Top

Health and Quality of Life Outcomes

Published in:

Open Access 01-12-2022 | Public Health | Research

Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults

Authors: Rıdvan M. Adın, Ali Naim Ceren, Yeliz Salcı, Ayla Fil Balkan, Kadriye Armutlu, Çiğdem Ayhan Kuru

Published in: Health and Quality of Life Outcomes | Issue 1/2022

Abstract

Background

Fatigue is emerging as a major public health problem that is highly associated with poor health-related quality of life and disability. Among adults, fatigue has become increasingly common because of workload or lifestyle changes. This study aimed to cross-culturally adapt the Chalder Fatigue Scale (CFS) into Turkish, to investigate its psychometric properties, and to establish normative data in healthy adults by age and gender.

Methods

The validity of the CFS was tested with a total sample of 476 healthy adults aged 20–40 years (264 males and 212 females) and test–retest/measurement error analyses were performed with 161 participants (94 males and 67 females). The test–retest reliability was examined using the intraclass correlation coefficient (ICC), and internal consistency was determined using Cronbach's α-coefficient. Predictive validity was assessed using the Receiver Operating Characteristic to validate the cut-off value of the CFS for non-fatigued and fatigued participants. Factor analyses and hypothesis testing were conducted to assess construct validity. Hypothesis testing examined convergent and known-group validity by testing 14 predefined hypotheses.

Results

The mean (SD) and median (25–75%) CFS scores were 10.7 (4.9) and 11 (7–14) for the total sample (n = 476). The cut-off point for CFS was set at ≥ 12 with a sensitivity of 65.8% and a specificity of 85.9%. The CFS provided evidence of excellent fit of the two-factor structure (CFI = 0.963, RMSEA = 0.06, SRMR = 0.02). There was evidence of strong internal consistency demonstrated by Cronbach's α = 0.863 and good test–retest reliability by ICC = 0.76. Thirteen out of 14 hypotheses (92.9%) were confirmed and the scale showed low to moderate correlation with other measurement instruments (r = 0.31–0.51).

Conclusions

The CFS has been shown to be a reliable and valid instrument that can be used in various populations for the assessment of fatigue.

Level of evidence

Level II.

Zwarts MJ, Bleijenberg G, van Engelen BG. Clinical neurophysiology of fatigue. Clin Neurophysiol. 2008;119(1):2–10. https://doi.org/10.1016/j.clinph.2007.09.126.CrossRef

Azzolino D, Cesari M. Fatigue in the COVID-19 pandemic. Lancet Healthy Longev. 2022;3(3):e128–9. https://doi.org/10.1016/S2666-7568(22)00029-0.CrossRef

Reynolds KJ, Vernon SD, Bouchery E, Reeves WC. The economic impact of chronic fatigue syndrome. Cost Eff Resour Alloc. 2004;2(1):4. https://doi.org/10.1186/1478-7547-2-4.CrossRef

Jackson C. The Chalder Fatigue Scale (CFQ 11). Occup Med (Lond). 2015;65(1):86. https://doi.org/10.1093/occmed/kqu168.CrossRef

Peng R, Zhou WS, Zhou DX, Chu MY, Ling L. The mediating role of fatigue between mental health and its associated factors: evidence from Chinese healthcare workers during the COVID-19 pandemic. Front Psychiatry. 2021;12:924. https://doi.org/10.3389/fpsyt.2021.665992.CrossRef

Alqahtani JS, AlRabeeah SM, Aldhahir AM, Siraj R, Aldabayan YS, Alghamdi SM, Alqahtani AS, Alsaif SS, Naser AY, Alwafi H. Sleep quality, insomnia, anxiety, fatigue, stress, memory and active coping during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(9):4940. https://doi.org/10.3390/ijerph19094940.CrossRef

Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Prevalence and determinants of fatigue after COVID-19 in non-hospitalized subjects: a population-based study. Int J Environ Res Public Health. 2021. https://doi.org/10.3390/ijerph18042030.CrossRef

Liang L, Yang B, Jiang N, Fu W, He X, Zhou Y, Ma WL, Wang X. Three-month follow-up study of survivors of coronavirus disease 2019 after discharge. J Korean Med Sci. 2020;35(47):e418. https://doi.org/10.3346/jkms.2020.35.e418.CrossRef

Carfi A, Bernabei R, Landi F, Gemelli Against C-P-ACSG. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–5. https://doi.org/10.1001/jama.2020.12603.CrossRef

10.

Dittner AJ, Wessely SC, Brown RG. The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res. 2004;56(2):157–70. https://doi.org/10.1016/S0022-3999(03)00371-4.CrossRef

11.

Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, Wallace EP. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–53. https://doi.org/10.1016/0022-3999(93)90081-p.CrossRef

12.

Cella M, Chalder T. Measuring fatigue in clinical and community settings. J Psychosom Res. 2010;69(1):17–22. https://doi.org/10.1016/j.jpsychores.2009.10.007.CrossRef

13.

Wong WS, Fielding R. Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample. J Psychosom Res. 2010;68(1):89–93. https://doi.org/10.1016/j.jpsychores.2009.05.008.CrossRef

14.

Ha H, Jeong D, Hahm BJ, Shim EJ. Cross-cultural validation of the Korean version of the chalder fatigue scale. Int J Behav Med. 2018;25(3):351–61. https://doi.org/10.1007/s12529-017-9701-0.CrossRef

15.

Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res. 1998;45(1):53–65. https://doi.org/10.1016/s0022-3999(97)00291-2.CrossRef

16.

Tanaka M, Fukuda S, Mizuno K, Imai-Matsumura K, Jodoi T, Kawatani J, Takano M, Miike T, Tomoda A, Watanabe Y. Reliability and validity of the Japanese version of the Chalder Fatigue Scale among youth in Japan. Psychol Rep. 2008;103(3):682–90. https://doi.org/10.2466/pr0.103.3.682-690.CrossRef

17.

Chilcot J, Norton S, Kelly ME, Moss-Morris R. The Chalder Fatigue Questionnaire is a valid and reliable measure of perceived fatigue severity in multiple sclerosis. Mult Scler. 2016;22(5):677–84. https://doi.org/10.1177/1352458515598019.CrossRef

18.

De Vries J, Michielsen HJ, Van Heck GL. Assessment of fatigue among working people: a comparison of six questionnaires. Occup Environ Med. 2003;60(Suppl 1):i10-15. https://doi.org/10.1136/oem.60.suppl_1.i10.CrossRef

19.

Aaronson LS, Pallikkathayil L, Crighton F. A qualitative investigation of fatigue among healthy working adults. West J Nurs Res. 2003;25(4):419–33. https://doi.org/10.1177/0193945903025004007.CrossRef

20.

Corwin EJ, Klein LC, Rickelman K. Predictors of fatigue in healthy young adults: moderating effects of cigarette smoking and gender. Biol Res Nurs. 2002;3(4):222–33. https://doi.org/10.1177/109980040200300407.CrossRef

21.

Engberg I, Segerstedt J, Waller G, Wennberg P, Eliasson M. Fatigue in the general population- associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 2014. BMC Public Health. 2017;17(1):654. https://doi.org/10.1186/s12889-017-4623-y.CrossRef

22.

Gledhill, J. A qualitative study of the characteristics and representation of fatigue in a French speaking population of cancer patients and healthy subjects. Eur J Oncol Nurs. 2005;9(4):294–312; discussion 313–294. https://doi.org/10.1016/j.ejon.2004.11.002

23.

Chen MK. The epidemiology of self-perceived fatigue among adults. Prevent Med. 1986;15(1):74–81. https://doi.org/10.1016/0091-7435(86)90037-X.CrossRef

24.

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. https://doi.org/10.1097/00007632-200012150-00014.CrossRef

25.

Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49. https://doi.org/10.1007/s11136-010-9606-8.CrossRef

26.

Floyd FJ, Widaman KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess. 1995;7(3):286–99. https://doi.org/10.1037/1040-3590.7.3.286.CrossRef

27.

Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012.CrossRef

28.

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–63. https://doi.org/10.1016/j.jcm.2016.02.012.CrossRef

29.

Wood C, Magnello ME. Diurnal changes in perceptions of energy and mood. J R Soc Med. 1992;85(4):191–4.CrossRef

30.

De Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine: a practical guide. Cambridge: Cambridge University Press; 2011.CrossRef

31.

Ergin G, Yildirim Y. A validity and reliability study of the Turkish Checklist Individual Strength (CIS) questionnaire in musculoskeletal physical therapy patients. Physiother Theory Pract. 2012;28(8):624–32. https://doi.org/10.3109/09593985.2011.654321.CrossRef

32.

Hewlett S, Dures E, Almeida C. Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Care Res (Hoboken), 2011;63 Suppl 11(S11), S263–286. https://doi.org/10.1002/acr.20579

33.

Kücükdeveci AA, McKenna SP, Kutlay S, Gürsel Y, Whalley D, Arasil T. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res. 2000;23(1):31–8.CrossRef

34.

Hisli N. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol. 1989;7:3–13.

35.

Agargun MY. Pittsburgh uyku kalitesi indeksinin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi. 1996;7:107–15.

36.

Cho HJ, Costa E, Menezes PR, Chalder T, Bhugra D, Wessely S. Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care. J Psychosom Res. 2007;62(3):301–4. https://doi.org/10.1016/j.jpsychores.2006.10.018.CrossRef

37.

Worm M, Nikolaus S, Goldsmith K, Wiborg J, Ali S, Knoop H, Chalder T (2016) Cognitive behaviour therapy for chronic fatigue syndrome: differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands, vol 87. https://doi.org/10.1016/j.jpsychores.2016.06.006

38.

Zdun-Ryżewska A, Basiński K, Michalik A. A confirmatory factor analysis for an adapted and validated Polish version of the Chalder Fatigue Questionnaire. Int J Occup Med Environ Health. 2020;33(1):67–76.CrossRef

39.

Morriss RK, Wearden AJ, Mullis R. Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome. J Psychosom Res. 1998;45(5):411–7. https://doi.org/10.1016/s0022-3999(98)00022-1.CrossRef

40.

Picariello F, Moss-Morris R, Macdougall IC, Chilcot J. Measuring fatigue in haemodialysis patients: The factor structure of the Chalder Fatigue Questionnaire (CFQ). J Psychosom Res. 2016;84:81–3. https://doi.org/10.1016/j.jpsychores.2016.03.124.CrossRef

41.

Worm-Smeitink M, Gielissen M, Bloot L, van Laarhoven HWM, van Engelen BGM, van Riel P, Bleijenberg G, Nikolaus S, Knoop H. The assessment of fatigue: psychometric qualities and norms for the Checklist individual strength. J Psychosom Res. 2017;98:40–6. https://doi.org/10.1016/j.jpsychores.2017.05.007.CrossRef

42.

Bultmann U, de Vries M, Beurskens AJ, Bleijenberg G, Vercoulen JH, Kant I. Measurement of prolonged fatigue in the working population: determination of a cutoff point for the checklist individual strength. J Occup Health Psychol. 2000;5(4):411–6. https://doi.org/10.1037//1076-8998.5.4.411.CrossRef

43.

Tench CM, McCurdie I, White PD, D’Cruz DP. The prevalence and associations of fatigue in systemic lupus erythematosus. Rheumatology (Oxford). 2000;39(11):1249–54. https://doi.org/10.1093/rheumatology/39.11.1249.CrossRef

44.

Meites K, Lovallo W, Pishkin V. A comparison of four scales for anxiety, depression, and neuroticism. J Clin Psychol. 1980;36(2):427–32.CrossRef

45.

Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.CrossRef

46.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRef

47.

Williams F, Monge PR. Reasoning with statistics: how to read quantitative research. Cambridge: Harcourt College Publishers; 2001.

48.

Connelly LM. Correlations. Medsurg Nurs. 2012;21(3):171–2.

49.

Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. BMJ. 1997;314(7080):572.CrossRef

50.

Stratford PW. Estimating the standard error of measurement from reliability studies. Physiother Can. 2004;56(1):27–30.CrossRef

51.

Kumar R, Indrayan A. Receiver operating characteristic (ROC) curve for medical researchers. Indian Pediatr. 2011;48(4):277–87. https://doi.org/10.1007/s13312-011-0055-4.CrossRef

52.

De Vet HC, Ader HJ, Terwee CB, Pouwer F. Are factor analytical techniques used appropriately in the validation of health status questionnaires? A systematic review on the quality of factor analysis of the SF-36. Qual Life Res, 2005;14(5):1203–1218; dicussion 1219–1221, 1223–1204. https://doi.org/10.1007/s11136-004-5742-3

53.

Kaiser HF, Rice J. Little jiffy, mark IV. Educ Psychol Measur. 1974;34(1):111–7.CrossRef

54.

Kaiser HF. The application of electronic-computers to factor-analysis. Educ Psychol Meas. 1960;20(1):141–51. https://doi.org/10.1177/001316446002000116.CrossRef

55.

Hooper D, Coughlan J, Mullen M. Evaluating model fit: a synthesis of the structural equation modelling literature. In Proceedings of the 7th European Conference on Research Methodology for Business and Management Studies. London, Academic Conferences and Publishing Limited; 2008. p. 195-200.

56.

Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscipl J. 1999;6(1):1–55. https://doi.org/10.1080/10705519909540118.CrossRef

57.

Stevens JP. Applied multivariate statistics for the social sciences. London: Routledge; 2012.CrossRef

58.

Kaplan D. Model modification in covariance structure analysis: application of the expected parameter change statistic. Multivariate Behav Res. 1989;24(3):285–305. https://doi.org/10.1207/s15327906mbr2403_2.CrossRef

59.

Fong TC, Chan JS, Chan CL, Ho RT, Ziea ET, Wong VC, Ng BF, Ng SM. Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach. Qual Life Res. 2015;24(9):2273–8. https://doi.org/10.1007/s11136-015-0944-4.CrossRef

60.

Bensing JM, Hulsman RL, Schreurs KM. Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women. Med Care. 1999;37(10):1078–83. https://doi.org/10.1097/00005650-199910000-00011.CrossRef

61.

Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. 1994;308(6931):763–6. https://doi.org/10.1136/bmj.308.6931.763.CrossRef

62.

Mechanic D. The concept of illness behaviour: culture, situation and personal predisposition. Psychol Med. 1986;16(1):1–7. https://doi.org/10.1017/s0033291700002476.CrossRef

63.

Abbey SE, Garfinkel PE. Neurasthenia and chronic fatigue syndrome: the role of culture in the making of a diagnosis. Am J Psychiatry. 1991;148(12):1638–46. https://doi.org/10.1176/ajp.148.12.1638.CrossRef

64.

Galland-Decker C, Marques-Vidal P, Vollenweider P. Prevalence and factors associated with fatigue in the Lausanne middle-aged population: a population-based, cross-sectional survey. BMJ Open. 2019;9(8):e027070. https://doi.org/10.1136/bmjopen-2018-027070.CrossRef

65.

Lerdal A, Wahl A, Rustoen T, Hanestad BR, Moum T. Fatigue in the general population: a translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scand J Public Health. 2005;33(2):123–30. https://doi.org/10.1080/14034940410028406.CrossRef

66.

Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, O’Connor L, Leavy D, O’Brien K, Dowds J, Sugrue JA, Hopkins D, Martin-Loeches I, Ni Cheallaigh C, Nadarajan P, McLaughlin AM, Bourke NM, Bergin C, O’Farrelly C, Bannan C, Conlon N. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS ONE. 2020;15(11):e0240784. https://doi.org/10.1371/journal.pone.0240784.CrossRef

67.

Cleare AJ, Heap E, Malhi GS, Wessely S, O’Keane V, Miell J. Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet. 1999;353(9151):455–8. https://doi.org/10.1016/S0140-6736(98)04074-4.CrossRef

Title: Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults
Authors: Rıdvan M. Adın
Ali Naim Ceren
Yeliz Salcı
Ayla Fil Balkan
Kadriye Armutlu
Çiğdem Ayhan Kuru
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Public Health
Fatigue
Published in: Health and Quality of Life Outcomes / Issue 1/2022
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/s12955-022-02074-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2022

Relationship between social capital and quality of life among adult stroke patients: a cross-sectional study in Anhui Province, China

Predictors of health-related quality of life after cardiac surgery: a systematic review

Translation, cross-cultural adaptation and validation of the Work Role Functioning Questionnaire 2.0 into Brazilian Portuguese in a general population

Cross-cultural adaptation of the Spanish MINICHAL instrument into English for use in the United Kingdom

Measurement properties of the Swedish clinical outcomes in routine evaluation outcome measures (CORE-OM): Rasch analysis and short version for depressed and anxious out-patients in a multicultural area

Adaptation and validation of the HIV Knowledge Questionnaire-18 for the general population of Indonesia