Abstract
Purpose
To examine the psychometric properties of the 9-item Fatigue Severity Scale (FSS) using a Rasch model application.
Methods
A convenience sample of HIV-infected adults was recruited, and a subset of the sample was assessed at 6-month intervals for 2 years. Socio-demographic, clinical, and symptom data were collected by self-report questionnaires. CD4 T-cell count and viral load measures were obtained from medical records. The Rasch analysis included 316 participants with 698 valid questionnaires.
Results
FSS item 2 did not advanced monotonically, and items 1 and 2 did not show acceptable goodness-of-fit to the Rasch model. A reduced FSS 7-item version demonstrated acceptable goodness-of-fit and explained 61.2% of the total variance in the scale. In the FSS-7 item version, no uniform Differential Item Functioning was found in relation to time of evaluation or to any of the socio-demographic or clinical variables.
Conclusion
This study demonstrated that the FSS-7 has better psychometric properties than the FSS-9 in this HIV sample and that responses to the different items are comparable over time and unrelated to socio-demographic and clinical variables.
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Abbreviations
- AIDS:
-
Acquired immune deficiency syndrome
- BMI:
-
Body mass index
- DIF:
-
Differential item functioning
- DS:
-
Daytime sleepiness subscale
- FSS:
-
Fatigue severity scale
- GSDS:
-
General sleep disturbance scale
- HIV:
-
Human immunodeficiency virus
- PCA:
-
Principal component analysis
- SE:
-
Standard error
References
Cunningham, W. E., Shapiro, M. F., Hays, R. D., Dixon, W. J., Visscher, B. R., George, W. L., et al. (1998). Constitutional symptoms and health-related quality of life in patients with symptomatic HIV disease. American Journal of Medicine, 104, 129–136.
Marcellin, F., Preau, M., Ravaux, I., Dellamonica, P., Spire, B., & Carrieri, M. P. (2007). Self-reported fatigue and depressive symptoms as main indicators of the quality of life (QOL) of patients living with HIV and Hepatitis C: Implications for clinical management and future research. HIV Clinical Trials, 8, 320–327.
Jenkin, P., Koch, T., & Kralik, D. (2006). The experience of fatigue for adults living with HIV. Journal of Clinical Nursing, 15, 1123–1131.
Lee, K. A., Portillo, C. J., & Miramontes, H. (2001). The influence of sleep and activity patterns on fatigue in women with HIV/AIDS. Journal of the Association of Nurses in Aids Care, 12(Suppl), 19–27.
Phillips, K. D., Sowell, R. L., Rojas, M., Tavakoli, A., Fulk, L. J., & Hand, G. A. (2004). Physiological and psychological correlates of fatigue in HIV disease. Biological Research for Nursing, 6, 59–74.
Henderson, M., Safa, F., Easterbrook, P., & Hotopf, M. (2005). Fatigue among HIV-infected patients in the era of highly active antiretroviral therapy. HIV Medicine, 6, 347–352.
Sullivan, P. S., & Dworkin, M. S. (2003). Prevalence and correlates of fatigue among persons with HIV infection. Journal of Pain and Symptom Management, 25, 329–333.
Pence, B. W., Barroso, J., Leserman, J., Harmon, J. L., & Salahuddin, N. (2008). Measuring fatigue in people living with HIV/AIDS: Psychometric characteristics of the HIV-related fatigue scale. AIDS Care, 20, 829–837.
Barroso, J., Preisser, J. S., Leserman, J., Gaynes, B. N., Golden, R. N., & Evans, D. N. (2002). Predicting fatigue and depression in HIV-positive gay men. Psychosomatics, 43, 317–325.
Millikin, C. P., Rourke, S. B., Halman, M. H., & Power, C. (2003). Fatigue in HIV/AIDS is associated with depression and subjective neurocognitive complaints but not neuropsychological functioning. Journal of Clinical and Experimental Neuropsychology, 25, 201–215.
Barroso, J., Hammill, B. G., Leserman, J., Salahuddin, N., Harmon, J. L., & Pence, B. W. (2010). Physiological and psychosocial factors that predict HIV-related fatigue. AIDS Behavior.
Darko, D. F., McCutchan, J. A., Kripke, D. F., Gillin, J. C., & Golshan, S. (1992). Fatigue, sleep disturbance, disability, and indices of progression of HIV infection. American Journal of Psychiatry, 149, 514–520.
Walker, K., McGown, A., Jantos, M., & Anson, J. (1997). Fatigue, depression, and quality of life in HIV-positive men. Journal of Psychosocial Nursing and Mental Health Services, 35, 32–40.
Simmonds, M. J., Novy, D., & Sandoval, R. (2005). The differential influence of pain and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency virus. Clinical Journal of Pain, 21, 200–206.
Voss, J. G. (2005). Predictors and correlates of fatigue in HIV/AIDS. Journal of Pain and Symptom Management, 29, 173–184.
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123.
Johansson, S., Ytterberg, C., Hillert, J., Widen, H. L., & von Koch, L. (2008). A longitudinal study of variations in and predictors of fatigue in multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 79, 454–457.
Lerdal, A., Bakken, L. N., Kouwenhoven, S. E., Pedersen, G., Kirkevold, M., Finset, A., et al. (2009). Poststroke fatigue-a review. Journal of Pain and Symptom Management, 38, 928–949.
Aouizerat, B. E., Miaskowski, C. A., Gay, C., Portillo, C. J., Coggins, T., Davis, H., et al. (2010). Risk factors and symptoms associated with pain in HIV-infected adults. Journal of the Association of Nurses AIDS Care, 21, 125–133.
Rabkin, J. G., McElhiney, M. C., Rabkin, R., & Ferrando, S. J. (2004). Modafinil treatment for fatigue in HIV+ patients: A pilot study. Journal of Clinical Psychiatry, 65, 1688–1695.
Rabkin, J. G., McElhiney, M. C., Rabkin, R., & McGrath, P. J. (2010). Modafinil treatment for fatigue in HIV/AIDS: A randomized placebo-controlled study. Journal of Clinical Psychiatry.
Lerdal, A., Wahl, A., Rustoen, T., Hanestad, B. R., & Moum, T. (2005). Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale. Scandinavian Journal of Public Health, 33, 123–130.
Whitehead, L. (2009). The measurement of fatigue in chronic illness: A systematic review of unidimensional and multidimensional fatigue measures. Journal of Pain and Symptom Management, 37, 107–128.
Lee, K. A. (1992). Self-reported sleep disturbances in employed women. Sleep, 15, 493–498.
Lee, K. A., Hicks, G., & Nino-Murcia, G. (1991). Validity and reliability of a scale to assess fatigue. Psychiatry Research, 36, 291–298.
Bond, T. G., & Fox, C. M. (2001). Applying the Rasch model. Fundamental measurement in the human sciences. Mahawah, New Jersey: Erlbaum Publishers.
Wright, B. D., & Stone, M. H. (1979). Best test design. Chicago: MESA Press.
Linacre, J. M. (2006). Winsteps computer program, Version 3.63.0. Chicago: Rasch Measurement.
Linacre, J. M. (2010). Winstep—Rasch model computer program. Version 3.69.1.16. http://www.winsteps.com, 2010 Retrieved June 2010.
Spector, P. E. (1992). Summated rating scale construction: An introduction. Beverly Hills and London: Sage Publications, Inc.
Linacre, J. M. (2004). Optimizing rating scale category effectiveness. In E. V. Smith & R. M. Smith (Eds.), Introduction to Rasch measurement: Theory, models and applications (pp. 258–278). Maple Grove: JAM Press Publisher.
Linacre, J. M. (2002). Optimizing rating scale category effectiveness. Journal of Applied Measurement, 3, 85–106.
Bond, T. G., & Fox, C. M. (2007). Applying the Rasch model: Fundamental measurement in the human sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Wright, B. D., & Masters, G. N. (1982). Rating scale analysis: Rasch measurement. Chicago: MESA Press.
Smith, A. B., Rush, R., Fallowfield, L. J., Velikova, G., & Sharpe, M. (2008). Rasch fit statistics and sample size considerations for polytomous data. BMC Medical Research Methodology, 8, 33.
Nilsson, I., & Fisher, A. G. (2006). Evaluating leisure activities in the oldest old. Scandinavian Journal of Occupational Therapy, 13, 31–37.
Patomella, A. H., Tham, K., & Kottorp, A. (2006). P-drive: assessment of driving performance after stroke. Journal of Rehabilitationl Medicine, 38, 273–279.
Linacre, J. M. (2005). Rasch-model computer programs. Internet 2005. Retrieved June 5, 2007, available from: URL: http://www.winsteps.com.
Smith, R. M., & Miao, C. Y. (1994). Assessing unidimensionality for Rasch measurement. In M. Wilson (Ed.), Objective measurement: Theory into practice. Greenwich: Ablex.
Raiche, G. (2005). Critical eigenvalue sizes in standardized residual prinicipal component analysis. Rasch Measurement Transactions, 19, 1012.
Mantel, N. (1963). Chi-square tests with one degree of freedom: Extensions of the Mantel Haenszel procedure. Journal of American Statistical Association, 58, 690–700.
Mantel, N., & Haenzel, W. (1959). Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute, 22, 719–748.
Petersson, I., Lilja, M., Hammel, J., & Kottorp, A. (2008). Impact of home modification services on ability in everyday life for people ageing with disabilities. Journal of Rehabilitation Medicine, 40, 253–260.
Kottorp, A., Bernspang, B., & Fisher, A. G. (2003). Activities of daily living in persons with intellectual disability: Strengths and limitations in specific motor and process skills. Australian Occupational Therapy Journal, 50, 195–204.
Stauffer, L. M., Fisher, A. G., & Duran, L. (2000). ADL performance of black Americans and white Americans on the assessment of motor and process skills. American Journal of Occupational Therapy, 54, 607–613.
Lerdal, A. (2009). Energy and fatigue in individuals with multiple sclerosis—a multi-method approach. Saarbrücken: VDM Verlag D. Müller.
Barroso, J., & Lynn, M. R. (2002). Psychometric properties of the HIV-Related Fatigue Scale. Journal of the Association of Nurses in AIDS Care, 13, 66–75.
Voss, J. G., Dodd, M., Portillo, C., & Holzemer, W. (2006). Theories of fatigue: application in HIV/AIDS. Journal of the Association of Nurses in AIDS Care, 17, 37–50.
Lerdal, A. (2002). A theoretical extension of the concept of energy through an empirical study. Scandinavian Journal of Caring Science, 16, 197–206.
Mills, R., Young, C., Nicholas, R., Pallant, J., & Tennant, A. (2009). Rasch analysis of the fatigue severity scale in multiple sclerosis. Multiple Sclerosis, 15, 81–87.
Lerdal, A., Johansson, S., Kottorp, A., & von Koch, L. (2010). Psychometric properties of the fatigue severity scale: Rasch analyses of responses in a Norwegian and a Swedish MS cohort. Multiple Sclerosis, 16, 733–741.
Lee, K. A., Gay, C., Portillo, C. J., Coggins, T., Davis, H., Pullinger, C. R., et al. (2009). Symptom experience in HIV-infected adults: A function of demographic and clinical characteristics. Journal of Pain and Symptom Management, 38, 882–893.
Silverberg, M. J., Jacobson, L. P., French, A. L., Witt, M. D., & Gange, S. J. (2009). Age and racial/ethnic differences in the prevalence of reported symptoms in human immunodeficiency virus-infected persons on antiretroviral therapy. Journal of Pain and Symptom Management, 38, 197–207.
Acknowledgments
This research was supported by a grant from the National Institute of Mental Health (NIMH, 5 R01 MH074358). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Data collection was supported by the General Clinical Research Center in the UCSF CTSA (1 UL RR024131). Dr. Lerdal has received funding from the Research Council of Norway (Grant # 19256), the Norwegian Nurses Organization and the U.S.–Norway Fulbright Foundation. Dr. Aouizerat is supported by an NIH Roadmap K12 (KL2 RR024130). Authors wish to acknowledge the contributions to the study from Traci Coggins, Skip Davis, Ryan Kelly, Yeonsu Song, Kristen Nelson, and Matthew Shullick.
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Lerdal, A., Kottorp, A., Gay, C. et al. A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model. Qual Life Res 20, 1447–1456 (2011). https://doi.org/10.1007/s11136-011-9877-8
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DOI: https://doi.org/10.1007/s11136-011-9877-8