title: Fatigue in patients with Juvenile Idiopathic Arthritis: relationship to perceived health, physical health, self-efficacy, and participation.
abstract: BACKGROUND
  Fatigue is common in patients with JIA and affects daily life negatively. We assessed the presence and severity of fatigue in patients with JIA, including factors presumed associated with fatigue (e.g., disease activity, disability, pain, physical activity, exercise capacity, and self-efficacy), and whether fatigue is related to participation in physical education classes, school attendance, and sports frequency.
  
  
  METHODS
  The current study used baseline data of 80 patients with JIA (age 8-13) who participated in an intervention aimed at promoting physical activity. Primary outcome measurements were fatigue, assessed using the Pediatric-Quality-of-Life-Inventory (PedsQl)-Fatigue-scale and energy level assessed using a VAS scale. Other outcome measurements were disease activity (VAS Physician Global Assessment Scale), disability (Childhood Health Assessment Questionnaire), physical activity (accelerometer), exercise capacity (Bruce treadmill test), self-efficacy (Childhood Arthritis Self-Efficacy Scale), and participation (self-report).
  
  
  RESULTS
  Sixty percent of patients with JIA suffered from daily low-energy levels; 27% suffered from very low-energy levels more than half the week. Low energy levels were best predicted by disability and low physical activity. Fatigue measured with the PEDsQL was higher compared to the control-population. Disability and low self-efficacy were main predictors of fatigue. Self-efficacy was a predictor of fatigue but did not act as moderator. Fatigue was a predictor for sports frequency but not for school attendance.
  
  
  CONCLUSIONS
  Fatigue is a significant problem for JIA patients. Interventions aimed at reducing perceived disability, stimulating physical activity, and enhancing self-efficacy might reduce fatigue and thereby enhance participation.
  
  
  BACKGROUND
  Trial number ISRCTN92733069.
authors.affiliation: Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands. w.armbrust@umcg.nl.
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
authors.forename: Otto H T M
authors.initials: OH
authors.lastname: Lelieveld
authors.affiliation: Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Tuinstra
authors.affiliation: Department of Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
authors.forename: G J F Joyce
authors.initials: GJ
authors.lastname: Bos
authors.affiliation: Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Cappon
authors.affiliation: Reade, Center for Rehabilitation and Rheumatology, location: Dr. Jan van Breemenstraat, Amsterdam, The Netherlands.
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
authors.forename: Pieter J J
authors.initials: PJ
authors.lastname: Sauer
authors.affiliation: Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Mariët
authors.initials: M
authors.lastname: Hagedoorn
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications* / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D010465:Perception; D010809:Physical Fitness / Q000502:physiology; D011247:Pregnancy; D011788:Quality of Life; D020377:Self Efficacy
keywords: Exercise capacity; Fatigue; Juvenile idiopathic arthritis; Participation; Patient reported outcome; Physical activity; Self-efficacy