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. 2017 Oct;40(5):772-783.
doi: 10.1007/s10865-017-9840-4. Epub 2017 Mar 9.

Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights

Daniel J H Powell  1   2 , Christina Liossi  3 , Wolff Schlotz  3   4 , Rona Moss-Morris  3   5
Affiliations

Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights

Daniel J H Powell et al. J Behav Med. 2017 Oct.

Abstract

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.

Keywords: Affect; Ambulatory assessment; Ecological momentary assessment; Fatigue; Multiple sclerosis; Psychological stress.

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Conflict of interest statement

Conflict of interest

Daniel J. H. Powell, Christina Liossi, Wolff Schlotz, and Rona Moss-Morris declares that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Figures

Fig. 1
Fig. 1
Step line charts (solid lines) depicting change in Momentary Fatigue Severity ratings in three individuals from the relapsing-remitting MS group over the six assessments (A1–A6) from four assessment days. Dashed lines indicate person-means and dotted lines indicate daily-means. Corresponding within-person indices are presented, including mean, median (med), mean successive squared difference (MSSD; Jahng et al., 2008), probability of acute change (PAC; acute change defined as change ≥5 units between two adjacent assessments; Jahng et al., 2008), and proportion of ratings ≥5
Fig. 2
Fig. 2
Average fatigue trajectories over time in the relapsing-remitting MS group (red solid line) and the control group (green dashed line). The circular indicators represent unique Momentary Fatigue Severity assessments in the relapsing-remitting MS group; the triangular indicators represent those in the control group
See this image and copyright information in PMC

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