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Fatigue, functional status, health and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe fatigue, functional limitations due to fatigue and health in patients with chronic obstructive pulmonary disease (COPD), as well as to compare patients with individuals from the general population and to test if pulmonary rehabilitation can reduce fatigue and functional limitations, and thus improve health. A further aim was to test the Fatigue Impact Scale (FIS) among patients with COPD.

Two studies (I, II) had a descriptive comparative design with data from 36 and 151 patients with COPD respectively, and 37 and 95 individuals respectively, randomly selected from the general population. One study (III) was a randomised pre-test post-test study with 12 patients with COPD randomised to 12 weeks’ pulmonary rehabilitation and 14 patients in a control group. In a further study (IV), the FIS was tested for validity and reliability among 296 patients with COPD who reported fatigue.

Assessments: Structured questions frequency, duration and severity of fatigue, functional limitations due to fatigue with FIS, six minutes’ walking distance, hand grip strength, functional performance and satisfaction with Canadian Occupational Performance Measure and health with St George’s Hospital Respiratory Questionnaire and Short Form-36.

Almost half of the patients with COPD had a problem with fatigue every day and experienced fatigue as a severe symptom. More than 44% reported that fatigue was one of the worst symptoms. The experience of fatigue was related to the patients’ functional performance and health perceptions. Patients with COPD experienced a higher frequency, longer daily duration and greater severity of fatigue than individuals from the general population. After a 12 week pulmonary rehabilitation programme, there were no statistically significant differences between the patients randomised to the rehabilitation group and those in the control group. The patients in the rehabilitation group improved walking distances, performance and satisfaction with regard to their own selected activities compared with baseline.

Confirmatory factor analysis on the three-factor model proposed for FIS showed that the fit of the model was not acceptable. Further validation of the FIS resulted in a removal of 15 items (FIS-25) and support for Pipers´ theoretical framework of subjective manifestations of fatigue including physical, emotional and cognitive dimensions and a general behavioural factor. The internal consistency, sensitivity and stability correlations of FIS-25 were satisfactory.

In conclusion, fatigue is a major concern among patients with COPD, impacting on functioning and health. Interventions with 12 weeks’ pulmonary rehabilitation might not be effective enough to reduce fatigue and the functional limitations due to fatigue. More research is needed to solve the symptom burden of fatigue and its impact on functioning and health in patients with COPD.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2007. , 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 980
Keyword [en]
chronic obstructive pulmonary disease, fatigue, functional status, health, pulmonary rehabilitation, Fatigue impact scale, confirmatory factor analysis
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-8268ISBN: 978-91-85715-95-4 (print)OAI: oai:DiVA.org:liu-8268DiVA: diva2:23117
Public defence
2007-02-16, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2009-05-15
List of papers
1. Fatigue in patients with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Fatigue in patients with chronic obstructive pulmonary disease
2004 (English)In: Journal of Advanced Nursing, Vol. 45, no 2, 172-177 p.Article in journal (Refereed) Published
Abstract [en]

Background. Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives.

Objective. The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls.

Method. The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire.

Results. Almost half of the patients (47·2%), reported fatigue every day during the preceding month compared with 13·5% of the control group (P < 0·001). The duration of fatigue was more than 6 hours in 52·7% of the patients and 44·4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18·9% (P < 0·001) and 10·8% (P < 0·01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0·001).

Conclusion. These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.

Keyword
chronic obstructive pulmonary disease, fatigue, Fatigue Impact Scale, nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14291 (URN)10.1046/j.1365-2648.2003.02878.x (DOI)
Available from: 2007-02-13 Created: 2007-02-13
2. Severity of fatigue is related to functional limitation and health in patients with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Severity of fatigue is related to functional limitation and health in patients with chronic obstructive pulmonary disease
2008 (English)In: INTERNATIONAL JOURNAL OF NURSING PRACTICE, ISSN 1322-7114, Vol. 14, no 6, 455-462 p.Article in journal (Refereed) Published
Abstract [en]

Fatigue is one of the most prevalent symptoms in patients with chronic obstructive pulmonary disease (COPD). In research as well as in clinical practise, fatigue and its influence on functioning and health has not been in focus. The aim of this study was to compare fatigue, functional limitations owing to fatigue and health between patients with COPD and individuals from the general population to assess the differences between patients experiencing no, moderate and severe fatigue. Patients with COPD (n = 151) and individuals from the general population (n = 95) answered questions about fatigue, the Fatigue Impact Scale and the Medical Outcomes Survey Short Form-36. The patients with COPD reported a higher frequency, longer daily duration and more severity of fatigue compared with individuals from the general population as well as more functional limitations and worse health. The patients who reported severe fatigue had more functional limitations and worse health compared with patients reporting moderate fatigue. These results indicate that fatigue severity should be screened for during the nursing care process with purpose to reduce the symptom burden.

Keyword
chronic obstructive pulmonary disease, fatigue, functioning, health, respiratory nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16414 (URN)10.1111/j.1440-172X.2008.00720.x (DOI)
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2009-08-21
3. Effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease: a randomized controlled trial
Open this publication in new window or tab >>Effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease: a randomized controlled trial
2009 (English)In: Clinical Rehabilitation, ISSN 0269-2155, Vol. 23, no 2, 125-136 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To test the effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease.

Design: Randomized controlled trial.

Setting: Pulmonary outpatient department.

Subjects: Thirty patients randomly assigned to a rehabilitation (3 men, 9 women, mean age 66 ( 2) years) or a control group (10 men, 4 women, mean age 64 ( 2) years).

Interventions: The patients in the rehabilitation group participated in a multidisciplinary rehabilitation programme comprising exercise training twice weekly, for a 12-week period, nutritional and self-care advice, and education about disease and energy conservation strategies.

Main measures: Fatigue, functional limitations due to fatigue, functional performance and satisfaction, six-minute walking distance, hand grip strength and health perception were assessed at baseline and after 12 weeks.

Results: At baseline there were no significant differences between the groups, except for gender. The six-minute walking distance was 312.6 (+/- 79.3) m for the rehabilitation group and 3603 (+/- 84.7) m for the control group. After 12 weeks, the rehabilitation group improved their walking distance by 40.6 (+/- 27.2) m (P<0.05). The rehabilitation group improved in performance (from 4.8 (12.0) to 6.0 (+/- 1.5) scores, P<0.01) and satisfaction (from 4.6 (+/- 2.2) to 6.0 (+/- 2.1) scores, P<0.001) with regard to own selected daily activities. No statistically significant differences were seen between the changes within the rehabilitation group and changes within the control group at the 12-week follow-up.

Conclusions: Although the pulmonary rehabilitation programme had an immediate effect, it was not sustained.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16975 (URN)10.1177/0269215508096174 (DOI)
Available from: 2009-03-01 Created: 2009-02-27 Last updated: 2009-08-21
4. Fatigue Impact Scale: Its validation in patients with chronic obstructive pulmonary disease
Open this publication in new window or tab >>Fatigue Impact Scale: Its validation in patients with chronic obstructive pulmonary disease
Show others...
2007 (English)In: Psychology, Health and Medicine, ISSN 1354-8506, Vol. 12, no 4, 470-484 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate the reliability and validity of the Fatigue Impact Scale (FIS) among patients with chronic obstructive pulmonary disease (COPD) and shorten the questionnaire. The empirically developed FIS, which comprised three subscales (cognitive, physical and psychosocial), was tested originally on Pipers' theoretical framework of subjective manifestations of fatigue, including behavioural, physical, emotional and cognitive expressions. The data analysed here consisted of responses from 296 patients with COPD who reported fatigue. The dimensionality of the FIS was examined using confirmatory factor analysis. A reduction of 15 items from the original FIS was made based on theory, modification indices and factor loadings. The results indicate that a nested-factor model with one general behavioural factor and three specific factors, physical, emotional and cognitive, shows acceptable fit. A modified version of 25 items, FIS-25 was developed. The original FIS and the FIS-25 were able to discriminate between patients with differing duration of fatigue. Test - retest correlations ranged from .70 to .85 for items and .94 for the total scale. Due to modification, the FIS-25 needs to be validated on a new group of patients with COPD.

Keyword
Fatigue Impact Scale, confirmatory factor analysis, chronic obstructive pulmonary disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14294 (URN)10.1080/13548500601086771 (DOI)
Available from: 2007-02-13 Created: 2007-02-13 Last updated: 2009-08-21Bibliographically approved

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