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MS Fatigue: How Is It Measured?

Medically reviewed by Evelyn O. Berman, M.D.
Written by Joan Grossman
Posted on July 22, 2022

As many as 95 percent of people with multiple sclerosis (MS) experience fatigue. Measuring fatigue can provide important insights into how best to treat and manage this common symptom.

The causes of MS-related fatigue are currently not fully understood. Theories include immune system dysfunction or problems with the central nervous system as a result of MS. A high prevalence of fatigue in people with MS may also be caused by problems related to the condition, such as sleep disturbances, pain, or medication side effects.

Disability in MS is widely measured with the Expanded Disability Status Scale, but that tool has limited consideration of fatigue. Clinically, fatigue has been difficult to define in the field of neurology. This is because fatigue is gauged by subjective perceptions or experiences, such as pain. However, research has validated measurement tools that can help clinicians better understand the severity and impact of fatigue.

Forms of Fatigue

Fatigue is one of the most common symptoms of MS and can take on different forms. It is a multidimensional symptom that can affect the body and mind in individual ways. Fatigue measurement scales address the following three forms of fatigue recognized by researchers:

  • Physical fatigue — Causes muscle weakness, muscle spasms, spasticity, and other symptoms that impair physical activity
  • Cognitive fatigue — Affects attention, thinking, memory, and other cognitive functions
  • Psychosocial fatigue — Reduces the desire to go out or connect with people

The term “lassitude” is a particular characteristic of fatigue that is associated with MS. It is defined as severe tiredness that may occur daily despite sleeping well and can be worsened by heat and humidity. Lassitude can come on suddenly and often hinders everyday activities. It can be associated with depression in MS and is considered difficult to measure.

Measurement Tools

Many clinical tools have been developed to measure the three major forms of fatigue in MS. Fatigue scales are generally based on self-reporting by someone living with MS. Fatigue questionnaires may assess total score or subscales of physical, cognitive, or psychosocial fatigue symptoms.

The self-reporting measurement tools described below are some of the most common scales for evaluating fatigue in people with MS.

Modified Fatigue Impact Scale

The Modified Fatigue Impact Scale (MFIS) is a questionnaire that assesses how fatigue affects everyday life. The MFIS is based on the scoring of 21 items that address physical, cognitive, and psychosocial fatigue and focuses on fatigue’s impact on daily activities.

Fatigue Impact Scale

The Fatigue Impact Scale, a 40-item questionnaire, is the basis for the MFIS. This scale evaluates how fatigue is affecting someone on the day the test is administered.

Rochester Fatigue Diary

The Rochester Fatigue Diary (RFD) measures levels of fatigue each hour over the course of a day. Questions are answered on a scale of zero to 100, with higher scores indicating less severe fatigue. The RFD was designed to determine levels of severe fatigue or lassitude, rather than specific characteristics of physical, cognitive, or psychosocial fatigue.

Fatigue Severity Scale

The Fatigue Severity Scale (FSS), sometimes called Krupp’s Fatigue Severity Scale, includes nine items (seven in a shortened version). The questionnaire emphasizes the severity of physical or motor fatigue and assesses fatigue for the week before the test is administered. The FSS is also used to measure fatigue in chronic fatigue syndrome.

How Fatigue Measurement Is Used

Doctors and researchers administer these tools to assess the ways and degree to which fatigue affects people with MS. These measures can be used in studies to help researchers learn whether specific treatments, therapies, or interventions are effective in improving fatigue and its impact on daily life.

Fatigue measurement tools may help your doctor make specific diagnoses of fatigue that are associated with sleep disorders or depression. Correct diagnosis is important because different conditions call for different treatments. Measurement scales can also help evaluate the level of fatigue that may persist during or after treatment.

Researchers continue to seek more precise methods for analyzing and applying outcome measures of fatigue to health care policy and clinical practice guidelines.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 189,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with multiple sclerosis and experiencing fatigue? Have you had your fatigue levels measured by a health care provider? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on July 22, 2022
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Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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