title: Predicting fatigue in patients using home parenteral nutrition: a longitudinal study.
abstract: BACKGROUND
  Home parenteral nutrition (HPN) is a life-saving therapy for patients with diseases that preclude adequate oral or enteral food intake. HPN has a large impact on daily life. Many patients suffer from fatigue and depression, and they experience limits in social activities. This all contributes to a lower quality of life.
  
  
  OBJECTIVE
  Fatigue is the most frequently mentioned problem in Dutch HPN patients. Therefore, we studied the prevalence, course and predictors of fatigue in these patients.
  
  
  METHODS
  Patients completed questionnaires at baseline and follow-up (12 months later). Measurements included fatigue, depression, functional impairment, social support, self-efficacy, coping, anxiety and acceptance. Laboratory measures, including total bilirubin, creatinine, albumin and haemoglobin levels, were obtained from the medical records. Descriptive statistics, correlations and linear regression analysis were performed.
  
  
  RESULTS
  The response rate was 71% (n = 75). Sixty-five per cent of the patients were severely fatigued (n = 49). Eighty-nine per cent experienced persistent fatigue. Baseline fatigue predicted 57% of the variance of fatigue at follow-up, and avoidance was responsible for 3% of the variance. No significant correlations between fatigue and laboratory measures were found. A cross-sectional analysis showed that 46% of the variance of fatigue was explained by functional impairment, self-efficacy and depression.
  
  
  CONCLUSIONS
  Severe fatigue is a persistent problem for HPN patients. Baseline fatigue was the strongest predictor of fatigue at follow-up. Functional impairment, self-efficacy and depression are strongly related to fatigue. Early recognition and treatment of fatigue are important.
authors.affiliation: IQ Healthcare, Nursing Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. G.Huisman-deWaal@iq.umcn.nl
authors.forename: Getty
authors.initials: G
authors.lastname: Huisman-de Waal
authors.forename: Ellen
authors.initials: E
authors.lastname: Bazelmans
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.forename: Jan
authors.initials: J
authors.lastname: Jansen
authors.forename: Hans
authors.initials: H
authors.lastname: Sauerwein
authors.forename: Geert
authors.initials: G
authors.lastname: Wanten
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003863:Depression / Q000523:psychology; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000523:psychology*; D020377:Self Efficacy; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires