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The Impact of Fatigue on Patients with Multiple Sclerosis
Open accessAbstract
Although fatigue is recognized as a symptom of MS, there have been insufficient methods for evaluating this symptom. We administered the Fatigue Impact Scale to 85 MS patients and 20 hypertensive patients. Neurologic impairment, mental health, and general health status were also assessed. MS patients reported significantly higher fatigue impact than hypertensive patients. Most MS patients reported fatigue as either their worst (14%), or one of their worst (55%) symptoms. Disease classification and neurologic impairment had little bearing on Fatigue Impact Scale scores in the MS sample. The best predictive models for mental health and general health status in the MS sample both included the Fatigue Impact Scale as a significant factor. This study demonstrates that: 1) fatigue is a very prevalent and severe problem in MS, 2) fatigue impact cannot be predicted by clinical measures of neurologic impairment, 3) fatigue has a significant effect on the mental health and general health status of MS patients.
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“is often considered to be the worst symptom of disease (Fisk et al., 1994”
From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Fisk et al., 1994
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Bruce, J. M., Bruce, A. S., & Arnett, P. A. (2010) · Neuropsychology · doi:10.1037/a0015046 · Cited by 51
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BackgroundDisconnection as a mechanism for social cognition impairment in multiple sclerosis
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“Commonly, fatigue is assessed by several questionnaires including the Fatigue Severity Scale (FSS) [9], the Fatigue Assessment Instrument (FAI) [10], the Fatigue Impact Scale (FIS) [11], the Modified Fatigue Impact Scale (MFIS) [12] and, in Germany, the Fatigue Scale for Motor and Cognitive Functions (FSMC) [13] and t…”
MethodJongen, P. J., Lehnick, D., Sanders, E. A. C. M., Seeldrayers, P., Fredrikson, S., Andersson, M., Speck, J., & Focus Study group (2010) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-8-133 · Cited by 50
“Fatigue is reported by over 80% of patients [12] and often interferes with social or occupational activities [13].”
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Shah, A. (2009) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2008.12.003 · Cited by 50
“Social activities with friends and family are difficult to plan, as some days MS patients may awaken with an overwhelming sense of fatigue that cannot be alleviated with rest.(9) Cognitive processing, memory, and concentration are impaired during periods of fatigue.”
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Chen, W., Jiang, T., Huang, H., & Zeng, J. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1298915 · Cited by 48
Palliative Care in Amyotrophic Lateral Sclerosis, Parkinson's Disease, and Multiple Sclerosis
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Wilken, J. A., Kane, R. L., Sullivan, C. L., Gudesblatt, M., Lucas, S. M., Fallis, R. J., You, X., & Foulds, P. (2013) · International Journal of MS Care · doi:10.7224/1537-2073.2012-043 · Cited by 48
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“The MFIS-5 is an abbreviated version of the MFIS-21, which is a modified form of the Fatigue Impact Scale [25,26].”
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“Furthermore, global single-item QOL indicators are sensitive to change over time and have been shown to be comparable to multiitem scales (35, 36).”
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Schmidt, A. L., Pennypacker, M. L., Thrush, A., Leiper, C. I., & Craik, R. L. (2011) · Journal of Geriatric Physical Therapy · doi:10.1519/jpt.0b013e31820aa921 · Cited by 47
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Pilutti, L. A., Paulseth, J. E., Dove, C., Jiang, S., Rathbone, M. P., & Hicks, A. L. (2016) · International Journal of MS Care · doi:10.7224/1537-2073.2015-067 · Cited by 45
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“With a prevalence ranging between 53 and 95% (1, 2), it is the most frequent “hidden symptom” in multiple sclerosis (MS).”
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Hernández‐Ronquillo, L., Moien‐Afshari, F., Knox, K. B., Britz, J., & Téllez‐Zenteno, J. F. (2011) · Epilepsy Research · doi:10.1016/j.eplepsyres.2011.03.010 · Cited by 45
“Fatigue can be a major source of disablement in some medical conditions such as Parkinson disease and multiple sclerosis and is often reported by patients as being among their most severe and distressing symptoms (Fisk et al., 1994; Karlsen et al., 1999; Pepper et al., 1993; Winningham et al., 1994).”
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Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium
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Safety and efficacy of strength training in patients with sporadic inclusion body myositis
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“Table V shows that a significant difference in total distance walked during the 6MWT was found between the subgroups of EDSS (mild > moderate > severe), and MS subtype (RR > Sp = pp), whereas no difference was observed between the fatigue subgroups (same result when applying the MFISphysical subscore, data not shown).”
MethodInfluentialResults of a fatigue management programme in multiple sclerosis
Ward, N., & Winters, S. (2003) · British Journal of Nursing · doi:10.12968/bjon.2003.12.18.11778 · Cited by 44
A double-blind pilot study of the effect of Prokarin™ on fatigue in multiple sclerosis
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Carnitine for fatigue in multiple sclerosis
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Pence, B. W., Barroso, J. V., Leserman, J., Harmon, J. L., & Salahuddin, N. (2008) · AIDS Care · doi:10.1080/09540120701694063 · Cited by 43
Communicating about the experience of pain and fatigue in disability
Yorkston, K. M., Johnson, K. L., Boesflug, E., Skala, J., & Amtmann, D. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9572-1 · Cited by 43
“Fatigue has been characterized as multidimensional with dimensions such as physical, cognitive, and psychosocial [20].”
BackgroundFatigue in epilepsy: A prospective inter-ictal and post-ictal survey
Hamelin, S., Kahane, P., & Vercueil, L. (2010) · Epilepsy Research · doi:10.1016/j.eplepsyres.2010.07.006 · Cited by 43
The Impact of Coffee and Caffeine on Multiple Sclerosis Compared to Other Neurodegenerative Diseases
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“Studies have shown that 14% of patients withMS consider fatigue their worst problem and 55% as one of their worst problems (7).”
BackgroundClinical correlates of CES-D depressive symptom ratings in an MS population
Patten, S. B., Lavorato, D. H., & Metz, L. M. (2005) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2005.06.010 · Cited by 43
Minimizing the effect of TBI-related physical sequelae on vocational return
McNamee, S., Walker, W. C., Cifu, D. X., & Wehman, P. (2009) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2008.08.0106 · Cited by 42
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Kim, E., Cameron, M. H., Lovera, J. F., Schaben, L., BOURDETTE, D. N., & Whitham, R. H. (2011) · Multiple Sclerosis Journal · doi:10.1177/1352458511412062 · Cited by 42
“Seventy-five to ninety-five percent of people with multiple sclerosis (MS) report significant fatigue and up to 50–60% report that fatigue is their worst MS-related problem.(1,2) Medications for fatigue in MS are limited to the off-label use of amantadine(3) and stimulants such as modafinil(4,5) andmethylphenidate(6)…”
BackgroundReliability and validity of the Swedish version of the Fatigue Impact Scale (FIS)
Flensner, G., Ek, A., & Söderhamn, O. (2005) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038120510031806 · Cited by 42
Flensner, G., Ek, A., Landtblom, A., & Söderhamn, O. (2008) · Scandinavian Journal of Caring Sciences · doi:10.1111/j.1471-6712.2007.00542.x · Cited by 42
Royer, N., Coates, K. D., Aboodarda, S. J., Camdessanché, J., & Millet, G. Y. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.983643 · Cited by 42
“MVC torque has been found to be similar between PwMS experiencing higher vs. lower levels (i.e., sensation) of fatigue (highly fatigued = FSS score > 4 and/or MFIS score > 38 unless otherwise stated).”
BackgroundMethodInfluentialEffect of Neurofeedback Training on Depression and Fatigue in Patients with Multiple Sclerosis
Choobforoushzadeh, A., Doost, H. T. N., Molavi, H., & Abedi, M. R. (2014) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-014-9267-4 · Cited by 44
“Fatigue is not closely related to physical signs of disability or with MRI markers of disease activity, although it does seem to increase when the patient experiences relapses (Fisk et al. 1994).”
BackgroundFatigue in the elderly population
Poluri, A., Mores, J., Cook, D. B., FINDLEY, T. W., & Cristian, A. (2005) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2004.06.006 · Cited by 40
Noonan, V. K., Cook, K. F., Bamer, A. M., Choi, S. W., Kim, J., & Amtmann, D. (2012) · Quality of Life Research · doi:10.1007/s11136-011-0040-3 · Cited by 54
“Developed to measure perceived impact of fatigue on the lives of individuals with MS, the MFIS is a 21-item version of the Fatigue Impact Scale (FIS) [9, 10].”
MethodRay, A. D., Mahoney, M. C., & Fisher, N. M. (2015) · Disability and Rehabilitation · doi:10.3109/09638288.2015.1031286 · Cited by 40
“Self-reported fatigue represents one of the most debilitating symptoms affecting 50–60% of individuals with MS [1,2].”
BackgroundPosterior fossa lesion volume and slowed information processing in multiple sclerosis
Archibald, C. J., Wei, X., Scott, J. N., Wallace, C. J., Zhang, Y., Metz, L. M., & Mitchell, J. R. (2004) · Brain · doi:10.1093/brain/awh167 · Cited by 40
“Fatigue is another signi®cant symptom of multiple sclerosis that could affect cognitive performance (Fisk et al., 1994; Krupp and Elkins, 2000); thus, we included a 10-point visual analogue rating of fatigue severity at the beginning and end of the test session.”
MethodSelf-citationHow does fatigue influence community-based exercise participation in people with multiple sclerosis?
Smith, C., Olson, K. L., Hale, L. A., Baxter, D. G., & Schneiders, A. G. (2011) · Disability and Rehabilitation · doi:10.3109/09638288.2011.573054 · Cited by 40
“MSrelated fatigue is one of the most distressing symptoms reported by PwMS, and appears complex and unique in nature [3,4].”
BackgroundWahls, T. L., Bisht, B., Darling, W. G., Shivapour, E. T., Lutgendorf, S. K., Snetselaar, L., & Chenard, C. A. (2015) · Degenerative Neurological and Neuromuscular Disease · doi:10.2147/dnnd.s76523 · Cited by 40
“Overall, during the 12month intervention, subjects reported the following symptoms (number of subjects) in mild intensity: joint pain (6), abdominal pain (4), chest pain (2), bruising (6), easy bleeding (3), diarrhea (5), constipation (11), nausea (6), headache (11), palpitations (1), and skin rash (2), Bisht et al.”
BackgroundMeasuring Patient-Centered Outcomes in Neurologic Disease
Schwartz, C. E. (1995) · Archives of Neurology · doi:10.1001/archneur.1995.00540320026010 · Cited by 40
Mäurer, M., Comi, G., Freedman, M. S., Kappos, L., Olsson, T. P., Wolinsky, J. S., Miller, A. E., Dive-Pouletty, C., Bozzi, S., & O’Connor, P. W. (2016) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2016.02.012 · Cited by 39
Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?
Kallweit, U., Baumann, C. R., Harzheim, M., Hidalgo, H., Pöhlau, D., Bassetti, C. L., Linnebank, M., & Valko, P. O. (2013) · Multiple Sclerosis International · doi:10.1155/2013/286581 · Cited by 40
“Hindawi Publishing Corporation Multiple Sclerosis International Volume 2013, Article ID 286581, 7 pages http://dx.doi.org/10.1155/2013/286581”
BackgroundInfluentialSilverman, E. P., Miller, S. N., Zhang, Y., Hoffman-Ruddy, B., Yeager, J., & Daly, J. J. (2017) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/2055217317710829 · Cited by 41
“The respiratory and swallowing problems may escalate as the disease progresses, and patients become more affected by fatigue and physical inactivity.(2) 4”
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“Fatigue is an extremely common problem for patients with MS, with substantial numbers reporting it to be a moderate-to-severe problem [26-29].”
BackgroundChinnadurai, S. A., Venkatesan, S. A., Shankar, G., Samivel, B., & Ranganathan, L. N. (2016) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2016.08.001 · Cited by 38
Strober, L. B., Becker, A., & Randolph, J. J. (2018) · Applied Neuropsychology Adult · doi:10.1080/23279095.2018.1458518 · Cited by 41
“CHQ ¼ Cognitive Health Questionnaire; MFIS ¼ Modified Fatigue Impact Scale; PSQI ¼ Pittsburgh Sleep Quality Index; PES ¼ MOS-Pain Effects Scale; CMDI ¼ Chicago Multiscale Depression Inventory; STAI ¼ State Trait Anxiety Inventory; DMSES ¼ Disease Management Self Efficacy Scale; SDMT ¼ Symbol Digit Modalities Test; FS…”
MethodInfluentialPredictors of dyadic adjustment in multiple sclerosis
King, K. E., & Arnett, P. A. (2005) · Multiple Sclerosis Journal · doi:10.1191/1352458505ms1212oa · Cited by 38
Joshi, V. L., Tang, L. H., Mikkelsen, T. B., Nielsen, J. F., Zinckernagel, L., Borregaard, B., Agarwal, S., Ersbøll, A. K., Yonis, H. G. H., Kragholm, K. H., et al. (2022) · Resuscitation · doi:10.1016/j.resuscitation.2022.11.005 · Cited by 40
Ergin, G., & Yıldırım, Y. (2012) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2011.654321 · Cited by 37
“…conditions, fatigue can be a major source of disability and is often reported by patients as being among their most severe and distressing symptoms (Fisk et al, 1994; Karlsen, Larsen, Tandberg, and Jorgensen, 1999; Pepper et al, 1993; Shulman, Taback, Bean, and Weiner, 2001; Winningham et al,…”
BackgroundDalgas, U., Langeskov‐Christensen, M., Skjerbæk, A. G., Jensen, E., Baert, I., Romberg, A., Santoyo-Medina, C., Gebara, B., de Noordhout, B. M., Knuts, K., et al. (2018) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2018.02.026 · Cited by 37
Daily Temporal Associations Between Physical Activity and Symptoms in Multiple Sclerosis
Kratz, A. L., Fritz, N. E., Braley, T. J., Scott, E. L., Foxen-Craft, E. C., & Murphy, S. L. (2018) · Annals of Behavioral Medicine · doi:10.1093/abm/kay018 · Cited by 39
“excess of those that are attributable to MS-related neurological damage [21].”
BackgroundPalliative care in patients with multiple sclerosis
Ben‐Zacharia, A. B., & LUBLIN, F. D. (2001) · Neurologic Clinics · doi:10.1016/s0733-8619(05)70048-7 · Cited by 37
Fatigue in irritable bowel syndrome: characterization and putative role of leptin
Piche, T., Huet, P., Gelsi, È., Barjoan, E. M., Cherick, F., Caroli-Bosc, F. X., Hébuterne, X., & Tran, A. (2007) · European Journal of Gastroenterology & Hepatology · doi:10.1097/01.meg.0000252627.50302.b4 · Cited by 37
Cognitive fatigue in multiple sclerosis: Findings from a two-wave screening project
Barak, Y., & Achiron, A. (2006) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2005.09.015 · Cited by 37
“Validation studies have shown a high degree of internal consistency for evaluating fatigue in MS patients [9,10].”
BackgroundMostert, S., & Kesselring, J. (2005) · Multiple Sclerosis Journal · doi:10.1191/1352458505ms1156oa · Cited by 37
A Comparison of Fatigue Scales in Postpoliomyelitis Syndrome
Vasconcelos, O. M., Prokhorenko, O. A., Kelley, K. F., Vo, A. H., Olsen, C. H., Dalakas, M. C., Halstead, L. S., Jabbari, B., & Campbell, W. W. (2006) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2006.06.009 · Cited by 37
Cognitive dysfunction in pediatric multiple sclerosis
Suppiej, A., & Cainelli, E. (2014) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s48495 · Cited by 36
“In adults, the frequency ranges from 65% to 95% across studies 39,40 and many patients with MS describe fatigue as their most disabling symptom, significantly interfering with daily functioning.”
Achieving valid patient-reported outcomes measurement: a lesson from fatigue in multiple sclerosis
Hobart, J. C., Cano, S., Baron, R., Thompson, A. J., Schwid, S., Zajicek, J., & Andrich, D. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458513483378 · Cited by 36
Rendas‐Baum, R., Yang, M. S., Cattelin, F., Wallenstein, G. V., & Fisk, J. D. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9704-7 · Cited by 37
“It was designed to capture patients’ perceived impact of fatigue on their lives, namely how fatigue affects their mental health and general health status [16].”
BackgroundMethodInfluentialSelf-citationSchelhaas, H. J., van de Warrenburg, B. P. C., Kremer, H. P. H., & Zwarts, M. J. (2003) · Neurology · doi:10.1212/01.wnl.0000096009.50213.6c · Cited by 36
Correale, L., Buzzachera, C. F., Liberali, G., Codrons, E., Mallucci, G., Vandoni, M., Montomoli, C., & Bergamaschi, R. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.698460 · Cited by 35
“The prevalence of fatigue in people with MS is elevated, occurring at a rate as high as 55% (40).”
BackgroundDietary intake of nutrients and its correlation with fatigue in multiple sclerosis patients.
Bitarafan, S., Harirchian, M.-H., Nafissi, S., Sahraian, M. A., Togha, M., Siassi, F., Saedisomeolia, A., Alipour, E., Mohammadpour, N., Chamary, M., et al. (2014) · Europe PMC (PubMed Central) · Cited by 34
A qualitative review of the neurophysiological underpinnings of fatigue in multiple sclerosis
Yusuf, A., & Koski, L. M. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.04.012 · Cited by 34
“Self-report questionnaires such as the Fatigue Severity Scale (FSS) [3] and Fatigue Impact Scale [4] were developed tomeasure the severity of fatigue and its impact on daily life.”
Brenner, P., Granqvist, M., Königsson, J., Nimer, F. A., Piehl, F., & Jokinen, J. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.01.002 · Cited by 34
“The Modified Fatigue Impact Scale (MFIS) is modified version of the Fatigue Impact Scale (Fisk et al., 1994) and is a widely used instrument for measuring MS fatigue.”
Schakel, W., van der Aa, H. P. A., Bode, C., Hulshof, C. T. J., van Rens, G. H. M. B., & van Nispen, R. M. A. (2018) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.17-23224 · Cited by 34
“The impact of fatigue was assessed with the Dutch version of the Modified Fatigue Impact Scale (MFIS), originally developed to measure the impact of fatigue on physical, cognitive, and psychosocial functioning in patients with chronic illness, with multiple sclerosis in particular.(28) The questionnaire consists of 21…”
MethodKalron, A., Menascu, S., Frid, L., Aloni, R., & Achiron, A. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1519603 · Cited by 34
“Fatigue may be the most prominent symptom in people with MS who have minimal activity limitations [13].”
BackgroundThe impact of fatigue on communication in multiple sclerosis. The insider's perspective
Blaney, B., & Lowe-Strong, A. (2008) · Disability and Rehabilitation · doi:10.1080/09638280701869629 · Cited by 34
“Fatigue is reported as the worst (14%) or one of the worst (55%) symptoms of MS [17].”
BackgroundChetta, A. A., Franceschini, M., Rampello, A., Bovolenta, F., Marino, A., & Tzani, P. (2010) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0600 · Cited by 34
Řasová, K., Brandejský, P., Havrdová, E., Zálišová, M., & Rexova, P. (2005) · Multiple Sclerosis Journal · doi:10.1191/1352458505ms1155oa · Cited by 34
Fatigue in neuroimmunological diseases
Greim, B., Engel, C., Apel, A., & Zettl, U. K. (2007) · Journal of Neurology · doi:10.1007/s00415-007-2025-2 · Cited by 34
“Modified Fatigue Impact Scale from Fisk [7], German Modified Fatigue Impact Scale from Zimmermann and Hohlfeld [26]).”
MethodPlow, M. A., Finlayson, M. L., Motl, R. W., & Béthoux, F. (2012) · BMC Neurology · doi:10.1186/1471-2377-12-122 · Cited by 33
“symptom [1-5].”
Benign multiple sclerosis: a need for a consensus
Glad, S. B., Aarseth, J. H., Nyland, H., Riise, T., & Myhr, K. M. (2010) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.2010.01375.x · Cited by 34
Öncü, J., Başoğlu, F., & Kuran, B. (2013) · Rheumatology International · doi:10.1007/s00296-013-2825-x · Cited by 34
Metadata
- Authors
- Fisk, J. D., Pontefract, A., Ritvo, P. G., Archibald, C. J., & Murray, T. J.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Fisk, John D.
- ORCID
- Fisk, John D.
- Venue
- Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
- Publisher
- Cambridge University Press (CUP)
- Published
- 1994-02
- Volume
- 21
- Issue
- 1
- Pages
- 9-14
- ISSN
- 0317-1671 (ISSN-L)
- 2057-0155
- OpenAlex
- W155259919
- Cited by
- 1,025
- References
- 26
- Citations by year
- 2026: 24 · 2025: 26 · 2024: 34 · 2023: 52 · 2022: 49 · 2021: 63 · 2020: 45 · 2019: 31 · 2018: 46 · 2017: 44 · 2016: 38 · 2015: 56 · 2014: 31 · 2013: 44 · 2012: 38
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Dalhousie University
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- multiple sclerosis, fatigue, Fatigue Impact Scale, fatigue effects, mental health, health status, neurological deficit, hypertension, symptom burden, disease classification
- MeSH terms
- Adult, Affect, Aged, Fatigue, Female, Humans, Hypertension, Male, Mental Health, Middle Aged, Multiple Sclerosis, Psychiatric Status Rating Scales, Surveys and Questionnaires
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