Instruments for measuring fatigue in people with rheumatic and musculoskeletal diseases: a systematic review of measurement properties 2025 Machado+

[Andy]

Authors: Eduardo José Ferreira Santos, Bayram Farisogullari, Katie Fishpool, George Young, Coziana Ciurtin, Fiona Cramp, Emmanuel Oghenetejiri Erhieyovwe, Gary J Macfarlane, Jen Pearson, Emma Dures, Pedro M Machado

Abstract​

Objective To summarise the measurement properties of instruments used to assess fatigue in people with rheumatic and musculoskeletal diseases (RMDs).

Methods A systematic review (SR) of measurement properties was conducted in children, adolescents/young adults and adults with RMDs, following Joanna Briggs Institute and COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. Searches were performed in Medline, Embase, CINAHL and Cochrane Library. Risk of bias assessment, data extraction and synthesis were conducted independently by two reviewers. Instruments were assessed according to Outcome Measures in Rheumatology (OMERACT) criteria.

Results Out of 16 657 records, 109 articles underwent full-text review, and 60 met inclusion criteria. These studies evaluated the psychometric properties of 27 instruments. Most studies focused on construct validity (54/60, 90%) and intermethod reliability (45/60, 75%), with an overall low risk of bias. In contrast, test–retest reliability (13/60, 21.7%) and responsiveness (14/60, 23.3%) were less frequently assessed, but also with an overall low risk of bias. Evidence regarding clinical trial discrimination and thresholds of meaningful change was limited or absent, indicating the need for further research in these domains. Only five instruments—the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue, the 36-Item Short Form Survey Instrument (SF-36) Vitality, the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ), the BRAF Numerical Rating Scales (BRAF-NRS) and the Fatigue Severity Scale (FSS)—were rated as valid, reliable and low risk of bias, fulfilling OMERACT endorsement criteria.

Conclusions This SR comprehensively supports the use of several well-validated instruments to assess fatigue, particularly FACIT-Fatigue, SF-36 Vitality, BRAF-MDQ, BRAF-NRS and FSS, in both clinical and research settings.

Open access

 

[Utsikt]

Content validity is considered the most critical measurement property when selecting a PRO measure. This is best assessed through head-to-head studies where individuals of all ages affected by fatigue evaluate the relevance, comprehensiveness and clarity of multiple instruments.104 105 In this review, construct validity was the most frequently assessed property, reported in 43 of the 60 included studies (72%). Instruments that showed sufficient evidence for construct validity included FACIT-F, BRAF-MDQ, BRAF-NRS, FSS, SF-36 Vitality, PedsQL-Fatigue, MDF-Fibro-17 and RAID-F.

If the authors are not able to recognise the serious content validity issues that these PROMs face, I have little faith in the assessments in the review.

 

[Kitty]

It also strikes me that "measuring" fatigue (as per title) and "assessing" it (the objective) are very different things, and the first is implausible anyway.

Doesn't give me much confidence in what follows.

 

[Andy]

The only two mentions of 'CFS' are in the references.

"Fatigue is described as being overwhelming, distressing, extreme, not restored by sleep, multidimensional and part of a vicious circle where fatigue feeds and fosters itself.11–13"

Ref 12 being Sharpe M. Cognitive behavior therapy for chronic fatigue syndrome: efficacy and implications. Am J Med 1998

and

"..we took a broad approach and investigated any (semi-) quantitative self-reported fatigue score used to evaluate MSK fatigue. In adult populations, this could include instruments such as the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F),33 Rheumatoid Arthritis Impact of Disease-Fatigue (RAID-F),34 35 Fatigue-Visual Analogue Scale (VAS),36 36-Item Short Form Survey (SF-36) vitality scale,37 the Multidimensional Assessment of Fatigue (MAF),38 Profile of Mood States-subscale fatigue,39 Checklist Individual Strength,40 "

Ref 40 is to Vercoulen JH, Swanink CM, Fennis JF, et al. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 1994

 

[Sean]

"Fatigue is described as being overwhelming, distressing, extreme, not restored by sleep, multidimensional and part of a vicious circle where fatigue feeds and fosters itself.11–13"​

​

Ref 12 being Sharpe M. Cognitive behavior therapy for chronic fatigue syndrome: efficacy and implications. Am J Med 1998​

1998 is the most up to date reference they could find?

Smells an awful lot like selective citation to me.

 

[rvallee]

If the authors are not able to recognise the serious content validity issues that these PROMs face, I have little faith in the assessments in the review.

Simply asking a simple rating of 1-10 is just as good as any of those in most cases, and likely never falls below 90% of accuracy. Not because it's a good or accurate way, but because those questionnaires have too much fluff and confusion embedded in them that whatever usefulness they add, they end up undoing it, and then some. Too much biases. It's the biases, they are everywhere about everything all the time when there is no standard objective measure.

I'm getting to the point where I don't think questionnaires are a valid tool for things like this. It's just the wrong way of doing things, but it's precisely because they aren't useful or accurate that it's impossible to stop the cycle, because it can always simply be argued one way or another. Endless arguments, zero usefulness to those.

Without an objective ground truth, something to compare to, even attempting to formulate a questionnaire is probably always the wrong thing to do, because there is no way to actually validate them, not in a real, scientific sense, the only sense that matters. I'm surprised they didn't include the CFQ, because why the hell not?

 

[Sean]

I am becoming actively hostile to questionnaires, and now operate on the presumption they are of very limited and uncertain value at best, and typically worse than that.

Problematic enough a tool in the hands of honest and diligent researchers with the most honourable intentions, and an open invitation for abuse and exploitation in the hands of the less honest and diligent.