The Flinders Fatigue Scale: Preliminary Psychometric Properties and Clinical Sensitivity of a New Scale for Measuring Daytime Fatigue 2007

[Sly Saint]

Abstract
Study objectives:
To evaluate the psychometric properties and clinical significance of a new scale for measuring daytime fatigue associated with insomnia: The Flinders Fatigue Scale (FFS).

Methods:
The 7-item FFS was used in two separate studies. Study 1 was an on-line validation study involving 1093 volunteers (mean [SD] age = 38.6 [14.7] y, 626 poor sleepers, 467 good sleepers) in a cross-sectional design; Study 2 investigated the clinical sensitivity of the FFS on 113 insomnia patients (mean [SD] age = 48.3 [15.0] y) in response to a 5-week cognitive-behavior therapy for insomnia (CBT-I) program.

Results:
The FFS had an internal consistency of 0.91; it comprised a single factor, accounting for 67% of the total variance. Poor sleepers in Study 1 scored significantly higher than good sleepers on the FFS (p < 0.0001). In Study 2, significant reductions in FFS scores were found in response to CBT-I (p < 0.0001). These reductions in fatigue correlated with improvements on subjective sleep parameters (all p < 0.0001). The FFS showed good discriminant validity with the Epworth Sleepiness Scale.

Conclusions:
The Flinders Fatigue Scale is a brief, clinically sensitive measure with strong psychometric properties.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556916/

Both the DSM-IV and the ICSD-2 indicate a number of typical daytime consequences of insomnia. These include fatigue, malaise, poor attention and concentration, memory impairment, social or vocational dysfunction, irritability, mood disturbance, daytime sleepiness, lack of motivation or energy, prone to accidents, physical symptoms (e.g., headaches, gastrointestinal complaints), and concerns or worries about sleep; which can lead to a reduced quality of life.15 Of all these daytime symptoms, fatigue appears to be the most prevalent daytime complaint, as evidenced by both its emphasis in the scientific literature,4 and in clinical settings.11 Indeed, self-reported fatigue is higher in people experiencing insomnia compared to other sleep disorders (e.g., obstructive sleep apnea), yet comparable to that of cancer and chronic fatigue syndrome.16,17 Fatigue associated with insomnia can be considered as subjective feelings of tiredness, weariness and exhaustion,18 as opposed to the likelihood to doze or fall asleep, which is often associated with daytime sleepiness.19 To date, the most popular measures of fatigue used in insomnia research are the Fatigue Severity Scale (FSS)20 and the Multidimensional Fatigue Inventory (MFI).21

The FSS is a self-report questionnaire, designed to measure the level of a person's fatigue in a variety of situations (e.g., “I am easily fatigued,” “Exercise brings on my fatigue”).20 It is a relatively brief measure, containing only 9 items that provide a global measure of fatigue, and was originally developed on clinical samples (e.g., multiple sclerosis, lupus). In contrast, the MFI contains 20 items divided into 5 subscales: general fatigue (e.g., “I feel tired”), physical fatigue (e.g., “Physically I feel only able to do a little”), reduction in activities (e.g., “I feel very active”), reduction in motivation (e.g., “I dread having to do things”), and mental fatigue (e.g., “My thoughts easily wander”),21 though no global fatigue score is provided. The MFI was primarily developed to measure fatigue in cancer patients. Both measures possess good internal consistency (e.g., FSS α = 0.80; MFI α = 0.84), characteristics essential for a valid daytime impairment measure in treatment outcome studies.11 One criticism of the FSS, however, is the scale's questionable validity (i.e., it includes “fatigue” in each item without providing an initial description of the term).4

Not only do self-reported measures require strong psychometric properties, but they also need to be sensitive to treatment.11 Unfortunately, recent treatment outcome studies using these scales have not delivered promising results.

 

[Creekside]

I'm trying to compare my fatigue(like) symptoms from ME with those from lack of sleep ... and I simply can't do that from memory. There must be some way to measure cognitive fatigue: neural firing rates, differences in blood content coming out of the brain, length of astrocyte cillia; something. Forget about questionnaires.

"Unfortunately, recent treatment outcome studies using these scales have not delivered promising results." I translate that as: "The scales aren't giving us dramatic positive results from our useless treatments, so let's change the scales!"

 

[bobbler]

All these scales just utterly manage to miss the point in some key ways - maybe because I have ME/CFS not 'fatigue' but I struggle to name or be sure of a condition where this is useful. OR why answers to these questions would be useful in 'treatment' or adjustment terms.

Why is this 'daytime' fatigue for example, when that implicitly misses the issue that someone can and will be ehxausted 24/7 or have a different issue (sleep reversal) caused by the condition actually underlying it all.

SUrely the biggie is debilitation, and how much less you can do vs before. Maybe, if there is something useful being done by any fatigue treater, you'd want to know the pattern of that - not for a survey or scale, but to understand how it affects someone and get to the cause (which isn't 'sleep hygeine' anoher red herring this lot get stuck in but imagine if they'd done this properly in describing how going over threshold and then PEM works for us - I'd imagine there are similar things for anything else).

Memory problems are memory problems, whether they are caused by exhaustion or not - so why do these become part of a fatigue scale.

And all these Qs are v heavy on the 'I feel', and are combining things which should be clues taken separately

I am very concerned that crapola scales with little place re: what they purport to be related to, are just being used as a functional fixedness for more crapola along the same red herring lines.

What on earth can be the usefulness of trivialising and invalidating wanting to actually understand someone's issue by basically smudging any info into one that someone might give that is useful and make them answer invalid and useless Qs which take effort and make little sense (ergo noone can answer objectively wihout wondering 'you realise that doesn't make much sense for you to ask me, what are you getting at) other than agendas and for someone to manipulate their 'treatment' tactics around?

It's all non-illness stuff clearly based on what they intend to barrage people psychologically to change their answers on - leaving them so exhausted and barraged they don't remember that none of these things are actually specifically what their complaint was.

Imagine if someone went into a GP with gout and someone applied this (or the chalder fatigue scale) to them, put them through therapy focused on changing their answers to it and re-tested. Would it have either diagnosed the issue or addressed it? How is the validity of this for what most people will be able to term in very specific issues when they go to a GP for the first time any different - it is just a distraction

The whole thing stuns me frankly as an emperor's new clothes why does noone else see this situation.

and I fail to see the usefulness even in the terms of if it were a scale just asking people if they were 50% less able or fatigued or what (which might be a valid Q) vs what they plan to do with it. None of the component questions seem to make it more rather than less valid or give clues how they will improve it.

It isn't like the pain scale where someone pointing to a 9 vs a 7 gives diagnostic info or helps the right pain control to be administered at that time because it aids (rather than undermines) communication.

Which to me sort of flags another Q people need to be asking: at what date did 'fatigue' (I think that term being a big part of the issue) being so exhausted one can't lift their own arm for days become 'not as urgent or important' as pain on an equivalent scale. Both indicate something is pretty wrong. That always used to be the basic common sense thing. If a doctor suddenly, or on a slow but sure downward decline over a few months could not drag their own body somewhere, couldn't manage to do their work, or their child was pale and unable to move surely they'd think nothing other than 'they are ill with something' so where the heck did all this come from. Other than leaving it for so long they could call it 'chronic' rather than 'left in the same desperate situation for years'. So why all this bigotry when this important and fair and basic symptom is mentioned to turn it into 'do you feel ..'

If some of these areas were to 'profile' the fatigue ie Qs on memory, sleep, 'central' levels at worst, 'local' ie muscular fatiguability grades, debility at worst vs best were being plotted on a chart to pinpoint and better define and describe the exact/specific issue in each person and triage and describe the areas most affected it might be the opposite thing and I don't understand why everything is done backwards to the logic of it being taken seriously as a medic would expect for themself.

 

[Creekside]

And all these Qs are v heavy on the 'I feel', and are combining things which should be clues taken separately

Also, the responses to the questions may depend quite strongly on how the question is worded, and maybe even where in the questionnaire it is placed (putting it before a question about pain or sleep might give different responses than if it's placed after that section).