Fatigue scale for motor skills and cognition

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The Fatigue Scale for Motor Skills and Cognition (FSMC) is a diagnostic procedure and is used to clarify cognitive and motor fatigue symptoms, which are common and serious symptoms in patients with multiple sclerosis (MS). The method was developed on the basis of existing MS fatigue scales ( Fatigue Severity Scale [FSS], FAI, FIS, Modified Fatigue Impact Scale [MFIS], FRS, Physical and Cognitive Fatigue Scale ) and in an extensive study for the objective assessment of the MS fatigue validated. The psychometric parameters are very good, the internal consistency is α> 0.91, the retest reliability is r> 0.80 (Penner et al., 2009).

background

Fatigue is estimated to affect 75–95% of people with MS and is one of the symptoms that makes people feel the most bothered. Fatigue can occur at any point in time during an MS disease, is often already present at the onset of the disease and usually persists throughout the course of the disease. The effects on the quality of life of those affected can be serious and can be seen as the main cause of part-time employment or even incapacity for work; Fisk et al. a., 1994; Freal, Kraft, & Coryell, 1984

The symptoms of fatigue can currently only be measured reliably using questionnaires. More detailed studies of the already existing MS fatigue scales (see above) show a high degree of heterogeneity in the scale structure and the underlying fatigue aspects (e.g. muscle strength, exercise performance, etc.) as well as weaknesses in terms of methodological criteria; Schwartz, Jandorf, & Krupp, 1993.

A reliable and early diagnosis of MS fatigue should not only lead to an improvement in understanding within the socio-familial and professional environment, as well as the acceptance of the individual patient for their symptoms, but should also be seen as a prerequisite for the further course of the choice of therapy become.

The Fatigue Scale for Motor Skills and Cognition (FSMC) was developed on a scientific basis. It serves as a general and objective measurement method for diagnosing and quantifying the core symptoms of fatigue. In contrast to the previous MS fatigue scales, the focus of the FSMC is on recording the two main components (motor / cognitive) of fatigue and allows the symptoms to be graded.

Test setup and implementation

The questionnaire contains 20 items, which are made up of the subscales for clarifying cognitive and motor fatigue. The patients give their judgments on a 5-point Likert scale. The FSMC is a measure for self-assessment and can be filled out by the patient in the waiting area within 5 minutes. The processing of the FSMC is not subject to any time or age-related restrictions. However, it is important to explicitly point out to the patient that he has read the instructions carefully.

evaluation

The evaluation key for the two subscales looks like this:

Cognitive scale - items 1, 4, 7, 8, 11, 13, 15, 17, 18, 20
(Example item: "Because of my state of exhaustion, it is more difficult for me to learn something new than before.")
Motor scale - items 2, 3, 5, 6, 9, 10, 12, 14, 16, 19
(Example item: "My movements are clearly slower in a state of exhaustion.")

The 5-point Likert scale provides for an allocation of 1–5. This allows a maximum of 50 points per sub-scale and 100 points for the overall scale. A patient who has neither motor nor cognitive fatigue would therefore achieve a point value of 20 on the overall scale.

Classification of the patient based on cut-off values

The cut-off value determined and validated on a healthy sample (Penner et al., 2009) to differentiate between normal findings on the one hand and pathological fatigue on the other hand is 43 for the overall scale, 22 for the cognitive scale and 22 for the motor scale. The detailed classification of findings can be found in the table below.

FSMC total ≥ 43 Slight fatigue
≥ 53 Moderate fatigue
≥ 63 Severe fatigue
FSMC cognitive ≥ 22 Mild cognitive fatigue
≥ 28 Moderate cognitive fatigue
≥ 34 Severe cognitive fatigue
FSMC motorized ≥ 22 Mild motor fatigue
≥ 27 Moderate motor fatigue
≥ 32 Severe motor fatigue

literature

  • IK Penner, C. Raselli, M. Stöcklin, K. Opwis, L. Kappos, P. Calabrese: The FSMC (Fatigue Scale for Motor and Cognitive Functions) - validation of a new instrument to assess MS related fatigue in clinical routine. In: Multiple Sclerosis. 15, 2009, pp. 1509-1517.
  • IK Penner, N. Bechtel, C. Raselli, M. Stöcklin, K. Opwis, L. Kappos, P. Calabrese: Fatigue in multiple sclerosis: relation to depression, physical impairment, personality and action control. In: Multiple Sclerosis. 13 (9), Nov 2007, pp. 1161-1167. PMID 17967844
  • IK Penner, A. Vogt, C. Raselli, M. Stöcklin, K. Opwis, L. Kappos: The FSMC (Fatigue Scale for Motor and Cognitive Functions): a new patient-reported outcome measure for cognitive and motor fatigue in multiple sclerosis . In: Multiple Sclerosis. 11, 2005, p. S66.

Individual evidence

  1. ↑ a b L. B. Krupp, NG LaRocca, J. Muir-Nash, AD Steinberg: The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. In: Archives Neurology. 46, 1989, pp. 1121-1123.
  2. ↑ a b J. E. Schwartz, L. Jandorf, LB Krupp: The measurement of fatigue: a new instrument. In: Journal of Psychosomatic Research. 37, 1993, pp. 753-762.
  3. ↑ a b J. D. Fisk, A. Pontefract, PG Ritvo, CJ Archibald, TJ Murray: The impact of fatigue on patients with multiple sclerosis. In: Canadian Journal of Neurological Sciences. 21, 1994, pp. 9-14.
  4. ↑ Multiple Sclerosis Council for Clinical Practice Guidelines: Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. In: Paralyzed Veterans of America. Washington, DC 1998.
  5. ↑ T. Chalder, G. Berelowitz, T. Pawlikowska and a .: Development of a fatigue scale. In: Journal of Psychosomatic Research. 37, 1993, pp. 147-153.
  6. ^ RH Paul, WW Beatty, R. Schneider u. a .: Cognitive and physical fatigue in multiple sclerosis: Relations between self-report and objective performance. In: Applied Neuropsychology. 5, 1998, pp. 143-148.
  7. ^ LB Krupp, PK Coyle, C. Doscher u. a .: Fatigue therapy in multiple sclerosis: Results of a double blind, randomized parallel trial of amantadine, pemoline and placebo. In: Neurology. 45, 1995, pp. 1956-1961.
  8. ↑ Multiple Sclerosis Council for Clinical Practice Guidelines: Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Paralyzed Veterans of America, Washington, DC 1998, OCLC 41890595 .
  9. ↑ G. Comi, L. Leocani, P. Rossi et al. a .: Physiopathology and treatment of fatigue in multiple sclerosis. In: Journal of Neurology. 248, 2001, pp. 174-179.
  10. ↑ JE Freal, GH force JK Coryell: Symptomatic fatigue in multiple sclerosis. In: Archives of Physical Medicine and Rehabilitation. 65, 1984, pp. 135-138.