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Fatigue among children with a chronic disease: a cross-sectional study , 2021, Nap-van der Vlist et al

Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Mar 6, 2021.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Hampshire, UK
    Objective To determine: (1) which biological/lifestyle, psychological and/or social factors are associated with fatigue among children with a chronic disease and (2) how much each of these factors contributes to explaining variance in fatigue.

    Design and setting This was a cross-sectional study across two children’s hospitals.

    Patients We included children aged 8–18 years who visited the outpatient clinic with cystic fibrosis, an autoimmune disease or postcancer treatment.

    Main outcome measures Fatigue was assessed using the PedsQL Multidimensional Fatigue Scale. Generic biological/lifestyle, psychological and social factors were assessed using clinical assessment tools and questionnaires. Multiple linear regression analyses were used to test the associations between these factors and fatigue. Finally, a multivariable regression model was used to determine which factor(s) have the strongest effect on fatigue.

    Results A total of 434 out of 902 children were included (48% participation rate), with a median age of 14.5 years; 42% were male. Among these 434 children, 21.8% were severely fatigued. Together, all biopsychosocial factors explained 74.6% of the variance in fatigue. More fatigue was uniquely associated with poorer physical functioning, more depressive symptoms, more pressure at school, poorer social functioning and older age.

    Conclusions Fatigue among children with a chronic disease is multidimensional. Multiple generic biological/lifestyle, psychological and social factors were strongly associated with fatigue, explaining 58.4%; 65.8% and 50.0% of the variance in fatigue, respectively. Altogether, almost three-quarters of the variance in fatigue was explained by this biopsychosocial model. Thus, when assessing and treating fatigue, a transdiagnostic approach is preferred, taking into account biological, psychological and social factors.

    Open access, https://bmjpaedsopen.bmj.com/content/5/1/e000958
    MEMarge and Peter Trewhitt like this.
  2. Trish

    Trish Moderator Staff Member

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    The conclusion seems to make a leap of logic from an association between severe fatigue and psychosocial factors, to a one way causation BPS model of psychosocial factors as the cause of the fatigue.

    Have I misread that?
    MEMarge, Mithriel, Hutan and 3 others like this.
  3. Sphyrna

    Sphyrna Established Member (Voting Rights)

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    >Finally, the study was designed to determine which biopsychosocial factors are associated with fatigue, but was not designed to identify causal relationships between the biopsychosocial factors and fatigue.

    I can't quite put my finger on it, but I'm confident that the increased pressure at school caused cystic fibrosis. Any thoughts?
    But yeah, it's just another cross-sectional study showing that bad things are associated with other bad things. More news at 11.
    MEMarge, Mithriel, Hutan and 7 others like this.
  4. Snowdrop

    Snowdrop Senior Member (Voting Rights)

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    So, they mean social-psychological like hormones then. Oh wait . . .
    Mithriel, Amw66 and Peter Trewhitt like this.
  5. alktipping

    alktipping Senior Member (Voting Rights)

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    meaningless waffle why do people get paid for tripe who does this benefit certainly not sick kids .
    Amw66, Sphyrna and Peter Trewhitt like this.
  6. Mithriel

    Mithriel Senior Member (Voting Rights)

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    The biggest problem with the biopsychosocial approach is that they include the physical, the psychological and the social but give them all equal weight within the figures then use those figures to push a psychological agenda.

    They should at least check their findings occasionally by considering each factor separately. For instance the physical strain of living with cystic fibrosis is enormous for children. The psychological strain of spending much of your life in hospital very much aware of your mortality as your friends die off should be looked at independently of other factors.

    There are other psychological stressors on sick children that are important like depression, anxiety that should be explored.

    The social side is often neglected, money worries, bad housing, hospital transport even finding clothes that fit properly could be make easier too.

    By adding everything up into one BPS problem you make it impossible to tease out anything that would actually make life better.
  7. MEMarge

    MEMarge Senior Member (Voting Rights)

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    Participants were:
    "Children aged 8–18 years with cystic fibrosis (CF), an autoimmune disease, or postcancer treatment were recruited from the PROactive study, in which they were included from December 2016 through February 2020. The lower age limit was chosen because we aimed to investigate self-reported fatigue.

    The group of children with an autoimmune disease included children with an immunodeficiency disorder, an autoinflammatory condition, or an autoimmune disease in the strictest sense.

    To best assess which transdiagnostic factors are associated with fatigue, we included children who were at least 1-year postdiagnosis (the CF and autoimmune disease groups) or who were within 1 year after completing their cancer treatment.

    This was done as disease-specific factors, such as disease activity (generally highest in the first year after diagnosis), receiving the diagnosis, starting treatment and the disease itself can cause significant fatigue in the first year postdiagnosis or during the cancer treatment."

    Surely many youngsters with Cystic Fibrosis will be fatigued, with the need for regular physio, problems absorbing oxygen etc.

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