Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions

Abstract

Objectives: To scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4) consequences and (5) effectiveness of interventions.

Methods: A systematic literature search of reviews was performed in five bibliographical databases. A hierarchical data extraction was applied based on review type (Cochrane reviews (CRs), followed by non-Cochrane systematic reviews (SRs) and narrative reviews (NRs)) and year of publication. Extracted data were summarised in elaborated narrative syntheses. Results were discussed with a patient panel.

Results: One hundred and thirty-four reviews were included (19 CRs, 44 SRs, 71 NRs). No agreed on definition was reported for general fatigue, nor for types of fatigue. Twenty-five measurement instruments were found, all self-reported. Five instruments proposed a threshold for excessive fatigue. Pain, physical function and depressive symptoms were the most frequently studied disease-related determinants of fatigue; female sex and stress the most frequent contextual determinants. Work performance, followed by impact on pain, physical activity and social roles were the most frequently studied consequences. Whenever quantified, associations between fatigue with determinants and consequences were on average small. For non-pharmacological interventions, if effect sizes were reported, these were negligible to small and for pharmacological interventions negligible to moderate. Patients recommended actions for research and practice.

Conclusion: Syntheses of reviews point to the complexity of fatigue. The extensive amount of evidence could be used to offer tailored management plans to patients in clinical practice and inform future research agendas.

Keywords: Arthritis; Arthritis, Psoriatic; Arthritis, Rheumatoid; Osteoarthritis; Spondylitis, Ankylosing.

Figure 1

Schematic representation of the construct fatigue in RMDs based on included reviews.

Figure 2

Identified determinants of fatigue categorised within the ICF model. The overall direction of associations between determinants and fatigue across reviews were summarised and colour-coded for (A) rheumatoid arthritis, (B) spondyloarthritis, (C) osteoarthritis and (D) fibromyalgia. A positive association indicates that an increase in the factors contributes to more severe experiences of fatigue. These summaries are reported independent of strength (weak, moderate or strong) and statistical significance of the associations. The bubble size represents the number of underlying studies according to the reviews that studied these associations. *In multivariable analyses, only worrying coping retained its significant association with fatigue. †Higher fatigue during winter was suggested, but multivariable analyses were inconsistent. ‡Variable summarising a concept that includes ≥2 dimensions: for details, see online supplemental file S7–S10. FM, fibromyalgia; ICF, international classification of functioning; GI, gastrointestinal.