Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb 18;10(2):e0115541.
doi: 10.1371/journal.pone.0115541. eCollection 2015.

Clinically significant fatigue: prevalence and associated factors in an international sample of adults with multiple sclerosis recruited via the internet

Tracey J Weiland  1 , George A Jelinek  2 , Claudia H Marck  3 , Emily J Hadgkiss  3 , Dania M van der Meer  3 , Naresh G Pereira  4 , Keryn L Taylor  5
Affiliations

Clinically significant fatigue: prevalence and associated factors in an international sample of adults with multiple sclerosis recruited via the internet

Tracey J Weiland et al. PLoS One. .

Abstract

Background: Fatigue contributes a significant burden of disease for people with multiple sclerosis (PwMS). Modifiable lifestyle factors have been recognized as having a role in a range of morbidity outcomes in PwMS. There is significant potential to prevent and treat fatigue in PwMS by addressing modifiable risk factors.

Objectives: To explore the associations between clinically significant fatigue and demographic factors, clinical factors (health-related quality of life, disability and relapse rate) and modifiable lifestyle, disease-modifying drugs (DMD) and supplement use in a large international sample of PwMS.

Methods: PwMS were recruited to the study via Web 2.0 platforms and completed a comprehensive survey measuring demographic, lifestyle and clinical characteristics, including health-related quality of life, disability, and relapse rate.

Results: Of 2469 participants with confirmed MS, 2138 (86.6%) completed a validated measure of clinically significant fatigue, the Fatigue Severity Scale. Participants were predominantly female from English speaking countries, with relatively high levels of education, and due to recruitment methods may have been highly pro-active about engaging in lifestyle management and self-help. Approximately two thirds of our sample (1402/2138; 65.6% (95% CI 63.7-67.7)) screened positive for clinically significant fatigue. Bivariate associations were present between clinically significant fatigue and several demographic, clinical, lifestyle, and medication variables. After controlling for level of disability and a range of stable socio-demographic variables, we found increased odds of fatigue associated with obesity, DMD use, poor diet, and reduced odds of fatigue with exercise, fish consumption, moderate alcohol use, and supplementation with vitamin D and flaxseed oil.

Conclusion: This study supports strong and significant associations between clinically significant fatigue and modifiable lifestyle factors. Longitudinal follow-up of this sample may help clarify the contribution of reverse causation to our findings. Further research is required to explore these associations including randomized controlled trials of lifestyle interventions that may alleviate fatigue.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Dr. Taylor and Professor Jelinek conduct residential retreats for people with multiple sclerosis, some of whom may have participated in this study; Prof. Jelinek receives royalties for his book “Overcoming Multiple Sclerosis”. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

References

    1. van der Mei IA, Simpson S Jr., Stankovich J, Taylor BV (2011) Individual and joint action of environmental factors and risk of MS. Neurol Clin 29: 233–255. 10.1016/j.ncl.2010.12.007 - DOI - PubMed
    1. Sawcer S, Hellenthal G, Pirinen M, Spencer CC, Patsopoulos NA, et al. (2011) Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis. Nature 476: 214–219. 10.1038/nature10251 - DOI - PMC - PubMed
    1. Marrie RA (2011) Demographic, genetic, and environmental factors that modify disease course. Neurol Clin 29: 323–341. 10.1016/j.ncl.2010.12.004 - DOI - PubMed
    1. Feinstein A (1999) The clinical neuropsychiatry of multiple sclerosis. Cambridge: University Press;
    1. Branas P, Jordan R, Fry-Smith A, Burls A, Hyde C (2000) Treatments for fatigue in multiple sclerosis: a rapid and systematic review. Health Technol Assess 4: 1–61. - PubMed

Publication types