Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights
Open accessAbstract
Studies investigating the prevalence, cause, and consequence of multiple sclerosis (MS) fatigue typically use single measures that implicitly assume symptom-stability over time, neglecting information about if, when, and why severity fluctuates. We aimed to examine the extent of moment-to-moment and day-to-day variability in fatigue in relapsing-remitting MS and healthy individuals, and identify daily life determinants of fluctuations. Over 4 weekdays, 76 participants (38 relapsing-remitting MS; 38 controls) recruited from multiple sites provided real-time self-reports six times daily (n = 1661 observations analyzed) measuring fatigue severity, stressors, mood, and physical exertion, and daily self-reports of sleep quality. Fatigue fluctuations were evident in both groups. Fatigue was highest in relapsing-remitting MS, typically peaking in late-afternoon. In controls, fatigue started lower and increased steadily until bedtime. Real-time stressors and negative mood were associated with increased fatigue, and positive mood with decreased fatigue in both groups. Increased fatigue was related to physical exertion in relapsing-remitting MS, and poorer sleep quality in controls. In relapsing-remitting MS, fatigue fluctuates substantially over time. Many daily life determinants of fluctuations are similar in relapsing-remitting MS and healthy individuals (stressors, mood) but physical exertion seems more relevant in relapsing-remitting MS and sleep quality most relevant in healthy individuals.
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The single-item measures used to assess momentary symptoms have not been validated.
“Use of single item measures that have not been validated to assess momentary symptoms is a limitation of this study.”
From Ecological momentary assessment of pain, fatigue, depressive, and cognitive symptoms reveals significant daily variability in multiple sclerosis (2017) · cites this paper as [35]
In Method > Measures (page not available), the paper describes its single-item momentary fatigue measure and explicitly reports evidence of convergent and discriminant validity. Its Discussion identifies a different limitation—combining physical and mental fatigue in one item—not a lack of validation. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThere are no standard, validated ecological momentary assessment measures of the symptoms examined in this study.
“to our knowledge there are no standard, validated EMA measures of the symptoms examined in this study.”
From Ecological momentary assessment of pain, fatigue, depressive, and cognitive symptoms reveals significant daily variability in multiple sclerosis (2017) · cites this paper as [35]
The Method > Measures section describes an adapted momentary fatigue item and reports evidence of its validity, but does not say that standard, validated EMA measures are unavailable. Searches for that assertion and related wording found no passage addressing the availability of such measures for the symptoms in the citing study. Page numbers were not provided in our copy. (LLM, conf=0.72)
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Disease progression shapes circadian and locomotor disruption in a model of multiple sclerosisPreprint
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- Authors
- Powell, D. J. H., Liossi, C., Schlotz, W., & Moss-Morris, R.
- Affiliations
- University of Aberdeen (GB)
- University of Southampton (GB)
- Max Planck Institute for Empirical Aesthetics (DE)
- King's College London (GB)
- Corresponding author
- Powell, Daniel J. H.
- Venue
- Journal of Behavioral Medicine
- Published
- 2017-03-09
- Volume
- 40
- Issue
- 5
- Pages
- 772-783
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- PMC
- PMC5613039
- OpenAlex
- W2593383909
- Cited by
- 99
- References
- 61
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 13 · 2023: 12 · 2022: 9 · 2021: 16 · 2020: 13 · 2019: 7 · 2018: 4 · 2017: 3
- FWCI
- 5.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Behavioral Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Publication Server of Goethe University Frankfurt am Main (Goethe University Frankfurt) (submittedVersion, cc-by)
- Funders
- Economic and Social Research Council (ES/1026266/1)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- multiple sclerosis, fatigue, relapsing-remitting multiple sclerosis, ecological momentary assessment, daily stress, mood, physical exertion, sleep quality, circadian rhythm, symptom fluctuation
- MeSH terms
- Ecological Momentary Assessment, Adolescent, Adult, Affect, Aged, Physical Exertion, Fatigue, Female, Humans, Male, Middle Aged, Sleep, Time Factors, Case-Control Studies, Multiple Sclerosis, Relapsing-Remitting, Young Adult, Self Report
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