COSMIN database

Self-report fatigue questionnaires in multiple sclerosis, Parkinson's disease and stroke: a systematic review of measurement properties

Elbers, R. G., Rietberg, M. B., van Wegen, E. E., Verhoef, J., Kramer, S. F., Terwee, C. B., and Kwakkel, G.
PURPOSE: To critically appraise, compare and summarize the measurement properties of self-report fatigue questionnaires validated in patients with multiple sclerosis (MS), Parkinson's disease (PD) or stroke.

METHODS: MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTdiscus were searched. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of studies. A qualitative data synthesis was performed to rate the measurement properties for each questionnaire.

RESULTS: Thirty-eight studies out of 5,336 records met the inclusion criteria, evaluating 31 questionnaires. Moderate evidence was found for adequate internal consistency and structural validity of the Fatigue Scale for Motor and Cognitive functions (FSMC) and for adequate reliability and structural validity of the Unidimensional Fatigue Impact Scale (U-FIS) in MS.

CONCLUSIONS: We recommend the FSMC and U-FIS in MS. The Functional Assessment of Chronic Illness Therapy Fatigue subscale (FACIT-F) and Fatigue Severity Scale (FSS) show promise in PD, and the Profile of Mood States Fatigue subscale (POMS-F) for stroke. Future studies should focus on measurement error, responsiveness and interpretability. Studies should also put emphasis on providing input for the theoretical construct of fatigue, allowing the development of questionnaires that reflect generic and disease-specific symptoms of fatigue.
Qual Life Res
1573-2649 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
CIS - Checklist Individual Strength (versions: CIS-20; CIS-20R)   
D-FIS - Fatigue impact scale for daily use [Alias: FIS-D - Fatigue Impact Scale for Daily Administration]
EMIF-SEP - Adapted French version of fatigue impact scale
FACIT-Fatigue - Functional Assessment of Chronic Illness Therapy- Fatigue Scale
FAI / FSI - Fatigue Assessment Instrument (FAI) = Fatigue Severity Inventory (FSI)
FAS - Fatigue Assessment Scale
FIS / FFSS - Fatigue Impact Scale (FIS) or Fisk Fatigue Severity Score (FFSS)
FSMC - Fatigue scale for motor and cognitive functions
FSS - Fatigue Severity Scale (versions: FSS-7 - 7-item version and FSS-5 - 5-item version)   
MFI - Multidimensional Fatigue Inventory (versions: MFI-20)   
MFIS - Modified Fatigue Impact Scale [Alias: MFIS C-5 or MFIS P-8 - Modified fatigue impact scale cognitive and physical]   
MFSI-G - Multidimensional Fatigue Symptom Inventory-General subscale
MFSS - Multiple sclerosis-specific fatigue severity scale
NFI-MS - Neurological fatigue index for multiple sclerosis
NHP - Nottingham Health Profile   
PFS-16 (2) - Parkinson fatigue Scale 2-point scale version (Also PFS-16 (5) - 5 point scale version)
POMS-F - Profile of Mood States-Fatigue
PS - Performance scale (versions: PS-F - Performance scale fatigue subscale)
Rhoten Fatigue Scale
SF-36-V - 36-item Short Form Health Survey-Vitality subscale
SOFI - Swedish Occupational Fatigue Inventory
U-FIS - Unidimensional fatigue impact scale
VAS - Visual Analogue Scale (versions: vertical; horizontal)   
WEIMUS - Würzburger Erschöpfungsinventars bei Multiple sclerosis