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Demonstration of two types of fatigue in subjects with chronic liver disease using factor analysis

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Abstract

Purpose

The purpose of this investigation was to determine if it was possible to separate fatigue self-reports into two distinct types of fatigue symptom clusters in research subjects with chronic liver disease (CLD). It was hypothesized that when items from the Medical Outcomes Study Short-Form (SF-36v2) are combined with items from the Fatigue Severity Scale (FSS), these distinct factors will emerge.

Methods

Confirmatory and exploratory factor analyses from data collected in a prospective, natural history study of CLD patients were conducted. Items were selected from the SF-36v2 and the FSS for entry into the factor analyses. In order to establish convergent and discriminant validity, derived factor scores were correlated with subscale scores of the Human Activity Profile (HAP), Mental Component Score (MCS) from the SF-36v2, and the Emotional Functioning Subscale of the Chronic Liver Disease Questionnaire (CLDQ-EF).

Results

106 participants with CLD were included (50% female; age: 51 ± 10). Two factors were identified. The factors included one that clustered around questions addressing fatigue related to physical activity (peripheral fatigue) and the other to the questions addressing generalized fatigue that did not require physical tasks to produce the fatigue (central fatigue). The standardized factor loadings of all items were greater than 0.6 on their underlying constructs. Moreover, all factor loadings are significant at p < 0.01. Peripheral fatigue was related to HAP (r = 0.26, r = 0.24, p < 0.01), as was central fatigue (r = −0.34, r = −0.33, p < 0.01). Central fatigue was related to MCS and CLDQ-EF (r = −0.60; r = −0.63, p < 0.01), whereas peripheral fatigue was not (r = 0.07, p > 0.40). We then tested the original scales to determine if the newly created factors correlated better with the validity measures. The full FSS did not correlate as well as the newly created central fatigue scale, while the original peripheral fatigue scale (the SF-36v2 physical functioning) was more related to HAP than the newly created scale.

Conclusions

In individuals with CLD, two separate factors pertaining to fatigue were identified. This recognition of the multifaceted nature of fatigue may help increase the specificity of self-reports of fatigue and lead to treatments that can specifically address the underlying factors contributing to fatigue.

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Acknowledgements

This work was supported by the Betty and Guy Beatty Center for Integrated Research.

Funding

This work was funded by the Betty and Guy Beatty Center for Integrated Research.

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Authors and Affiliations

  1. Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Ali A. Weinstein, Carey Escheik, Lynn H. Gerber & Zobair M. Younossi

  2. Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, USA

    Ali A. Weinstein & Lynn H. Gerber

  3. Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA

    Ali A. Weinstein & Heibatollah Baghi

  4. Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, VA, USA

    Guoqing Diao

  5. Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA

    Lynn H. Gerber & Zobair M. Younossi

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  1. Ali A. Weinstein
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  2. Guoqing Diao
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Correspondence to Ali A. Weinstein.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Weinstein, A.A., Diao, G., Baghi, H. et al. Demonstration of two types of fatigue in subjects with chronic liver disease using factor analysis. Qual Life Res 26, 1777–1784 (2017). https://doi.org/10.1007/s11136-017-1516-6

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  • DOI: https://doi.org/10.1007/s11136-017-1516-6

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