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Rehab Measures: Modified Fatigue Impact Scale

Link to instrument

Download the MSQLI: A User’s Manual (PDF) 

Title of Assessment

Modified Fatigue Impact Scale 

Acronym

MFIS

Instrument Reviewer(s)

Initially reviewed by Tammie Johnson, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA in 9/2012

Summary Date

12/10/2012 

Purpose

The MFIS is a modified form of the Fatigue Impact Scale (Fisk et al, 1994) based on items derived from interviews with MS patients concerning how fatigue impacts their lives. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning.

Description

  • The full-length MFIS has 21 items while the abbreviated version has 5 items. The full-length version has the advantage of generating subscales.
  • The MFIS is a 21-item shortened version of the 40-item FIS and has been recommended for use by the Multiple Sclerosis Council for Clinical Practice Guidelines. It assesses the perceived impact of fatigue on the subscales physical, cognitive and psychosocial functioning during the past 4 weeks (Rietberg et al., 2010).
  • The MFIS is one of the components of the MSQLI.
  • Description of scoring: Likert scale. Participants rate on a 5-point Likert scale, with 0 = ‘Never’ to 4 = ‘Almost always’ their agreement with 21 statements.
  • Total score (0‐84) and subscales for physical (0‐36), cognitive (0‐40) and psychosocial functioning (0‐8). The 5 item version is scored (0‐20). Higher numbers indicate greater fatigue.
  • Rasch analysis revealed that the 21-item scale was found to contain a “physical” and a “cognitive” dimension (the original 2 social items were found to be part of the physical dimension).
  • Scoring for Standard 21-item version: either represented as a total score by summing the totals from each subscale or by each individual subscale (see below).
  • Physical subscale: range from 0-36
    • Add raw scores on items: 4+6+7+10+13+14+17+20+21
  • Cognitive subscale: range from 0-40
    • Add raw scores on items: 1+2+3+5+11+12+15+16+18+19
  • Psychosocial subscale: range from 0-8
    • Add raw scores on items: 8+9
  • Scoring for 5-item version:
    • Total score is the sum of items 1+9+10+17+19
    • Range from 0-20

Area of Assessment

 

Body Part

 

ICF Domain

Body Structure; Body Function; Activity; Participation 

Domain

 

Assessment Type

 

Length of Test

05 Minutes or Less; 06 to 30 Minutes 

Time to Administer

Administration time is approximately 5-10 minutes for the full-length version and 2-3 minutes for the abbreviated version.

Number of Items

The standard version of the MFIS consists of 21items.  The abbreviated version of the MFIS consists of 5 items.  

Equipment Required

  • Quetionnaire
  • Pen

Training Required

Training can be done by downloading and reading the MSQLI document on the MS site.

Type of training required

Reading an Article/Manual 

Cost

Free 

Actual Cost

Free

Age Range

 

Administration Mode

 

Diagnosis

Traumatic Brain Injury 

Populations Tested

  • Multiple Sclerosis

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Multiple Sclerosis: (Rietberg, 2010; n= 43; ambulatory patients with MS (mean age 48.7 years; SD 7 years; 30 women; median Expanded Disability Status Scale score 3.5)

  • Smallest Detectable Change (SDC) = 16.2
  • Minimal Detectable Change (MDC) % = 19.3%

Cut-Off Scores

Not Established

Normative Data

Multiple Sclerosis: (Tellez et al, 2005; 231 MS patients and 123 healthy controls, 164 patients with relapsing-remitting, 47 with secondary progressive, 12 with primary progressive)

  • Median MFIS score= 33.0 (range 0-82)

Traumatic Brain Injury: (Sendroy-Terrill et al., 2010, n=243, 73% men, less than 5% of participants unconsciousness of < 1 day, 41 % showed LOC 1 day to 1 week, 31 % LOC from 1 week to 1 month, 24% had LOCs from 1 month to 1 year. Recived treatment in a comprehensive inpatient rehabilitation hospital. Cohorts based on years postinjury (1 to >30 years))

  • Mean for total MFIS= 23.7±21.1
  • Mean for MFIS - Physical= 10.2±9.6
  • Mean for MFIS - Cognitive=11.4±10.4
  • Mean for MFIS - Psychosocial= 2.0±2.0

Test-retest Reliability

Multiple Sclerosis: (Rietberg, 2010; n= 43; ambulatory patients with MS (mean age 48.7 years; SD 7 years; 30 women; median Expanded Disability Status Scale score 3.5)

  • Excellent test-retest reliability (ICC =0.85)

Interrater/Intrarater Reliability

Multiple Sclerosis: (Amtmann et al, 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week; mean age 50.7, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%)

  • Excellent reliability: Cronbach’s alpha = 0.94-0.96 for total MFIS

Internal Consistency

Multiple Sclerosis: (Kos et al, 2005)

  • MFIS has been found to show change after intervention.
  • After a 4‐week rehabilitation program, the MFIS did change, but the FSS did not.

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Multiple Sclerosis: (Rietberg, 2010; n= 43; ambulatory patients with MS; mean age 48.7 years; SD 7 years; 30 women; median Expanded Disability Status Scale score 3.5)

  • Excellent: MFIS vs. Fatigue Severity Scale (FSS): r = 0.66; MFIS vs. the Checklist Individual Strength (CIS20R): r = 0.54

Multiple Sclerosis: (Tellez et al, 2005; (231 MS patients and 123 healthy controls, 164 patients with relapsing-remitting, 47 with secondary progressive, 12 with primary progressive)

  • Excellent: between MFIS and FSS (r=0.68, p<0.0001)
  • Adequate to Excellent: between MFIS subscale and FSS
    • MFIS-physical: r=0.75, p<0.0001
    • MFIS-cognitive: r=0.44, p<0.0001
    • MFIS-psychosocial: r= 0.62, p<0.0001

Predictive Validity:

Traumatic Brain Injury: (Sendroy-Terrill et al., 2010, n=243, 73% men, less than 5% of participants unconsciousness of < 1 day, 41 % showed LOC 1 day to 1 week, 31 % LOC from 1 week to 1 month, 24% had LOCs from 1 month to 1 year. Recived treatment in a comprehensive inpatient rehabilitation hospital. Cohorts based on years postinjury (1 to >30 years))

  • MFIS-physical: with each additional decade of age at time of injury, there was a 2 point increase on the MFIS-physical score (P=.02)
  • MFIS-psychosocial: with each additional decade of age at time of injury, there was a 0.5 point increase (P=.01)

Construct Validity (Convergent/Discriminant)

Multiple Sclerosis: (Mills et al, 2010; n=415)

  • Given the Rasch analysis, Mills et al. suggested that the physical and cognitive subscales should be used separately eliminating questions 4, 14, 17 from the physical and questions 1‐3, 5, and 11. In addition, the authors suggest the total score not be used.

Content Validity

Multiple Sclerosis: (Amtmann et al., 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week. Mean age 507, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%)

  • Validity: Spearman Rank Correlation Fatigue Severity Scale to MFIS:
    • Excellent for MFIS total and subscales of physical and psychosocial (0.69-0.77)
    • Adequate for MFIS cognitive subscale
  • IRT analyses indicate that the FSS is less precise in measuring both low and high levels of fatigue, compared with the MFIS.
  • For those interested in measuring both physical and cognitive aspects of fatigue, and whose sample is expected to have higher levels of fatigue, the MFIS is a better choice even though it is longer.

Face Validity

Not Established

Floor/Ceiling Effects

Multiple Sclerosis: (Amtmann et al., 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week; mean age 50.7, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%)

  • Floor effects: (number of respondents with the lowest possible score)
    • MFIS total= 1.1%
    • MFIS-phy=1.6%
    • MFIS-cog=2.7%
    • MFIS-psychosocial=7.4%
  • Ceiling effect: (number of respondents with the highest possible score)
    • MFIS total= 0.7%
    • MFIS-phy=1.6%
    • MFIS-cog=0.9%
    • MFIS-psychosocial=9.0%

Responsiveness

Not Established

Professional Association Recommendations

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, and the TBI EDGE Taskforce are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

UR

UR

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

NR

UR

UR

UR

MS EDGE

R

R

R

R

R

TBI EDGE

NR

LS

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Is this tool appropriate for use in intervention research studies? (Y/N)

StrokEDGE

No

No

Yes

MS EDGE

No

Yes

Yes

TBI EDGE

No

No

No

Considerations

  • The MFIS is a shortened modification of the Fatigue Impact Scale, designed as a self-report measure to rate fatigue in Multiple Sclerosis.
  • The MFIS cannot be used to generate a single overall score of fatigue. The conceptual interaction between the two dimensions remains unclear, which poses problems when interpreting change scores in these individual scales. Studies in which a global MFIS score was used as either an outcome measure or selection tool may need to be re-evaluated (Mills et al., 2010).
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Bibliography

Amtmann, D., Bamer, A. M., et al. (2012). "Comparison of the psychometric properties of two fatigue scales in multiple sclerosis." Rehabil Psychol 57(2): 159-166. Find it on PubMed

Belmont, A., Agar, N., et al. (2006). "Fatigue and traumatic brain injury." Ann Readapt Med Phys 49(6): 283-288, 370-284. Find it on PubMed

Fisk, J. D., Ritvo, P. G., et al. (1994). "Measuring the functional impact of fatigue: initial validation of the fatigue impact scale." Clin Infect Dis 18 Suppl 1: S79-83. Find it on PubMed

Kos, D., Kerckhofs, E., et al. (2005). "Evaluation of the Modified Fatigue Impact Scale in four different European countries." Mult Scler 11(1): 76-80. Find it on PubMed

Mills, R. J., Young, C. A., et al. (2010). "Rasch analysis of the Modified Fatigue Impact Scale (MFIS) in multiple sclerosis." J Neurol Neurosurg Psychiatry 81(9): 1049-1051. Find it on PubMed

Ponsford, J. L., Ziino, C., et al. (2012). "Fatigue and sleep disturbance following traumatic brain injury--their nature, causes, and potential treatments." J Head Trauma Rehabil 27(3): 224-233. Find it on PubMed

Rietberg, M. B., Van Wegen, E. E., et al. (2010). "Measuring fatigue in patients with multiple sclerosis: reproducibility, responsiveness and concurrent validity of three Dutch self-report questionnaires." Disabil Rehabil 32(22): 1870-1876. Find it on PubMed

Sendroy-Terrill, M., Whiteneck, G. G., et al. (2010). "Aging with traumatic brain injury: cross-sectional follow-up of people receiving inpatient rehabilitation over more than 3 decades." Arch Phys Med Rehabil 91(3): 489-497. Find it on PubMed

Tellez, N., Rio, J., et al. (2005). "Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS?" Mult Scler 11(2): 198-202. Find it on PubMed 

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 12/10/2012 9:25 AM  by Jason Raad 
Last modified at 12/4/2013 5:12 PM  by Jason Raad