title: Predictors of Fatigue Impact in Persons With Long-Standing Multiple Sclerosis.
abstract: BACKGROUND
  Fatigue is a common experience among persons diagnosed with multiple sclerosis (MS). Fatigue negatively influences quality of life, interferes with activities of daily living, and impairs the ability to maintain gainful employment. Mechanisms underlying the pathophysiologic determinants of fatigue in MS are poorly understood, and effective treatments to manage fatigue present a challenge. Although the use of pharmacologic therapies is recommended to treat symptomatic fatigue, undertreatment of fatigue is common. Better long-term management and symptomatic relief may be provided by the use of nonpharmacologic treatments such as increased physical activity, energy conservation, and cognitive behavioral therapy.
  
  
  METHODS
  The purpose of this study was to explore the physical, cognitive, and psychosocial dimensions of fatigue impact among persons with long-standing MS-defined here as having been diagnosed with MS for 17 years or more. A sample of 331 participants with MS completed surveys measuring fatigue impact, MS-related functional limitation, depressive symptoms, barriers to health promotion, personal resources, and health promoting behaviors.
  
  
  RESULTS
  MS-related functional limitation and depressive symptoms were the strongest predictors of fatigue impact. MS-related functional limitation explained the greatest amount of variance in models predicting physical and psychosocial fatigue impact, whereas depressive symptoms explained the most variance in models predicting total and cognitive fatigue impact. Barriers to health promotion explained the least amount of variance among the models. Personal resources and health promoting behaviors were not significant predictors of fatigue impact in this study.
  
  
  CONCLUSIONS
  Interventions aimed at reducing MS-related functional limitations, depressive symptoms, and barriers to health promotion may have beneficial influences on fatigue impact, whereas actions designed to promote personal resource adequacy as well as engagement in health promoting behaviors may not translate into improvements in fatigue impact in persons with MS.
authors.affiliation: Questions or comments about this article may be directed to Janet D. Morrison, RN MSN MSCN, at jmorrison@mail.nur.utexas.edu. She is a Doctoral Candidate/Graduate Research Assistant, School of Nursing, The University of Texas at Austin, Austin, TX. Alexa K. Stuifbergen, PhD RN FAAN, Dean, Laura Lee Blanton Chair in Nursing, James R. Dougherty, Jr. Centennial Professor in Nursing, School of Nursing, The University of Texas at Austin, Austin, TX.
authors.forename: Janet D
authors.initials: JD
authors.lastname: Morrison
authors.forename: Alexa K
authors.initials: AK
authors.lastname: Stuifbergen
mesh_terms: D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003863:Depression / Q000523:psychology; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires