Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2018

Open Access 01-12-2018 | Research

Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20)

Authors: Gloria-Beatrice Wintermann, Jenny Rosendahl, Kerstin Weidner, Bernhard Strauß, Andreas Hinz, Katja Petrowski

Published in: Health and Quality of Life Outcomes | Issue 1/2018

Login to get access

Abstract

Background

Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients.

Methods

A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study.

Results

The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37).

Conclusions

In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.

Trial registration

German Clinical Trials Registration DRKS00003386. Registered 13 December 2011, retrospectively registered.
Appendix
Available only for authorised users
Literature
1.
Chaboyer W, Grace J. Following the path of ICU survivors: a quality-improvement activity. Nurs Crit Care. 2003;8(4):149–55.CrossRefPubMed
2.
Steenbergen S, Rijkenberg S, Adonis T, Kroeze G, van Stijn I, Endeman H. Long-term treated intensive care patients outcomes: the one-year mortality rate, quality of life, health care use and long-term complications as reported by general practitioners. BMC Anesthesiol. 2015;15:142.CrossRefPubMedPubMedCentral
3.
4.
5.
Thomas DC, Kreizman IJ, Melchiorre P, Ragnarsson KT. Rehabilitation of the patient with chronic critical illness. Crit Care Clin. 2002;18(3):695–715.CrossRefPubMed
6.
Benjamim CF, Hogaboam CM, Kunkel SL. The chronic consequences of severe sepsis. J Leukoc Biol. 2004;75(3):408–12.CrossRefPubMed
7.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953–9.CrossRefPubMed
8.
Carruthers BM, van de Sande MI, De Meirleir KL, et al. Myalgic encephalomyelitis: international consensus criteria. J Intern Med. 2011;270(4):327–38.CrossRefPubMedPubMedCentral
9.
Jaenichen D, Brunkhorst FM, Strauss B, Rosendahl J. Physical and mental long-term sequelae following intensive care of severe sepsis in patients and relatives. Psychother Psychosom Med Psychol. 2012;62(9–10):335–43.PubMed
10.
Fuller-Thomson E, Nimigon J. Factors associated with depression among individuals with chronic fatigue syndrome: findings from a nationally representative survey. Fam Pract. 2008;25(6):414–22.CrossRefPubMed
11.
Nater UM, Lin JM, Maloney EM, et al. Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population. Psychosom Med. 2009;71(5):557–65.CrossRefPubMed
12.
Smets EM, Garssen B, Bonke B, De Haes JC. The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.CrossRefPubMed
13.
Hashem MD, Nallagangula A, Nalamalapu S, et al. Patient outcomes after critical illness: a systematic review of qualitative studies following hospital discharge. Crit Care. 2016;20(1):345.CrossRefPubMedPubMedCentral
14.
Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.CrossRefPubMed
15.
Klugkist M, Sedemund-Adib B, Schmidtke C, Schmucker P, Sievers HH, Huppe M. Confusion assessment method for the intensive care unit (CAM-ICU): diagnosis of postoperative delirium in cardiac surgery. Anaesthesist. 2008;57(5):464–74.CrossRefPubMed
16.
Wintermann GB, Brunkhorst FM, Petrowski K, et al. Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med. 2015;43(6):1213–22.CrossRefPubMed
17.
O’Sullivan SB, Schmitz TJ. Physical rehabilitation. Philadelphia, PA: F.A. Davis; 2007.
18.
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol group. Ann Med. 2001;33(5):337–43.CrossRefPubMed
19.
Wittchen H-U, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV. : Göttingen: Hogrefe; 1997.
20.
Schwarz R, Krauss O, Hinz A. Fatigue in the general population. Onkologie. 2003;26(2):140–4.PubMed
21.
Hinz A, Kohlmann T, Stobel-Richter Y, Zenger M, Brahler E. The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population. Qual Life Res. 2014;23(2):443–7.CrossRefPubMed
22.
Elbers RG, van Wegen EE, Verhoef J, Kwakkel G. Reliability and structural validity of the multidimensional fatigue inventory (MFI) in patients with idiopathic Parkinson's disease. Parkinsonism Relat Disord. 2012;18(5):532–6.CrossRefPubMed
23.
Lin JM, Brimmer DJ, Maloney EM, Nyarko E, Belue R, Reeves WC. Further validation of the Multidimensional Fatigue Inventory in a US adult population sample. Popul Health Metr. 2009;7:18.CrossRefPubMedPubMedCentral
24.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRefPubMed
25.
Hu LT, Bentler PM. Evaluating model fit. In: Hoyle R, editor. Structural equation modeling: concepts, issues, and applications. Thousand Oaks: Sage; 1995. p. 76–99.
26.
Chilcot J, Guirguis A, Friedli K, et al. Measuring fatigue using the multidimensional fatigue Inventory-20: a questionable factor structure in Haemodialysis patients. Nephron. 2017;136(2):121–6.CrossRefPubMed
27.
Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. Upper Saddle River: Prentice-Hall, Inc; 2010.
28.
Singer S, Kuhnt S, Zwerenz R, et al. Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer. 2011;105(3):445–51.CrossRefPubMedPubMedCentral
29.
Dencker A, Sunnerhagen KS, Taft C, Lundgren-Nilsson A. Multidimensional fatigue inventory and post-polio syndrome - a Rasch analysis. Health Qual Life Outcomes. 2015;13:20.CrossRefPubMedPubMedCentral
30.
Fillion L, Gelinas C, Simard S, Savard J, Gagnon P. Validation evidence for the French Canadian adaptation of the multidimensional fatigue inventory as a measure of cancer-related fatigue. Cancer Nurs. 2003;26(2):143–54.CrossRefPubMed
31.
Hagelin CL, Wengstrom Y, Runesdotter S, Furst CJ. The psychometric properties of the Swedish multidimensional fatigue inventory MFI-20 in four different populations. Acta Oncol. 2007;46(1):97–104.CrossRefPubMed
32.
Buss T, Kruk A, Wisniewski P, Modlinska A, Janiszewska J, Lichodziejewska-Niemierko M. Psychometric properties of the polish version of the multidimensional fatigue Inventory-20 in cancer patients. J Pain Symptom Manage. 2014;48(4):730–7.CrossRefPubMed
33.
Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010;14(1):R14.CrossRefPubMedPubMedCentral
34.
Holzner B, Kemmler G, Meraner V, et al. Fatigue in ovarian carcinoma patients: a neglected issue? Cancer. 2003;97(6):1564–72.CrossRefPubMed
35.
Addington AM, Gallo JJ, Ford DE, Eaton WW. Epidemiology of unexplained fatigue and major depression in the community: the Baltimore ECA follow-up, 1981-1994. Psychol Med. 2001;31(6):1037–44.CrossRefPubMed
36.
McCann K, Boore JR. Fatigue in persons with renal failure who require maintenance haemodialysis. J Adv Nurs. 2000;32(5):1132–42.CrossRefPubMed
37.
Paiva CE, Barroso EM, Carneseca EC, et al. A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC Med Res Methodol. 2014;14:8.CrossRefPubMedPubMedCentral
38.
Jubran A, Lawm G, Duffner LA, et al. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med. 2010;36(12):2030–7.CrossRefPubMedPubMedCentral
39.
Chiumello D, Taccone P, Berto V, et al. Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position. Intensive Care Med. 2012;38(2):221–9.CrossRefPubMed
40.
American Psychiatric Association A. Diagnostic and statistical manual of mental disorders: DSM-5 TM. 5th ed. Arlington, VA: American Psychiatric Association; 2013.CrossRef
41.
Nordin A, Taft C, Lundgren-Nilsson A, Dencker A. Minimal important differences for fatigue patient reported outcome measures-a systematic review. BMC Med Res Methodol. 2016;16:62.CrossRefPubMedPubMedCentral
Metadata
Title
Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20)
Authors
Gloria-Beatrice Wintermann
Jenny Rosendahl
Kerstin Weidner
Bernhard Strauß
Andreas Hinz
Katja Petrowski
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2018
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-018-0862-6

Other articles of this Issue 1/2018

Health and Quality of Life Outcomes 1/2018 Go to the issue

Research

The capability set for work – correlates of sustainable employability in workers with multiple sclerosis

Research

The impact of depression and anxiety on quality of life in Chinese cancer patient-family caregiver dyads, a cross-sectional study

Research

Measurement properties of the Short Form-36 (SF-36) and the Functional Assessment of Cancer Therapy - Anemia (FACT-An) in patients with anemia associated with chronic kidney disease

Research

Quality of life after low-dose rate-brachytherapy for prostate carcinoma – long-term results and literature review on QLQ-C30 and QLQ-PR25 results in published brachytherapy series

Research

Chinese translation and psychometric testing of the cardiac self-efficacy scale in patients with coronary heart disease in mainland China

Research

Mapping of the Gastrointestinal Short Form Questionnaire (GSF-Q) into EQ-5D-3L and SF-6D in patients with gastroesophageal reflux disease