Johansson S, Ytterberg C, Hillert J, Widén Holmqvist L, von Koch L
Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
J Neurol Neurosurg Psychiatry. 2008 Apr;79(4):454-7. doi: 10.1136/jnnp.2007.121129.
To describe variations in fatigue over the course of 2 years in a sample of persons with multiple sclerosis (MS), and to investigate the predictive value of the following variables on variations in fatigue: sex, age, sense of coherence, living with a partner, living with children, work status, immunomodulatory treatment, mood, disease severity, disease course, time since diagnosis and time.
Every 6 months, 219 outpatients at an MS specialist clinic were assessed using the Fatigue Severity Scale (FSS). Predictive values were explored with Generalised Estimating Equation employing proportional odds models; FSS scores were categorised as non-fatigue, borderline fatigue or fatigue.
FSS scores varied significantly (p = 0.02); 54% changed FSS category one or several times, 27% were persistently fatigued and 19% persistently non-fatigued. Independent predictors of increased fatigue were depressive symptoms, weak/moderate sense of coherence, living with a partner and not working. Furthermore, moderate disease severity predicted increase when combined with >10 years since diagnosis or a progressive course. Independent predictors of decreased fatigue were no depressive symptoms, strong sense of coherence, living alone and working. Moreover, mild and severe disease predicted a decrease when combined with >10 years since diagnosis, and mild severity combined with a progressive course.
Mood, sense of coherence and living with a partner were independent predictors of fatigue in persons with MS. In addition to monitoring disease related variables, health related services should apply a broad range of approaches and repeatedly assess fatigue in persons with MS, to provide preventive care and appropriate interventions.
描述多发性硬化症（MS）患者样本在2年病程中疲劳情况的变化，并研究以下变量对疲劳变化的预测价值：性别、年龄、连贯感、与伴侣同住、与子女同住、工作状态、免疫调节治疗、情绪、疾病严重程度、疾病病程、确诊时间和时间。
每6个月，使用疲劳严重程度量表（FSS）对一家MS专科诊所的219名门诊患者进行评估。采用广义估计方程和比例优势模型探讨预测价值；FSS评分分为无疲劳、临界疲劳或疲劳。
FSS评分有显著变化（p = 0.02）；54%的患者FSS类别改变了一次或几次，27%的患者持续疲劳，19%的患者持续无疲劳。疲劳增加的独立预测因素是抑郁症状、弱/中度连贯感、与伴侣同住和不工作。此外，中度疾病严重程度与确诊超过10年或病程进展相结合时预测疲劳增加。疲劳减少的独立预测因素是无抑郁症状、强烈的连贯感、独居和工作。此外，轻度和重度疾病与确诊超过10年相结合时预测疲劳减少，轻度严重程度与病程进展相结合时也如此。
情绪、连贯感和与伴侣同住是MS患者疲劳的独立预测因素。除了监测与疾病相关的变量外，健康相关服务应采用广泛的方法，并反复评估MS患者的疲劳情况，以提供预防性护理和适当的干预措施。
