A new study suggests a strong association in multiple sclerosis (MS) patients between high levels of fatigue and mental health, quality of life (QoL), and the ability to move about and participate in daily activities, although disability is not related to fatigue levels. These findings are of importance and highlight the value of including fatigue assessment in physical therapy evaluations, to help healthcare professionals better manage MS.
The study, “Associations between fatigue and disability, functional mobility, depression, and quality of life in people with multiple sclerosis,” was published in the International Journal of MS Care.
Led by Dr. Eduard Gappmaier from the University of Utah in Salt Lake City, the study involved 89 people with MS. Participants underwent a neuromuscular examination, and were asked to fill in a health status and fatigue questionnaire to determine their level of fatigue. The questionnaire included questions such as:
- Have you been less alert?
- Have you been limited in your ability to do things away from home?
- Have you had trouble maintaining physical effort for long periods?
- Have you been less able to complete tasks that require physical effort?
- Have you had trouble concentrating?
Participants’ ability to move, in order to participate in daily activities, was also assessed by functional mobility tests.
Results showed that people reporting higher levels of fatigue had a greater impairment in their ability to move about and participate in daily activities. They also had higher levels of depression, and lower physical and mental QoL.
Still, researchers did not find a significant relationship between disability and the level of fatigue.
Fatigue in MS can be influenced by many factors. These can be primary or direct factors such as inflammation, neuronal damage, immune response, and disruptions in the hormonal system. Secondary or indirect factors include sleep problems, depression and other psychological problems, the use of medication, and the lack of exercise.
Fatigue is known to contribute significantly to mental and general health, and is also an independent predictor of QoL. According to the authors, because the study did not show an association between neurologic disability and the level of fatigue experienced by people with MS, it is very important to assess fatigue in patients regardless of their level of disability.