COSMIN database

Fatigue in child chronic health conditions: a systematic review of assessment instruments

Crichton, A., Knight, S., Oakley, E., Babl, F. E., and Anderson, V.
BACKGROUND AND OBJECTIVE: Fatigue is common in chronic health conditions in childhood, associated with decreased quality of life and functioning, yet there are limited data to compare assessment instruments across conditions and childhood development. Our objective was to describe fatigue assessment instruments used in children with chronic health conditions and critically appraise the evidence for the measurement properties of identified instruments.

METHODS: Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO (using the EBSCOhost platform). Study selection included quantitative assessment of fatigue in children with health conditions. Data extraction was as follows: (1) study design, participant and fatigue instruments, (2) measurement properties of fatigue instruments, (3) methodological quality of included studies, and (4) synthesis of the quality of evidence across studies for the measurement properties of fatigue instruments.

RESULTS: Twenty fatigue assessment instruments were identified (12 child reports, 7 parent reports, 1 staff report), used in 89 studies. Fatigue was assessed in over 14 health conditions, most commonly in children with cancer and chronic fatigue syndrome. Evidence for the measurement properties of instruments varied, and overall quality was low. Two fatigue instruments demonstrated strong measurement properties for use in children with diverse health conditions and children with cancer.

CONCLUSIONS: The review is limited to children younger than 18 years and results are specific to health conditions described, limiting generalizability of findings to other populations. Evidence for the measurement properties of fatigue instruments varied according to the population in which instruments were used and informant. Further evidence is required for assessment of fatigue in younger children, and children with particular health conditions.
1098-4275 (Electronic)
Publication year:
Symptom status:
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Role functioning
Social functioning
Children (0-18)
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 digestive system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Endocrine, nutritional and metabolic diseases and related symptoms
Mental and behavioural disorders and related symptoms
Neoplasms and related symptoms
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
CFS - Chalder Fatigue Scale [alias: FQ - Fatigue Questionnaire][alias: FRS - Fatigue Rating Scale]
CIS - Checklist Individual Strength (versions: CIS-20; CIS-20R)   
EOSQ - Early Onset Scoliosis Questionnaire
FACIT-Fatigue - Functional Assessment of Chronic Illness Therapy- Fatigue Scale
FS-A - Fatigue Scale-Adolescents
FS-C (Also Fs-C-C) - Fatigue Scale-Children
FS-P - Fatigue Scale-parent
FS-S - Fatigue Scale-Staff
FSS - Fatigue Severity Scale (versions: FSS-7 - 7-item version and FSS-5 - 5-item version)   
PedsQL 3.0 CP Module-p - Pediatric Quality of Life Inventory 3.0 Cerebral Palsy Module-parent
PedsQL 3.0 ESRD - Pediatric Quality Of Life Inventory 3.0 End-Stage Renal Disease (Module versions: Toddler; Child; Young Child; Teenager; PedsQL 3.0 ESRD-Parent Form)
PedsQL-MFS - Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale
POMS - Profile of Mood States (versions: POMS-11; POMS-14; POMS-37; POMS-65; Brief POMS; POMS-Adolescent; POMS-sf; revised POMS)
PROMIS Paediatric Fatigue
PROMIS Paediatric Peer relationship
VAS - Visual Analogue Scale (versions: vertical; horizontal)