Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions,... 2023 Beckers et al

Full title: Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions

Abstract

Objectives
To scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4) consequences and (5) effectiveness of interventions.

Methods
A systematic literature search of reviews was performed in five bibliographical databases. A hierarchical data extraction was applied based on review type (Cochrane reviews (CRs), followed by non-Cochrane systematic reviews (SRs) and narrative reviews (NRs)) and year of publication. Extracted data were summarised in elaborated narrative syntheses. Results were discussed with a patient panel.

Results
One hundred and thirty-four reviews were included (19 CRs, 44 SRs, 71 NRs). No agreed on definition was reported for general fatigue, nor for types of fatigue. Twenty-five measurement instruments were found, all self-reported. Five instruments proposed a threshold for excessive fatigue. Pain, physical function and depressive symptoms were the most frequently studied disease-related determinants of fatigue; female sex and stress the most frequent contextual determinants. Work performance, followed by impact on pain, physical activity and social roles were the most frequently studied consequences. Whenever quantified, associations between fatigue with determinants and consequences were on average small. For non-pharmacological interventions, if effect sizes were reported, these were negligible to small and for pharmacological interventions negligible to moderate. Patients recommended actions for research and practice.

Conclusion
Syntheses of reviews point to the complexity of fatigue. The extensive amount of evidence could be used to offer tailored management plans to patients in clinical practice and inform future research agendas.

Open access, https://rmdopen.bmj.com/content/9/3/e003056

 

"Definition of fatigue

Fatigue in RMDs was defined in 16 NRs. Across reviews, there was agreement that fatigue is a complex, highly subjective symptom, including various types with specific characteristics that can occur simultaneously or alternatingly in daily life.2 11–14 Fatigue can, therefore, be defined and expressed differently over time within one person, among persons with the same RMD or different RMDs. The reviews differentiate fatigue in several ways, including acute versus chronic fatigue, central versus peripheral and spinal fatigue, normal versus pathological fatigue and various definitions have been provided for fatigue in general (table 2) and different types of fatigue. However, no agreed on definition for fatigue or (any of the) different types of fatigue were found for any RMD (online supplemental file S5). Figure 1 attempts to synthesise the types of fatigue identified in studies in RMDs. Many papers distinguish between physical and mental fatigue. Described subtypes for physical fatigue include asthenia, fatigability and muscle weakness, and for mental fatigue this includes weariness and cognitive fatigue (figure 1)."

Click to see figure 1 mentioned above.

 

All the listed conditions are painful, often severely so. Don't these researchers know that being in pain for days, weeks, months and years is utterly exhausting?

 

I obviously missed that bit. Oops.

 

In short: we got nothing, wasted decades on BS. How about more BS?

 

I would sadly assume: absolutely not. Intellectually they know in some form, but it's purely associative and rote memorization.

This is all a consequence of the "one symptom at a time" approach to clinical care that left only holistic models to wishy-washy quackery. When the biology is not understood, medicine is simply incapable of doing any better than complete amateurs, generally do worse, and often do far worse.