One-item Scale Is Reliable Tool to Assess Fatigue in Parkinson’s Patients, Study Finds

The one-item Fatigue Visual Analog Scale (VAFS) is a highly consistent and reliable tool to assess fatigue in patients with Parkinson’s disease, and is associated with their quality of life, according to researchers.

Their study, “The dimensionality of fatigue in Parkinson’s disease,” was published in the Journal of Translational Medicine.

Fatigue is one of the most common, but often under-recognized, symptoms of Parkinson’s disease, affecting 30-70 percent of patients. About one-third of Parkinson’s patients consider fatigue the single most bothersome symptom, even more than the disease-associated motor symptoms.

Fatigue in Parkinson’s tend to develop early in the disease, and it significantly affects patients’ quality of life. Fatigue can be defined as an overwhelming sense of tiredness and lack of energy, making the performance of routine activities, physical or mental, a strain.

However, a universally accepted definition and classification is still missing, creating large challenges to its measurements.

Recently, the International Parkinson and Movement Disorder Society (MDS) — a society of clinicians, researchers, and other healthcare professionals who specialize in Parkinson’s disease — evaluated nine of the most commonly used scales to assess fatigue in Parkinson’s patients based on their ease of use, but none was considered to be a “highly recommended” tool for that purpose.

In the current study, researchers evaluated four of those scales to determine whether they could be reliable tools to assess fatigue in these patients, and whether their scores could be linked to fatigue’s negative impact on patients’ quality of life.

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The study involved 22 Parkinson’s patients (15 men and seven women; mean age of 69), and 15 age-matched individuals (two men and 13 women; mean age of 63), who were, in most cases, the spouses or caregivers of the Parkinson’s patients.

All participants completed four scales: the Fatigue Severity Scale (FSS), the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), the Parkinson Fatigue Scale (PFS), and the Fatigue Visual Analog Scale (VAFS).

Parkinson’s patients were also asked to list their top three most bothersome Parkinson’s symptoms, and to complete 13 quality of life-related measures, including cognition, sleep, depression, life orientation, physical activity, and Parkinson’s symptoms.

The scores from the four scales showed that Parkinson’s patients experienced much more fatigue than their spouses/caregivers. Many of the patients had excessive and unusual fatigue, and six (27 percent) included fatigue in their top three most bothersome symptoms.

The results of the Fatigue Severity Scale, Parkinson Fatigue Scale, and Visual Analogue Fatigue Scale were highly consistent, and could predict with elevated certainty if the results were from Parkinson’s patients or from spouses/caregivers.

Among them, the Visual Analogue Fatigue Scale was the most reliable tool, and patients who rated their fatigue as lower than 5.5 (when lower values indicated more fatigue) were found to be three times more likely to have excessive fatigue.

“Although lengthy questionnaires that are specific and detailed may serve their purposes, it appears that a simple question asking subjects how they feel overall (such as fatigue or pain) succinctly captures the status of their well-being,” the researchers wrote.

They also found that while fatigue scores were associated with changes in many of the quality of life-related measures analyzed, the 39-item Parkinson’s Disease Questionnaire (PDQ-39) showed the strongest association.

The PDQ-39 is a tool that includes eight disease dimensions: mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort.

“The potential utility of a single measure such as the VAFS in [Parkinson’s] that is reliably correlated with quality of life is consistent with the pursuit to develop clinical tests and measurements that are accessible, easy to use, and universally interpretable across health science disciplines,” they concluded.