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Fatigue in rheumaoid arthritis patients with low disease activity

Lenferink, L.I.M. (2013) Fatigue in rheumaoid arthritis patients with low disease activity.

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Abstract:Objectives Fatigue is reported to be one of the most common symptoms among people with rheumatoid arthritis (RA). Although rheumatologists are highly effective in controlling disease activity, patients still experience fatigue. The primary aim of this study was to analyse the relation between disease activity and multidimensional fatigue by using a novel multidimensional fatigue questionnaire (BRAF-MDQ) in RA patients with low disease activity. First the prevalence of clinically relevant fatigue was examined. As the Dutch translation of the BRAF-MDQ had not been validated yet, the second aim was to evaluate the BRAF-MDQ psychometrically. Thirdly, the possible differences in scores on the fatigue dimensions between patients with non-clinically relevant fatigue, clinically relevant fatigue and clinically severe fatigue were explored. The final aim was to determine how multidimensional fatigue is related to disease activity and health-related quality of life (HRQoL). Methods The data of 199 RA patients (69 % women, mean age 59 years, mean DAS-28 score 1.99) were selected from a multi-centre randomized clinical trial. Firstly, the prevalence of fatigue was examined, using a numeric rating scale of fatigue. Spearman Rho correlations were used to determine how multidimensional fatigue was related to disease activity and HRQoL, using the DAS-28 score and the SF-36 respectively. The dimensional structure, item internal consistency, item discriminant validity, distinctiveness and reliability, external construct validity and possible floor- and ceiling effects were examined to psychometrically evaluate the BRAF-MDQ. Mann-Whitney U-tests were utilized to explore whether the scores on the dimensions significantly differed between patients with different severities of fatigue. Results Clinically relevant fatigue was highly prevalent (73 %) in RA patients with low disease activity. The four-dimensional structure of the BRAF-MDQ was broadly confirmed, however major floor effects were detected for three dimensions. The scores on the dimensions differed significantly between patients with different severities of fatigue. The correlation coefficients between disease activity and dimensions of fatigue ranged from .05 to .09 and significant moderate to strong relations were shown for HRQoL. Discussion The findings indicate that even though RA inflammation is clinically under control, the majority of the patients still reported clinically relevant fatigue. Moreover, fatigue does not necessarily interfere with patients’ daily, social, emotional and cognitive life. Although the four-dimensional structure of the BRAF-MDQ is broadly confirmed, the major floor effects point to possibilities for improvement of fatigue measurement by, for example, computer adaptive testing.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/64187
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