Fatigue in multiple sclerosis compared to stroke

There is no 'suggestion' that fatigue is a problem in stroke. Don't any of you high faluting scientists ever talk to survivors?  Fatigue and spasticity are my top two problems. Solve them and I would be fully recovered in no time.
http://journal.frontiersin.org/article/10.3389/fneur.2015.00116/full?
Claudia Lukoschek¹, Annette Sterr^2,3,4, Dolores Claros-Salinas^1,5, Rolf Gütler¹ and Christian Dettmers^1,5,6*

• ¹Kliniken Schmieder Konstanz, Konstanz, Germany
• ²University of Surrey, Guildford, UK
• ³University of Freiburg, Freiburg im Breisgau, Germany
• ⁴Department of Neurology, University of São Paulo, São Paulo, Brazil
• ⁵Lurija Institute, Kliniken Schmieder Allensbach, Allensbach, Germany
• ⁶Department of Psychology, University of Konstanz, Konstanz, Germany

Objectives: Fatigue is typically associated with multiple sclerosis (MS), but recent studies suggest that it is also a problem for patients with stroke. While a direct comparison of fatigue in, e.g., Stroke and MS is desirable, it is presently not easily possible because of different definitions and assessment tools used for the two conditions. In the present study, we therefore assessed fatigue in Stroke and MS using a generic, not disease-specific instrument to allow transdiagnostic comparison.

Method: A total of 137 patients with MS and 102 patients with chronic stroke completed the SF-36, a generic questionnaire assessing health related quality of life. Fatigue was measured through the vitality scale of the SF-36. The vitality scale consists of two positive items (“lot of energy,” “full of life”) and two negative ones (“worn out,” “tired”). The two negative ones were scaled in reverse order. The vitality scale has been recommended as reciprocal index of fatigue.

Results: Normalized vitality scores in MS (35.3) and stroke (42.1) were clearly lower than published reference values from the SF-36 in age-matched healthy controls. The sum score of the vitality items was lower in MS than in stroke patients. This difference could not be explained by age, gender, or the Physical Functioning Scale of the SF-36. Both patient groups showed no positive correlation between fatigue and physical functioning. Fatigue – as determined with the vitality scale of the SF-36 – correlated with the estimated working capacity in MS patients, but not in stroke patients.

Conclusion: These findings confirm high fatigue in MS and stroke patients with higher values in MS. Fatigue has a higher impact on working capacity in MS than in stroke(really? have you talked to survivors?). Fatigue in both patient groups is not a direct consequent of physical functioning/impairment. Vitality score of the SF-36 is a suitable transdiagnostic measure for the assessment of fatigue in stroke and MS.

Introduction

Fatigue is a prominent and frequent symptom in multiple sclerosis (MS), and affects 60–90% of patients (1, 2). Fatigue is often experienced as the most disabling and limiting symptom, and greatly contributes to the degradation of general well-being, quality of life, and social participation (3, 4). Moreover, the impact of fatigue in the workplace can be severe and frequently triggers early retirement, even in the early phase of the disease (5). In contrast to the importance of fatigue for patients, treatment options are limited and efficacy varies substantively across patients (6) (see also Khan et al., this special issue). Understanding and distinguishing different pathophysiological mechanisms might improve individually tailored treatment options.

While fatigue is most prominent in MS, it is also observed in other conditions. This is particularly for patients with Stroke, where fatigue has been identified as “a major yet neglected issue” (7). This perspective has spearheaded more research in this arena (8–10), but the characteristics of fatigue in stroke have yet to be fully determined. It is further unclear to what extent fatigue in MS and Stroke share similarities in their impact on the individual, and whether fatigue is equally prevalent in the two conditions.

Because fatigue is by far best characterized in MS, benchmarking fatigue characteristics of other conditions against MS is important. However, such comparisons are challenging because the majority of assessment instruments, such as the Fatigue Severity Scale (11) and the Fatigue Scale for Motor and Cognitive Functions (FSMC) (12), have been specifically developed for MS, and might therefore not be equally sensitive in other neurological conditions. Moreover, a recent review on fatigue measures in neurological conditions concluded that the FSMC and the Unidimensional Fatigue Impact Scale (13, 14) are best suited for measuring fatigue in MS, while the Profile of Mood States Fatigue subscale (POMS-F) is the optimal measure for stroke (15).

If fatigue characteristics and fatigue prevalence are to be compared across neurological conditions, it is necessary to use a generic, disease-unspecific measure, which allows the transdiagnostic comparison of fatigue prevalence. Such a generic measure has been derived from the vitality subscale of the short form SF-36 (15). The SF-36 is a well-validated and accepted measure of health, which is used in a wide range of health care settings and research (16). Its vitality subscale has already been used to assess fatigue in patients with myocardial infarction (17). The present study therefore used the vitality subscale to contrast fatigue in 137 MS and 102 Stroke patients. Based on the prevailing notion that the fatigue affects the majority of MS patients, we predicted a more severe manifestation and a higher impact on working capacity in MS compared to Stroke.

More at link.