Osteoarthritis Clinical Aspects
Abstract# 1976 - The Fatigue Experience in Osteoarthritis
Authors: J. Denise Power et al.
Background: Fatigue is becoming increasingly recognized as an important and potentially disabling symptom of rheumatic disease, particularly rheumatoid arthritis and lupus. To date, little is known about whether fatigue is also a concern for persons with osteoarthritis (OA). In this study, Power and associates attempt to increase our understanding of the role fatigue plays in OA.
Methods: Focus groups were conducted separately among men and women aged ≥ 55 years with symptomatic hip or knee OA. Prior to participating in the focus groups respondents completed questionnaires that assessed demographic characteristics, measures of OA pain and disability and an assessment of fatigue. A total of 8 focus groups were conducted, each containing 3 to 8 participants. During the focus groups participants were asked to identify and articulate themes associated with fatigue and OA. The sessions were audio taped and transcribed. Researchers reviewed the transcripts to identify emergent themes.
Results: A total of 46 individuals (28 women, 18 men) participated in the focus groups. All were Caucasian with an average age of 72 years. They reported moderate pain and disability and an average fatigue score of 31 on a scale that ranged from 0 (no fatigue) to 52 (greatest possible fatigue). Major themes identified by the participants included: fatigue characteristics, factors affecting fatigue, impact of fatigue, and coping methods. Fatigue was described as “exhausting”, “being worn out”, “coming up against a brick wall”, and “wilting.” Participants generally distinguished fatigue from sleepiness and were able to articulate differences between physical and mental fatigue. Participants noted that OA pain, aging, poor sleep, the weather, and medication use were potential contributors to fatigue, and that mood both affected and was affected by fatigue. The fatigue was said to adversely affect social activities, physical capacity, and overall functioning. Rest, exercise, avoidance of activity, and getting help were cited as the major ways to cope with the fatigue. On the whole, participants reported that they only discussed their fatigue with a spouse.
Conclusions: Participants indicate that fatigue has a significant influence of a variety of aspects of their lives and, at least for some, the fatigue is linked strongly to the intensity of their pain.
Editorial Comment: Fatigue has generally been overlooked both as a symptom of OA and as a contributor to impaired functional status. However, the results of this focus group study suggest that fatigue is an important factor that can, in at least some cases, significantly impair functional capacity and hamper quality of life. This implies that fatigue might be thought of as an important symptoms associated with OA. Moreover, participants report both positive (exercise) and negative (activity avoidance) coping strategies to manage their fatigue. Given the perceived importance of fatigue for these focus group participants, fatigue might be an important issue that should be evaluated both clinically and as a moderator/outcome in clinical research.
Given that the sample was small and restricted to only older Caucasian adults, the generalizability of these findings are highly suspect. Moreover, the contribution of other factors that might produce fatigue independent of OA such as obesity and poor sleep cannot be definitive established in focus group research. Nonetheless, these results indicate that fatigue might be an important factor in OA and one that requires attention. As such, identifying factors that influence fatigue in persons with OA (e.g., pain management, physical activity) might be important avenues of research to both enhance our understanding of the role fatigue plays, and to develop interventions to reduce fatigue in persons with OA.