Anners Lerdal

Prevalence and characteristics of chronic pain in the general Norwegian population

Background. Population‐based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health‐related variables between persons with and without chronic pain were evaluated.

Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale:

Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the general population. Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19—81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity. Results: The FSS showed satisfactory internal consistency (Cronbachs alpha 0.88). The prevalence of high fatigue (FSS score>=5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p=0.004). Respondents with chronic illness (more than six months) reported a higher mean (M=4.69, SD=1.35) than the rest of the sample (M=3.67, SD=1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r=0.20, p<0.001). Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed.

Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults.

Objectives:To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain. Methods:A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables. Results:Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain. Conclusion:This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain.

A prospective study of patterns of fatigue in multiple sclerosis

We sought to identify clinical characteristics and socio‐demographic variables associated with longitudinal patterns of fatigue in multiple sclerosis (MS) patients. A questionnaire including the Fatigue Severity Scale (FSS) was mailed to a community sample of 502 MS patients three times 1 year apart. Three patterns of fatigue were defined: persistent fatigue (PF) (mean FSS score ≥5 at all time‐points), sporadic fatigue (SF) (mean FSS score ≥5 at one or two time‐points) and no fatigue (mean FSS score <5 at all time‐points). Among the 267 (53%) patients who responded at all time‐points, 101 [38%, 95% confidence intervals (CI) 32–44] had persistent, 98 (37%, 95% CI 31–43) sporadic and 68 (25%, 95% CI 20–31) no fatigue. Persistent and sporadic fatigue were more common in patients with, increased neurological impairment (P < 0.001), primary progressive MS (P = 0.01), insomnia (P < 0.001), heat sensitivity (P < 0.001), sudden‐onset fatigue (P < 0.001) or mood disturbance (P < 0.001) compared with patients without fatigue. Multivariable analysis showed that depression (PF P = 0.02, SF P < 0.001), heat sensitivity (PF P = 0.04, SF P = 0.02) and physical impairment (PF P = 0.004, SF P = 0.01) were associated with both sporadic and persistent fatigue. About 75% of the patients had persistent or sporadic fatigue over a 2 years observation period. Multivariable analyses confirmed a significant association between levels of depression, physical impairment and persistent fatigue.

Fatigue and its association with sociodemographic variables among multiple sclerosis patients

Objective: To explore the relationship between fatigue, sociodemographic and clinical variables in a population of patients with multiple sclerosis (MS). Rationale: There is a need to identify empirical relationships with possible antecedents of fatigue among patients with MS. Methods: A mailed questionnaire designed to survey sociodemographic variables and the Fatigue Severity Scale (FSS) was mailed to 502 individuals from the population of patients with definite MS in the city of O slo. A total of 368 (73%) responded. C linical data were collected from the O slo C ity MS-Registry. Results: The prevalence of fatigue in this population was 60.1%. The FSS score showed a negative correlation with education (r =-0.15, P <0.01) and a positive correlation with age (r =0.20, P B-0.001) and time since disease onset (r =0.11, P B-0.05). When controlled for gender, level of education and time since disease onset, the data showed a positive relationship between fatigue and age (P B-0.001) among patients with primary progressive (PP) disease. This relationship between age and fatigue was not found among patients with relapsing-remitting/secondary progressive (RR/SP) disease. Conclusion: The negative relationship between level of formal educatio n (FE) and fatigue among individuals with RR/SP disease suggests that behavioral factors may be among the antecedents of fatigue in this patient group. In contrast to normative data from the general population, our findings revealed no differences in fatigue related to gender. Thus, this study supports the hypothesis that there are disease-specific antecedents of fatigue among patients with MS.

Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke

Purpose. The aim of this study was to describe prevalence of fatigue and its relationship with demographic and clinical variables during the first 2 weeks (acute phase) following a stroke. Method. Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patients medical records. The sample consists of 115 patients with first-ever stroke admitted to two hospitals in Norway in 2007 and 2008. Post-stroke fatigue was measured with the Fatigue Severity Scale (FSS). The FSS measure was applied in the analysis as a continuous variable, and also used to categorise patients into three groups of fatigue intensity: no fatigue (mean FSS-score <4), moderate fatigue (mean FSS-score = 4–4.9) and severe fatigue (mean FSS-score ≥5). Patients who reported fatigue lasting longer than 3 months before the stroke were defined as having prestroke fatigue. Results. Pre-stroke fatigue was reported by 34 patients (30%). After stroke, 24% had severe fatigue, and fatigue was more common for women (57%). Controlling for sex and prestroke fatigue, the multivariate analysis showed that prestroke fatigue, lower physical function and depressive symptoms were related to post-stroke fatigue. Conclusion. Pre-stroke fatigue and fatigue during the acute phase needs to be assessed in relation to physical functioning and depression during recovery and the rehabilitation process.

Quality of life in the general Norwegian population, measured by the Quality of Life Scale (QOLS-N)

The main aim of the present study was to derive norms or reference values from the general Norwegian population for the Norwegian version of the Quality of Life Scale (QOLS-N). In addition, associations between socio-demographic and health variables on the level of quality of life were examined. The sample consisted of 1893 subjects from a total of 4000 randomly selected Norwegian citizens representative of the entire Norwegian population, aged 19–81. The subjects received a mailed questionnaire containing the QOLS-N. Results show that the mean quality of life score was 84.1 (SD 12.5). Women reported a higher quality of life than men. People with higher levels of education reported a higher quality of life. Those who were married or cohabitating reported the highest quality of life and those who were unemployed reported a lower quality of life than those who worked. In addition, people reporting long-term diseases or health problems scored significantly lower on quality of life. These results could serve as reference values for the level of quality of life, as measured by the QOLS-N in the Norwegian population.

Psychometric properties of the Fatigue Severity Scale—Rasch analyses of individual responses in a Norwegian stroke cohort

BACKGROUND The psychometric properties of the Fatigue Severity Scale (FSS) have not been tested in people with stroke, despite its being the most frequently used instrument measuring fatigue in this population. OBJECTIVE The objective of our study was to assess the psychometric properties of the FSS using both traditional and modern test theory approaches in people with stroke. DESIGN AND SETTING A total of 119 patients admitted to two hospitals in Norway with their first stroke were recruited to a longitudinal study of poststroke fatigue. Data on socio-demographics, fatigue and other clinical variables were collected by face-to-face interviews using standardized questionnaires or by mailed questionnaires at four time points six months apart. A total of 428 responses on the FSS were analysed. The internal scale validity, person response validity, unidimensionality, and uniform differential item functioning were assessed by applications of a Rasch model and by Cronbachs alpha. Additionally, concurrent validity was assessed using bivariate correlation analysis. RESULTS Items #1 and #2 in the original FSS demonstrated unacceptable high mean-square values. When these two items were removed, the psychometric properties in FSS-7 demonstrated better evidence of validity. No systematic differential item functioning of the items in FSS-7 was found in relation to any of the analysed variables. CONCLUSION In patients with stroke, the FSS-7 showed better psychometric properties and had better potential to detect changes in fatigue over time than the FSS-9 version, suggesting satisfactory grounds for removal of items #1 and #2 for its application.

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a persons self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.

Psychometric properties of the WHOQOL-BREF questionnaire for the Norwegian general population.

In 1994, the World Health Organization Quality of Life (WHOQOL) Group developed the procedure (the WHOQOL 100) to measure quality of life in healthy and ill persons from diverse cultures. The purpose of this study was to analyze the psychometric properties of a 26-item version of the WHOQOL 100, the WHOQOL-BREF, when applied to the Norwegian general population. The questionnaire was sent to 4,000 randomly selected Norwegian citizens aged 19 to 81 years. The response rate was 48.5%. Cronbachs alpha ranged from .60 in the social relationships domain to .84 in the physical health domain. Factor analysis resulted in a four-component solution partly supporting the established domain structure. Multiple regression analysis with sex, age, education, cohabitation and self-reported disease as independent variables explained 28%, 8%, 4%, and 15% of the variance for the physical health, psychological, social relationships and environmental domains, respectively. Self-reported disease was the strongest factor. The results appear to be promising regarding scaling qualities, discriminative power, and domain structure.