Brazilian version of the Multidimensional Fatigue Inventory for Parkinson’s disease

Lopes, Josiane; Araújo, Hayslenne Andressa Gonçalves de Oliveira; Smaili, Suhaila Mahmoud

doi:10.1590/1980-5918.033.AO61

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ORIGINAL ARTICLE • Fisioter. mov. 33 • 2020 • https://doi.org/10.1590/1980-5918.033.AO61 copy

Brazilian version of the Multidimensional Fatigue Inventory for Parkinson’s disease

Versão brasileira do Inventário Multidimensional de Fadiga na doença de Parkinson

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The multidimensional fatigue inventory (MFI) has not been applied in Brazilian Parkinson`s disease (PD) population due to the lack of validation.

Objective:

The aim of this study was to cross-culturally adapt, to validate, and investigate the psychometric properties of Brazilian version of the MFI in PD.

Method:

Idiopathic PD individuals (N = 90) were recruited. The MFI was translated into Brazilian Portuguese using established forward-backward translation procedures, and the psychometric properties were evaluated. All individuals were assessed by socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson’s Disease Rating Scale (MDS-UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16) and MFI-PD/ BR with retest of the MFI-PD/BR after seven days.

Results:

The adaptation phase kept the same items of original MFI-PD. No data missing, floor nor ceiling effects were found. The overall Cronbach's alpha coefficient for the 20 items was 0.81, ranging from 0.73 to 0.81 for each of the five subscales. Bland and Altman analysis showed no systematic differences between assessments. The intraclass correlation coefficient test-retest was higher or equal 0.70 (p < 0.01) for the MFI-PD/BR score, which was moderately correlated with the HADS, MDS-UPDRS score (motor examination, motor and non-motor experiences of daily living and motor complications), FSS and PFS-16. It was revealed the MFI-PD/ BR > 55 points as cut-off point to indicate fatigued subjects with accuracy of 0.84 (p < 0.001).

Conclusion:

The MFI-PD/BR can be considered a valid and reproducible instrument for assessing PD-related fatigue.

Keywords:
Parkinson Disease; Fatigue; 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)
Sex, n (%)	5.85 ± 2.99	6.76 ± 3.77
HADS anxiety	6.30 ± 3.18	6.73 ± 3.16
HADS depression	12.15 ± 5.20	13.50 ± 5.83
HADS total score	2 (2 - 2.5)	2 (2 - 2.5)
HY, stage	0/ 3/ 7/ 6/ 4/ 0/ 0	5/ 6/ 32/ 12/ 15/ 0/ 0
HY, stage: 1/1.5/2/2.5/ 3/4/5 (n)	16.25 ± 11.24	13.95 ± 9.11
MDS-UPDRS - part I score	16.35 ± 8.29	15.31 ± 7.73
MDS-UPDRS - part II score	33.10 ± 10.46	36.85 ± 14.57
MDS-UPDRS - part III score	5.20 ± 5.47	4.75 ± 5.03
MDS-UPDRS - part IV 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
MFI-PD total score	60.94 ± 12.80	58.05 ± 12.34
MFI general fatigue	12.71 ± 3.86	12.50 ± 3.70
MFI physical fatigue	14.59 ± 3.85	13.09 ± 3.43
MFI reduced activity	13.88 ± 3.03	13.23 ± 2.79
MFI mental fatigue	10.88 ± 3.23	10.95 ± 3.33
MFI reduced motivation	8.88 ± 2.57	9.37 ± 2.47

Variables (n=319)	Fatigued (n = 32)	Nonfatigued (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
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
MFI-PD total score	66.67 ± 7.71	52.88 ± 11.73	0.00
MFI general fatigue	14.17 ± 3.08	10.43 ± 3.23	0.00
MFI physical fatigue	15.33 ± 2,25	11,93 ± 3.54	0.00
MFI reduced activity	14.17 ± 2.53	12.40 ± 3.06	0.02
MFI mental fatigue	12.33 ± 2.83	9.93 ± 3.28	0.00
MFI reduced motivation	10.66 ± 2.88	8.20 ± 2.37	0.00

MFI/PD-BR - Item and subscale	Mean (SD)	CITC	α
1. I feel fit.	2.95 (1.25)	0.61	0.84
2. Physically I feel only able to do a little.	3.50 (1.06)	0.48	0.84
3. I feel very active.	2.92 (1.11)	0.45	0.84
4. I feel like doing all sorts of nice things.	1.83 (1.01)	0.17	0.85
5. I feel tired.	3.25 (1.23)	0.44	0.84
6. I think I do a lot in a day.	3.03 (1.22)	0.42	0.84
7. When I am doing something, I can keep my thoughts on it.	2.44 (1.19)	0.34	0.85
8. Physically I can take on a lot.	3.34 (1.21)	0.63	0.84
10. I think I do very little in a day.	3.34 (1.27)	0.43	0.84
11. I can concentrate well.	2.52 (1.19)	0.58	0.84
12. I feel rested.	2.31 (1.22)	0.51	0.84
13.I takes a lot of effort to concentrate on things.	2.88 (1.16)	0.41	0.84
14. Physically I feel I am in a bad condition.	3.06 (1.24)	0.64	0.84
15. I have a lot of plans.	2.64 (1.21)	0.19	0.85
16. I tired easily.	3.33 (1.33)	0.63	0.84
17. Physically I feel only able to do a little.	3.77 (1.06)	0.29	0.85
18. I don`t feel like doing anything	2.30 (1.25)	0.39	0.85
19. My thoughts easily wander.	3.00 (1.20)	0.26	0.85
20.Physically I feel I am in a excellent condition	3.30 (1.19)	0.64	0.84
MFI-PD total score	58.04 (12.33)	1.00	0.81
MFI general fatigue	11.82 (3.64)	0.80	0.73
MFI physical fatigue	13.20 (3.52)	0.85	0.73
MFI reduced activity	13.06 (2.98)	0.69	0.76
MFI mental fatigue	10.82 (3.31)	0.61	0.76
MFI reduced motivation	9.12 (2.82)	0.45	0.79

				Bland-Altman
MFI/PD-BR (subscale)	ICC	[95% CI]	SEM	d	95%CI of d	SD of d	95%LC
MFI (General Fatigue)
Intra-observer	0.82	0.72 - 0.88	2.97	-0.67	-1.21 - (-0.12)	0.01	-5.90 - 4.55
Interobserver	0.70	0.56 - 0.81	3.83	0.09	-0.62 - 0.81	0.79	-6.81 - 7.00
MFI (Physical fatigue)
Intra-observer	0.79	0.68 - 0.87	3.02	0.10	-0.44 - 0.66	0.69	-5.15 - 5.37
Interobserver	0.76	0.63 - 0.84	3.29	1.01	0.40 - 1.62	0.00	-4.85 - 6.89
MFI (Reduced Activity)
Intra-observer	0.79	0.65 - 0.87	2.40	-0.17	-0.77 - 0.42	0.56	-5.92 - 5.57
Interobserver	0.78	0.63 - 0.86	2.70	0.25	-0.42 - 0.92	0.46	-6.20 - 6.70
MFI (Mental fatigue)
Intra-observer	0.74	0.60 - 0.83	3.16	-0.12	-0.72 - 0.47	0.67	-5.82 - 5.57
Interobserver	0.72	0.67 - 0.88	3.03	0.32	-0.30 - 0.96	0.30	-5.73 - 6.39
MFI (Reduced Motivation)
Intra-observer	0.77	0.53 - 0.87	2.17	-0.25	-0.93 - 0.43	0.47	-6.84 - 6.34
Interobserver	0.75	0.59 - 0.85	2.58	-0.04	-0.68 - 0.59	0.88	-6.17 - 6.08
MFI (Total)
Interobserver	0.89	0.82 - 0.93	7.53	-1.10	-2.47 - 0.25	0.10	-14.16 - 11.94
Intra-observer	0.85	0.76 - 0.90	9.51	1.64	-0.09 - 3.38	0.06	-14.99 - 18.27

Variable	MFI-PD/BR
	Correlation	p-value
Demographics
Age, years	0.087⁺	0.496
Education, years	0.143⁺⁺	0.260
Sex (male: female)	-0.112⁺	0.378
Clinical features
Disease duration, months	0.079⁺⁺	0.534
MMSE	-0.242⁺⁺	0.054
HADS anxiety	0.244⁺	0.052
HADS depression	0.644⁺	0.000
HADS total score	0.507⁺	0.000
HY, stage	0.365⁺	0.003
MDS-UPDRS - part I score	0.592⁺	0.000
MDS-UPDRS - part II score	0.406⁺	0.001
MDS-UPDRS - part III score	0.431⁺	0.000
MDS-UPDRS - part IV score	0.284⁺	0.023
MDS-UPDRS total score	0.569⁺	0.000
LEDD (mg/day)	0.072⁺⁺	0.570
Fatigue measures
FSS total score	0.662⁺	0.000
PFS-16 total score	0.728⁺	0.000

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[1] *JL: PhD, e-mail: jolopes@unicentro.br HAGOA: Doctoral student, e-mail: h.andressa.goa@hotmail.com SMS: PhD, e-mail: suhailaneuro@gmail.com