercise in men with CWP. Objectives To investigate the effects of resistance exercise (RE) on land compared to aerobic pool exercise (PE) in men with CWP. Methods Thirty-four men with CWP, mean age 49 (SD 8, range 26-59) years were randomized to 12 weeks of standardised pool exercise or land-based resistance exercise. The primary outcome was the Multidimensional Fatigue Inventory (MFI-20). Depression, anxiety, isometric force, pain and health related quality of life were also assessed. Results No significant difference was found for change in MFI-20 between the two exercise groups. RE improved isometric force in right shoulder abduction (RE: Δ2.2 SD 1.5 N, PE: Δ0.6 SD 1.2 N, p=0.009), right knee flexion (RE: Δ50, SD 50 N, PE: Δ-17, SD 71 N, p=0.003) and left knee flexion (RE: Δ33 SD 39, PE: Δ-9 SD 52 N, p=0.017) as compared to pool exercise. The drop-out rate was 29% in the RE group and 18% in the PE group. Within-group analyses showed improvement in the resistance exercise group for MFI General fatigue (p=0.040) and isometric force (p=0.003→0.015) at 12 weeks after baseline. In the pool exercise group improvement was found for MFI Physical fatigue (p=0.044), MFI Reduced motivation (p=0.021), anxiety (p=0.028) and physical component of health related quality of life (p=0.006). Both exercise groups reported fewer pain localizations at post-test. (p=0.033 and p=0.022). Conclusions A 12-week resistance exercise program improved isometric strength, when compared to a 12-week pool exercise program. The pool exercise group improved anxiety and health related quality of life over time. Both groups improved in fatigue and distribution of pain. Aerobic and resistance exercise appear to improve different aspects of health and the patients goals and preferences should guide the choice of treatment. Further exercise studies with larger groups are needed to gain more knowledge about differences in outcomes in men with CWP. Disclosure of Interest None declared