Support Care Cancer (2015) 23:191–212 DOI 10.1007/s00520-014-2389-7
REVIEW ARTICLE
Systematic review of the Multidimensional Fatigue Symptom Inventory-Short Form Kristine A. Donovan & Kevin D. Stein & Morgan Lee & Corinne R. Leach & Onaedo Ilozumba & Paul B. Jacobsen
Received: 5 May 2014 / Accepted: 5 August 2014 / Published online: 22 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Fatigue is a subjective complaint that is believed to be multifactorial in its etiology and multidimensional in its expression. Fatigue may be experienced by individuals in different dimensions as physical, mental, and emotional tiredness. The purposes of this study were to review and characterize the use of the 30-item Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) in published studies and to evaluate the available evidence for its psychometric properties. Methods A systematic review was conducted to identify published articles reporting results for the MFSI-SF. Data were analyzed to characterize internal consistency reliability of multi-item MFSI-SF scales and test-retest reliability. Correlation coefficients were summarized to characterize concurrent, convergent, and divergent validity. Standardized effect sizes were calculated to characterize the discriminative validity of the MFSI-SF and its sensitivity to change. Results Seventy articles were identified. Sample sizes reported ranged from 10 to 529 and nearly half consisted exclusively of females. More than half the samples were composed of
cancer patients; of those, 59 % were breast cancer patients. Mean alpha coefficients for MFSI-SF fatigue subscales ranged from 0.84 for physical fatigue to 0.93 for general fatigue. The MFSI-SF demonstrated moderate test-retest reliability in a small number of studies. Correlations with other fatigue and vitality measures were moderate to large in size and in the expected direction. The MFSI-SF fatigue subscales were positively correlated with measures of distress, depressive, and anxious symptoms. Effect sizes for discriminative validity ranged from medium to large, while effect sizes for sensitivity to change ranged from small to large. Conclusions Findings demonstrate the positive psychometric properties of the MFSI-SF, provide evidence for its usefulness in medically ill and nonmedically ill individuals, and support its use in future studies.
K. A. Donovan (*) : P. B. Jacobsen Health Outcomes and Behavior Program, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-SCM, Tampa, FL 33612, USA e-mail:
[email protected] Fatigue is generally defined as a sense of persistent tiredness or exhaustion that is often distressing to the individual. It is a common subjective complaint among persons with chronic illness, including cancer, and among persons who are healthy or acutely ill. Accordingly, the etiology of fatigue is believed to be multifactorial [1]. Fatigue is often described by those who experience it in terms of physical, mental, and emotional tiredness. These sensations may be sufficiently consistent as to be characterized as unidimensional or, conversely, as sufficiently distinct in their expression as to be characterized as different dimensions of fatigue [2]. This multidimensional characterization of fatigue is evidenced by the large number and variety of multidimensional fatigue measures currently available [3–5].
K. D. Stein : C. R. Leach Behavioral Research Center, Intramural Research Department, American Cancer Society, Atlanta, GA, USA K. D. Stein : C. R. Leach : O. Ilozumba Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA M. Lee Department of Psychology, University of South Florida, Tampa, FL, USA
Keywords Fatigue . Chronic illness . Cancer . Multidimensional Fatigue Symptom Inventory
Introduction
192
Although the availability of multidimensional fatigue measures heralds the wide acceptance of fatigue as multidimensional in nature, it also makes the decision of which measure to use and when to use it a challenge. As we have previously noted [6], the choice depends on several considerations [4, 5, 7]. These include what dimensions of fatigue one wishes to measure, the practical aspects of any one measure’s usability, the measure’s clinical and/or research utility, and whether the scale possesses robust psychometric properties, including the strength of the evidence for the measure’s reliability and validity and the population(s) on which the psychometric data are based [8]. The Multidimensional Fatigue Symptom Inventory-Short Form [9] (MFSI-SF), first published in 1998, is a 30-item selfreport measure derived from an initial pool of 83 items designed to assess five empirically derived dimensions of fatigue: general fatigue, physical fatigue, emotional fatigue, mental fatigue, and vigor. A total fatigue score may be calculated by subtracting the vigor subscale score from the sum of the four fatigue subscales. The psychometric properties of the MFSI-SF were originally established in women with a diagnosis of breast cancer and women with no history of cancer. The measure was further validated in a study of males and females with a variety of different cancer diagnoses [10]. Since its development, the MFSI-SF has been used to describe fatigue in a variety of clinical and nonclinical populations and as a patient-reported outcome measure in clinical studies. A cursory review of the literature demonstrates that the MFSI-SF is a widely used multidimensional measure of fatigue. We believe that as the MFSI-SF continues to be used and the data based on its use accumulate, it is important to examine how it has been used subsequent to the original validation studies and to characterize the evidence base supporting its current and future use. Toward that end, the aims of this paper are to review and characterize the use of the MFSI-SF in published studies and to evaluate the available evidence for its psychometric properties. To accomplish this, we conducted a systematic review of the literature to identify published studies that reported results on the MFSI-SF. These data were used to describe the characteristics of studies that have used the MFSI-SF and were analyzed based on statistical considerations to summarize evidence regarding the reliability, validity, and sensitivity to change of the MFSI-SF.
Methods Search and selection strategy The identification of relevant publications began with an electronic search of Web of Science to identify journal articles citing one of two published papers that described the development and early validation of the MFSI-SF [9, 10]. We also
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searched Medline, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL) from 1998, the year the MFSI-SF was first published, through December 2013 using the search term Multidimensional Fatigue Symptom Inventory. Study abstracts were screened based on two eligibility criteria. The first criterion was that each study must have been published in a peer-reviewed English language journal. The second was that each study had to report results based on the administration of the MFSI-SF. Studies in which fatigue was assessed without using the MFSI-SF were excluded. Similarly, reviews summarizing results of published studies of fatigue were excluded. Reference lists from studies retrieved also were reviewed to ensure that all possible studies that derived empirical results for the MFSI-SF were captured. Discrepancies among reviewers in the selection of studies were resolved by discussions designed to yield consensus. Bias was reduced by conducting a comprehensive search of published studies in several electronic databases and searching reference lists of published reviews. Review and data extraction Each member of a pair of authors separately reviewed the studies that met eligibility criteria and collected relevant information from each of the studies using a standardized form to ensure consistency within as well as between paired authors. As with article selection, discrepancies in the information extracted were resolved through consensus discussion. The information included participants’ demographic and clinical characteristics, the purpose and design of the study, and the MFSI-SF subscales for which results were reported. In addition, studies were reviewed to determine if they contained results bearing on the reliability and validity of the MFSI-SF, and if so, this information also was collected. With respect to reliability, evidence for the internal consistency and test-retest reliability of the instrument was identified. With respect to construct validity, evidence of structural, concurrent, convergent, divergent, and discriminative validity was extracted. For purposes of this review, we considered structural validity to be the extent to which the original factor structure of the MFSISF was reproducible, concurrent validity to be the degree to which MFSI-SF scales are correlated with other published measures of fatigue, convergent validity to be the degree to which MFSI-SF scales correlated with measures of conceptually related constructs, and divergent validity to be the degree to which MFSI-SF scales either negatively correlated or did not correlate with measures of constructs believed to be conceptually distinct from fatigue. Discriminative validity was evident if MFSI-SF scores of one group differed as expected from those of a comparison group. Finally, evidence of the sensitivity to change of the MFSI-SF as a result of an intervention or disease treatment likely to alter the level of fatigue was extracted.
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Statistical analysis Descriptive statistics, including means and percentages, were calculated to characterize the samples identified in the relevant articles. The psychometric properties were evaluated using information available from the published articles. Cronbach’s alpha coefficients and correlation coefficients, when reported, were used to assess the internal consistency reliability and test-retest reliability of the MFSI-SF subscales, respectively. Correlation coefficients between MFSI-SF subscales and other published measures were examined when available to characterize the concurrent, convergent, and divergent validity of the MFSI-SF. Summary statistics in the form of mean correlation coefficients with two-sided 95 % confidence intervals for the mean were calculated in some instances for illustrative purposes. Consistent with Cohen [11], correlation coefficients in the order of 0.10 were considered small, those of 0.30 moderate, and those of 0.50 large. Finally, Cohen’s d [11], a measure of effect size, was calculated to characterize the discriminative validity of the MFSI-SF and a standardized effect size [12] using baseline and follow-up scores. The standard deviation of baseline scores was calculated to characterize the sensitivity of the MFSI-SF to change. An effect size of 0.20 to 0.30 was considered a small effect, around 0.50 a medium effect, and around 0.80 a large effect [11]. When effect sizes were calculated by the authors of the published studies, we did not recalculate these statistics but reproduced them in our results.
Results Search results and characteristics of selected studies A total of 431 abstracts were screened, and the complete texts of 178 studies were retrieved and reviewed (see Fig. 1). Ultimately, we identified 70 articles published between 1998 and 2013 that reported results on the administration of the MFSI-SF; this includes the 1998 study [9] of the psychometric properties of the instrument (see Table 1). Forty-four studies involved cancer patients; of these, 26 studies were exclusively of women with a diagnosis of breast cancer, and 15 were of a mix of cancer types, including three studies [13–15] that included women with gynecologic cancer. Among studies of cancer patients, 11 studies included noncancer controls. Various points in the cancer treatment trajectory were represented; results are reported for patients who completed the MFSI-SF before beginning treatment, while undergoing treatment, after having completed treatment, and well into posttreatment survivorship. While the MFSI-SF seems to have been used predominantly to assess fatigue in cancer patients, especially breast
193 431 potentially relevant abstracts and cross references identified via Web of Science, Medline, PsycINFO, CINAHL, and manual search of reference lists
188 duplicate abstracts
243 abstracts screened
65 abstracts excluded (e.g., fatigue not assessed with MFSI-SF, reviews of fatigue measures, reviews of cancerrelated fatigue
178 studies obtained for further assessment of eligibility
108 full-text articles excluded (e.g., fatigue not assessed with MFSI-SF, MFSI-SF data not reported sufficient for review
70 studies included in present review
Fig. 1 Study identification
cancer patients, results also have been reported for a variety of health conditions, including, but not limited to, fibromyalgia [16], osteoarthritis [17], stroke [18], and hypertension [19, 20], and in kidney transplant candidates [21]. We also identified six studies [22–27] that used the MFSI-SF exclusively to assess fatigue in individuals with no reported health conditions. The MFSI-SF was administered across a range of study designs. Thirty-five studies employed a cross-sectional design and 25 employed a longitudinal design. The MFSI-SF was also administered in ten randomized controlled trials. Thirty-one studies reported results on all five subscales of the MFSI-SF. Twenty studies reported results limited to total fatigue (sum of four fatigue subscales minus vigor subscale) while 17 studies reported on four or fewer subscales consistent with the purpose of the particular study; in those studies, the majority reported on the physical subscale of the MFSI-SF. Two studies, the original validation study of the MFSI-SF that led to the final 30-item version and a study [28] to estimate the prevalence of severe fatigue according to draft International Statistical Classification of Disease and Related Health Problems-10 criteria for cancer-related fatigue, used the original 83-item version. Four studies reported results based on translations of the MFSI-SF into Chinese [29], German [30, 31], and Italian [23]. Two studies reported results based on modified approaches for scoring the MFSI-SF: One was the study [29] examining the psychometric properties of the Chinese version of the MFSISF in a patient sample of mixed cancer types that combined the physical and general subscales to create a new physical subscale. The other study [32] adapted the vigor subscale to assess “energy” in a study of “healthy and recreationally active individuals.”
Disease
Breast cancer
Breast cancer
Mix of cancer types
Mix of cancer types
Temporomandibular disorders
Breast cancer
None (nonclinical sample)
Breast cancer
Breast cancer
Authors
Stein et al. [9]
Broeckel et al. [40]
Mantovani et al. [59]
Stein et al. [10]
de Leeuw, Studts and Carlson [41]
Helgeson and Tomich [68]
Lim et al. [24]
Liu et al. [63]
Mills et al. [65]
Newly diagnosed; scheduled to receive at least 4 3 week cycles of adjuvant or neo-adjuvant anthracycline-based chemotherapy
NA
4.5 - 6.8 years post-diagnosis
Diagnosed with temporomandibular disorder; at least 3 months of pain; reported pain in past month
About to start chemotherapy
Histologically confirmed advanced stage tumor; signs of cancer-related anorexia/cachexia syndrome present
At least 5 years postdiagnosis or recurrence
About to start treatment and posttreatment
Position in disease/ treatment trajectory
Investigate the presence and magnitude of self-reported fatigue and fatigue-related symptoms and determine whether fatigue can be distinguished as a unique clinical symptom in a sample of patients diagnosed with chronic temporomandibular joint or masticatory muscle pain Evaluate the long-term impact of breast cancer on QOL by comparing disease-free survivors, survivors w/ a recurrence, and healthy controls Examine the associations among obesity, depressive symptoms, cytokine levels, and multidimensional fatigue symptoms among asymptomatic and healthy individuals Investigate the association between fatigue and light exposure among patients with breast cancer
Examine characteristics and correlates of sexual functioning in long-term breast cancer survivors treated with chemotherapy compared to noncancer controls Test the efficacy and safety of an integrated treatment (pharmaconutritional, antioxidant, and drug) in advanced cancer patients with CACS/OS Evaluate the factorial and construct validity of the MFSI-SF
Develop and validate a multidimensional measure of fatigue for use with cancer patients
Study purpose
100 % female
100 % female
63 patients
29 patients
51 % female
100 % female
70 individuals
267 disease free patients, 37 patients with a recurrence, 187 noncancer controls
Patients: 96 % female; healthy controls: 96 % female
80 % female
304 patients
55 patients; 55 healthy controls
52 % female
100 % female
100 % female
Sex
25 patients
58 patients; 61 noncancer controls
275 patients; 70 noncancer controls
Sample size
Table 1 Characteristics of studies reporting results on the administration of the Multidimensional Fatigue Symptom Inventory-Short Form
49.5 (11)
52.0 (10.5)
36 (7.8)
Disease free patients 54.4, patients with a recurrence 51.2, controls 53.2
Patients 32.3 (12.5), healthy controls 32.6 (12.7)
54.9 (11.5) (28–88)
58.2 (9.0)
Active treatment 53.6 (12.2) (28-83), posttreatment 54.1 (13.7) (32–86), noncancer 53.4 (11.5) (34–77) Patients 56.2 (8.8), noncancer controls 54.6 (8.9)
Age (mean and SD) (range)
Emotional, general, mental, physical, vigor
Scales reported in analyses
Total, vigor
General, mental, physical
Longitudinal
Longitudinal
Total
Total, emotional, general, mental, physical, Vigor
Cross-sectional Total, emotional, general, mental, physical, vigor
Longitudinal
Cross-sectional Emotional, general, mental, physical, vigor
Cross-sectional Total, emotional, general, mental, physical, vigor
Longitudinal
Cross-sectional Total
Longitudinal
Design
194 Support Care Cancer (2015) 23:191–212
NA
Hypertension
None (nonclinical sample)
Mix of cancer types
Gynecologic cancers
Chronic fatigue syndrome (CFS)
None (nonclinical sample)
Breast cancer
Bardwell et al. [19]
Gramignano et al. [23]
Mantovani et al. [61]
Prue et al. [13]
Siegel et al. [69]
Thomas et al. [26]
Young and White [28]
Completed curative treatment at least 6 months previously
NA
Diagnosis of CFS
Various points but within mean of 3 months of starting treatment
Histologically confirmed advanced stage tumor; signs of cancer-related anorexia/cachexia syndrome present
Active treatment
Post-treatment, between 1 month and 3 years previously
Scales reported in analyses
Emotional, general, mental, physical, Vigor
Cross-sectional Emotional, general, mental, physical, vigor African Americans 38.1 (1.4) (37–40), Caucasian Americans 35.6 (1.0) (35–37) African Americans: 49 % female; Caucasian Americans: 39 % female 100 % female 37 African Americans, 56 Caucasian Americans
88 % female
Cross-sectional Mental
Low NKCA 45.3 (9.6) (36–55), normal NKCA 43.5 (8.9) (35–52)
100 % female
22 low NKCA patients, 19 normal NKCA patients
59 (26–81)
60.9 (13.5) (31-84)
Cross-sectional
Cross-sectional Global, affective, behavioral, cognitive, somatic, vigor
Cross-sectional Total, emotional, general, mental, physical, vigor
Total
Total, emotional, general, mental, physical, vigor
100 % female
Longitudinal
Longitudinal
30 patients
58.9 (9.1)
60 (9) (42–73)
41 % female
Cross-sectional General
Longitudinal
Cross-sectional Total, emotional, general, mental, physical, vigor
Design
39 patients
Range=25-52
53.7 (12.6) (32–83)
51.2 (10.0) (34–79)
Age (mean and SD) (range)
83 % female
47 % female
100 % female
100 % female
Sex
40 African Americans, 64 Caucasian Americans 12 patients
25 patients
85 patients
Sample size
Estimate prevalence of 69 patients severe fatigue according to draft ICD-10 criteria for cancer-related fatigue; identify prevalence and moderators of clinical syndrome 51 patients
Determine whether chemotherapy-induced changes in the inflammatory markers SICAM-1, VEGF, and IL-6 are associated with fatigue, depressed mood, and poorer quality of life. Examine sleep, fatigue, and circadian rhythms in breast cancer patients before start of chemotherapy Investigate correspondence between daily and weekly ratings of fatigue over 1 month period by fatigued breast cancer survivors (defined as 5+ score on MFSI general) Determine if SES partially explains ethnic disparities in fatigue Test efficacy and safety of L-carnitine supplementation in patients who had advanced cancer and developed fatigue, high blood levels of reactive oxygen species or both Test the efficacy and safety of an integrated treatment (pharmaconutritional, antioxidant, and drug) in advanced cancer patients with CACS Explore incidence and magnitude of fatigue and determine acceptability of MFSI-SF with gynecologic cancer patients Compare clinical presentation of CFS patients with and without clinically reduced natural killer cell activity (NKCA) Examine how discrimination and ethnic identify relate to sleep architecture and fatigue
Stage I-IIIA and referred for adjuvant or neoadjuvant anthracycline-based chemotherapy
Banthia et al., 2006[39] Breast cancer
Study purpose
Position in disease/ treatment trajectory
Scheduled to begin neoadjuvant chemotherapy or adjuvant chemotherapy
Disease
Ancoli-Israel et al. [51] Breast cancer
Authors
Table 1 (continued)
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2 or more years post-treatment
1 to 5 years post-diagnosis; completed primary treatment
Brain tumor
Stroke
Breast cancer
Breast cancer
Breast cancer
Mix of cancer types
Major depressive disorder
Feuerstein et al. [71]
Mead et al. [18]
Clayton, Dudley and Musters [43]
Collado-Hidalgo et al. [72]
Hansen et al. [73]
Mantovani et al. [60]
Strigo et al. [74]
Unmedicated for depression
Histologically confirmed advanced stage tumor; signs of cancer-related anorexia/cachexia syndrome present
Completed primary treatment
Post-stroke
Completed primary treatment
At least 6 months post-diagnosis of fibromyalgia or failed back syndrome
Temporomandibular disorders in fibromyalgia or failed back syndrome
Balasubramaniam et al. [70]
Position in disease/ treatment trajectory
Disease
Authors
Table 1 (continued)
Identify which currently available fatigue scale is most valid, feasible, and reliable in stroke patients Investigate how fatigue and communication are related to survivor uncertainty and mood state, and survivor perception of patient-centered communication for women with varying fatigue levels Examine single-nucleotide polymorphisms in promoters of cytokine genes as genetic risk factors for cytokine-related fatigue in fatigued and nonfatigued breast cancer survivors Determine whether physical fatigue, depression, anxiety, and cognitive limitations are differentially associated with work limitations in breast cancer survivors versus non-cancer controls Phase III randomized trail to establish the most effective and safest treatment to improve key primary endpoints of CACS: increase of LBM, decrease of REE, and improvement of fatigue. Secondary endpoints also evaluated. Examine hypothesis that young adults with MDD would show increased affective bias to painful and nonpainful experimental pain stimuli
Determine prevalence of temporomandibular disorders and evaluate psychosocial domains in patients with fibromyalgia compared with patients with failed back syndrome Investigate role of both non-modifiable and modifiable factors in brain tumor survivors and their association to work limitations
Study purpose
100 % female
41 % female
80 % female
125 patients
15 patients, 15 healthy controls
Emotional, general, mental, physical, vigor
Scales reported in analyses
General
Cross-sectional General
Cross-sectional Total
Longitudinal
Cross-sectional Physical
Design
Patients 24.1 (5.6) (19-30), healthy controls 23.9 (5.2) (19-29)
61.9 (12.1)
Total
Total
Longitudinal
Longitudinal
Patients 49.5 (8.5), noncancer Cross-sectional Physical controls 39.8 (10.8)
Fatigued patients 54.1 (8.3), nonfatigued patients 61.1 (8.5)
100 % female
33 fatigued patients; 14 non-fatigued patients
100 patients; 103 noncancer controls
61.67 (11.30) (31–87)
brain tumor=20–29: 13.7 %, 30–39: 22.1 %, 40–49: 34.7 %, 50–59: 25.3 %, 60–70: 4.2 %; noncancer controls=20–29: 21.4 %, 30–39: 35.8 %, 40–49: 37.9 %, 50–59: 4.2 %, 60–70: 3.2 % (range=20–70) Median=73
Fibromyalgia patients 52.2 (7.8), failed back syndrome patients 50.0 (9.1)
Age (mean and SD) (range)
100 % female
44 % female
Patients: 59 % female; noncancer controls: 79 % female
Sex
60 patients
T1=55 patients; T2=51 patients
95 patients; 131 noncancer controls
Sample size
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Venous thromboembolism (VTE)
Explore associations between sleep disturbance/fatigue/ depression symptom cluster categories before treatment and longitudinal profiles of the symptoms during chemotherapy Deep vein thrombosis Outpatient with objectively Investigate relationships (DVT) and pulmonary diagnosed venous between QOL, psychological embolism (PE) thrombotic event (DVT distress (anxiety and and/or PE) depression), and fatigue in outpatients with a previous DVT and/or PE Alzheimer’s caregivers NA Examine whether personal and elderly non-caregiver mastery moderates relationship between caregiver status and fatigue Masticatory muscle pain Diagnosis of pain for at least Compare emotional reactivity 2 months and physiological response in masticatory muscle pain patients vs. pain-free controls Breast cancer 1-10 (mean=3) years post primary Investigate relationship treatment between perceived cognitive function at work and more generic performance-based neuropsychological measures of these functions
Krummenacher et al. [30]
Liu et al. [48]
Calvio et al. [76]
Schmidt et al. [75]
Roepke et al. [36]
Lukas et al. [31]
Ankylosing spondylitis
Günaydin et al. [45]
Breast cancer
Malignant brain tumor
At least 3 months after an objectively diagnosed venous thromboembolic event; scheduled for outpatient thrombophilia work-up Newly diagnosed; scheduled to receive at least 4 3 week cycles of adjuvant or neo-adjuvant anthracyclinebased chemotherapy
Disease duration: mean (10.3), range (1-35)
0-27 (mean=4) years post-diagnosis
Examine age, cancer stage, sleep quality and depressed mood as predictors of 5 dimensions of fatigue in fatigued breast cancer survivors (defined as 5+ score on MFSI general) Investigate perceived cognitive function in employed malignant brain tumor survivors relative to healthy group of workers Evaluate the frequency and multidimensional nature of fatigue and identify associations with demographic, diseasespecific, and other variables (e.g. depression, sleep disturbance in AS patients Investigate the associations of subjective sleep quality, fatigue, and vital exhaustion with platelet count in VTE patients
Calvio et al. [34]
Post-treatment
Breast cancer
Study purpose
Banthia et al. [50]
Position in disease/ treatment trajectory
Disease
Authors
Table 1 (continued)
100 % female
22 patients; 23 healthy controls
100 % female
Caregivers: 74 % female; non-caregivers: 78 % female
73 caregivers; 41 non-caregivers
122 patients; 113 noncancer controls
45 % female
100 % female
45 % female
16 % female
Patients: 65 % female; noncancer controls: 73 % female
100 % female
Sex
205 patients
76 patients
205 patients
62 patients
113 patients; 123 noncancer controls
70 patients
Sample size
Scales reported in analyses
Patients 44.9 (9.5), noncancer controls 39.2 (11.9)
Patients 41.0 (12.6) (28–54) Controls: Matched±5
Cross-sectional Physical
Cross-sectional Emotional, general, mental, physical, vigor
Cross-sectional Total, emotional, general, mental, physical, vigor Caregivers 72.2 (9.6) (63–82), noncaregivers 68.4 (6.7) (62–75)
Total
Cross-sectional Total, emotional, general, mental, physical, vigor
Longitudinal
Cross-sectional Total, emotional, general, mental, physical, vigor
Cross-sectional Total, emotional, general, mental, physical, vigor
Cross-sectional Physical
Cross-sectional Emotional, general, mental, physical, vigor
Design
47.4 (14.9)
51.1 (9.1)
47.2 (14.8) (18–80)
39.6 (10.3)
NR
52.5 (12.2) (32–83)
Age (mean and SD) (range)
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Disease
Sleep apnea
Mix of cancer types
Mix of cancer types
Gynecologic cancers
None (nonclinical sample)
Asymptomatic BRCA 1/2 carriers
Breast cancer
Allogeneic hematopoietic stell cell transplant patients and caregivers
Gynecologic cancer
Authors
Lee et al. [77]
Mantovani et al. [57]
Mantovani et al. [58]
Prue et al. [15]
Rief et al. [25]
Shochat et al. [27]
Taylor et al. [49]
Bevans et al. [46]
Donnelly et al. [14]
Table 1 (continued)
Post-surgery and in active treatment or post-treatment
Pre-HSCT, post-HSCT, and 6 weeks postdischarge
Completed initial treatment for breast cancer
At genetic risk (asymptomatic BRCA1⁄ 2 mutation carriers and non-carriers)
NA
Newly diagnosed with no treatment except surgery
Histologically confirmed advanced stage tumor; signs of cancer-related anorexia/cachexia syndrome present
Histologically confirmed advanced stage tumor; signs of cancer-related anorexia/cachexia syndrome present
Not specified
Position in disease/ treatment trajectory
Examine relationship among cardiorespiratory fitness, physical activity, and psychosocial variables in overweight or obese breast cancer survivors Explore psychometric properties of Distress Thermometer by examining relationship with Brief Symptom Inventory - 18 and MFSI in allogeneic HSCT patients and caregivers Determine feasibility and efficacy of physical activity
Test hypothesis that nocturnal secretion of inflammation markers and catecholamines would be associated with mood and stress variables Investigate association between BRCA 1/2 status and sleep quality in asymptomatic women
and work output in occupationally active breast cancer survivors relative to non-cancer control group Examine the relationship between the Psychomotor Vigilance Task (PVT) and subjective fatigue Prospective phase II clinical trial to test the safety and effectiveness of an intervention with the COX-2 inhibitor celecoxib on key variables of cachexia (including fatigue) in patients with advanced cancer of different disease sites Phase III randomized trail to establish the most effective and safest treatment to improve key primary endpoints of CACS: increase of LBM, decrease of REE, and improvement of fatigue. Secondary endpoints also evaluated. Examine course and correlates of fatigue in gynecologic cancer patients
Study purpose
100 % female
260 patients
33 patients
BRCA1/2 carriers: 51.4 (9.1) (42 - 61), non-carriers 54.5 (9.4) (45–64), controls 49.9 (6.8) (43–57) 55 (9.4) (28–81)
Patients 57.4 (13.9) (23–86), noncancer controls 55.4 (13.6) (24–86) 34.9 (9.6) (24.5–44.5)
Mean (SD): Arm 1=61.5 (9.7) Arm 2=60.6 (13.5) Arm 3=62.8 (11.5) Arm 4=62.4 (11.9) Arm 5=62.4 (9.4)
60.6 (9.7)
49.2 (9.4)
Age (mean and SD) (range)
100 % female
53 (10.3)
Patients: 37 % female; Patients 47.4 (14.3), caregivers: 75 % female caregivers 52.3 (13.5)
100 % female
17 BRCA 1/2 carriers, 20 non-carriers, 36 controls
65 patients; 91 caregivers
43 % female
100 % female
65 patients; 60 noncancer controls
130 individuals
45 % female
46 % female
19 % female
Sex
332 patients
24 patients
40 sleep apneic patients; 8 normal patients
Sample size
Scales reported in analyses
Longitudinal
Total
Total, emotional, general, mental, physical, vigor
Cross-sectional Total
Cross-sectional Total
Total
Total, emotional, general, mental, physical
Longitudinal
Longitudinal
Total
Total
Longitudinal
Longitudinal
Cross-sectional Total, emotional, general, mental, physical, vigor
Design
198 Support Care Cancer (2015) 23:191–212
Breast cancer
Osteoarthritis (OA)
Mix of cancer types
Kidney transplant candidates Before and after kidney and recipients transplantation
Obstructive sleep apnea
Hawker et al. [17]
Pien et al. [29]
Rodrigue et al. [21]
Tomfohr et al. [44]
At least 6 months posttreatment with persistent cancer-related fatigue
1 year or more post-primary treatment
NA
Breast cancer
Breckenridge et al. [78] Breast cancer
None (nonclinical sample)
Breast cancer
Bower et al. [54]
Cordero et al. [22]
Fagundes et al. [79]
Completed treatment within the last 2 years; at least 2 months past surgery,
Prior to start of chemotherapy to last week of cycle 4
Ancoli-Israel et al. [53] Breast cancer
Have not received treatment for OSA
Difficulties with movement in the last 3 months; swelling, pain, or stiffness lasting at least 6 wks Underwent treatment but did not receive intravenous chemotherapy
Completed treatment within the last 2 years; at least 2 months past surgery, radiotherapy or chemotherapy (whichever occurred last)
and within 3 years of diagnosis
Fagundes et al. [47]
Position in disease/ treatment trajectory
Disease
Authors
Table 1 (continued)
Examine effects of continuous positive airway pressure (CPAP) on fatigue in patients with obstructive sleep apnea Test whether increased morning bright light, compared to dim light, results in less fatigues during chemotherapy Determine feasibility and efficacy of lyengar yoga intervention for breast cancer survivors with persistent cancer-related fatigue Examine relationship of adjuvant endocrine therapy and perceived and performance-based cognitive function in occupationally active breast cancer survivors Examine fatigue according to acculturation status and to evaluate the factor structure of the MFSI-SF in a Hispanic community sample Examine the relationships between child maltreatment and quality of life in breast cancer survivors
Examine fatigue and sleep quality before and after kidney transplantation
behavioral change intervention in managing cancer-related fatigue Evaluate relationships between fatigue and both sympathetic and parasympathetic nervous system activity in breast cancer survivors/examine relationships between fatigue and autonomic activity at rest, as well as in response to standardized laboratory stressor Examine the relationships between OA pain, disability, fatigue, and depressed mood Examine psychometric properties of Chinese version of MFSI-SF
Study purpose
100 % female
31 patients
132 patients
158 Hispanics; 176 Anglos
100 % female
Hispanics: 69 % female; Anglos: 62 % female
survivors on adjuvant 100 % female endocrine therapy=77; survivors not on adjuvant endocrine therapy
100 % female
86 % male, 14 % female
Pre-tx patients: 38 % female; post-tx patients: 46 % female
65 % female
78 % female
100 % female
Sex
39 patients
59 patients
100 pre-tx patients; 100 post-tx patients
107 patients; 46 noncancer controls
529 people completed all three assessments
109 patients
Sample size
51.7 (9.5)
Hispanics 41.2 (16.1); Anglos 58.7 (16.9)
SERM/AI mn=44.9 (9.99) No SERM/AI=44.8 (8.88)
Intervention: 54.4 (5.7); control group=53.3 (4.9); range=40–65)
Placebo: 48.30 (9.04), range=39–57; Treatment: 48.14 (9.69), range=38–58 54 (9.1) (32–70)
Pre-tx patients 52.1 12.2, (40–64), post-tx patients 53.1 (11.3) (42–64)
Patients: 53.56±11.02; range=26–83
75.4 (56.7–95.8)
51.7 (9.4)
Age (mean and SD) (range)
Total
Total, emotional, general, mental, physical, vigor
Scales reported in analyses
Vigor
Total, emotional, general, mental, physical, vigor
Total
Cross-sectional Total, emotional, general, mental, physical, vigor
Cross-sectional Emotional, general, mental, physical, vigor
Cross-sectional Physical
Randomized controlled trial
Randomized controlled trial
Randomized controlled trial
Cross-sectional Total, emotional, general, mental, physical, vigor
Cross-sectional Total, physical (a combination of physical and general), emotional, vigor, mental
Longitudinal
Randomized controlled trial Longitudinal
Design
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Disease
Breast cancer
Breast cancer
Chronic heart failure
Mix of cancer types
Hypertension
Fibromyalgia
Head and neck cancer
Mix of cancer types
Breast cancer
Prostate cancer
Breast cancer
Authors
Liu et al. [64]
Liu et al. [52]
Redwine et al. [35]
Ritterband et al. [55]
Sadja et al. [20]
Schmidt et al. [16]
Aynehchi et al. [80]
Barton et al. [62]
Bennett et al. [81]
Cormie et al. [38]
Ganz et al. [82]
Table 1 (continued)
Completed primary treatment within past 3 months
Pain duration of at least six months; current pain level of at least 30 on a 0–100 visual analog scale At least 3 months post-treatment Within 2 years of diagnosis, in active treatment or completed treatment; experiencing cancer-related fatigue Completed treatment within the last 3 years; at least 2 months post surgery, radiotherapy or chemotherapy (whichever occurred last) NR
Not taking blood pressure medication
At least 1 month since completion of active treatment
radiotherapy or chemotherapy (whichever occurred last) Newly diagnosed; scheduled to receive at least 4 3 week cycles of adjuvant or neoadjuvant anthracycline-based chemotherapy Newly diagnosed; scheduled to receive at least 4 3 week cycles of adjuvant or neoadjuvant anthracycline-based chemotherapy NA
Position in disease/ treatment trajectory
Determine the safety and efficacy of resistance exercise by prostate cancer survivors with bone metastatic disease Examine relationship between subjective cognitive complaints and neuropsychological
Investigate cortisol and IL-6 responses to acute laboratory stressor in former and never smokers
Evaluate effects of focused breathing technique designed to enhance self-regulation in patients with fibromyalgia Validate Modified Brief Fatigue Inventory Evaluate efficacy and toxicity of American ginseng for cancer-related fatigue
Measure whether a Tai chi intervention effectively reduces somatic and/or cognitive symptoms of depression in patients with heart failure (copied directly from abstract) Evaluate effects of internet intervention designed to improve sleep of cancer survivors with insomnia Examine predictors of exercise adherence to 12-week exercise intervention
Examine the relationships between fatigue, objective and subjective measures of sleep, and inflammatory markers Explore longitudinal relationship between fatigue and both subjectively and objectively measured sleep
Study purpose
189 patients
20 patients
89 patients (64 never smokers, 25 former smokers)
52 patients, 57 noncancer controls 341 patients
20 patients
51 individuals
28 patients
24 patients
97 patients
53 patients
Sample size
100 % female
100 % male
51.8
Patients: 73.1 (7.5); controls: 71.2 (6.9); range ( 57–83)
Never smokers: 51.2 (10.2), former smokers: 52.0 (7.5)
Intervention: 55.3 (12.7), controls: 55.9 (11.8)
78 % female
100 % female
59.2 (12.8) (26–86)
Total: 46.64 (9.38); women: 49.07±8.63 range=40–58; men: 43.92±9.61 range=34–54 40.8 (13.7) (27–55)
56.7 (11.7) (45–68.5)
67 (11.9) (43–83)
50.7 (9.8)
50.3 (9.9)
Age (mean and SD) (range)
55 % female
100 % female
53 % female
86 % female
13 % female
100 % female
100 % female
Sex
Total, general, emotional, mental, physical, vigor
Longitudinal
Randomized controlled trial
Mental, physical
Total, general, emotional, mental, physical, vigor
Cross-sectional Total
Randomized controlled trial
Cross-sectional Total
Emotional, general, mental, physical, vigor
Physical Randomized controlled trial
Longitudinal
Total, emotional, general, mental, physical, vigor
Total, physical
Total, emotional, general, mental, physical, vigor
Total
Scales reported in analyses
Randomized controlled trial
Randomized controlled trial
Longitudinal
Longitudinal
Design
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Disease
Headache
Breast cancer
Breast cancer
Mix of cancer types
Insomnia
Authors
Gass and Glaros [83]
Janusek et al. [66]
Moskowitz et al. [84]
Sobel-Fox et al. [42]
Thorndike et al. [56]
Table 1 (continued)
Completed treatment at least 3 months prior; self-reported experience of at least 3 episodes of debilitating fatigue in past month Diagnosed with insomnia; reported sleep complaints lasting at least 6 months; currently experiencing sleep difficulties and fatigue-related daytime impairment
Completed primary treatment
Post breast surgery
6 month or longer history of recurrent headaches
Position in disease/ treatment trajectory
21 patients; 19 healthy controls
Sample size
Investigate whether Internet-delivered cognitive behavioral therapy for insomnia also reduces comorbid psychological and fatigue symptoms 44 patients
Determine whether childhood 40 patients adversity increases vulnerability for more intense and sustained behavioral symptoms, poorer quality of life, and greater immune dysregulation Examine whether symptom 94 patients; 100 noncancer clusters appear in employed controls breast cancer survivors and whether clusters are related to job stress and aerobic activity Examine relationship between 52 patients unidimensional and multidimensional assessments of fatigue in cancer survivors
function, chemotherapy exposure, and menstrual status Examine association between headaches and autonomic nervous system activity
Study purpose
Intervention patients: 82 % female; control patients: 73 % female
64 % female
100 % female
100 % female
Patients: 90 % female; healthy controls: 89 % female
Sex
Total: 44.9 (11.0); intervention patients: 44.7 (10.6); control patients: 45.1 (11.7)
57.8 (13.3) (28–84)
Patients: 49.5 (8.5); controls: 39.9 (10.8)
55.6 (9.4)
Patients: 32.9 (11.7); healthy controls: 30.4 (11.2)
Age (mean and SD) (range)
Scales reported in analyses
Total
Randomized controlled trial
Longitudinal
Total
Emotional, general, mental, physical, vigor
Cross-sectional Physical
Longitudinal
Cross-sectional Total, emotional, general, mental, physical, vigor
Design
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Reliability of the MFSI-SF
internal consistency reliability of the multi-item fatigue subscales. Eight of these studies [9, 10, 22, 36, 39–42] reported on all five of the subscales: physical mean alpha=0.84 (95 % confidence interval (CI)=0.81–0.86), general mean alpha= 0.93 (95 % CI=0.91–0.95), mental mean alpha=0.87 (95 % CI=0.85–0. 90), emotional mean alpha=0.90 (95 % CI= 0.87–0.94), vigor mean alpha=0.86 (95 % CI=0.82–0.89). Two studies [36, 40] reported only a range of alpha coefficients for the subscales as a group; the lowest reported coefficient was 0.74 and the highest was 0.94. Six studies [17, 21, 29, 36, 43, 44] included a Cronbach’s alpha coefficient for the total fatigue score. The mean alpha coefficient for total fatigue was 0.87 (95 % CI=0.83–0.91) and ranged from 0.74 to 0.95. One study [27] combined the MFSI-SF with the Brief Symptom Inventory and reported only that Cronbach’s alpha coefficients for the combined scales ranged from 0.85 to 0.96.
Internal consistency reliability Table 2 presents data related to the reliability of the MFSI-SF. Sixteen studies reported on the
Test-retest reliability Three studies [9, 18, 29] published data on the test-retest reliability of the MFSI-SF. The first was the
Sample sizes in the identified publications ranged from a low of 10 in a double-blind crossover study [33] to determine the contribution of hyperammonemia to minimal hepatic encephalopathy development in males and a high of 529 in a longitudinal study [17] examining the relationships between osteoarthritis pain, disability, fatigue, and depressed mood. Thirty-three of the samples included in the 70 studies were 100 % female; only one study [33] included a sample that was 100 % male. Sixty-five studies reported mean age of the sample; 34 of these studies also reported age range in addition to mean age while two studies [19, 34] reported only range. The mean/median age of participants ranged from 20 to 75 years. There were few studies of older cancer patients; only six reported a mean/median age greater than 65 years of age [17, 18, 35–38].
Table 2 Reliability of the Multidimensional Fatigue Symptom Inventory-Short Form Authors
Internal consistency reliability
Test-retest reliability
Stein et al. [9]
General (0.96), emotional (0.93), physical (0.85), mental (0.90), vigor 0.88
3 to 4 weeks: general (0.51), physical (0.54), emotional (0.57), mental (0.64), vigor (0.55); 6 to 8 weeks: general (0.60), physical (0.61), emotional (0.66), mental (0.70), vigor (0.64)
Broeckel et al. [40]
Subscale alpha range=0.81 to 0.94 (patients), =0.74 to 0.91 (noncancer controls) General (0.96), emotional (0.92), physical (0.87), mental (0.91), and vigor (0.90) General (0.96), emotional (0.89), physical (0.89), mental (0.90), vigor (0.88) Patients: general (0.94), mental (0.91), physical (0.75); controls: general (0.94), mental (0.84), physical (0.81) General (0.95), emotional (0.82), physical (0.81), mental (0.84), vigor (0.79) General: T1 (0.91), T2 (0.93) Total (0.95) total alpha=0.86, subscales alpha range=0.87 to 0.94 Total: T1 (0.74), T2 (0.85), T3 (0.89) Physical (0.84), mental (0.84), mental (0.84), vigour (0.83), total (0.90) [mental is reported twice and emotional is not reported] Total (0.89) Total (0.84) Less-acculturated Hispanics: general (0.85), physical (0.83), mental (0.85), emotional (0.93), vigor (0.82); highly-acculturated Hispanics: general (0.89), physical (0.85), mental (0.84), emotional (0.92), vigor (0.86); Anglos: general (0.94), physical (0.81), mental (0.85), emotional (0.91), vigor (0.89) Physical (0.85) General (0.94), physical (0.88), mental (0.92), emotional (0.93), vigor (0.90)
Stein et al. [85] de Leeuw, Studts and Carlson [41] Helgeson and Tomich [68] Banthia et al. [39] Mead et al. [18] Clayton, Dudley and Musters [43] Roepke et al. [36] Hawker et al. [17] Pien et al. [29]
Rodrigue et al. [21] Tomfohr et al. [44] Cordero et al. [22]
Sadja et al. [20] Sobel-Fox et al. [42]
mean of 3.9 days: general (0.76)
2 weeks: total (0.48), physical (0.51), emotional (0.40), mental (0.66), vigour (0.46)
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original study [9] detailing the development and psychometric evaluation of the instrument. In that study, the scales produced moderate correlations between assessments at 3to 4-week intervals (mean=0.56 (95 % CI=0.50–0.62)) and 6- to 8-week intervals (mean=0.64 (95 % CI=0.59–0.69)) in a group of breast cancer patients about to start active treatment or in the posttreatment period and in a noncancer control group. The test-retest correlation, for example, was r=0.55 for vigor between the first and second administration of the MFSI-SF and 0.64 between the first and third administration. Test-retest correlations for mental fatigue were 0.64 in the first interval and 0.70 in the second. Similarly, Pien et al. [29] reported a test-retest intraclass correlation coefficient of 0.46 for vigor and 0.66 for mental fatigue over a 2-week period while Mead et al. [18] reported a test-retest correlation coefficient of 0.76 for general fatigue over a mean of 4 days. Validity of the MFSI-SF Structural validity Three studies [10, 22, 29] evaluated the factor structure of the MFSI-SF; these results reflect whether the interrelationships of the dimensions measured by the MFSI-SF correlate with the construct of interest and subscale scores. Stein et al. [10] confirmed the five-factor model of the MFSI-SF in a heterogeneous sample of cancer patients. In a study [29] examining the psychometric properties of the Chinese version of the MFSI-SF in a patient sample of mixed cancer types, factor analysis confirmed four subscales: physical, emotional, mental, and vigor. The physical and general subscales were combined to create a new physical subscale; high factor loadings and intercorrelations between subscales supported the four-factor model of the Chinese MFSI-SF. In the third study, Cordero et al. [22] evaluated the factor structure of the MFSI-SF in a Hispanic community sample. The vigor, mental, and emotional subscales were largely maintained; the general and physical subscales were not, and the study concluded that the general fatigue subscale was “problematic” for Hispanics. Concurrent validity Evidence bearing on the concurrent validity of the MFSI-SF was reported in seven studies identified. As shown in Table 3, MFSI-SF fatigue subscales have been shown to be positively correlated with the Profile of Mood States (POMS) fatigue subscale [10, 18, 19, 25], the Fatigue Symptom Inventory (FSI) [10, 21], and the fatigue item of the Bathy Ankylosing Spondylitis Disease Activity Index [45]. The correlation coefficients between the POMS fatigue subscale and the MFSI-SF fatigue subscales range from a low of r=0.62 with emotional fatigue to a high of 0.88 with general fatigue; both of these coefficients are from the initial psychometric study by Stein et al. [9]. Correlations between the FSI and the MFSI-SF fatigue subscales range from a low of
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r=0.36 between the FSI average fatigue item and emotional fatigue to a high of r=0.82 between the FSI average fatigue item and general fatigue; these coefficients are from the follow-up validation study of the MFSI-SF by Stein et al. [10]. Similarly, MFSI-SF vigor has been shown to be positively correlated with the Medical Outcomes Study 36-Item Short Form (MOS SF-36) vitality scale [9, 10]. The mean correlation between MFSI-SF vigor and the SF-36 vitality scale is 0.67 (95 % CI=0.53–0.82). Convergent validity Evidence bearing on the convergent validity of the MFSI-SF was reported in 26 studies (see Table 3). Correlations were reported with the Distress Thermometer [46], a brief screening measure of psychological distress, and measures of depression and anxiety, including the Center for Epidemiologic Studies-Depression Scale (CES-D) [9, 17, 24, 28, 47–50], the Beck Depression Inventory-II [29], the Symptom Checklist 90-RevisedDepresssion and Anxiety Scales [15, 41], the Hospital Anxiety and Depression Scale [31], and State Trait Anxiety Inventory (STAI) [9]. Among the eight studies [9, 17, 24, 47–51] reporting associations with the CES-D, correlation coefficients ranged from 0.37 to 0.85; the mean correlation of total fatigue with the CES-D was r=0.77 (95 % CI= 0.70–0.85). In the one study [9] reporting associations with the STAI, correlation coefficients range from 0.51 to 0.80. Several studies reported correlations between MFSI-SF fatigue subscales and measures of sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) [21, 27, 36, 48, 50, 52, 53]. Among the seven studies reporting associations with the PSQI, correlation coefficients range from 0.15 to 0.51. The mean correlation of MFSI-SF total fatigue with PSQI total was 0.45 (95 % CI=0.41–0.49). Divergent validity Evidence bearing on the divergent validity of the MFSI-SF was reported in 16 studies (see Table 3). Most notably, negative correlations were reported between the MFSI-SF fatigue subscales and the MOS SF-36 scales [9, 18, 29, 31] and between the MFSI-SF vigor subscale and the Symptom Checklist-90-Revised [41]. Discriminative validity In Table 4, we present discriminative validity data for the MFSI-SF from 30 studies. To briefly summarize the instrument’s ability to discriminate between groups, we focus herein on the 15 studies comparing a patient group with a specific medical condition to a nonpatient control group on the MFSI-SF. The mean effect size across the 15 studies on each of the subscales is as follows: physical mean d=0.73 (95 % CI=0.48–0.98), general mean d=0.78 (95 % CI=0.35–1.20), mental mean d=0.54 (95 % CI=0.19–0.89), emotional mean d=.53 (95 % CI=0.35–0.70), vigor mean d=.76 (95 % CI=0.42–0.1.09). Consistent with Cohen’s categorization of effect sizes [11], the magnitude of these effects
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Table 3 Validity of the Multidimensional Fatigue Symptom Inventory-Short Form Authors
Concurrent validity
Convergent validity
Divergent validity
Stein et al. [9]
SF-36-Vitality with vigor (0.64); POMS-F with general (0.88), physical (0.68), emotional (0.62), mental (0.64)
STAI with general (0.58), physical (0.51), emotional (0.80), mental (0.54); CES-D with general (0.68), physical (0.61), emotional (0.78), mental (0.64)
SF-36-Vitality with general (-0.78), physical (-0.58), emotional (-0.51), mental (-0.46), vigor (0.64); POMS-F: with vigor (-,59); STAI with vigor (-0.66); CES-D with vigor (-0.65); MC-20 with general (-0.21), physical (-0.14), emotional (-0.26), mental (-0.22), vigor (-0.13)
Broeckel et al. [40] Stein et al. [10]
FSI average with general (0.82), emotional (0.36), physical (0.58), mental (0.50), total (0.74); SF-36 vitality with vigor (0.74)
de Leeuw, Studts and Carlson [41]
FSI average with vigor (-0.60); SF-36 physical component score with general (-0.55), emotional (-0.21), physical (-0.56), mental (-0.34), total (-0.55); SF-36 vitality with general (-0.82), emotional (-0.43), physical (-0.53), mental (-0.48), total (-0.78) SCL90-r somatization with vigor (-0.45); SCL90-r depression with vigor (-0.45); SCL90-r anxiety with vigor (-0.37); MPI pain with vigor (-0.31); MPI general activity level with general (-0.08), with physical (-0.13), emotional (-0.05), mental (-0.05); PSQI total with vigor (-0.41)
SCL90-r somatization with general (0.49), physical (0.67), emotional (0.50), mental (0.39); SCL90-r depression with general (0.60), physical (0.49), emotional (0.66), mental (0.50), general (0.39); SCL90-R anxiety with physical (0.42), emotional (0.61), mental (0.35); MPI pain with general (0.23), physical (0.42), emotional (0.27), mental (0.10); MPI general activity level with vigor (0.17); PSQI total with general (0.50), physical (0.37), emotional (0.43), mental (0.26) CES-D with general (0.48), physical (0.35), CES-D with vigor (-0.39) emotional (0.70), mental (-0.51) PSQI total with total (0.46); PSQI subscales of subjective sleep quality, sleep disturbance, use of sleep med and daytime dysfunction with MFSI subscales (range=0.22 to 0.71); FOSQ subscales with MFSI total and subscale (range=0.22 to 0.80); FACT-B subscales with MFSI subscales (range=0.29 to 0.65); CES-D with total fatigue (0.76) unstandardized regression coefficient: unstandardized regression coefficient: week 1: daily (visual analogue scale) week 1: daily (visual analogue fatigue with weekly (general) (0.26), scale) fatigue with weekly (vigor) (physical) (0.21), (mental) (0.17), (-0.27); week 2: daily (visual (emotional) (0.05); week 2: daily analogue scale) fatigue with weekly (visual analogue scale) fatigue with (vigor) (-0.25); week 3: daily weekly (general) (0.26), (physical) (visual analogue scale) fatigue with (0.25), (mental) (0.25), (emotional) weekly (vigor) (-0.24); week 4: (0.01); week 3: daily (visual analogue daily (visual analogue scale) fatigue scale) fatigue with weekly (general) with weekly (vigor) (-0.22) (0.27), (physical) (0.22), (mental) (0.23), (emotional) (-0.01); week 4: daily (visual analogue scale) fatigue with weekly (general) (0.25), (physical) (0.15), (mental) (0.18), (emotional) (0.05)
Lim et al. [63] Ancoli-Israel et al. [51]
Banthia et al. [39]
Bardwell et al. [19]
Patients: worse sexual functioning with total (0.31) SF-36 physical component score with vigor (0.48)
POM-SF fatigue with general: AA (0.91), CA (0.84)
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Table 3 (continued) Authors
Concurrent validity
Young and White [28]
Mead et al. [18]
Banthia et al. [50]
Lukas et al. [31] Roepke et al. [36] Lee et al. [77]
Prue et al. [15]
Bevans et al. [46]
Fagundes et al. [47] Hawker et al. [17] Pien et al. [29]
SPAQ total with global (SR) (-0.17), SPAQ leisure with global (SR) (-0.11), SPAQ work with global (SR) (-0.12)
SF-36 vitality with general (-0.47) Patients: MPCC total with total (0.00), disease illness MPCC 1 with total (-0.17), common ground MPCC 3 with total (-0.09)
CES-D with vigor (-0.47); PSQI global with vigor (-0.31)
BASDAI fatigue item with general (0.71), physical (0.74), emotional (0.56), mental (0.45) fatigue, vigor (-0.32)
Krummenacher et al. [30] Liu et al. [48]
Taylor et al. [49]
TSK-F beliefs about activity with global (0.39), with HADS depression (SR) (0.78); HADS anxiety with global (0.70); HADS total with global (SR) (0.77), total (0.56); EPQ-R-S neuroticism (0.58)
Patients: Whole Person MPCC 2 with total (0.10), POMS-SF with total (0.80), Uncertainty in Illness Scale total with total (0.60), PPCS with total (0.23) WLQ with physical (0.71) Average AB (based on test of temperature sensitivity) with total (0.62) CES-D with general (0.38), physical (0.42), mental (0.37), emotional (0.81); PSQI global with mental (0.15), emotional (0.24), general (0.44), physical (0.42)
Hansen et al. [73] Strigo et al. [74]
Rief et al. [25] Shochat et al. [27]
Divergent validity
POMS fatigue with general (0.75), FAS with general (0.71)
Clayton, Dudley and Musters [43]
Günaydin et al. [45]
Convergent validity
POMS-F with total (0.75)
JSQ total with total (0.46), MVEQ-SF with (0.75) PSQI with total (0.46), CES-D with total (0.71) HADS total with total (0.74) Total with SF-12 physical (-0.58), SF-12 mental (-0.37) PSQI with global (0.50) PMS with (-0.60) PVT Count of Lapses with total (0.14), general (0.07), physical (0.32), emotional (0.13), mental (-0.04), vigor (0.14); average response time with total (0.15) RSCL psychological distress with total (0.66) NR Carriers: PSQI total with total (0.42); non-carriers: PSQI total with total (0.32); controls: PSQI total with total (0.43); entire sample: PSQI total with total (0.41) CES-D with total (0.64) RS-ES with total (-0.52), 7-day physical activity recall hours/week with total (-0.02), 7-day physical activity recall met-hours/week with total (-0.04) Patients (all time points): DT with total Patients (all time points): DT with (0.56), emotional (0.48), general (0.35), vigor (-0.48); caregivers (all time mental (0.30), physical (0.47); points): DT with vigor (-0.45) caregivers (all time points): DT with total (0.51), emotional (0.62), general (0.34), physical (0.23) CES-D with total (0.80) CES-D with total: T1 (0.77), T2 (0.82), T3 (0.85) BDI-II with total (0.68), physical (0.60), emotional (0.71), mental 0.51; SF-36
BDI-II with vigor (-0.27); SF-36 mental component with total
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Table 3 (continued) Authors
Concurrent validity
Convergent validity mental component with vigor (0.41); SF-36 physical component with vigor (0.17)
Rodrigue et al. [21]
Pre-transplant FSI severity score with total (0.72); post-transplant FSI severity score with total (0.69)
Liu et al. [52]
Aynehchi et al. [80] Ganz et al. [82]
MBFI with total (0.81)
Sobel-Fox et al. [42]
Average VAS fatigue rating at W1: general (0.58), emotional (0.52), mental (0.54), physical (0.46); average VAS fatigue rating at W2: general (0.66), emotional (0.54), mental (0.51), physical (0.44); average VAS fatigue rating at W3: general (0.58), emotional (0.51), mental (0.52), physical (0.35); average VAS fatigue rating at W4: general (0.60), emotional (0.62), mental (0.50), physical (0.42); mean daily VAS fatigue ratings at W1: general (0.60), emotional (0.53), mental (0.54), physical (0.49); mean daily VAS fatigue ratings at W2: general (0.66), emotional (0.56), mental (0.53), physical (0.45); mean daily VAS fatigue ratings at W3: general (0.57), emotional (0.51), mental (0.51), physical (0.33); mean daily VAS fatigue ratings at W4: general (0.62), emotional (0.60), mental (0.50), physical (0.41)
Pre-transplant PSQI global with total (0.49); post-transplant PSQI global with total (0.48) Baseline: PSQI total with total (0.40), general (0.31), emotional (0.32), physical (0.30), mental (0.34); C4W3: PSQI total with total (0.51), with general (0.43), with emotional (0.40), physical (0.43), mental (0.51) NR PAOFI memory with mental (0.61), physical (0.03); PAOFI HLC with mental (0.47), physical (0.13)
ranged from medium to large with patients consistently reporting worse scores on the MFSI-SF than nonpatient controls. Sensitivity to change of the MFSI-SF Data reflecting sensitivity of the MFSI-SF to change are presented in Table 5. For purposes of this study, we limited our evaluation of sensitivity to change to longitudinal studies involving the effects of an intervention or disease treatment that is likely to alter the level of fatigue or vigor relative to a pretreatment baseline. Nine studies [14, 16, 35, 38, 44, 53–56] reported results in the context of nonpharmacological interventions designed to ameliorate symptoms that included fatigue. These
Divergent validity (-0.60), physical (-0.50), emotional (-0.60), mental (-0.34); SF-36 physical component with total (-0.53), physical (-0.57), emotional (-0.38), mental (-0.41)
Baseline: PSQI total with vigor (-0.32); C4W3: PSQI total with vigor (-0.36)
Average VAS fatigue rating at W1: vigor (-0.48); average VAS fatigue rating at W2: vigor (-0.34); average VAS fatigue rating at W3: vigor (-0.55); average VAS fatigue rating at W4: vigor (-0.64); mean daily VAS fatigue ratings at W1: vigor (-0.37); mean daily VAS fatigue ratings at W2: vigor (-0.32); mean daily VAS fatigue ratings at W3: vigor (-0.51); mean daily VAS fatigue ratings at W4: vigor (-0.64)
nonpharmacological interventions involved a randomized controlled trial of light therapy for fatigue in breast cancer patients in active treatment [53], an Internet intervention for sleep in cancer survivors with insomnia [55, 56], continuous positive airway pressure on fatigue in individuals with obstructive sleep apnea [44], yoga for fatigue in breast cancer survivors [54], physical activity in gynecologic cancer survivors [14], diaphragmatic breathing for self-regulation in fibromyalgia patients [16], Tai Chi in heart transplant patients [35], and resistance exercise in prostate cancer survivors [38]. The mean effect sizes for postintervention versus preintervention fatigue calculated across more than one study were the following: general=2.56 (95 % CI=−1.00–6.11), physical=1.78
Support Care Cancer (2015) 23:191–212 Table 4 Discriminative validity of the Multidimensional Fatigue Symptom Inventory-Short Form
207 Table 4 (continued) Authors
Authors
Discriminative validity
Discriminative validity
Stein et al. [9]
Breast cancer patients versus noncancer controls: general (0.37), physical (0.28), emotional (0.30), mental (0.14), vigor (-0.33); Broeckel et al. Breast cancer patients versus noncancer controls: [40] total fatigue (0.73) de Leeuw, Studts Temporomandibular disorder patients versus and Carlson controls: general (0.57), physical (0.91), [41] emotional (0.55), mental (0.32), vigor (0.73) Prue et al. [13] Surgery patients versus no surgery patients: total (1.32), general (0.77), physical (0.99), mental (0.69), emotional (1.33), vigor (0.54); patients receiving treatment versus patients awaiting treatment: total (0.91), general (0.04), physical (0.14), mental (1.15), emotional (1.41), vigor (0.79) Siegel et al. [69]
Low NKCA versus patients normal NKCA patients: mental (1.27) Thomas et al. [26] African Americans versus Caucasians: general (2.56), physical (3.64), mental (1.72), emotional (1.39), vigor (0.18) Balasubramaniam Fibromyalgia patients versus failed back et al. [70] syndrome patients: general (1.44), emotional (0.92), physical (1.46), mental (1.42), vigor (0.41) Feuerstein et al. brain tumor patients versus non-cancer controls: [71] physical (0.51) Collado-Hidalgo Fatigued versus non-fatigued: general (1.86) et al. [72] Hansen et al. [73] Breast cancer patients versus noncancer controls: physical (0.84) Strigo et al. [74] Major depressive disorder patients versus controls: total (4.35) Calvio et al. [34] Malignant brain tumor patients versus noncancer controls: physical (0.54) Günaydin et al. Fatigued patients versus non-fatigued patients: [45] general (1.39), physical (1.84), emotional (1.2), mental (0.92), vigor (-0.65) Roepke et al. [36] Alzheimer’s caregivers versus non-caregivers: total (1.11) Schmidt et al. [75] Masticatory muscle pain patients versus controls: emotional (0.54), general (1.22), physical (1.74), mental (1.01), vigor (-1.02) Calvio et al. [76] Breast cancer patients versus noncancer controls: physical (0.88) Lee et al. [77] Patients with sleep apnea versus patients without sleep apnea: total (0.72), general (0.69), physical (0.27), emotional (0.42), mental (0.72), vigor (-0.54) Prue et al. [15] Gynecologic cancer patients versus noncancer controls: total baseline (0.08), month 1 (0.11), month 2 (0.11), month 3 (0.10), month 4 (0.08), month 5 (0.06), month 6 (0.07), month 7 (0.09), month 8 (0.07), month 9 (0.04), month 10 (0.03), month 11 (0.05) Shochat et al. [27] BRCA1/2 carriers versus controls: total (0.22); BRCA1/2 non-carriers versus controls: total (0.16)
Bevans et al. [46] Patients versus caregivers: total at baseline (0.21), discharge (0.35), 6 weeks post discharge (0.44) Fagundes et al. Fatigued versus non-fatigued: total (1.64) [47] Pien et al. [29] Cancer patients versus noncancer controls: total (0.71), physical (0.55), emotional (0.56), mental (0.30), vigor (1.22) Rodrigue et al. Pre-kidney transplant versus post-kidney transplant: [21] general (0.39), physical (0.63), emotional (0.30), mental (0.42), vigor (-0.41), total (0.56) Breckenridge SERM/A1 versus no SERM/A1: physical (0.04) et al. [78] Cordero et al. [22] Anglos versus less-acculturated Hispanics: physical (0.40), mental (0.41), emotional (0.46), general (0.33), vigor (-0.29); Anglos versus highlyacculturated Hispanics: physical (0.20), mental (0.08), emotional (0.02), general (0.25), vigor (-0.12) Fagundes et al. Breast cancer patients versus noncancer controls: [79] physical (0.51) Ritterband et al. Intervention participants versus controls: total (1.16), [55] general (0.91), physical (0.47), emotional (0.77), mental (0.66), vigor (1.63) Bennett et al. [81] never smokers versus former smokers: total (0.08) Gass and Glaros Headache patients versus controls: general (1.03), [83] emotional (0.80), physical (0.87), mental (0.73), vigor (-0.70), total (1.02) Moskowitz et al. Patients versus noncancer controls: physical (0.82) [84]
(95 % CI=−0.71–4.27), mental=1.29 (95 % CI=−0.44–3.02), emotional=0.15 (95 % CI=−1.01–1.30), vigor=−0.75 (95 % CI=−2.50–1.01), and total=0.31 (95 % CI=−0.24–0.87). The magnitude of these effects ranged from small to large with the intervention group reporting reduced fatigue and increased vigor from preintervention to postintervention. The remainder of the studies [20, 23, 57–62] presented in Table 5 refers to pharmacologic interventions designed to reduce symptoms, including fatigue. As shown in Table 5, we also identified seven studies [15, 46, 52, 63–66] that assessed fatigue related to disease treatment. All seven studies included cancer patients undergoing various forms of cancer treatment, including chemotherapy; four of these studies [52, 63–65] provided data sufficient for us to calculate mean effect size for MFSI-SF total fatigue=0.19 (95 % CI=−0.05–0.34). The effect size for the five subscales was calculated using data from a single study [63]: general=0.39, physical=0.26, mental= 22, emotional=0.08, vigor=−0.27. The magnitude of these effects ranged from small to medium with patients generally reporting worsening fatigue and decreasing vigor over the course of treatment.
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Table 5 Sensitivity of the Multidimensional Fatigue Symptom Inventory-Short Form Authors
Sensitivity to change/treatment
Mantovani et al. [59]
Liu et al. [63]
Mills et al. [65] Gramignano et al. [23]
baseline to 1 month: total (-0.79), to 2 months (-0.86), to 4 months (-0.61); from baseline to 1 month: vigor (0.81), to 2 months (0.81), to 4 months (1.31) C1W-1 to C1W1: total (0.81), general (0.67), physical (0.35), mental (0.37), emotional (0.04), vigor (-0.40); from C4W-1 to C4W1: total (0.13), general (0.11), physical (0.17), mental (0.07), emotional (0.12), vigor (-0.14) C1W1 to C4W1: total (0.87) baseline to 2 weeks after supplementation: total (-0.61), to 4 weeks after supplementation (-0.96) baseline to 1 month: total (-0.26), to 2 months (-0.38), to 4 months (-0.38) baseline to post-treatment: total (Arm 1) (-0.32), (Arm 2) (0.54), (Arm 3) (-0.53), (Arm 4) (-0.25), (Arm 5) (-0.49) baseline to post-treatment: total (-0.23) baseline to post-treatment: total (Arm 1) 0.07, (Arm 2) 0.54, (Arm 3) -0.01, (Arm 4) 0.19, (Arm 5) -0.41
Mantovani et al. [61] Mantovani et al. [60] Mantovani et al. [57] Mantovani et al. [58] Prue et al. [15]
Bevans et al. [46]
baseline to month 1: total (0.60), to month 2 (0.54), to month 3 (0.47), to month 4 (0.31), to month 5 (0.21), to month 6 (0.03), to month 7 (0.05), to month 8 (0.00), to month 9 (-0.10), to month 10 (-0.27), to month 11 (-0.05) prior to transplant to discharge: total: patients (-0.04), caregivers (-0.15)
Donnelly et al. [14]
intervention patients pre-intervention to 12 weeks post-intervention: total (0.13), to 6 months post-intervention (0.20) pretreatment to 3 weeks post treatment: total (placebo CPAP) (-0.10), (Therapeutic CPAP) (-0.53); pre-treatment to 3 weeks post treatment: (patients with excessive sleepiness and fatigue), total (placebo CPAP) (-0.22), (therapeutic CPAP) (-1.07 ) baseline to treatment cycle 1: (bright white light) general (1.80), physical (3.01), mental (0.88), emotional (-0.76), vigor (-2.10), (dim red light) general (4.52), physical (3.44), mental (1.26), emotional (0.48), vigor (-2.48), to treatment cycle 4 (bright white light) general (2.46), physical (2.46), mental (1.33), emotional (-1.37), vigor (-1.11), (dim red light) general (8.28), physical (5.36), mental (5.2), emotional (2.59), vigor (-2.97) baseline to 3-month follow-up; vigor (yoga versus health education) (1.20)
Tomfohr et al. [44]
Ancoli-Israel et al. [53]
Bower et al. [54] Liu et al. [64] Liu et al. [52]
Redwine et al. [35] Ritterband et al. [55]
Sadja et al. [20] Schmidt et al. [16] Barton et al. [62]
Sensitivity to change/intervention
baseline to C1W2: total (0.21), to C1W3 (0.20), to C4W2 (0.58), to C4W3 (0.45) C1W1 to C1W2: total (-0.33), to C1W3 (-0.33), to C4W1 (0.34), to C4W2 (0.27), to C4W3 (0.04) pre-intervention versus post-intervention (t'ai chi'): total (0.87) intervention patients pre-post: total (0.80), general (0.70), physical (0.27), emotional (0.40), mental (0.47), vigor (1.20), control patients pre-post: total (-0.36), general (-0.21), physical (-0.20), emotional (-0.37), mental (-0.19), vigor (-0.43) pre-medication versus post-medication: physical (sample) -0.21, (men) -0.23, (women) -0.19 assessment 1 to assessment 2: total (1.18), general (-0.96), emotional (-0.36), physical (-0.62), mental (-0.84), vigor (0.66) Baseline to 4 weeks (Ginseng): general (0.62), physical (0.08), mental (0.11), emotional (0.03), vigor (0.10), total (0.33); Baseline to 8 weeks: (Ginseng): general (0.87), physical (0.16), mental (0.15), emotional (0.16), vigor (0.26), total (0.54)
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209
Table 5 (continued) Authors
Sensitivity to change/treatment
Cormie et al. [38]
Janusek et al. [66]
Sensitivity to change/intervention Pre-intervention to post-intervention (Exercise): general (0.34), emotional (-0.03), physical (-0.23), mental (0.75), vigor (0.09), total (0.21)
Total fatigue at least 2 weeks after surgery (T1) to T2 (-0.05), to T3 (-0.10), to T4 (-0.10), to T5 (0.17); T1 to T5 (-0.14)
Thorndike et al. [56]
Discussion We identified 70 articles published between 1998 and 2013 that reported results on the MFSI-SF. The instrument has thus far been used predominantly with cancer patients, but results also have been reported for patients with other health conditions (e.g., osteoarthritis and fibromyalgia) as well as for individuals with no reported health conditions. In general, the studies reflect a broad range of sample sizes of men and women across a wide age range. They also reflect a variety of study designs, including randomized controlled trials. Reliability of the MFSI-SF has been assessed primarily in terms of internal consistency and test-retest reliability. Mean Cronbach’s alpha coefficients for MFSI-SF measures ranged from 0.83 to 0.93, indicating good internal consistency. Testretest reliability of the MFSI-SF was reported in only three studies, but results suggest moderately strong reliability over time. Validity of the MFSI-SF has been assessed primarily in terms of its concurrent, convergent, divergent, and discriminative validity. There is good evidence for the concurrent validity of the fatigue and vigor subscales of the MFSI-SF. Studies generally reported moderate to high correlations between these MFSI-SF subscales and other measures commonly used with medically ill patients such as the POMS fatigue subscale and the FSI. It is noteworthy that, to date, no studies have examined the concurrent validity between the MFSI-SF and item banks such as the PROMIS fatigue item bank. There is good evidence for the convergent validity of the MFSI-SF. Studies generally reported moderate to high correlations of the MFSI-SF with measures of distress and depressive and anxious symptomatology and with measures of sleep quality and work limitations, among others. Divergent validity of the MFSI-SF has been demonstrated by moderate to high negative correlations between the MFSI-SF and various MOS SF-36 scales. Discriminative validity has been demonstrated in several studies comparing medically ill patients and nonpatient controls. In general, medically ill patients, including those with cancer, reported scores indicative of greater fatigue and less vigor than controls. Effect sizes reported or calculated based on available data ranged from medium to large.
Pre-intervention to post-intervention: total (intervention group) (0.97); pre-intervention to post-intervention: total (intervention BDI-II subgroup) (2.16)
With regard to structural validity of the MFSI-SF, existing evidence is too limited to draw conclusions. The fact that the original five-factor structure that gave rise to the five empirically derived MFSI subscales has been replicated with a cancer sample [10] is encouraging. Two other studies [29, 22] did not yield similar results. It should be noted, however, that in one study a Chinese language version of the MFSI-SF was administered to cancer patients [29] and in the other study, the English language version of the MFSI-SF was administered to a Hispanic community sample [22]. Given these differences in methodology, it is unclear whether the lack of a consistent factor structure is attributable to cultural differences, linguistic differences, or patient versus community status differences. Evaluating the consistency of the factor structure for the English language version in cancer patients should be considered a priority since, as our review indicates, this reflects the most common use of the MFSI-SF. That said, there is also a need for studies that evaluate all major aspects of validity for translated versions of the MFSI-SF used with cancer patients. Regardless of the quality of the translation procedures, the psychometric equivalence of a translated version of a test to the original test cannot be assumed and must be evaluated [67]. The issue of variation across cultures for the English language version is also important and should be addressed initially in studies in which the MFSI-SF is administered to specific racial and ethnic subgroups of cancer patients. The sensitivity of the MFSI-SF to change has been demonstrated in intervention studies in which fatigue was a primary or secondary outcome and in longitudinal disease treatment studies. Across intervention studies, effect sizes ranged from small to large, an indication that the interventions generally were effective in reducing fatigue and increasing vigor as measured by the MFSI-SF. Across treatment studies, results indicated that fatigue as measured by the MFSI-SF increased over the course of treatments expected to produce fatigue, such as chemotherapy and radiotherapy; effect sizes in these studies were positive and ranged from small to medium. Taken together, these results strongly support the use of the MFSI-SF as an outcome measure in studies evaluating treatments likely to produce fatigue as well as studies testing
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interventions to prevent or relieve fatigue. It should be noted, however, that the minimal clinically important difference (MCID) for the MFSI-SF scores has yet to be reported. Determining this value would aid investigators in evaluating the clinical meaningfulness of any observed treatment- or intervention-related differences in MFSI-SF scores. A key issue to consider in evaluating a multidimensional measure such as the MFSI-SF is the relationships among the various subscales. Surprisingly, we were able to identify only one study that reported the correlations among the scales [50]. In this study of breast cancer survivors, vigor was correlated negatively with general, physical, mental, and emotional fatigue (range=−0.25 to −0.52), while correlations were all positive (range=0.16 to 0.67) among the four fatigue subscales. Although this pattern would be expected, the low to generally moderate range of correlations suggests the scales may be tapping different aspects of the fatigue experience. Of relevance is a recent review of 56 studies examining the behavior of physical and mental fatigue in cancer patients that included four studies in which the MFSI-SF was administered [2]. Findings suggested that physical and mental fatigue often behave similarly; for example, they both tend to be higher in cancer patients than those in healthy controls. In contrast, there is evidence to suggest that physical fatigue is more severe than mental fatigue in patients with advanced disease. This issue clearly merits additional study and should extend beyond the physical and mental dimensions of fatigue.
Conclusions In conclusion, the purposes of this paper were to systematically review and evaluate the psychometric properties of the MFSI-SF based on its use in published research studies and to characterize the evidence base supporting its current and future use. Our extensive and exhaustive review of the use of the MFSI-SF in published research studies since its inception to the present day not only supports a characterization of the MFSI-SF as psychometrically sound but also provides further empirical evidence of its usefulness and strongly supports its use in future studies.
Conflict of interest disclose.
The authors have no conflicts of interest to
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