Chronic fatigue syndrome in Queensland: An investigation of fatigue, incidence of falls and fear of falling, and balance and mobility function

Jane Anne Clarke (2007). Chronic fatigue syndrome in Queensland: An investigation of fatigue, incidence of falls and fear of falling, and balance and mobility function MPhil Thesis, School of Health and Rehabilitation Science, The University of Queensland.

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Author Jane Anne Clarke
Thesis Title Chronic fatigue syndrome in Queensland: An investigation of fatigue, incidence of falls and fear of falling, and balance and mobility function
School, Centre or Institute School of Health and Rehabilitation Science
Institution The University of Queensland
Publication date 2007-07
Thesis type MPhil Thesis
Supervisor Low Choy, Nancy L.
Language eng
Subjects 320000 Medical and Health Sciences
Abstract/Summary This study was conducted in two parts, a survey study and a comparative balance and mobility pilot study. Firstly, a series of self-administered questionnaires were mailed to people in Queensland with chronic fatigue syndrome (CFS). The main purpose of the survey study was to 1) develop a demographic and health profile of the population of people who suffer from CFS in Queensland; 2) to establish the reliability and validity of an alternate measure of fatigue, the Multidimensional Assessment of Fatigue (MAF) and 3) to document functional mobility, history of falls and degree of fear of falling experienced by those with CFS. The average age of CFS subjects who participated in the survey study was 52 years, and 69 percent were between the ages of 40 and 70 years. Seventy-seven percent of the subjects were women. CFS subjects reported a mean duration of CFS symptoms of 16.95 years. Sixty-three percent of CFS subjects suffered from a concomitant diagnosis of fibromyalgia. Fatigue severity was measured by the Fatigue Severity Scale (FSS) and the MAF. The mean fatigue score obtained from the FSS and the MAF was 6.3 (SD+/-0.7) and 37.81 (SD+/-6.96) respectively. The FSS (Intraclass Coefficient=0.9, p<0.001) and the MAF (Intraclass Coefficient=0.84, p<0.001) were highly reliable when measuring fatigue in CFS over two occasions within a one-month period. There was a weak, but significant correlation between the MAF and the FSS (Spearman’s Rank Order Coefficient=0.476, p<0.001), indicating that the MAF is a reliable and valid measure of fatigue in the CFS population. Fifty-one percent of the CFS cohort reported a history of a fall occurring in the past six months, while thirty-nine percent of the total CFS cohort were identified as recurrent fallers. A fear of falling was reported by fifty-two percent of CFS subjects. The mean modified falls efficacy score for the CFS cohort was 7.7 (SD. +/-2.24). Falls and fear of falling appeared to be related to a concurrent diagnosis of fibromyalgia. The high incidence of falls and fear of falling in the CFS population prompted a pilot comparative study of balance and mobility function in women with CFS. The main aims of this study were to 1) identify the type of balance and mobility deficits experienced by a cohort of younger women with CFS; 2) to compare balance and mobility function of women with CFS to an age matched control group and 3) to identify the test conditions that are best able to differentiate the balance and mobility performance of the CFS cohort and controls. The grip strength, gaze stability and balance and mobility function of 14 females with a current diagnosis of CFS and 20 age matched control females was tested. Upper limb strength (p<0.003) and dynamic visual acuity (p<0.003) were significantly reduced in CFS subjects when compared to control subjects. There were no significant differences between CFS and control subjects for postural stability measures of bilateral stance on the Clinical Test of Sensory Integration of Balance. There was a strong trending increase in velocity of postural sway demonstrated when CFS females stood on a firm surface with eyes closed (p=0.018). No significant difference between the CFS cohort and the controls was demonstrated for all single leg stance (SLS) time and sway measures. However there was a strong trend for increased postural sway and less time measured for left and right SLS with eyes open. Slower reaction times when weight shifting in a mediolateral direction ((R) p=0.004, (L) p=0.007) were demonstrated in CFS subjects. CFS subjects performed the Timed Up and Go (TUG) test, manual TUG and the combined TUG significantly slower than control subjects (p=0.001). Gait parameters were significantly different between the two groups on all 10m walk tests. CFS subjects exhibited a slower gait velocity, shorter step length, less cadence and longer duration of gait cycle. Dual tasking did not appear to effect the gait pattern of CFS subjects more than controls, however, more complex multitask conditions may have identified greater differences between the two groups. This study has demonstrated that a community based cohort of the CFS population in Queensland experience significant levels of impairment and disability associated with fatigue and other CFS symptoms, falls and perceived fear of falling. Preliminary findings suggest that people with CFS exhibit mild balance and mobility deficits and impaired upper limb strength and gaze stability. Recommendations are made regarding the future delivery of intervention programmes for people with CFS in Queensland.

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