title: Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model.
abstract: OBJECTIVE
  To develop a symptoms cluster model that can describe factors of fibromyalgia syndrome (FMS) associated with fatigue severity as reported by the sample and to explore FMS clinical symptom subclusters based on varying symptom intensities.
  
  
  METHODS
  FMS individuals (n = 120, 82% ages 31-60 years, 90% women, 59% white) diagnosed with the 1990 or 2010 American College of Rheumatology diagnostic criteria were enrolled. Participants completed multiple validated self-report questionnaires to measure fatigue, pain, depression, anxiety, pain catastrophizing, daytime sleepiness, cognitive function, and FMS-related polysymptomatic distress. Cluster analysis using SPSS 19.0 and structural equation modeling using AMOS 17.0 were used.
  
  
  RESULTS
  Final structural equation modeling the symptoms cluster model showed good fit and revealed that FMS fatigue was associated with widespread pain, symptoms severity, pain intensity, pain interference, cognitive dysfunction, catastrophizing, anxiety, and depression (χ(2)  = 121.72 (98df), P > 0.05, χ(2) /df = 1.242, comparative fit index = 0.982, root mean square error of approximation = 0.045). Two distinct clinical symptom subclusters emerged: subcluster 1 (78% of total subjects), defined by widespread pain, unrefreshed waking, and somatic symptoms, and subcluster 2 (22% of total subjects), defined by fatigue and cognitive dysfunction with pain being a less severe and less widespread occurrence.
  
  
  CONCLUSIONS
  Overall, subcluster 1 had more intense symptoms than subcluster 2. FMS symptoms may be categorized into 2 clinical subclusters. These findings have implications for an illness whose diagnosis and management are symptom dependent. A longitudinal study capturing the variability in the symptom experience of FMS subjects is warranted.
authors.affiliation: School of Nursing, University of Nevada, Las Vegas, and National Institute of Nursing Research, NIH, Bethesda, Maryland.
authors.forename: Nada
authors.initials: N
authors.lastname: Lukkahatai
authors.affiliation: National Institute of Nursing Research, NIH, Bethesda, Maryland, and Medstar Research Institute, Washington Hospital Center, Washington, DC.
authors.forename: Brian
authors.initials: B
authors.lastname: Walitt
authors.affiliation: National Institute of Nursing Research, NIH, Bethesda, Maryland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Espina
authors.affiliation: National Center for Biotechnology Information, National Library of Medicine, Bethesda, Maryland.
authors.forename: Alves
authors.initials: A
authors.lastname: Gelio
authors.affiliation: National Institute of Nursing Research, NIH, Bethesda, Maryland.
authors.forename: Leorey N
authors.initials: LN
authors.lastname: Saligan
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D058443:Catastrophization; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003071:Cognition; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005221:Fatigue / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires