Predictors of patient-reported fatigue symptom severity in a nationwide multiple sclerosis cohort

Simon Englund; Marie Kierkegaard; Joachim Burman; Katharina Fink; Anna Fogdell-Hahn; Martin Gunnarsson; Jan Hillert; Annette Langer-Gould; Jan Lycke; Petra Nilsson; Jonatan Salzer; Anders Svenningsson; Johan Mellergård; Tomas Olsson; Elisa Longinetti; Thomas Frisell; Fredrik Piehl

doi:10.1016/j.msard.2022.104481

Predictors of patient-reported fatigue symptom severity in a nationwide multiple sclerosis cohort

Mult Scler Relat Disord. 2023 Feb:70:104481. doi: 10.1016/j.msard.2022.104481. Epub 2022 Dec 23.

Authors

Simon Englund¹, Marie Kierkegaard², Joachim Burman³, Katharina Fink⁴, Anna Fogdell-Hahn⁴, Martin Gunnarsson⁵, Jan Hillert⁴, Annette Langer-Gould⁶, Jan Lycke⁷, Petra Nilsson⁸, Jonatan Salzer⁹, Anders Svenningsson¹⁰, Johan Mellergård¹¹, Tomas Olsson⁴, Elisa Longinetti⁴, Thomas Frisell¹², Fredrik Piehl⁴

Affiliations

¹ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: simon.englund@ki.se.
² Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
³ Department of Neuroscience, Uppsala University, Uppsala, Sweden.
⁴ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁶ Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, United States.
⁷ Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden.
⁸ Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden.
⁹ Department of Pharmacology and Clinical Neuroscience, Umea University, Umeå, Sweden.
¹⁰ Clinical Sciences, Danderyd Hospital Stockholm, Stockholm, Sweden.
¹¹ Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.
¹² Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

PMID: 36603296
DOI: 10.1016/j.msard.2022.104481

Abstract

Background: Fatigue is a debilitating symptom of multiple sclerosis (MS), but its relation to sociodemographic and disease-related characteristics has not been investigated in larger studies. The objectives of this study were to evaluate predictors of self-reported fatigue in a Swedish nationwide register-based MS cohort.

Methods: Using a repeated cross-sectional design, we included 2,165 persons with relapsing- remitting and secondary progressive MS with one or multiple Fatigue Scale for Motor and Cognitive Functions (FSMC) scores, which was modelled using multivariable linear regressions for multiple predictors.

Results: Only associations to expanded disability status scale (EDSS) and Symbol Digit Modalities Test (SDMT) were considered clinically meaningful among MS-associated characteristics in our main model; compared to mild disability (EDSS 0-2.5), those with severe disability (EDSS ≥6) scored 17.6 (95% CI 13.1-22.2) FSMC points higher, while the difference was 10.7 (95% CI 8.0-13.4) points for the highest and lowest quartiles of SDMT. Differences between highest and lowest quartiles of health-related quality of life (HRQoL) instruments were even greater and considered clinically meaningful; EuroQoL Visual Analogue Scale (EQ-VAS) 31.9 (95% CI 29.9-33.8), Multiple Sclerosis Impact Scale (MSIS-29) psychological component 35.6 (95% CI 33.8-37.4) and MSIS-29 physical component 45.5 (95% CI 43.7-47.4).

Conclusion: Higher self-reported fatigue is associated with higher disability level and worse cognitive processing speed, while associations to other MS-associated characteristics including MS type, line of disease modifying therapy (DMT), MS duration, relapse and new cerebral lesions are weak. Furthermore, we found a strong correlation between high fatigue rating and lower ratings on health-related quality of life instruments.

Keywords: Cohort studies; Comorbidity; Fatigue; Health-related quality of life; Multiple sclerosis; Quality of life.

MeSH terms

Cross-Sectional Studies
Fatigue / psychology
Humans
Multiple Sclerosis* / psychology
Patient Reported Outcome Measures
Quality of Life