title: Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors.
abstract: OBJECTIVE
  To determine the biopsychosocial correlates of general, physical, and mental fatigue in patients with postpoliomyelitis syndrome (PPS) by assessing the additional contribution of potentially modifiable factors after accounting for important nonmodifiable disease-related factors. It was hypothesized that disease-related, behavioral, and psychosocial factors would contribute in different ways to general, physical, and mental fatigue in PPS and that a portion of fatigue would be determined by potentially modifiable factors.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A tertiary university-affiliated hospital post-polio clinic.
  
  
  METHODS
  Fifty-two ambulatory patients with PPS who were not severely depressed were included.
  
  
  METHODS
  Potential correlates for fatigue included disease-related factors (acute polio weakness, time since acute polio, PPS duration, muscle strength, pain, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, body mass index, disability, fibromyalgia), behavioral factors (physical activity, sleep quality), and psychosocial factors (depression, stress, self-efficacy).
  
  
  METHODS
  Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI; assesses fatigue on 5 subscales) and the Fatigue Severity Scale (FSS).
  
  
  RESULTS
  Multivariate models were computed for MFI General, Physical, and Mental Fatigue. Age-adjusted multivariate models with nonmodifiable factors included the following predictors of (1) MFI General Fatigue: maximum inspiratory pressure, fibromyalgia, muscle strength; (2) MFI Physical Fatigue: maximum expiratory pressure, muscle strength, age, time since acute polio; and (3) MFI Mental Fatigue: none. The following potentially modifiable predictors made an additional contribution to the models: (1) MFI General Fatigue: stress, depression; (2) MFI Physical Fatigue: physical activity, pain; and (3) MFI Mental Fatigue: stress.
  
  
  CONCLUSIONS
  PPS fatigue is multidimensional. Different types of fatigue are determined by different variables. Potentially modifiable factors account for a portion of fatigue in PPS.
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, 3801 University St., Montreal, Quebec, H3A 2B4, Canada. daria.trojan@mcgill.ca
authors.forename: Daria A
authors.initials: DA
authors.lastname: Trojan
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Arnold
authors.forename: Stan
authors.initials: S
authors.lastname: Shapiro
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Le Cruguel
authors.forename: Sridar
authors.initials: S
authors.lastname: Narayanan
authors.forename: Maria C
authors.initials: MC
authors.lastname: Tartaglia
authors.forename: Zografos
authors.initials: Z
authors.lastname: Caramanos
authors.forename: Deborah
authors.initials: D
authors.lastname: Da Costa
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009483:Neuropsychological Tests; D010146:Pain / Q000209:etiology / Q000523:psychology; D016262:Postpoliomyelitis Syndrome / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D012123:Pulmonary Ventilation; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications