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Flensner, Gullvi
Publications (10 of 15) Show all publications
Engström, M., Flensner, G., Landtblom, A.-M., Ek, A.-C. & Karlsson, T. (2013). Thalamo-striato-cortical determinants to fatigue in multiple sclerosis. Brain and Behavior, 3(6), 715-728
Open this publication in new window or tab >>Thalamo-striato-cortical determinants to fatigue in multiple sclerosis
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2013 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 3, no 6, p. 715-728Article in journal (Refereed) Published
Abstract [en]

Background

The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue.

Methods

MS participants with self-reported fatigue were examined by functional magnetic resonance imaging (fMRI) during the performance of a complex working memory task. In this task, cognitive effort was challenged by a parametric design, which modeled the cerebral responses at increasing cognitive demands. In order to explore the theory of central fatigue in MS we also analyzed the cerebral responses by adding perceived fatigue scores as covariates in the analysis and by calculating the functional connectivity between regions in the thalamo-striatocortical network. The main findings were that MS participants elicited altered brain responses in the thalamo-striato-cortical network, and that brain activation in the left posterior parietal cortex and the right substantia nigra was positively correlated to perceived fatigue ratings. MS participants had stronger cortical-to-cortical and subcortical-to-subcortical connections, whereas they had weaker cortical-to-subcortical connections.

Conclusions

The findings of the present study indicate that the thalamo-striato-cortical network is involved in the pathophysiology of fatigue in MS, and provide support for the theory of central fatigue. However, due to the limited number of participants and the somewhat heterogeneous sample of MS participants, these results have to be regarded as tentative, though they might serve as a basis for future studies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2013
Keywords
Basal ganglia, functional magnetic resonance imaging, parietal cortex, substantia nigra, working memory
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-99384 (URN)10.1002/brb3.181 (DOI)000346972200012 ()
Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-12-06Bibliographically approved
Flensner, G., Landtblom, A.-M., Soderhamn, O. & Ek, A.-C. (2013). Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study. BMC Public Health, 13
Open this publication in new window or tab >>Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13Article in journal (Refereed) Published
Abstract [en]

Background: Among individuals diagnosed with the chronic neurologic disease, multiple sclerosis (MS), a majority suffers from fatigue, which strongly influences their every-day-life. The aim of this study was to investigate work capacity and health-related quality of life (HRQoL) in a group of MS patients and also to investigate if work capacity and HRQoL could be predicted by background factors, fatigue, heat sensitivity, cognitive dysfunction, emotional distress or degree of disability. less thanbrgreater than less thanbrgreater thanMethods: A descriptive, cross-sectional, designed survey was undertaken A questionnaire was sent to 323 individuals diagnosed with MS, aged between 20 and 65 years, with physical disability on the expanded disability status score (EDSS) in the interval 0 andgt;= EDSS andlt;= 6.5, living in sterg"tland county in eastern Sweden. Questions on background factors, occupation and work, together with the health-related quality of life short form instrument (SF-36), the fatigue severity scale (FSS), the perceived deficit questionnaire (PDQ) and the hospital anxiety depression scale (HAD) were posed. Associations between variables were analyzed using Pearsons and Spearmans correlations. Differences between groups were tested using the Chi-square test, the Mann Whitney U-test, and the Students t-test. Predictive factors were analyzed using multiple linear and multiple logistic regression analysis. less thanbrgreater than less thanbrgreater thanResults: Of those who completed the questionnaire (n = 257, 79.6%), 59.8% were working. Work capacity was found significantly more among men (p andlt; 0.005), those with a higher level of education (p andlt; 0.001), those reporting less fatigue (p andlt; 0.001), and those having no heat sensitivity (p = 0.004). For work capacity, significant predictors were low physical disability (EDSS), low fatigue, higher level of education, male sex and lower age. Those with work capacity showed significantly higher HRQoL than those who had no work capacity (p andlt; 0.001). Levels of fatigue, cognition and emotional distress were found to be major contributing factors for HRQoL. less thanbrgreater than less thanbrgreater thanConclusions: Work capacity and HRQoL among individuals diagnosed with MS are highly influenced by fatigue which can be considered as a key symptom. Work capacity was influenced by heat-sensitivity, cognitive difficulties and emotional distress and significant predictive factors besides fatigue, were physical disability (EDSS), age, sex, and level of education. Remaining at work also gives a better HRQoL.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Cognition, Education, Emotional distress, Heat sensitivity, Regression analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-92615 (URN)10.1186/1471-2458-13-224 (DOI)000317116400001 ()
Note

Funding Agencies|Swedish Research Council||University West||

Available from: 2013-05-16 Created: 2013-05-14 Last updated: 2017-12-06
Fex, A., Flensner, G., Ek, A.-C. & Söderhamn, O. (2012). Self-Care Agency and Perceived Health Among Persons Using Advanced Medical Technology at Home. Journal of Advanced Nursing, 68(4), 806-815
Open this publication in new window or tab >>Self-Care Agency and Perceived Health Among Persons Using Advanced Medical Technology at Home
2012 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 806-815Article in journal (Refereed) Published
Abstract [en]

Aim. This paper is a report of a study of self-care agency and perceived health in a group ofpersons using advanced medical technology at home.

Background. An increasing number of persons are using medical technology for self-care. Few studies describe daily life in this context at an overriding level, irrespective of the specific sort of technology. A connection between self-care, perceived health and sense of coherence has previous been implied.

Methods. A descriptive, comparative, cross-sectional quantitative design was used. Data were collected from a questionnaire in the winter 2009/2010. The questionnaire addressed perceiveed health and daily life with medical technology, and applied Swedish versions of the Appraisal of Self-care Agency scale and the 13-item version of Antonovsky’s sense of coherence scale.

Results. The questionnaire was answered by 180 adults performing self-care at home involving long-term oxygen, a ventilator, peritoneal or blood dialysis. Health-related and technology-related variables in daily life were rated as satisfactory to a high extent. Perceived health was rated significantly lower among participants using long-term oxygen. Sufficient sense of coherence and knowledge of how to use technology, close contacts with other persons, and not feeling helpless contributed positively as factors for self-care agency. Positive factors for perceived health were being satisfied with life, having an active life, and not feeling helpless, while age was a negative factor.

Conclusion. Daily life is manageable for persons using these types of technology. Long-term oxygen treatment and advanced age can be seen as risk factors for perceiving ill health.

Keywords
Appraisal of self-care agency scale, high-tech care; home ventilator; home dialysis; long-term oxygen; nursing; sense of coherence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63741 (URN)10.1111/j.1365-2648.2011.05781.x (DOI)000301426000009 ()
Note
Funding Agencies|Department of Nursing, Health and Culture, University West||Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linkoping University||University of Agder||University West, Sweden||University of Agder, Norway||Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
Engström, M., Flensner, G., Landtblom, A.-M. & Karlsson, T. (2011). Aberrant brain activation in the core control network for cognitive function in MS. Paper presented at RSNA 2011, Chicago.
Open this publication in new window or tab >>Aberrant brain activation in the core control network for cognitive function in MS
2011 (English)Conference paper, Published paper (Other academic)
Abstract [en]

Purpose: The purpose of this study was to investigate if patients with multiple sclerosis (MS) and fatigue have aberrant brain activation in the anterior insular cortex (AIC) and the anterior cingulate cortex (ACC), which are regions in the brain that are suggested to be a core network for cognitive control (Cole and Schneider, 2007; Sridharan et al., 2008).

 Materials and Methods: Twelve patients with MS and eleven healthy controls were examined with functional Magnetic Resonance Imaging (fMRI) while performing a complex working memory task. The task was to indicate if words presented in video goggles had appeared in previously presented sentences. Axial blood oxygen level dependent (BOLD) images were analyzed with SPM8 software. Images were realigned for movement correction, normalised to standard brain template, and smoothed with 8mm Gaussian kernel. We used a parametric contrast that tapped brain activation as a function of difficulty level of the task, i.e. words presented after 1, 2, 3, or 4 consecutive sentences.

Results: Healthy controls elicited more activation in the left superior parietal lobe (p<0.001 family wise error (FWE) corrected for multiple comparisons), the right caudate head (p=0.002), and ACC (p=0.004) compared to MS patients. The MS patients had more activity in the left and right inferior parietal lobe (p=0.001 and p=0.029, respectively). In addition, in a region of interest analysis the MS patients had more activation in the left dorsal and ventral AIC (p=0.011 and p=0.009, respectively). The figure shows brain activation at working memory across both healthy controls and MS.

 Conclusion: MS patients elicited, as predicted, aberrant activation in the AIC-ACC network in that they had activation depletion in ACC and increased activity in the left AIC. It has recently been proposed that the AIC engenders awareness and the ACC engenders volitional action (Craig, 2009). The abnormal activation in this region could therefore explain the frequent symptoms of fatigue and cognitive impairment in MS.

 Clinical Relevance statement: Cognitive impairment occurs in 40-70% of individuals with MS and the patophysiology is unknown. Increased knowledge might contribute to novel strategies for symptomatic treatment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70396 (URN)
Conference
RSNA 2011, Chicago
Available from: 2011-09-06 Created: 2011-09-06 Last updated: 2013-09-04
Engström, M., Flensner, G., Landtblom, A.-M., Ek, A.-C. & Karlsson, T. (2011). Fatigue and cognitive effort in multiple sclerosis: an fMRI study. Paper presented at Brain & Cognition, Sevilla 2011.
Open this publication in new window or tab >>Fatigue and cognitive effort in multiple sclerosis: an fMRI study
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2011 (English)Conference paper, Published paper (Other academic)
Abstract [en]

Despite recent advances in therapy and diagnosis, fatigue remains a mayor challenge in multiple sclerosis (MS).  To further the understanding of the neural underpinnings of fatigue, we undertook a study using functional magnetic resonance imaging (fMRI) to investigate neural networks that may be affected by MS-related fatigue. Twelve MS patients and 12 age- and sex matched controls were administered the Fatigue Impact Scale (FIS) to assess clinically significant fatigue, and underwent a neuropsychological examination. The participants performed a working memory task (Daneman’s  ‘Reading Span’ task) while being monitored by means of a 1.5 T Philips Achieva MR scanner. We have previously shown that this task triggers an executive network comprising frontal and parietal areas typically involved in working memory. In addition, the task engages a core network involving the anterior insula and the anterior cingulate cortex.  This latter network may be implicated in allocation of mental resources and monitoring of the present state of the individual. There were two main findings. MS participants evidenced less activation than controls in the anterior cingulate and the left parietal cortex (Brodmann area 7) and more activation in left hemisphere language areas as well as the anterior insula. The second main finding was that clinical ratings of fatigue were strongly correlated with activity in wide areas of the core network, as well as posterior language areas. We take this finding to indicate that fatigue is related to compensatory involvement of the core network, and that excess activity in the core network possibly could be used as an objective marker of fatigue in MS.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70395 (URN)
Conference
Brain & Cognition, Sevilla 2011
Available from: 2011-09-06 Created: 2011-09-06 Last updated: 2013-09-04
Fex, A., Flensner, G., Ek, A.-C. & Söderhamn, O. (2011). Health-illness transition among persons using advanced medical technology at home. Scandinavian Journal of Caring Sciences, 25(2), 253-261
Open this publication in new window or tab >>Health-illness transition among persons using advanced medical technology at home
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 253-261Article in journal (Refereed) Published
Abstract [en]

Scand J Caring Sci; 2010 Health-illness transition among persons using advanced medical technology at home. This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition.

Place, publisher, year, edition, pages
Blackwell, 2011
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-63739 (URN)10.1111/j.1471-6712.2010.00820.x (DOI)000290589300007 ()20718935 (PubMedID)
Note
This is the pre-reviewed version of the following article: Angelika Fex, Gullvi Flensner, Anna-Christina Ek and Olle Söderhamn, Health-illness transition among persons using advanced medical technology at home, 2011, Scandinavian Journal of Caring Sciences, (25), 2, 253-261. which has been published in final form at: http://dx.doi.org/10.1111/j.1471-6712.2010.00820.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11
Fex, A., Flensner, G., Ek, A.-C. & Söderhamn, O. (2011). Living with an adult family member using advanced medical technology at home. Nursing Inquiry, 18(4), 336-347
Open this publication in new window or tab >>Living with an adult family member using advanced medical technology at home
2011 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 18, no 4, p. 336-347Article in journal (Refereed) Published
Abstract [en]

An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from health-care professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs were receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context.

Place, publisher, year, edition, pages
Blackwell Publishing, 2011
Keywords
Dependent-care; Next of kin; Orem; Self-care; Transition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63740 (URN)10.1111/j.1440-1800.2011.00535.x (DOI)000297471100007 ()
Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
Flensner, G., Ek, A.-C., Soderhamn, O. & Landtblom, A.-M. (2011). Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey. BMC NEUROLOGY, 11(27)
Open this publication in new window or tab >>Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey
2011 (English)In: BMC NEUROLOGY, ISSN 1471-2377, Vol. 11, no 27Article in journal (Refereed) Published
Abstract [en]

Background: Many individuals diagnosed with Multiple Sclerosis (MS) are sensitive to increased body temperature, which has been recognized as correlating with the symptom of fatigue. The need to explore this association has been highlighted. The aim of this study was to investigate the occurrence of heat sensitivity and its relations to disease course, disability, common MS-related symptoms and ongoing immunosuppressive treatments among individuals 65 years of age or younger diagnosed with MS. Methods: A cross-sectional designed survey was undertaken. A questionnaire was sent to MS-patients with an Expanded Disability Status Score (EDSS) in the interval of 0-6.5 and who were between 20 and 65 years of age, living in an eastern region of Sweden (n = 334). Besides occurrence of heat sensitivity (Yes/No) and corresponding questions, the Fatigue Severity Scale (FSS), the MS-related symptom checklist and the Perceived Deficit Questionnaire (PDQ) were included. Data were analysed in relation to data level using Chi-square, Mann Whitney U-test, and Students t-test. Pearsons and Spearmans correlations were calculated. In the logistic regression analyses (enter) dichotomized MS-symptoms were used as dependent variables, and EDSS, disease-course, time since onset, heat-sensitivity, age and sex (female/male) were independent variables. In the linear regression analyses, enter, mean FSS and summarized PDQ were entered as dependent variables and EDSS, disease-course, time since onset, heat sensitivity, age and sex (female/male) were independent variables. Results: Of the responding patients (n = 256), 58% reported heat sensitivity. The regression analyses revealed heat sensitivity as a significant factor relating not only to fatigue (p andlt; 0.001), but also to several other common MS symptoms such as pain (p andlt; 0.001), concentration difficulties (p andlt; 0.001), and urination urgency (p = 0.009). Conclusions: Heat sensitivity in MS patients is a key symptom that is highly correlated with disabling symptoms such as fatigue, pain, concentration difficulty and urination urgency.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67032 (URN)10.1186/1471-2377-11-27 (DOI)000288330000001 ()
Note
Original Publication: Gullvi Flensner, Anna-Christina Ek, Olle Soderhamn and Anne-Marie Landtblom, Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey, 2011, BMC NEUROLOGY, (11), 27. http://dx.doi.org/10.1186/1471-2377-11-27 Licensee: BioMed Central http://www.biomedcentral.com/Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2012-04-03
Flensner, G., Ek, A.-C., Landtblom, A.-M. & Söderhamn, O. (2008). Fatigue in relation to perceived health: people with multiple sclerosis compared with people in the general population. Scandinavian Journal of Caring Sciences, 22(3), 391-400
Open this publication in new window or tab >>Fatigue in relation to perceived health: people with multiple sclerosis compared with people in the general population
2008 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 391-400Article in journal (Refereed) Published
Abstract [en]

Fatigue is not only a complex phenomenon accompanying different illness conditions but is also a common complaint among individuals in the general population. Among individuals diagnosed with the chronic neurological disease multiple sclerosis (MS), one-third describe fatigue as the very first symptom, however it is invisible to others. When adopting an action-theoretic approach to health, fatigue may be considered to influence the individual’s goals of life and subjectively perceived health. The aim of this study was to describe perceived fatigue in relation to perceived health among working-aged individuals diagnosed with MS (n = 155), and in a comparative group of individuals randomly selected from the general population living in the same geographical area (n = 190). A self-report questionnaire including the Fatigue Impact Scale, a checklist of six symptoms, questions covering perceived health and levels of and perceptions of fatigue was used for the data collection. The responses on perceived health were dichotomized into two categories: ‘good health’ and ‘ill health’. Of the individuals with MS, 50% graded their perceived health as ill compared with 18% in the reference group (p < 0.001), and 68% graded fatigue as one of their worst symptoms compared with 21% in the reference group. In both groups, higher presence of symptoms and impact of fatigue in daily activities correlated negatively to perceived health. Compared with the individuals in the reference group, the individuals with MS reported higher impact of fatigue in physical areas in both the category of ‘good health’ (p < 0.001) and ‘ill health’ (p < 0.01). The perceived impact of fatigue was mirrored in increased problems in social and family activities. In conclusion, individuals with MS perceive fatigue as one of their worst symptoms three times as often as individuals in the general population. However, individuals with MS probably also adapt themselves or shift in their response to fatigue more than individuals in the general population.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43147 (URN)10.1111/j.1471-6712.2007.00542.x (DOI)72082 (Local ID)72082 (Archive number)72082 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Flensner, G. (2005). Fatigue in individuals with multiple sclerosis: lived experiences and perceived impact in daily life. (Doctoral dissertation). Linköping: Linköping Universitet
Open this publication in new window or tab >>Fatigue in individuals with multiple sclerosis: lived experiences and perceived impact in daily life
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to gain knowledge about experiences of fatigue among individuals diagnosed with MS and to compare these experiences with those of individuals in the general population. Individuals' experiences of fatigue have been approached both inductively and deductively and qualitative and quantitative research methods have been combined. A total of 372 individuals participated in the studies: 178 individuals diagnosed with MS (I-IV), and 194 individuals randomly selected from the general population. These individuals functioned as reference group and were comparable with the MS sufferers as regards age and sex (III-IV).

Experiences of fatigue were investigated before-and-after an intervention with a cooling suit among eight individuals diagnosed with MS (I). Fatigue as lived through and its perceived meaning were addressed in a phenomenological interview study among nine individuals with MS (II). Reliability and validity of a tool to assess impact of fatigue in daily life, the Swedish version of the Fatigue Impact Scale (FIS), was investigated in a cross-sectional study among 161 individuals with MS in comparison with 194 individuals in the general population (III). Further, experiences of fatigue, in terms of its perceived impact in daily life in relation to perceived health was addressed in a study which comprised 155 individuals diagnosed with MS who were compared with 190 individuals from the general population (IV).

The collection of data included open interviews conducted before-and-after the intervention (I) and in the phenomenological study (II). A self-written semi-structured oneweek diary was completed during the test-period with the cooling suit (I). Perceived impact of fatigue in daily life was assessed in a self-assessment questionnaire, with the FIS (I, III, IV) and a symptom list (IV) included. The individuals' perceived health was addressed by means of a single rating-question (IV).

Living with fatigue means living with a time-consuming and an all-absorbing phenomenon, which is both non-constructively and constructively perceived and involves either the whole body or parts of it (II). Experiences of fatigue were reduced during the intervention period. Overall levels of fatigue, in terms of its duration and perceived severity, and also its perceived impact in daily life, were reported diminished and the participants reported a sense of well-being and contentment during the period (I). Among the individuals with MS, fatigue was regarded as one of, or as their worst symptom. The experience of fatigue was more than three times as frequent as among the individuals in the general population. In MS, the perceived impact of fatigue in daily life was not found to be related either to age or numbers of years of being diagnosed with MS, but it was with the indicated levels of perceived health (IV). Among individuals diagnosed with MS, the FIS was found to be a reliable and valid tool measuring impact of fatigue in daily life. Also in the reference group comprising individuals in the general population, the FIS captured and distinguished between different levels of the impact of fatigue (III).

Place, publisher, year, edition, pages
Linköping: Linköping Universitet, 2005. p. 63
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 917
Keywords
action-theory, cooling, daily life, fatigue, perceived health, phenomenology, scale testing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31911 (URN)17744 (Local ID)91-85299-31-6 (ISBN)17744 (Archive number)17744 (OAI)
Public defence
2005-11-18, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved
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