RESEARCH - Measuring fatigue in RA: a systematic review of scales in use

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Arthritis Care & Research

Volume 57, Issue 3, Pages 429-439

Published Online: 29 Mar 2007

Original Article

Measuring fatigue in rheumatoid arthritis: A systematic review of scales in use

S. Hewlett 1 *, M. Hehir 1, J. R. Kirwan 2

1University of the West of England, Bristol, UK

2University of Bristol Academic Rheumatology Unit, Bristol, UK

Abstract

Objective

Fatigue is an important outcome for patients with rheumatoid arthritis

(RA). The purpose of this study was to identify the scales being used

to measure RA fatigue, and to systematically examine the evidence for

their validation.

Methods

Articles measuring fatigue in RA were sought using the terms RA and

fatigue, and RA and tiredness, plus scale, questionnaire, inventory,

and checklist. Index articles reporting identifiable RA fatigue data

were examined for the fatigue scale used. Index and validation

articles for each scale were reviewed for evidence supporting scale

validation to measure RA fatigue using a standardized checklist of

content, face, criterion, and construct validity, reliability, and

sensitivity to change.

Results

A total of 61 index articles used 23 different fatigue scales to

measure RA fatigue on 71 occasions. Seventeen scales had either no

data on validation in RA or limited evidence. Reasonable evidence of

validation was identified for 6 scales, each also having some evidence

of sensitivity to change: ordinal scales, the Short Form 36 vitality

subscale, the Functional Assessment of Chronic Illness Therapy Fatigue

Scale, visual analog scales (VAS), the Profile of Mood States, and the

RA-specific Multidimensional Assessment of Fatigue scale (MAF).

However, the 4 generic scales would benefit from further validation in

patients with RA, the VAS requires standardization, and the MAF would

benefit from further sensitivity data.

Conclusion

It was possible to identify evidence of reasonable validation for 6 of

23 scales being used to measure RA fatigue. Researchers and clinicians

should select scales to measure RA fatigue carefully.

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