Fatigue in Parkinson’s disease: Brazilian validation of the modified fatigue impact scale

LOPES, Josiane; ARAÚJO, Hayslenne Andressa Gonçalves de Oliveira; SMAILI, Suhaila Mahmoud

doi:10.1590/0004-282X20200033

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Articles • Arq. Neuro-Psiquiatr. 78 (08) • Aug 2020 • https://doi.org/10.1590/0004-282X20200033 copy

Fatigue in Parkinson’s disease: Brazilian validation of the modified fatigue impact scale

Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

The instruments that measure the impact of fatigue on physical, cognitive and psychosocial aspects has yet to be validated in Brazilian population with Parkinson’s disease (PD). The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the Modified Fatigue Impact Scale (MFIS-PD/BR).

Methods:

Ninety PD individuals were recruited. The adaptation of the MFIS-PD was performed by translation and back translation methodology. Psychometric analysis was applied in order to perform the administration of the socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson’s Disease Rating Scale (UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), Geriatric Depression Scale (GDS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16), and MFIS-PD/BR with retest of the MFIS-PD/BR after 7 days.

Results:

The adaptation phase kept the same items of original MFIS-PD. The Cronbach’s alpha for the MFIS-PD/BR was 0.878 when all responses items were scored. The test-retest intraclass correlation coefficients was above 0.80 (p<0.01) for the MFIS-PD/BR score, which was moderately correlated with the HADS, GDS, MDS-UPDRS score total and non-motor experiences of daily living, FSS and PFS-16. It was revealed the MFIS-PD/BR>29 points as cut-off point to indicate fatigued subjects with accuracy of 0.835 (p<0.001).

Conclusions:

The MFIS-PD/BR is valid and reproducible to use in assessing the fatigue symptom in Brazilian PD subjects.

Keywords:
Parkinson Disease; Fatigue; Validation Studies; Psychometrics

Variable	Adaptation sample (n=20)	Validation sample (n=70)
Demographics
Age, years	63.80±6.47	68.40±10.21
Education, years	8 (4.25-11)	8 (4-12.75)
Sex (male: female)	13: 7	45: 25
Clinical features
Disease duration, months	51 (31-92.75)	56.50 (27.25-96.25)
MMSE	27.50 (25.25-28.75)	26 (25-28)
HADS anxiety	5.85±2.99	6.76±3.77
HADS depression	6.30±3.18	6.73±3.16
HADS total score	12.15±5.20	13.50±5.83
GDS total score	3.5 (2-6.75)	4 (2-7)
HY, stage	2 (2-2.5)	2 (2-2.5)
HY, stage: 1/1.5/2/2.5/3/4/5 (n)	0/ 3/ 7/ 6/ 4/ 0/ 0	5/ 6/ 32/ 12/ 15/ 0/ 0
MDS-UPDRS - part I score	16.25±11.24	13.95±9.11
MDS-UPDRS - part II score	16.35±8.29	15.31±7.73
MDS-UPDRS - part III score	33.10±10.46	36.85±14.57
MDS-UPDRS - part IV score	5.20±5.47	4.75±5.03
MDS-UPDRS total score	70.90±27.90	70.87±28.56
LEDD (mg/ day)	519 (312.50-850)	500 (300-856.25)
Fatigue measures
FSS total score	4.26±1.39	3.70±1.39
PFS-16 total score	3.20±0.83	3.03±0.80
MFIS-PD total score	31.05±19.91	30.25±17.81

Variable	Fatigued (n=32)	Non-fatigued (n=38)	p-value
Demographics
Age, years	68.20±9.53	68.52±10.72	0.90
Education, years	9 (4-14.5)	8 (4-11)	0.52
Sex (male: female)	21 (65.6%): 11 (34.3%)	24 (63.1%): 14 (36.8%)	0.68
Clinical features
Disease duration, months	63 (48 - 89.75)	51 (17.75-111)	0.21
MMSE	26 (23.25-27.75)	26.50 (25-28.75)	0.24
HADS anxiety	8.20±3.30	5.90±3.80	0.01
HADS depression	8.62± 2.84	5.60 ±2.81	0.00
HADS total score	16.83±4.77	11.50±5.53	0.00
GDS total score	5.5 (3.25-9)	3.5 (2-6)	0.01
HY, stage	2.37±0.64	2.03±0.52	0.02
MDS-UPDRS - part I score	20.75± 8.69	9.87±6.63	0.00
MDS-UPDRS - part II score	18.87±8.14	13.17±6.71	0.00
MDS-UPDRS - part III score	39.37±15.53	35.35±13.95	0.28
MDS-UPDRS - part IV score	6.91±5.80	3.45±4.05	0.00
MDS-UPDRS total score	85.91±29.68	61.85±23.98	0.00
LEDD (mg/ day)	500 (300-737.50)	487.50 (300-893.75)	0.81
Fatigue measures
FSS total score	4.75±1.17	3.06±1.10	0.00
PFS-16 total score	3.84±0.45	2.55±0.52	0.00
MFIS-PD total score	42.87±17.55	22.67±13.19	0.00

MFIS/PD-BR - Item	Mean (SD)	CITC	α
1. I have been clumsy and uncoordinated.	0.90 (0.95)	0.401	0.851
2. I have had to pace myself in my physical activities.	2.18 (1.61)	0.056	0.855
3. I have been less motivated to do anything that requires physical effort.	1.37 (1.32)	0.675	0.848
4. I have trouble maintaining physical effort for long periods.	1.45 (1.33)	0.683	0.848
5. My muscles have felt weak	1.93 (1.52)	0.544	0.849
6. I have been physically uncomfortable.	1.71 (1.37)	0.570	0.849
7. I have been less able to complete tasks that require physical effort.	1.71 (1.30)	0.693	0.848
8. I have limited my physical activities.	1.60 (1.51)	0.735	0.846
9. I have needed to rest more often or for longer periods.	1.71 (1.53)	0.622	0.848
10. I have been less alert	1.18 (1.18)	0.680	0.848
11. I have had difficulty paying attention for long periods of time.	1.25 (1.33)	0.700	0.848
12. I have been unable to think clearly.	1.15 (1.23)	0.622	0.849
13. I have been forgetful.	1.64 (1.37)	0.503	0.849
14. I have had difficulty making decisions	0.90 (1.19)	0.566	0.849
15. I have been less motivated to do anything that requires thinking	1.29 (1.32)	0.747	0.847
16. I have had trouble finishing tasks that require thinking.	1.14 (1.46)	0.738	0.847
17. I have had difficulty organizing my thoughts when doing things at home or at work.	1.09 (1.34)	0.805	0.847
18. My thinking has been slowed down.	1.65 (1.43)	0.675	0.847
19. I have had trouble concentrating.	0.98 (1.09)	0.668	0.849
20. I have been less motivated to participate in social activities.	1.59 (1.43)	0.647	0.848
21. I have been limited in my ability to do things away from home.	1.71 (1.65)	0.629	0.847

MFIS/PD-BR (subscale)	ICC	[95% CI]	SEM	Bland-Altman
MFIS/PD-BR (subscale)	ICC	[95% CI]	SEM	d	95%CI of d	SD of d	95%LC
MFIS (Physical)
Intra-observer	0.88	0.81 - 0.93	2.84	-0.18	-1.39 -1.01	0.75	-11.69 - 11.32
Interobserver	0.86	0.77 - 0.91	5.52	-1.31	-2.66 - 0.03	0.05	-14.22 - 11.59
MFIS (Cognitive)
Intra-observer	0.96	0.93 - 0.97	1.96	-0.57	-1.51 - 0.35	0.22	-9.50 - 8.34
Interobserver	0.92	0.87 - 0.95	5.60	-1.32	-2.68 - 0.03	0.05	-14.32 - 11.66
MFIS (Psychosocial)
Intra-observer	0.89	0.84 - 0.93	1.12	0.15	-0.50 - 0.8	0.63	-6.14 - 6.45
Interobserver	0.84	0.75 - 0.90	2.06	-0.15	-0.65 - 0.34	0.53	-4.95 - 4.64
MFIS (Total)
Intra-observer	0.93	0.88 - 0.95	8.84	-0.60	-2.80 -1.58	0.58	-21.56 - 20.34
Interobserver	0.92	0.88 - 0.95	9.93	-2.79	-5.15 - (-0.44)	0.02	-25.31 - 19.72

Variable	MFIS-PD/BR	p- value
Variable	Correlation	p- value
Demographics
Age, years	0.10⁺	0.43
Education, years	-0.03⁺⁺	0.78
Sex (male; female)	-0.14⁺	0.24
Clinical features
Disease duration, months	0.06⁺⁺	0.60
MMSE	-0.33⁺⁺	0.00
HADS anxiety	0.26⁺	0.03
HADS depression	0.64	0.00
HADS total score	0.52	0.00
GDS total score	0.56⁺	0.00
HY, stage	0.32⁺	0.01
MDS-UPDRS - part I score	0.64⁺	0.00
MDS-UPDRS - part II score	0.33⁺	0.00
MDS-UPDRS - part III score	0.29⁺	0.01
MDS-UPDRS - part IV score	0.36⁺	0.00
MDS-UPDRS total score	0.51⁺	0.00
LEDD (mg/ day)	0.00⁺⁺	0.99
Fatigue measures
FSS total score	0.56⁺	0.00
PFS-16 total score	0.71⁺	0.00

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[1] Correspondence: Josiane Lopes; E-mail: josianelopes@yahoo.com.br