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Rehab Measures: Global Fatigue Index

Link to instrument

http://www.son.washington.edu/research/maf/users-guide.asp 

Title of Assessment

Global Fatigue Index 

Acronym

GFI
 
Note: The GFI is largely derived from the Multidimensional Assessment of Fagitue (MAF). For this reason, this review will need to include information on the MAF.

Instrument Reviewer(s)

Initially reviewed by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 9/2012

Summary Date

12/10/2012 

Purpose

To measure fatigue

Description

  • GFI is derived from 15 of the 16 items of the Multidimensional Assessment of Fatigue (MAF).
  • MAF was originally created for individuals with rheumatoid arthritis (Belza et al, 1993)
  • Measures fatigue across four dimensions
    • Severity (items 1-2)
    • Distress(item 3)
    • Impact of fatigue on various activities of daily living (items 4-14)
    • Timing of fatigue (item 15)
  • Self-administered questionnaire
  • Scoring responses for MAF
    • Items 1, 4-14: numerical responses: 1 = not at all to 10 = a great deal
    • Item 2: numerical responses: 1= mild to 10=severe
    • Item 3: numerical responses: 1=no distress to 10= a great deal of distress
    • Items 15 and 16: categorical response 1-4
    • Do not assign a score to items 4-14 if the respondents have a response of “do not do any activity for reasons other than fatigue.”
    • Assign a zero to items 2-16 if a respondent selects “no fatigue” on item 1.
    • The higher the score, the more severe the fatigue
  • Scoring responses for GFI
    • Item 16 of the MAF is not included in the GFI
    • Convert item 15 to 0-10 scale by multiplying each score by 2.5
    • Sum items 1, 2, and 3 and average 4-14, and 15
    • Do not assign a score to items 4-14 if the respondents have a response of “do not do any activity for reasons other than fatigue.”
    • Assign a zero to items 2-16 (item 16 is not included in the GFI) if a respondent selects “no fatigue” on item 1.
    • Scores range from 1 (no fatigue) to 50 (severe fatigue).

Area of Assessment

 

Body Part

 

ICF Domain

Body Structure; Body Function; Participation 

Domain

 

Assessment Type

 

Length of Test

05 Minutes or Less 

Time to Administer

5 minutes

Number of Items

15 items 

Equipment Required

  • Paper
  • Pencil

Training Required

No specia training

Type of training required

No Training 

Cost

Free 

Actual Cost

The MAF is copyrighted by Basia Bazia.  There is no charge for use of the MAF, except for colleagues in industry who may then be charged a nominal fee. 

Age Range

 

Administration Mode

 

Diagnosis

Arthritis; Multiple Sclerosis; Pulmonary Disease; Traumatic Brain Injury 

Populations Tested

  • Traumatic Brain Injury
  • Pulmonary disease
  • Osteoarthritis
  • Rheumatoid arthritis
  • Hepatitis C
  • Multiple Sclerosis
  • Synovitis
  • HIV+ adults with IL-2HIV+ adults
  • Oncology, mixed cancer diagnosis
  • Coronary heart disease
  • Breastfeeding women
  • Postpartum women

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Traumatic Brain Injury: (Cantor et al, 2008, n=223 individuals with mild to severe TBI and 85 noninjured controls. For the TBI group: 52.5% male and 47.5% female, age=47.8(SD 12.1), time since injury= 15.0(SD=13.2) years.)

  • Using a cut-off score of 21 on the GFI, chi-square test results indicate that 75% of individuals with TBI had statistically significant fatigue as compared to 40% of those in the control group (chi square (df=1, n=308)=34.05, P< 0.001).

Traumatic Brain Injury: (Englander et al, 2010, n=119 individuals at least 1 year post-TBI, 80 males, mean age=40±12 years, time since injury=9±7.6 years)

  • Used a cut-off score of 27 and above for the presence of fatigue for the GFI. 53% of the participants scored in the abnormal range of the GFI (>27).

Normative Data

Traumatic Brain Injury: (Bushnik T et al, 2007, n=64, average age=42 yo (SD=12; range=16-66 years) and duration of injury=10 years (SD=8; range=1.2-31 years)

  • Average GFI 24.4 (SD=11.7)

Traumatic Brain Injury: (Cantor et al, 2008, n=223 individuals with mild to severe TBI and 85 noninjured controls. For the TBI group: 52.5% male and 47.5% female, age=47.8(SD 12.1), time since injury= 15.0(SD=13.2) years.)

  • Average GFI for TBI group 28.361±11.280
  • Average GFI for control group 19.972±10.618

GFI Scores Across Samples (this table is from the MAF User's Guide)
Reference (alphabetically)
Condition
Sample Size
Mean (SD)
Cronbachs Alpha
Belza, 1995
Healthy Controls
51
17.0(11.13)
.93
Belza, 1995
Rheumatoid Arthritis
46
29.2(9.9)
.93
Bormann et al, 2001
HIV + adults
209
23.8(13.48)
.96
Grady et al, 1998
HIV + adults w/IL-2HIV+ adults
28; 22
11.5(10.8); 12.6 (13.6)
NR
Wambach et al, 1998 Breastfeeding women 41 23.51 (11.05) .89-.93
Williams et al 1999
Postpartum women
74
Grp 1 26.43 (12.07)
Grp 2
27.44 (11.51) @
.91-.92
* Only baseline scores presented
# Two measurement points: when fatigue was expected to be high and when it was expected to be low
@ Group 1 = mothers with newborns on apnea monitors; Group 2 = mothers with newborns not on apnea monitors

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Not Established

Internal Consistency

HIV+ adults: (Bormann et al, 2001. n=209 HIV+ and symptomatic adults)

  • Excellent internal consistenty, Cronbach’s alpha = .96
  • The GFI score did not change significantly within an 8 week period indicating stability

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Convergent Validity:

HIV+ adults: (Bormann et al, 2001; n=209 HIV+ and symptomatic adults)

  • Adequate Pearson’s correlations with the BDI, Perceived Stress Scale, Health Distress Scale, Illness Intrusiveness Scale, and number of days spent in bed all had significant relationships at or above .51, p<.001
  • Excellent, GFI correlated inversely with SF-36 physical health summary scores (r=-.79, p<.001) and SF-36 mental health summary scores (r=-.74, p<.001). The poorer the physical or mental health, the greater the fatigue.

Traumatic Brain Injury: (Bushnik et al, 2007, n=64, average age=42 yo (SD=12; range=16-66 years) and duration of injury=10 years (SD=8; range=1.2-31 years)

  • There was a trend towards an association between lower basal cortisol levels and higher Fatigue Severity Scale scores (Spearman’s ρ=-0.231; p=0.067) and higher GFI scores (Spearman’s ρ=-0.235; p=0.063). Note: It was expected that lower cortisol levels would result in more fatigue.

Traumatic Brain Injury: (Ashman et al, 2008, n=202 mild to severe TBI and 73 individuals with no disability. For the TBI group: 109 males, 93 females; age= 47.7 (SD=12.3); time since injury 14.7(SD=13.4) years.)

  • GFI was associated with response speed factor scores in neuropsychological testing at time 1 (T1) and time 3 (T3) (T1:r=-0.18, P<.01; T3:r=-0.15, P=.03).

Discriminant Validity:

HIV+ adults: (Bormann et al, 2001. n=209 HIV+ and symptomatic adults)

  • 2 item vitality subscale from SF-36, had a high inverse relationship with the GFI (r=-.80, p<.001)
  • GFI highly correlated with HIV Self-Efficacy fatigue subscale (r=-.64, p<.001)
  • The higher the self-efficacy in managing the fatigue, one reports less fatigue

Content Validity

Not Established

Face Validity

  • Cantor et al reports “the GFI is one of the most widely used measures of fatigue.”

Floor/Ceiling Effects

Not Established

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

NR

LS

NR

R

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 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)

TBI EDGE

No

No

Yes

Considerations

  • The GFI is largely derived from the MFA.
  • Articles routinely report the lack of uniformity in defining fatigue in TBI which may contribute to weaknesses in this measure’s validity.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Ashman, T. A., Cantor, J. B., et al. (2008). "Objective measurement of fatigue following traumatic brain injury." J Head Trauma Rehabil 23(1): 33-40. Find it on PubMed

Belza, B. L. (1995). "Comparison of self-reported fatigue in rheumatoid arthritis and controls." J Rheumatol 22(4): 639-643. Find it on PubMed

Belza, B. L., Henke, C. J., et al. (1993). "Correlates of fatigue in older adults with rheumatoid arthritis." Nurs Res 42(2): 93-99. Find it on PubMed

Bormann, J., Shively, M., et al. (2001). "Measurement of fatigue in HIV-positive adults: reliability and validity of the Global Fatigue Index." J Assoc Nurses AIDS Care 12(3): 75-83. Find it on PubMed

Bushnik, T., Englander, J., et al. (2007). "Fatigue after TBI: association with neuroendocrine abnormalities." Brain Inj 21(6): 559-566. Find it on PubMed

Cantor, J. B., Ashman, T., et al. (2008). "Fatigue after traumatic brain injury and its impact on participation and quality of life." J Head Trauma Rehabil 23(1): 41-51. Find it on PubMed

Englander, J., Bushnik, T., et al. (2010). "Fatigue after traumatic brain injury: Association with neuroendocrine, sleep, depression and other factors." Brain Inj 24(12): 1379-1388. Find it on PubMed

Grady, C., Anderson, R., et al. (1998). "Fatigue in HIV-infected men receiving investigational interleukin-2." Nurs Res 47(4): 227-234. Find it on PubMed

Wambach, K. A. (1998). "Maternal fatigue in breastfeeding primiparae during the first nine weeks postpartum." J Hum Lact 14(3): 219-229. Find it on PubMed

Williams, P. D., Press, A., et al. (1999). "Fatigue in mothers of infants discharged to the home on apnea monitors." Appl Nurs Res 12(2): 69-77. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 12/10/2012 9:48 AM  by Jason Raad 
Last modified at 12/4/2013 5:28 PM  by Jason Raad