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Comparative Study
. 2010 Oct;33(5):355-63.
doi: 10.1007/s10865-010-9266-8. Epub 2010 May 28.

Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach

Yvonne Bol  1 , Annelien A Duits, Richel Lousberg, Raymond M M Hupperts, Michelle H P Lacroix, Frans R J Verhey, Johan W S Vlaeyen
Affiliations
Comparative Study

Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach

Yvonne Bol et al. J Behav Med. 2010 Oct.

Abstract

Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients.

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Figures

Fig. 1
Fig. 1
Cognitive-behavioral model. Fear-Avoidance Fatigue-related fear and avoidance behavior, Catastrophizing catastrophizing about fatigue. Values shown are standardized regression coefficients. Explained variances are provided in parentheses. * p < .01; ** p < .0.001
Fig. 2
Fig. 2
Biomedical model. Fear-Avoidance Fatigue-related fear and avoidance behavior, Catastrophizing catastrophizing about fatigue. Values shown are standardized regression coefficients. Explained variances are provided in parentheses. * p < .01; ** p < .0.001
Fig. 3
Fig. 3
Final model. Fear-Avoidance Fatigue-related fear and avoidance behavior, catastrophizing catastrophizing about fatigue. Values shown are standardized regression coefficients. Explained variances are provided in parentheses. * p < .01; ** p < .0.001
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