COSMIN database

The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures

Whitehead, L.
Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980-2007. Criteria for judging the "ideal" measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.
J Pain Symptom Manage
1873-6513 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Social functioning
Overall quality of life:
Overall quality of life
Adults (18-65)
Children (0-18)
Seniors (65+)
Certain conditions originating in the perinatal period and related symptoms
Certain infections and parasitic diseases and related symptoms
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the digestive system
Diseases of and symptoms related to the ear and mastoid process
Diseases of and symptoms related to the eye and adnexa
Diseases of and symptoms related to the genitourinary system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Diseases of and symptoms related to the respiratory system
Diseases of and symptoms related to the skin and subcutaneous tissue
Endocrine, nutritional and metabolic diseases and related symptoms
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
Pregnancy, childbirth and puerperium and related symptom
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
Abbreviated Fatigue Questionnaire
BFI - Brief Fatigue Inventory
CFS - Chalder Fatigue Scale [alias: FQ - Fatigue Questionnaire][alias: FRS - Fatigue Rating Scale]
CFS - Childhood Fatigue Scale
CRFDS - Cancer-Related Fatigue Distress Scale
EORTC QLQ-C30-FS - European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core-30 item-Fatigue Subscale
FACES - Fatigue, Anergia, Consciousness, Energized and Sleepiness Adjective (FACES) checklist
FACT-F - Functional Assessment of Cancer Therapy-Fatigue
FAI / FSI - Fatigue Assessment Instrument (FAI) = Fatigue Severity Inventory (FSI)
FAS - Fatigue Assessment Scale
FDS - Fatigue Descriptive Scale
FIS / FFSS - Fatigue Impact Scale (FIS) or Fisk Fatigue Severity Score (FFSS)
FSI - Fatigue Symptom Inventory
FSS - Fatigue Severity Scale (versions: FSS-7 - 7-item version and FSS-5 - 5-item version)   
GVA - Global Vigour and Affect
HRFS - HIV-Related Fatigue Scale
MAF - Multidimensional Assessment of Fatigue
May and Kline Adjective Checklist
MFI-20 - Multidimensional Fatigue Inventory-20 items
MFIS - Modified Fatigue Impact Scale [Alias: MFIS C-5 or MFIS P-8 - Modified fatigue impact scale cognitive and physical]   
MFSI-30 - Multidimensional Fatigue Symptom Inventory-30 items
MFSI - Multidimensional Fatigue Symptom Inventory
Myasthenia Gravis Fatigue Scale
Pearson–Byars Fatigue Feeling Checklist
PFRS - Profile of Fatigue-Related Symptoms
PFS-16 (2) - Parkinson fatigue Scale 2-point scale version (Also PFS-16 (5) - 5 point scale version)
PFS - Parent Fatigue Scale
PFS - Piper Fatigue Scale (versions: PFS-revised)
POMS-F - Profile of Mood States-Fatigue
Rhoten Fatigue Scale
SCFS - Schwartz Cancer Fatigue Scale
SDS - Zung Self-rating Depression Scale
SF-36-Fatigue - 36-item Short Form Health Survey-Fatigue subscale
SFS - Staff Fatigue Scale
SOFA - Schedule of Fatigue and Anergia
VAS-F - Visual Analogue Scale for Fatigue [alias: LFS - Lee Fatigue Scale]