Project References:
Modified Fatigue Impact scale
The Modified Fatigue Impact Scale (MFIS) is one of the most frequently used measures to assess fatigue.
The present investigation was conducted to develop normative data of the MFIS that considers age,
gender, and education.
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21 items (more employable than FIS) (10-20 min)
‘Impact’-occupational focus
Covers a broad range fatigue symptoms/experience (cognitive, psychosocial, physical)
Frequently used: clinicians more likely to be familiar
Appropriate age group
High internal consistency
Adequate divergent validity with measures of disease stage, motor function, and
cognition.
The MFIS had strong convergent validity with the PANAS-X fatigue subscale
Better choice than FSS for severe fatigue
Available and valid in Belgian, Italian, Slovenian, Spanish, greek vChinese and Arabic
Brain injury, MS, stroke, Parkinsons,
does not provide sufficient opportunity to differentiate diseases such as depression,
chronic fatigue syndrome, and chronic fatigue syndrome in chronic diseases.
Supporting literature:
o Strober, L. B., Bruce, J. M., Arnett, P. A., Alschuler, K. N., DeLuca, J., Chiaravalloti,
N., ... & Román, C. A. F. (2020). Tired of not knowing what that fatigue score
means? Normative data of the Modified Fatigue Impact Scale (MFIS). Multiple
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Sclerosis and Related Disorders, 46, 102576.
https://doi.org/10.1016/j.msard.2020.102576
Schiehser, D. M., Ayers, C. R., Liu, L., Lessig, S., Song, D. S., & Filoteo, J. V. (2013).
Validation of the modified fatigue impact scale in Parkinson's
disease. Parkinsonism & related disorders, 19(3), 335-338.
https://doi.org/10.1016/j.parkreldis.2012.11.013
Amtmann, D., Bamer, A. M., Noonan, V., Lang, N., Kim, J., & Cook, K. F. (2012).
Comparison of the psychometric properties of two fatigue scales in multiple
sclerosis. Rehabilitation psychology, 57(2), 159–166.
https://doi.org/10.1037/a0027890
Ng, S.S.M., Liu, T.W. & Tsoh, J. Translation and initial validation of Chinese
(Cantonese) version of Modified Fatigue Impact Scale (MFIS-C) in people with
stroke. BMC Neurol 22, 300 (2022). https://doi.org/10.1186/s12883-022-02832-w
Williams, H., Caplan, B., Bogner, J., Brenner, L., Schiehser, D. M., Delano-Wood, L.,
... & Liu, L. (2015). Validation of the Modified Fatigue Impact Scale in mild to
moderate traumatic brain injury. Journal of head trauma rehabilitation, 30(2), 116121.
Alawami, A. S., & Abdulla, F. A. (2021). Psychometric properties of an Arabic
translation of the modified fatigue impact scale in patients with multiple
sclerosis. Disability and Rehabilitation, 43(22), 3251-3259.
Lopes, J., Araújo, H. A. G. D. O., & Smaili, S. M. (2020). Fatigue in Parkinson’s
disease: Brazilian validation of the modified fatigue impact scale. Arquivos de
Neuro-Psiquiatria, 78, 473-480.
Learmonth, Y., Dlugonski, D., Pilutti, L. A., Sandroff, B. M., Klaren, R., & Motl, R.
W. (2013). Psychometric properties of the fatigue severity scale and the modified
fatigue impact scale. Journal of the neurological sciences, 331(1-2), 102-107.
Bakalidou, Daphnea,e; Voumvourakis, Konstantinosc; Tsourti, Zoid;
Papageorgiou, Effieb; Poulios, Antoniosc; Giannopoulos, Sotiriose. Validity and
reliability of the Greek version of the Modified Fatigue Impact Scale in multiple
sclerosis patients. International Journal of Rehabilitation Research: September
2014 - Volume 37 - Issue 3 - p 271-276
doi: 10.1097/MRR.0000000000000057
FAS
The Fatigue Assessment Scale (FAS) is a unidimensional fatigue scale to rate how a person usually
feels that is scored using a 5-point Likert scale from 1 (never) to 5 (always). It consists of 10 items
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this scale is short and easy to administer.
Not much information gathered
The FAS showed a good reliability and content validity.
available in 20 languages
26 different diseases or conditions
Strong support was obtained for the unidimensionality of the scale.
o Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., &
Wallace, E. P. (1993). Development of a fatigue scale. Journal of psychosomatic
research, 37(2), 147–153. https://doi.org/10.1016/0022-3999(93)90081-p
o Examination of the Dimensionality of Fatigue Helen J. Michielsen, Jolanda De
Vries, Guus L. Van Heck, Fons J.R. Van de Vijver, and Klaas Sijtsma European
Journal of Psychological Assessment 2004 20:1, 39-48
o Michielsen HJ, De Vries J, Van Heck GL et al. Examination of the Dimensionality of
Fatigue: The Construction of the Fatigue Assessment Scale (FAS). European
Journal of Psychological Assessment 2004; 20(1): 39-48.
o Hendriks, Celinea,b,c; Drent, Marjoleina,c,d; Elfferich, Marjona; De Vries,
Jolandaa,e,f. The Fatigue Assessment Scale: quality and availability in sarcoidosis
and other diseases. Current Opinion in Pulmonary Medicine: September 2018 Volume 24 - Issue 5 - p 495-503 doi: 10.1097/MCP.0000000000000496
FSS
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Shorter than MFIS
Less capable of measuring physical and cognitive
Less capable of measuring severe cases
Valid regarding mild-moderate cases
o Multiple versions:
o FSS-7 showed better psychometric properties and had better potential to detect
changes in fatigue over time than the FSS-9 version, suggesting satisfactory
grounds for removal of items #1 and #2 for its application.
Reliable for obese patients
o Amtmann, D., Bamer, A. M., Noonan, V., Lang, N., Kim, J., & Cook, K. F. (2012).
Comparison of the psychometric properties of two fatigue scales in multiple
sclerosis. Rehabilitation psychology, 57(2), 159–166.
https://doi.org/10.1037/a0027890
o Learmonth, Y., Dlugonski, D., Pilutti, L. A., Sandroff, B. M., Klaren, R., & Motl, R.
W. (2013). Psychometric properties of the fatigue severity scale and the modified
fatigue impact scale. Journal of the neurological sciences, 331(1-2), 102-107.
o Lerdal, A., & Kottorp, A. (2011). Psychometric properties of the Fatigue Severity
Scale—Rasch analyses of individual responses in a Norwegian stroke
cohort. International journal of nursing studies, 48(10), 1258-1265.
o Impellizzeri, F.M., Agosti, F., De Col, A. et al. Psychometric properties of the
Fatigue Severity Scale in obese patients. Health Qual Life Outcomes 11, 32 (2013).
https://doi.org/10.1186/1477-7525-11-32
Although many interventions for energy conservation strategies have been described,1,7-9 few
programs have been standardized and published. The treatment program used most frequently in
occupational therapy and described 8 in the literature is “Managing Fatigue,”10 which is referred to
as energy conservation management (ECM). It has been tested in several studies11-15 and many
countries. To fit the unique needs of each individual, ECM promotes a positive attitude focused on
decisionmaking and the optimum use of available energy
Blikman, L. J., Huisstede, B. M., Kooijmans, H., Stam, H. J., Bussmann, J. B., & van Meeteren, J.
(2013). Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a
systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 94(7), 13601376.
Boehm, N., Muehlberg, H., & Stube, J. E. (2015). Managing poststroke fatigue using telehealth: A
case report. The American Journal of Occupational Therapy, 69(6), 6906350020p1-6906350020p7.
Grill, B., & Cole, M. (2021). Approach to Fatigue and Energy Conservation. Physical Medicine and
Rehabilitation Clinics, 32(3), 493-507.
Miller, P., & Soundy, A. (2017). The pharmacological and non-pharmacological interventions for the
management of fatigue related multiple sclerosis. Journal of the neurological sciences, 381, 41-54.
Månsson Lexell, E., Haglund, L., & Packer, T. (2020). The “Managing Fatigue” programme for people
with multiple sclerosis–acceptance and feasibility with Swedish occupational therapists. Scandinavian
journal of occupational therapy, 27(7), 536-549.
Topics for discussion and reflection included MS-related fatigue,
energy conservation strategies, exercise, medication and diet, and
strategies for maximizing life via planning and prioritization or
delegation of tasks. The workbook includes reflection and planning
forms (a fatigue diary, weekly planner sheet, and weekly meal
planner), which participants completed as homework. Participants
were also encouraged to draw on the personal experiences of other
people with MS, written as case illustrations in the workbook, and on
other attendees' experiences to reflect on their own experiences of life
with MS and to identify and trial personal strategies to better manage
their fatigue.
Mulligan, H., Wilkinson, A., Barclay, A., Whiting, H., Heynike, C., & Snowdon, J.
(2016). Evaluation of a Fatigue Self-Management Program for People with Multiple
Sclerosis. International journal of MS care, 18(3), 116–121.
https://doi.org/10.7224/1537-2073.2015-019