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Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales

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Abstract

Purpose

Postoperative fatigue (POF) is an often underestimated problem after surgery. Studies on POF often report fatigue scores without relating this to the clinical relevance for the patients. The aim of this study was to define the cut-off point for clinically significant POF in three commonly applied fatigue scales; the Postoperative Fatigue Scale, Christensen’s Fatigue Scale, and the Chalder Fatigue Questionnaire. The identification of cut-off points will make it possible to indicate whether statistically significant findings of increased fatigue are of clinical relevance.

Methods

We combined data from day 0 (pre-operatively) and day 1, 3, 6, and 30 after surgery in two fatigue-related studies with 442 patients. In order to define clinically significant fatigue, a key question was added in each questionnaire; “Given your current description of fatigue, would you say it has been of considerable significance to you?”; “Yes/No”. We analysed each scale’s ability to identify clinically significant fatigue, by performing receiver-operating characteristics (ROC) analyses, and calculated the optimal cut-off point between Sensitivity and Specificity.

Results

The average weighted cut-off point for clinically significant POF when measured with the Postoperative Fatigue Scale was ≥ 50 (scale range 0–100), with Christensen’s Fatigue Scale ≥ 6 (scale range 1–10) and with the Chalder Fatigue Questionnaire ≥ 16 (scale range 0–33).

Conclusion

In three commonly used fatigue scales, we have identified cut-off points for clinically significant fatigue among patients recovering from surgery. This can be particularly valuable for diagnostic purposes and in treatment evaluation. Further, it may be possible to analyse and review data from earlier studies in light of clinical relevance.

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Funding

Telemark Hospital Trust, Department of Research and Development has been the sole funding source, providing a partial buy-out from consultant practice for Torkjell Nøstdahl.

Author information

Authors and Affiliations

  1. Department of Anaesthesia, Telemark Hospital Trust, Skien, Norway

    Torkjell Nøstdahl

  2. Research & Development, Vestfold Hospital Trust, Tønsberg, Norway

    Tomm Bernklev

  3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Tomm Bernklev & Johan Raeder

  4. Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Olav M. Fredheim

  5. Department of Pain and Complex Disorders, National Competence Centre for Complex Symptom Disorders, St. Olav University Hospital, Trondheim, Norway

    Olav M. Fredheim

  6. Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway

    Olav M. Fredheim

  7. Department of Medicine, Wellington Hospital, Wellington, New Zealand

    Johanna S. Paddison

  8. Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway

    Johan Raeder

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  1. Torkjell Nøstdahl
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  2. Tomm Bernklev
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Correspondence to Torkjell Nøstdahl.

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Appendix

Appendix

See Tables 6, 7, 8, and 9 and Figs. 7 and 8.

Table 6 The American Society of Anesthesiologists classification system
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Table 7 Sensitivity, Specificity, Likelihood Ratios, and Predictive Values at the averaged Cut-off point for PO-FS (≥ 50/100), ChrFS (≥ 6/10), and CFQ (≥ 16/33)
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Table 8 Mean (SD) fatigue level measured with PO-FS, ChrFS, and CFQ
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Table 9 Comparison of fatigue after laparoscopic (lap.) or open cholecystectomy measured with ChrFS; from Hill [11] and Nostdahl [24]
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Fig. 7
figure 7

Christensen Fatigue Scale (ChrFS) [23]

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Fig. 8
figure 8

Percentage of day-surgery patients with clinically significant fatigue level (i.e. above the cut-off point) measured with PO-FS, ChrFS, and CFQ

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Nøstdahl, T., Bernklev, T., Fredheim, O.M. et al. Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales. Qual Life Res 28, 991–1003 (2019). https://doi.org/10.1007/s11136-018-2068-0

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