Velauthapillai Arthiha, Vonk Madelon C, van den Ende Cornelia Hm, Vriezekolk Johanna E
Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands.
J Scleroderma Relat Disord. 2024 Oct;9(3):223-232. doi: 10.1177/23971983241242836. Epub 2024 May 2.
To explore the within-person fluctuations of fatigue in systemic sclerosis and its association with negative affect, positive affect, pain, perceived exertion of physical activity and quality of sleep.
We performed an ecological momentary assessment study in adult patients with a clinical diagnosis of systemic sclerosis. During 14 days, patients completed daily assessments of fatigue severity, negative affect, positive affect, pain, quality of sleep and perceived exertion of physical activity at four fixed time points. The day-to-day fluctuations in fatigue were quantified by the intra-individual variance and probability of acute change, capturing the magnitude and frequency of clinical relevant within-person day-to-day fluctuations, respectively. Using multilevel models, the within-person association between fatigue and the daily assessments were analysed.
Fifty-seven patients with systemic sclerosis participated. The mean (standard deviation) intra-individual variance was 1.08 (0.42) and the probability of acute change was mean (standard deviation) 0.40 (0.14), ranging from 0.08 to 0.77. For fatigue, a within-person variation of 51% was observed. Multilevel analyses showed that higher average levels and daily increases in negative affect, pain and perceived exertion of physical activity were associated with more fatigue, while the opposite was observed for positive affect and quality of sleep. Positive affect demonstrated the strongest association with fatigue fluctuations.
This is the first quantitative study showing that fatigue in systemic sclerosis is characterized by a dynamic course and that approximately half of the day-to-day fluctuations within persons are clinically meaningful. Furthermore, our results indicate that integrating activities with positive impact on mood into fatigue treatment strategies might reduce the frequency of fatigue fluctuations.
探讨系统性硬化症患者疲劳的个体内波动及其与消极情绪、积极情绪、疼痛、体力活动感知 exertion 和睡眠质量的关联。
我们对临床诊断为系统性硬化症的成年患者进行了一项生态瞬时评估研究。在 14 天内，患者在四个固定时间点完成对疲劳严重程度、消极情绪、积极情绪、疼痛、睡眠质量和体力活动感知 exertion 的每日评估。疲劳的每日波动通过个体内方差和急性变化概率进行量化，分别捕捉临床相关的个体内每日波动的幅度和频率。使用多水平模型分析疲劳与每日评估之间的个体内关联。
57 例系统性硬化症患者参与研究。个体内方差的均值（标准差）为 1.08（0.42），急性变化概率的均值（标准差）为 0.40（0.14），范围为 0.08 至 0.77。对于疲劳，观察到个体内变化为 51%。多水平分析表明，消极情绪、疼痛和体力活动感知 exertion 的较高平均水平和每日增加与更多疲劳相关，而积极情绪和睡眠质量则相反。积极情绪与疲劳波动的关联最强。
这是第一项定量研究，表明系统性硬化症中的疲劳具有动态过程，且个体内约一半的每日波动具有临床意义。此外，我们的结果表明，将对情绪有积极影响的活动纳入疲劳治疗策略可能会降低疲劳波动的频率。
