Mental fatigue assessment may add information after aneurysmal subarachnoid hemorrhage.

BACKGROUND: Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. AIMS OF THE STUDY: The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). METHODS: One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self-assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of ≥10.5 indicates mental fatigue. RESULTS: All patients with GOSE 8, indicating full recovery, had a mental fatigue score of <10.5. A linear correlation between the GOSE and the mental fatigue score was observed (p < 0.0001). CONCLUSIONS: Patients with a favorable outcome and GOSE 5-7 could benefit from the assessments of mental fatigue in order to receive satisfactory rehabilitation.

Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients.

BACKGROUND: Many cancer patients suffer from symptoms of anxiety, depression, and fatigue. Supportive treatments are increasingly used to alleviate distress in cancer. In this study, the effects of yoga on these symptoms are examined. METHODS: We performed a randomized controlled study on cancer patients with mixed diagnoses comparing yoga therapy with a waiting list control group. We measured anxiety symptoms with the General Anxiety Disorder (GAD-7) scale, depressive symptoms with the Patient Health Questionnaire-2 (PHQ-2), and fatigue with the European Organisation for Research and Treatment of Cancer Fatigue scale (EORTC QLQ-FA13). Yoga therapy was carried out in weekly sessions of 60 min each for 8 weeks. The program provided restrained body and breathing exercises as well as meditation. The control group did not receive any yoga therapy while on the waiting list. RESULTS: A total of 70 subjects participated in the study. Anxiety was significantly reduced by the yoga therapy in the intervention group compared to the control group (p = 0.005). However, yoga therapy did not show any significant effects on depression (p = 0.21) and fatigue (p = 0.11) compared to the control group. CONCLUSION: Yoga therapy may be used to alleviate anxiety symptoms in cancer patients and should be the subject of further research.

Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates.

The objectives of this study were to document the evolution of fatigue in the first year after traumatic brain injury (TBI), and to explore correlates of fatigue. Participants were 210 adults who were hospitalised following a TBI. They completed questionnaires 4, 8, and 12 months post-injury, including the Multidimensional Fatigue Inventory (MFI). Participants with severe TBI presented greater mental and physical fatigue, and reduced activity compared to participants with moderate TBI. For all MFI subscales except reduced motivation, the general pattern was a reduction of fatigue levels over time after mild TBI, an increase of fatigue after severe TBI, and stable fatigue after moderate TBI. Fatigue was significantly associated with depression, insomnia, cognitive difficulties, and pain at 4 months; the same variables and work status at 8 months; and depression, insomnia, cognitive difficulties, and work status at 12 months. These findings suggest that injury severity could have an impact on the course of fatigue in the first year post-TBI. Depression, insomnia, and cognitive difficulties remain strong correlates of fatigue, while for pain and work status the association with fatigue evolves over time. This could influence the development of intervention strategies for fatigue, implemented at specific times for each severity subgroup.

Managing Poststroke Fatigue Using Telehealth: A Case Report.

OBJECTIVE: The objective of this study was to examine the effectiveness of delivering Managing Fatigue: A Six-Week Course for Energy Conservation via telehealth for a 70-yr-old man with poststroke fatigue (PSF). METHOD: For this pilot case study, a questionnaire developed by the authors and the Patient-Reported Outcomes Measurement Information System Fatigue Short Form 7a were used for screening. The study was implemented via teleconference over an 8-wk period. The Fatigue Impact Scale (FIS) and the Canadian Occupational Performance Measure (COPM) were used to gather pretest and posttest data. RESULTS: After the participant completed the course, decreased fatigue impact was noted on the FIS, and modestly improved occupational performance and satisfaction were evidenced by the COPM. CONCLUSION: For this single participant experiencing PSF, performance and satisfaction on the COPM guardedly improved and fatigue impact decreased after participation in the energy conservation course offered by teleconference, a form of telehealth delivery. Further research is recommended with larger sample sizes.

The effects of auditive and visual settings on perceived restoration likelihood.

Research has so far paid little attention to how environmental sounds might affect restorative processes. The aim of the present study was to investigate the effects of auditive and visual stimuli on perceived restoration likelihood and attitudes towards varying environmental resting conditions. Assuming a condition of cognitive fatigue, all participants (N = 40) were presented with images of an open plan office and urban nature, each under four sound conditions (nature sound, quiet, broadband noise, office noise). After the presentation of each setting/sound combination, the participants assessed it according to restorative qualities, restoration likelihood and attitude. The results mainly showed predicted effects of the sound manipulations on the perceived restorative qualities of the settings. Further, significant interactions between auditive and visual stimuli were found for all measures. Both nature sounds and quiet more positively influenced evaluations of the nature setting compared to the office setting. When office noise was present, both settings received poor evaluations. The results agree with expectations that nature sounds and quiet areas support restoration, while office noise and broadband noise (e.g. ventilation, traffic noise) do not. The findings illustrate the significance of environmental sound for restorative experience.

A neuropsychological rehabilitation program for patients with Multiple Sclerosis based on the model of the ICF.

BACKGROUND: Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. OBJECTIVE: The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. METHODS: Forty patients with MS were randomised in an intervention (IG) - and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. RESULTS: In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. CONCLUSION: These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation.

Self-reported fatigue and physical function in late mid-life.

OBJECTIVE: To determine the association between the 5 subscales of the Multidimensional Fatigue Inventory (MFI-20) and physical function in late mid-life. DESIGN: Cross-sectional study. SUBJECTS: A population-based sample of adults who participated in the Copenhagen Aging and Midlife Biobank population cohort (n = 4,964; age 49-63 years). METHODS: Self-reported fatigue was measured using the MFI-20 comprising: general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. Handgrip strength and chair rise tests were used as measures of physical function. Multiple logistic regression analyses were used to determine the associations between handgrip strength and the chair rise test with the MFI-20 subscales, adjusted for potential confounders. RESULTS: After adjustments for potential confounders, handgrip strength was associated with physical fatigue (adjusted odds ratio (OR) 0.75 (95% confidence interval (CI) 0.66-0.86); p ≤ 0.001) and reduced motivation (adjusted OR 0.85 (95% CI 0.75-0.96); p ≤ 0.05), but not with the other subscales. After these adjustments, the chair rise test was associated with physical fatigue (adjusted OR 0.61 (0.53-0.69); p ≤ 0.001), general fatigue (adjusted OR 0.72 (0.62-0.84); p ≤ 0.001), reduced activity (adjusted OR 0.79 (0.70-0.90); p ≤ 0.001) and reduced motivation (adjusted OR 0.84 (0.74-0.95); p ≤ 0.01), but not with mental fatigue. Subgroup analyses for sex did not show statistically significant different associations between physical function and fatigue. CONCLUSION: The present study supports the physiological basis of 4 subscales of the MFI-20. The association between fatigue and function was independent of gender.

A prospective study of the association between the readiness for return to work scale and future work participation in Norway.

AIM: The aim of the study was to investigate the associations between the Norwegian version of the Readiness for return to work (RTW) scale and future work participation among persons in inpatient occupational rehabilitation. METHODS: A prospective cohort with one year follow up. The participants (n = 179) were persons with reduced work ability who participated in a one-week inpatient rehabilitation program. Four readiness for RTW factors were identified at baseline using explorative factor analysis: 'RTW inability' and 'RTW uncertainty' among persons not working, and 'uncertain work maintenance' and 'proactive work maintenance' among persons working. Work participation was measured as days without sickness benefits in the year following the rehabilitation program. The associations between work participation and readiness for RTW factors were analyzed in multivariate linear regression models controlling for gender, age, subjective health complaints, employment status and previous sickness benefit. RESULTS: High scores on the RTW inability factor were associated with low future work participation among persons not working before the rehabilitation program. Among persons working before the program, the proactive work maintenance factor was associated with high future work participation. Neither the RTW uncertainty factor nor the uncertain work maintenance factor was associated with future work participation. CONCLUSIONS: The associations between two readiness for RTW factors (RTW inability and proactive work maintenance) and future work participation indicate that these factors can be used as screening tools to tailor occupational rehabilitation programs.

Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury.

OBJECTIVE: Patients who suffer from mental fatigue after a stroke or traumatic brain injury (TBI) have a drastically reduced capacity for work and for participating in social activities. Since no effective therapy exists, the aim was to implement a novel, non-pharmacological strategy aimed at improving the condition of these patients. METHODS: This study tested a treatment with mindfulness-based stress reduction (MBSR). The results of the programme were evaluated using a self-assessment scale for mental fatigue and neuropsychological tests. Eighteen participants with stroke and 11 with TBI were included. All the subjects were well rehabilitated physically with no gross impairment to cognitive functions other than the symptom mental fatigue. Fifteen participants were randomized for inclusion in the MBSR programme for 8 weeks, while the other 14 served as controls and received no active treatment. Those who received no active treatment were offered MBSR during the next 8 weeks. RESULTS: Statistically significant improvements were achieved in the primary end-point--the self-assessment for mental fatigue--and in the secondary end-point--neuropsychological tests; Digit Symbol-Coding and Trail Making Test. CONCLUSION: The results from the present study show that MBSR may be a promising non-pharmacological treatment for mental fatigue after a stroke or TBI.

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis.

PURPOSE: To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). METHODS: This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey--Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. RESULTS: Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. CONCLUSIONS: Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union.

Players in team sports must recover in a relatively short period of time to perform at optimal levels. To enhance recovery, cryotherapy is widely used. To date, there are limited scientific data to support the use of cryotherapy for recovery. Players (n = 26) from a premier rugby club volunteered to participate in a random control trial (RCT) using contrast baths, ice baths, and no recovery. Statistical analysis, between group and within group, with repeated measures was conducted along with determination of effect sizes in 2 field tests. Pre and postfield tests including a 300-m test and a phosphate decrement test and subjective reports were conducted during the RCT. No significant difference was identified between base tests and retests in the phosphate decrement test or the 300-m tests. Effect size calculations identified a medium to large effect (d = 0.72) for 300-m tests for contrast baths against control. Trivial effects were identified for ice baths (d = 0.17) in the 300-m test against control. Effect size calculations in the phosphate decrement test showed a trivial effect (d = 0.18) contrast baths and a negative effect (d = -0.62) for ice baths. Treatment-treatment analysis identified a large effect for contrast baths (d = 0.99) in the phosphate decrement test and a medium effect for contrast baths (d = 0.53) in the 300-m test. Effect scores across contrast baths, ice baths, and passive recovery along with subjective reports indicate a trend toward contrast baths benefiting recovery in rugby. The continued use of 5-minute ice baths for recovery should be reconsidered based on this research because trends suggest a detrimental effect.

One-year follow-up to a randomized controlled trial of an energy conservation course for persons with multiple sclerosis.

In this randomized controlled trial, 169 persons with multiple sclerosis were randomly assigned to an immediate intervention group or a delayed control group using a crossover design. The outcome measures (Fatigue Impact Scale and SF-36 Health Survey) were measured four times before and after courses. This study investigated whether the immediate benefits of a 6-week, community-based, energy conservation course for persons with multiple sclerosis were maintained at 1-year follow-up. We performed intent-to-treat and compliers-only analyses using mixed effects analysis of variance models. Results showed that the beneficial effects were maintained 1-year postcourse compared with immediate postcourse. In addition, there were significant improvements in all three subscales of the Fatigue Impact Scale and in four subscales of SF-36 Health Survey 1-year postcourse compared with precourse. Together, these results provide strong evidence that the beneficial effects of the energy conservation course taught by occupational therapists were maintained up to 1-year postcourse.

Cancer-related fatigue: predictors and effects of rehabilitation.

BACKGROUND: The aims of the study were to examine the effects of a multidimensional rehabilitation program on cancer-related fatigue, to examine concurrent predictors of fatigue, and to investigate whether change in fatigue over time was associated with change in predictors. SAMPLE: 72 cancer survivors with different diagnoses. SETTING: rehabilitation center. INTERVENTION: 15-week rehabilitation program. MEASURES: Fatigue (Multidimensional Fatigue Inventory), demographic and disease/treatment-related variables, body composition (bioelectrical impedance), exercise capacity (symptom-limited bicycle ergometry), muscle force (handheld dynamometry), physical and psychological symptom distress (Rotterdam Symptom Check List), experienced physical and psychological functioning (RAND-36), and self-efficacy (General-Self-Efficacy Scale, Dutch version). Measurements were performed before (T0) and after rehabilitation (T1). RESULTS: At T1 (n = 56), significant improvements in fatigue were found, with effect sizes varying from -0.35 to -0.78. At T0, the different dimensions of fatigue were predicted by different physical and psychological variables. Explained variance of change in fatigue varied from 42%-58% and was associated with pre-existing fatigue and with change in physical functioning, role functioning due to physical problems, psychological functioning, and physical symptoms distress. CONCLUSIONS: Within this selected group of patients we found that (a) rehabilitation is effective in reducing fatigue, (b) both physical and psychological parameters predicted different dimensions of fatigue at baseline, and (c) change in fatigue was mainly associated with change in physical parameters.

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