Fatigue - concepts for physiotherapy management and measurement, 2007, O'Connell and Stokes

[Hutan]

An old paper, one that I found when I was looking for papers related to physiotherapy.
https://www.researchgate.net/public..._for_physiotherapy_management_and_measurement
Free

Abstract

Fatigue is a sensation known to everyone. However, it is a concept that eludes universal definition or description; it varies in severity, intensity and frequency. This review was undertaken to articulate the constructs associated with fatigue, and to consider the high levels of fatigue reported in conditions where physiotherapists have an integral role in management and rehabilitation, such as multiple sclerosis and stroke. The prevalence of fatigue in the general population, and in those with co-morbidities will be presented. Fatigue has been researched extensively in multiple sclerosis and cancer; this is not the case in Parkinson's disease and stroke: nonetheless, fatigue is reported frequently in these populations. Methods of measurement of fatigue will be discussed, and treatment approaches reviewed. The current evidence suggests that fatigue is best measured using self-report instruments, and that treatment approaches should be informed by comprehensive assessment.

 

[Hutan]

One of the things that is interesting about this paper, is its view of chronic fatigue syndrome, and the suggestion that the condition didn't have a name for many years prior.

Fatigue is not always directly attributable to some aggravating factor or pre-existing condition. It may pre- sent as a condition, independent of any other symptoms. As a condition, it is difficult to define and often eludes diagnosis for some time, due to the range of ways in which it may be reported and the various presentations of the condition.

Following many years without definition, this condition now has a group name – chronic fatigue syndrome (CFS). No two people with CFS have the same presentation; the nature, course and effect of fatigue fluctuate between different people. Increasing research is being completed into CFS in an attempt to better to define and treat this condition.

There's a quote about the lack of attention fatigue has had, despite it being very debilitating.

The 19th century physician Professor George Beard described fatigue as the ‘Central Africa of medicine, an unexplored territory which few men enter’;6 over a century later, we are no better informed.

Which highlights the ignoring that has gone on, both of all the people living in Central Africa, and all the people living with fatigue.



There's acknowledgement of the importance of fatigue in the symptoms of MS, post-stroke and Parkinsons:

Fatigue has been reported in MS, cancer, depression and stroke. It co-exists with other patholo- gies and, in some cases, becomes the most disturbing symptom of the disease. This is especially reported in people with MS.

Fatigue has been reported up to 2 years post stroke,19–24 and has been listed repeatedly as the worst, or one of the worst, persisting symptoms of stroke.

There's also a nice list of fatigue measuring tools and some discussion:

Worryingly, it has been suggested that different measures may result in different reporting of fatigue, depending on the response of the person to the measure. A sample of 43 people on chronic haemodialysis completed both the Visual Analogue Scale (VAS) and the fatigue subscale of the Profile of Mood States (POMS).50 The authors found that there was a shared variance of only 64%, indicating that different instruments may give different results, as respondents may interpret the questions differently.

 

[Trish]

Which highlights the ignoring that has gone on, both of all the people living in Central Africa, and all the people living with fatigue.

While some people in central Africa may prefer to be ignored rather than studied or colonised by outsiders, people with fatigue need to be properly understood and investigated and supported.

 

[Mithriel]

Following many years without definition, this condition now has a group name – chronic fatigue syndrome (CFS). No two people with CFS have the same presentation; the nature, course and effect of fatigue fluctuate between different people. Increasing research is being completed into CFS in an attempt to better to define and treat this condition.

That sounds like CFS is being used to mean, well, having chronic fatigue rather than the specific disease that was meant to be identical to ME. When patient groups complained that this would happen they were assured that they were being just silly and of course no professionals could mistake the syndrome of CFS with the symptom chronic fatigue.

If people think that CFS is just having a fatigue it is no wonder there has been no progress in forty years. Now we have the internet it is astounding how many of the symptoms we have in common which were acknowledged in ME but have been neglected for all these years.