Volume 33, Issue 126 (October 2020)                   IJN 2020, 33(126): 1-15 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Hejazizadeh N, Pazokian M, Abdi M. Fatigue in Patients with Multiple Sclerosis in Tehran in 1398. IJN 2020; 33 (126) :1-15
URL: http://ijn.iums.ac.ir/article-1-3281-en.html
1- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Medical– Surgical Department, Faculty Member, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 09126851924 Email: pazokian@sbmu.ac.ir
3- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (2382 Views)
Background & Aims: The prevalence of multiple sclerosis (MS) has been on the rise, especially among the youth in Iran. MS is more common in the individuals in their 20s and 40s, while women are also twice as likely to develop MS compared to men. Statistics suggest that there are 2.5 million MS patients worldwide, and this figure has been reported to be 15-30 cases per 100,000 in Iran. According to the Iranian MS Association, approximately 50,000 Iranians have MS, including 9,000 registered cases, and the rate is constantly increasing. Some of the main symptoms of MS are neurological, sensory, motor, and balance disorders, and fatigue is considered to be the most debilitating and common symptom; about one-third of MS patients report fatigue within the first three years of the disease diagnosis. Fatigue is an early symptom in 40% of MS patients, and 38% experience fatigue as the first diagnostic symptom. Extensive research has assessed the correlations between MS and various demographic variables, including individual factors (age, gender, education level), familial factors (family history of the disease), social factors (support of social institutions), economic factors (monthly income), emotional factors (family support), and disease-related factors (age at onset, length of hospital stay, medication). The present study aimed to measure fatigue in a large population of MS patients and determine its association with demographic variables.
Materials & Methods: This correlational study was conducted on 296 MS patients referring to the Iranian MS Association in Tehran, Iran during June-August 2019 via computation within a specific period. Fatigue was measured using Krupp fatigue intensity (1989), which has been used in extensive medical research. The minimum and maximum possible scores in this scale are nine and 63, respectively. Scores 9-18 indicate low fatigue, scores 18-45 indicate moderate fatigue, and scores above 45 show high fatigue. In Iran, Shahvaroughi Farahani et al. (2009) have measured the internal consistency of the items in this scale, which has been confirmed at the Cronbach's alpha coefficient of 0.96, showing that the items of this questionnaire measure a concept. In addition, the intraclass correlation-coefficient test has been applied to evaluate the relative reproducibility of the Persian version of the questionnaire, with the value reported to be 0.93. The inclusion criteria of our study were the ability to communicate, basic literacy, dealing with MS for a minimum of one year, and not being in the acute stage of the disease. Participation was completely voluntary and free. The patients were assured of confidentiality terms regarding their personal information, which was only disclosed to the research team and used for scientific purposes. Data of the patients were collected anonymously, and a code was assigned to each questionnaire to prevent the disclosure of information. Data analysis was performed in SPSS version 16 using independent t-test, ANOVA, Pearson's and Spearman's correlation-coefficient, D'Agostino-Pearson omnibus test, a correlation matrix, and Wilcoxon matched-pairs signed ranks test.
Results: In total, 296 MS patients were enrolled in the study with the mean age of 37.15 ± 8.85 years and mean disease duration of 29.95 ± 22.06 years. Regarding the treatment costs, 18 patients reported low treatment costs, 74 cases reported moderate costs, while 102 and 63 patients reported high and extremely high treatment costs, respectively. Notably, the variable of medical expenses was correlated with the type of patient insurance (P=0.009), and the patients with armed forces insurance paid the least expenses for their treatment. The mean exercise duration of the MS patients was 4.34 ± 2.91 hours per week, and the mean total fatigue score was 39.18 ±14.56. According to the obtained results, 31 patients (10.5%) had low fatigue, 157 patients (53.3%) had moderate fatigue, and 108 patients (36.2%) had high fatigue. A significant association was also observed between the involved organs of the patients and fatigue (P=0.004), so that fatigue was higher in the patients whose four limbs were affected by MS and those with visual impairment in addition to the four affected limbs. In the general classification of disorders in the MS patients (sensory, motor, and sensorimotor disorders), motor disorders were most prevalent (41.89%), followed by sensorimotor disorders (41.71%) and sensory disturbance (35.66%). Furthermore, a significant correlation was observed between the number of hospitalizations due to MS and fatigue (P=0.001), so that with the increased number of hospitalizations, the patients expressed more fatigue. On average, our participants had three hospitalizations, and a significant association was denoted between marital status and fatigue (P=0.042). Compared to the single patients, fatigue was more common among the married, divorced, and widowed patients. In addition, monthly income was significantly associated with fatigue (P=0.001), and the patients with inadequate income expressed more fatigue. Exercise was also significantly correlated with fatigue (P=0.018), and less fatigue was observed in the patients who had physical exercise.
Conclusion: Considering that fatigue is a common symptom in MS patients, special attention should be paid to the influential factors to identify, eliminate or reduce the factors that are changeable. According to the results, fatigue is one of the most debilitating and common symptoms experienced by MS patients. Therefore, these patients, their families, and the treatment team (especially nurses) must recognize the influential factors in fatigue in order to increase patient awareness and reduce fatigue in these patients. We attempted to identify and report some of the influential factors in fatigue, such as individual and psychological, environmental, and disease-related factors, in the MS patients. It is recommended that proper measures be taken to reduce the debilitative factors and strengthen the factors that reduce fatigue. Moreover, healthcare officials should plan to increase income and create suitable job opportunities for MS patients who experience the limitations caused by the disease. The family members of these patients (especially spouses) could also provide great support, which plays a key role in adapting to the disease, taking measures to reduce fatigue, adherence to the treatment regimen, and reducing the number of hospitalizations in MS patients.
Full-Text [PDF 1265 kb]   (1186 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2020/07/4 | Accepted: 2020/10/3 | Published: 2020/10/3

References
1. Fernández-Muñoz JJ, Cigarán-Méndez M, Navarro-Pardo E, Pérez-de-Heredia-Torres M, Parás-Bravo P, Fernández-de-las-Peñas C. Is the association between health-related quality of life and fatigue mediated by depression in patients with multiple sclerosis? A Spanish cross-sectional study. BMJ open. 2018;8(1):1-7. [DOI:10.1136/bmjopen-2017-016297] [PMID] [PMCID]
2. Safari M, Gholamzadeh A, Asadi A, Mahjour M. The therapeutic and anti-inflammatory effects of ginseng in multiple sclerosis patients. Razi Journal of Medical Sciences. 2020;27(2):59-69.
3. Daneshjoo A, Gheitasi M, Jaffari N. The effect of six weeks' massage in water on walking speed, postural control, pain intensity, fatigue and quality of life in women with multiple sclerosis. Anesthesiology and Pain. 2020;11(1):70-84.
4. Jalili N, Poursafa A, Khazaali K, Rostami H, Jamshidian E, Mohammadi Z, Kamali F, Bahrani N. Investigating Environmental Barriers Affecting Participation in Patient With Multiple Sclerosis. Archives of Rehabilitation. 2020;21(1):2-21. [DOI:10.32598/RJ.21.1.1627.2]
5. Shahnazari Z, Marandi SM, Shayegan Nejad V. The effect of pilates exercises and aquatic trainning on walking speed in women with multiple sclerosis. Journal of Research Development in Nursing and Midwifery. 2013;10(2):10-7.
6. Ghadampour E, Radmehr P, Yousefvand L. The effectiveness of acceptance and commitment based treatment on social competence and life expectancy of patients with multiple sclerosis. Armaghane danesh. 2017;21(11):1100-14.
7. Payamani F, Cheraghi F, Borzou SR, Hojjatoleslami S, Khatiban M. Nursing process based on Johnson's Behavioral System Model in Patients with Multiple Sclerosis: Case Report. Journal of Nursing Education (JNE). 2020;9(2):19-26.
8. Asgharkhah E, Shareh H. Effectiveness of group metacognitive therapy in self-efficacy and defense styles in women with multiple sclerosis. Journal of Fundamentals of Mental Health. 2017;19(4):330-40.
9. Dalvi-Isfahani F, Alimohammadi N, Pahlavanzadeh S. The Effectiveness of Group Psychological Training on the Depression of family caregivers Multiple Sclerosis Patients: Clinical Trials. Journal of Research in Behavioural Sciences. 2020;18(1):91-100.
10. Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis of multiple sclerosis: progress and challenges. The Lancet. 2017;389(10076):1336-46. [DOI:10.1016/S0140-6736(16)30959-X]
11. Blikman LJ, van Meeteren J, Twisk JW, de Laat FA, de Groot V, Beckerman H, Stam HJ, Bussmann JB, Trefams-Ace study group. Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial. Mult Scler J. 2017;23(11):1527-41. [DOI:10.1177/1352458517702751] [PMID]
12. Pazokian M, Shanan M, Zakerimoghadam M, Mehran A, Yekefallah L. The Comparative Effects of Stretching with Aerobic and Aerobic Exercises on Fatigue in Multiple Sclerosis Patients: A Randomized Controlled Clinical Trial. International Journal of Community Based Nursing and Midwifery. 2013;1(4):230-7.
13. Berger JR, Pocoski J, Preblick R, Boklage S. Fatigue heralding multiple sclerosis. Mult Scler J. 2013;19(11):1526-32. [DOI:10.1177/1352458513477924] [PMID]
14. Razazian N, Shokrian N, Bostani A, Moradian N, Tahmasebi S. Study of fatigue frequency and its association with sociodemographic and clinical variables in patients with multiple sclerosis. Neurosciences. 2014;19(1):38-42.
15. Abedini M, Paksersht M, Rafiei A, Valadan R, Amjadi O, Khajavi R, Abediankenari S, Habibi R. Demographic and clinical characteristics of multiple sclerosis. Journal of Mazandaran University of Medical Sciences. 2016;25(132):13-22.
16. Fragoso YD, Silva ÉO, Finkelsztejn A. Correlation between fatigue and self-esteem in patients with multiple sclerosis. Arquivos de neuro-psiquiatria. 2009;67(3B):818-21. [DOI:10.1590/S0004-282X2009000500007] [PMID]
17. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-52. [DOI:10.1212/WNL.33.11.1444] [PMID]
18. Sangelaji B, Salimi Y, Dastoorpour M, Mansouri T, Ashrafinia F, Esmaeilzadeh N, Asadi-Lari M. The relationship between disability and quality of life in multiple sclerosis patients. Health and Development Journal. 2013;2(3):203-13.
19. Newman MA, Dawes H, Van den Berg M, Wade DT, Burridge J, Izadi H. Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study. Mult Scler J. 2007;13(1):113-9. [DOI:10.1177/1352458506071169] [PMID]
20. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of neurology. 1989;46(10):1121-3. [DOI:10.1001/archneur.1989.00520460115022] [PMID]
21. Shahvaroughi-Farahani A, Azimian M, Falahpour M, Karimlou M. Reliability of the Persian version of the Fatigue Assay Scale in Multiple Sclerosis Patients. Quarterly Journal of Rehabilitation Research. 2009;10(4):46-51.
22. Bisecco A, Caiazzo G, d'Ambrosio A, Sacco R, Bonavita S, Docimo R, Cirillo M, Pagani E, Filippi M, Esposito F, Tedeschi G. Fatigue in multiple sclerosis: The contribution of occult white matter damage. Mult Scler J. 2016;22(13):1676-84. [DOI:10.1177/1352458516628331] [PMID]
23. Khodarahimi S, Rasti A. The roles of fatigue, depression, and Big Five Personality traits in males with and without multiple sclerosis disease. Clínica y salud. 2015;26(2):91-6. [DOI:10.1016/j.clysa.2015.03.002]
24. Ensan N, Boogar IR, Talepasand S, Estilaee F. The effectiveness of mindfulness-based stress reduction in fatigue severity among patients with multiple sclerosis. Studies in Medical Sciences. 2020;31(2):137-45.
25. Maleki FS, Khalkhali HR, Hemmati Maslak Pak M. Study The Effect Of Performance Roy Adaptation Model On Intensity And Effects Of Fatigue In Multiple Sclerosis Patients. The J Urmia Nurs Midwifery Fac. 2016;14(6):571-9.
26. Fernández‐Muñoz JJ, Morón‐Verdasco A, Cigarán‐Méndez M, Muñoz‐Hellín E, Pérez‐de‐Heredia‐Torres M, Fernández‐de‐Las‐Peñas C. Disability, quality of life, personality, cognitive and psychological variables associated with fatigue in patients with multiple sclerosis. Acta Neurol Scand. 2015;132(2):118-24. [DOI:10.1111/ane.12370] [PMID]
27. Tacchino A, Brichetto G, Zaratin P, Battaglia MA, Ponzio M. Self-assessment reliability in multiple sclerosis: the role of socio-demographic, clinical, and quality of life aspects. Neurol Sci. 2019;40(3):617-20. [DOI:10.1007/s10072-018-3589-6] [PMID]
28. Mills RJ, Young CA. The relationship between fatigue and other clinical features of multiple sclerosis. Mult Scler J. 2011;17(5):604-12. [DOI:10.1177/1352458510392262] [PMID]
29. Motaharinezhad F, Parvaneh S, Bakhtiary AH, Alizadeh N, Ghahari S. The effect of mood and cognition on relationship between sleep disturbances and fatigue in people with multiple sclerosis. Koomesh. 2016 19:613-9.
30. Sajjadi A, Farmahini Farahani B, Esmailpoor Zanjani S, Dormanesh B, Zare MO. Effective factors on fatigue in patients with chronic renal failure undergoing hemodialysis. J Crit Care Nurs. 2010;3(1):33-8.
31. Gerhard L, Dorstyn DS, Murphy G, Roberts RM. Neurological, physical and sociodemographic correlates of employment in multiple sclerosis: A meta-analysis. J Health Psychol. 2020;25(1):92-104. [DOI:10.1177/1359105318755262] [PMID]
32. Rejeh N, Hearavi-Karimoo M, Bahrami T, Raeesi R, Tadrisi SD. The assessment of factors affecting fatigue in older people with hemodialysis. Iranian Journal of Nursing Research. 2015;10(3):108-17.
33. Afrasiabifar A, Mehri Z, Sadat SJ, Shirazi HR. The effect of Orem's self-care model on fatigue in patients with multiple sclerosis: A single blind randomized clinical trial study. Iranian Red Crescent Medical Journal. 2016;18(8). [DOI:10.5812/ircmj.31955] [PMID] [PMCID]
34. Lerdal A, Celius EG, Moum T. Fatigue and its association with sociodemographic variables among multiple sclerosis patients. Mult Scler J. 2003;9(5):509-14. [DOI:10.1191/1352458503ms943oa] [PMID]
35. Ghanbari A, Shirmohamadi N, Paryad E, Kazemnejad LE. Predictors of fatigue in patients with chronic obstructive pulmonary disease. Journal of Knowledge & Health 2016;11(3):25-31.
36. Merkelbach S, Schulz H, Kölmel HW, Gora G, Klingelhöfer J, Dachsel R, Hoffmann F, Polzer U. Fatigue, sleepiness, and physical activity in patients with multiple sclerosis. J Neurol. 2011;258(1):74-9. [DOI:10.1007/s00415-010-5684-3] [PMID]
37. Neyestanak S, Heydari M, Hoseini AF, Ghodusi Borujeni M, Seyedfatemi N. Self esteem and its associated factors in patients with multiple sclerosis. Iran Journal of Nursing. 2012;25(78):14-22.
38. Flachenecker P, Kümpfel T, Kallmann B, Gottschalk M, Grauer O, Rieckmann P, Trenkwalder C, Toyka KV. Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler J. 2002;8(6):523-6. [DOI:10.1191/1352458502ms839oa] [PMID]
39. lriarte J, Subirá ML, de Castro P. Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors. Mult Scler J. 2000;6(2):124-30. https://doi.org/10.1191/135245800678827572 [DOI:10.1177/135245850000600212]

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Iran Journal of Nursing

Designed & Developed by : Yektaweb