Patient reported fatigue and disability in multiple sclerosis: it matters how you ask and when you ask
ECTRIMS Online Library. Srinivasan J. 279629; EP1485
Jared Srinivasan
Jared Srinivasan
Contributions
Abstract

Abstract: EP1485

Type:

Abstract Category: Clinical aspects of MS - Patient reported outcomes

K. Ciszewska1, J. Srinivasan1, L. Fafard1, K. Jaenicke1, A. Lange1, M. Buhse1,2, D. Golan3,4, M. Zarif1, C. Sullivan5, J. Wilken5,6, K. Blitz1, T. Fratto5,6, M. Gudesblatt1

1South Shore Neurologic Associates, Patchogue, 2Stony Brook University, Stony Brook, NY, United States, 3Faculty of Medicine, Technion-Israel Institute of Technology, 4Department of Neurology, Carmel Medical Center, Haifa, Israel, 5Washington Neuropsychology Research Group, Fairfax, VA, 6Department of Neurology, Georgetown University, Washington, DC, DC, United States

Background: Fatigue is both commonly reported and can be disabling in people with Multiple Sclerosis (PwMS). Fatigue is not a simple construct and represents a complicated mix of factors. Undiagnosed sleep apnea is common in PwMS reporting fatigue. Appropriate treatment of fatigue in PwMS requires identifying all contributing causative factors. Specifically asking PwMS regarding the presence and degree of fatigue can be problematic and ideally requires discussion more than a simple yes/no and how much question. Patient Reported Outcomes (PRO) for fatigue such as Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale provide more 'fatigue' questions than are typically involved in a routine discussion. However even use of these 2 scales on PwMS on the same day result in 18% discordant results.
Objective: Explore the relationship of both MFIS (global, physical, cognitive, psychosocial) and FSS as well as the variability of such fatigue scores in PwMS along a continuum of disability (PDDS).
Methods: Retrospective review of a prospective PwMS patient registry for those who completed both MFIS and FSS PRO in the course of routine care.
Results: 224 PWMS (73% female, 50 average age years±10). Average MFIS (global, physical, and psychosocial) and FSS scores all increase with early disability but remains elevated beyond even low levels of disability (PDDS 2), whereas MFIS cognitive fatigue increases and peaks at low levels of disability but declines with increasing physical disability. Variability of all PRO measures is maximum at low levels of PDDS disability and the variability declines with increased PDDS disability for all fatigue measures.
Conclusion: Fatigue related PRO such as MFIS with individual sub-scales provide greater information regarding 'subtypes' of fatigue than unidimensional PRO measures such as FSS but the marked variability of patient centric fatigue reported even with PRO measures suggests that further investigation is required as to what drives the underlying fatigue symptom for each patient.
Disclosure:
Mark Gudesblatt-
Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
Jared Srinivasan- Nothing to disclose
Kaitlyn Jaenicke- Nothing to disclose
Myassar Zarif- Speaker fees (Acorda, Biogen, Genzyme and Teva)
Barbara Bumstead- Speaker fees (Biogen, Genzyme).
Marijean Buhse: Speaker fees (Biogen, Genzyme).
Lori Fafard- Nothing to disclose
Daniel Golan- Nothing to disclose
Cynthia Sullivan- Paid research with Roche
Jeffrey Wilken- Paid consulting with Genzyme, paid research with Genzyme and
Biogen, Paid talks with EMD Serono, Genzyme
Timothy Fratto- Nothing to disclose

Abstract: EP1485

Type:

Abstract Category: Clinical aspects of MS - Patient reported outcomes

K. Ciszewska1, J. Srinivasan1, L. Fafard1, K. Jaenicke1, A. Lange1, M. Buhse1,2, D. Golan3,4, M. Zarif1, C. Sullivan5, J. Wilken5,6, K. Blitz1, T. Fratto5,6, M. Gudesblatt1

1South Shore Neurologic Associates, Patchogue, 2Stony Brook University, Stony Brook, NY, United States, 3Faculty of Medicine, Technion-Israel Institute of Technology, 4Department of Neurology, Carmel Medical Center, Haifa, Israel, 5Washington Neuropsychology Research Group, Fairfax, VA, 6Department of Neurology, Georgetown University, Washington, DC, DC, United States

Background: Fatigue is both commonly reported and can be disabling in people with Multiple Sclerosis (PwMS). Fatigue is not a simple construct and represents a complicated mix of factors. Undiagnosed sleep apnea is common in PwMS reporting fatigue. Appropriate treatment of fatigue in PwMS requires identifying all contributing causative factors. Specifically asking PwMS regarding the presence and degree of fatigue can be problematic and ideally requires discussion more than a simple yes/no and how much question. Patient Reported Outcomes (PRO) for fatigue such as Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale provide more 'fatigue' questions than are typically involved in a routine discussion. However even use of these 2 scales on PwMS on the same day result in 18% discordant results.
Objective: Explore the relationship of both MFIS (global, physical, cognitive, psychosocial) and FSS as well as the variability of such fatigue scores in PwMS along a continuum of disability (PDDS).
Methods: Retrospective review of a prospective PwMS patient registry for those who completed both MFIS and FSS PRO in the course of routine care.
Results: 224 PWMS (73% female, 50 average age years±10). Average MFIS (global, physical, and psychosocial) and FSS scores all increase with early disability but remains elevated beyond even low levels of disability (PDDS 2), whereas MFIS cognitive fatigue increases and peaks at low levels of disability but declines with increasing physical disability. Variability of all PRO measures is maximum at low levels of PDDS disability and the variability declines with increased PDDS disability for all fatigue measures.
Conclusion: Fatigue related PRO such as MFIS with individual sub-scales provide greater information regarding 'subtypes' of fatigue than unidimensional PRO measures such as FSS but the marked variability of patient centric fatigue reported even with PRO measures suggests that further investigation is required as to what drives the underlying fatigue symptom for each patient.
Disclosure:
Mark Gudesblatt-
Research support (Biogen, EMD Serono, Novartis, Sanofi, Teva); speaker fees/consultant (Acorda, Amgen, Biogen, EMD Serono, Medtronic, Novartis, Sanofi, Saol Therapeutics, Teva).
Jared Srinivasan- Nothing to disclose
Kaitlyn Jaenicke- Nothing to disclose
Myassar Zarif- Speaker fees (Acorda, Biogen, Genzyme and Teva)
Barbara Bumstead- Speaker fees (Biogen, Genzyme).
Marijean Buhse: Speaker fees (Biogen, Genzyme).
Lori Fafard- Nothing to disclose
Daniel Golan- Nothing to disclose
Cynthia Sullivan- Paid research with Roche
Jeffrey Wilken- Paid consulting with Genzyme, paid research with Genzyme and
Biogen, Paid talks with EMD Serono, Genzyme
Timothy Fratto- Nothing to disclose

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