Fatigue in Post-poliomyelitis Syndrome: Association With Disease-Related, Behavioral, and Psychosocial Factors

Trojan, Daria A.; Arnold, Douglas L.; Shapiro, Stan; Bar-Or, Amit; Robinson, Ann; Le Cruguel, Jean-Pierre; Narayanan, Sridar; Tartaglia, Maria C.; Caramanos, Zografos; Da Costa, Deborah

doi:10.1016/j.pmrj.2009.03.003

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Volume 1, Issue 5 , Pages 442-449, May 2009

Fatigue in Post-poliomyelitis Syndrome: Association With Disease-Related, Behavioral, and Psychosocial Factors

Daria A. Trojan, MD
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, 3801 University St., Montreal, Quebec, H3A 2B4, Canada^†
- Address correspondence to: D.A.T.
Douglas L. Arnold, MD
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^‡
Stan Shapiro, PhD
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada^‡‡
Amit Bar-Or, MD
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^§
Ann Robinson, RN
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^¶
Jean-Pierre Le Cruguel, BSc
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^∥
Sridar Narayanan, PhD
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^#
Maria C. Tartaglia, MD
- Department of Neurology, University of Western Ontario, London, Ontario, Canada^§§
Zografos Caramanos, MA
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^⁎⁎
Deborah Da Costa, PhD
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada^††

Received 17 May 2008; accepted 8 March 2009.

Objective

To determine the biopsychosocial correlates of general, physical, and mental fatigue in patients with postpoliomyelitis syndrome (PPS) by assessing the additional contribution of potentially modifiable factors after accounting for important nonmodifiable disease-related factors. It was hypothesized that disease-related, behavioral, and psychosocial factors would contribute in different ways to general, physical, and mental fatigue in PPS and that a portion of fatigue would be determined by potentially modifiable factors.

Design

Cross-sectional study.

Setting

A tertiary university-affiliated hospital post-polio clinic.

Patients

Fifty-two ambulatory patients with PPS who were not severely depressed were included.

Assessment of Risk Factors

Potential correlates for fatigue included disease-related factors (acute polio weakness, time since acute polio, PPS duration, muscle strength, pain, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, body mass index, disability, fibromyalgia), behavioral factors (physical activity, sleep quality), and psychosocial factors (depression, stress, self-efficacy).

Main Outcome Measurements

Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI; assesses fatigue on 5 subscales) and the Fatigue Severity Scale (FSS).

Results

Multivariate models were computed for MFI General, Physical, and Mental Fatigue. Age-adjusted multivariate models with nonmodifiable factors included the following predictors of (1) MFI General Fatigue: maximum inspiratory pressure, fibromyalgia, muscle strength; (2) MFI Physical Fatigue: maximum expiratory pressure, muscle strength, age, time since acute polio; and (3) MFI Mental Fatigue: none. The following potentially modifiable predictors made an additional contribution to the models: (1) MFI General Fatigue: stress, depression; (2) MFI Physical Fatigue: physical activity, pain; and (3) MFI Mental Fatigue: stress.

Conclusions

PPS fatigue is multidimensional. Different types of fatigue are determined by different variables. Potentially modifiable factors account for a portion of fatigue in PPS.