Heijman Michelle W J, van den Ende Cornelia H M, Peters Yvonne A S, Mahler Elien A M, Popa Calin D, Vriezekolk Johanna E
Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Rheumatol Adv Pract. 2023 Jul 8;7(2):rkad056. doi: 10.1093/rap/rkad056. eCollection 2023.
The variable course of fatigue adds to the disease burden of patients with OA yet it has been poorly understood. This study aimed to describe within-person fluctuations of fatigue severity and explore its associations with pain, positive affect, negative affect, sleep, and perceived exertion of physical activity.
Individuals with chronic knee pain or a clinical diagnosis of knee OA ≥40 years of age completed daily assessments about fatigue, pain, positive affect, negative affect, sleep, perceived exertion of physical activity (numeric rating scale 0-10), and overwhelming fatigue (yes/no) on a smartphone over 14 days. Within-person fluctuations of fatigue severity were described by the probability of acute changes (PACs) and s.d.s. Associations with pain, positive affect, negative affect, sleep, and perceived exertion of physical activity were explored using multilevel models.
Forty-nine individuals were included (mean age 63.4 years; 82% female). PACs and s.d.s of within-person daily fatigue fluctuations ranged from 0.00 to 0.80 and 0.35 to 2.95, respectively. Within-person associations of fatigue severity were moderate for positive affect [β = -0.57 (95% CI -0.67, -0.47)], weak for pain [β = 0.41 (95% CI 0.29, 0.53)] and negative affect [β = 0.40 (95% CI 0.21, 0.58)], and negligible for sleep [β = -0.13 (95% CI -0.18, -0.08)] and perceived exertion of physical activity [β = 0.18 (95% CI 0.09, 0.26)].
Some individuals showed almost stable day-to-day levels of fatigue severity, whereas others experienced a substantial number of clinically relevant fluctuations. To reduce the burden of daily fatigue fluctuations, our results suggest that pain, positive and negative affect rather than sleep and perceived exertion of physical activity should be considered as potential targets.
疲劳的变化过程增加了骨关节炎患者的疾病负担，但人们对此了解甚少。本研究旨在描述个体内疲劳严重程度的波动情况，并探讨其与疼痛、积极情绪、消极情绪、睡眠以及体力活动时的感知劳累程度之间的关联。
年龄≥40岁的慢性膝关节疼痛患者或临床诊断为膝关节骨关节炎的个体，在14天内通过智能手机完成关于疲劳、疼痛、积极情绪、消极情绪、睡眠、体力活动时的感知劳累程度（数字评分量表0 - 10）以及极度疲劳（是/否）的每日评估。通过急性变化概率（PACs）和标准差来描述个体内疲劳严重程度的波动情况。使用多层次模型探讨其与疼痛、积极情绪、消极情绪、睡眠以及体力活动时的感知劳累程度之间的关联。
纳入49名个体（平均年龄63.4岁；82%为女性）。个体内每日疲劳波动的PACs和标准差分别为0.00至0.80以及0.35至2.95。疲劳严重程度的个体内关联中，与积极情绪的关联为中度[β = -0.57（95%置信区间 -0.67，-0.47）]，与疼痛[β = 0.41（95%置信区间0.29，0.53）]和消极情绪[β = 0.40（95%置信区间0.21，0.58）]的关联为轻度，与睡眠[β = -0.13（95%置信区间 -0.18，-0.08）]和体力活动时的感知劳累程度[β = 0.18（95%置信区间0.09，0.26）]的关联可忽略不计。
一些个体的每日疲劳严重程度几乎保持稳定，而另一些个体则经历了大量具有临床意义的波动。为减轻每日疲劳波动的负担，我们的研究结果表明，应将疼痛、积极和消极情绪而非睡眠和体力活动时的感知劳累程度视为潜在的干预靶点。
