Examination of the Dimensionality of Fatigue
Abstract
Summary: This paper reports on two studies. The goal of Study I was to examine the dimensionality of existing fatigue scales. The aims of Study II were to construct a new self-report fatigue instrument and to examine its psychometric qualities. In Study I, 876 respondents completed the Fatigue Scale (Chalder et al., 1993), the Checklist Individual Strength (Vercoulen, Alberts, & Bleijenberg, 1999), the Emotional Exhaustion subscale of the MBI-NL (Schaufeli & Van Dierendonck, 1994), and the Energy and Fatigue subscale of the WHOQOL-100 (De Vries & Van Heck, 1995). Exploratory factor analyses and Mokken Scale Analyses provided strong support for the unidimensionality of each of these fatigue questionnaires. Furthermore, when all four measures were combined, only one factor was found, providing support for the view that fatigue is unidimensional. Based on these analyses, a new measure, the 10-item Fatigue Assessment Scale (FAS), was constructed in Study II. The instrument was administered to a sample of 1893 participants, representative of the Dutch population. The FAS showed a good reliability and content validity. Strong support was obtained for the unidimensionality of the scale.
References
Åhsberg, E. (2000). Dimensions of fatigue in different working populations.. Scandinavian Journal of Psychology, 41, 231– 241Åkerstedt, T. (1990). Psychological and psychophysiological effects of shift work.. Scandinavian Journal of Work, Environment & Health, 16, 67– 73Alberts, M. Smets, E.M.A. Vercoulen, J.H.M.M. Garssen, B., Bleijenberg, G. (1997). “Verkorte vermoeidheidsvragenlijst”: Een praktisch hulpmiddel bij het scoren van vermoeidheid ‘“Shortened fatigue questionnaire”: A practical aid in scoring fatigue’.. Nederlands Tijdschrift voor Geneeskunde, 141, 1526– 1530Alberts, M. Vercoulen, J.H.M.M., Bleijenberg, G. (2001). Assessment of fatigue. The application of the subjective feeling of fatigue in different research studies.. In A.J.J.M. Vingerhoets (Ed.), Assessment in behavioral medicine (pp.301-328). Hove, UK: Brunner-Routledge.Barofsky, I., Legro, M.W. (1991). Definition and measurement of fatigue.. Reviews of Infectious Diseases, 13, 94– 97Bartley, S.H., Chute, E. (1947). Fatigue and impairment in man. . New York: McGraw-Hill.Bensing, J. Hulsman, R., Schreurs, K. (1996). Vermoeidheid: Een chronisch probleem ‘Fatigue: A chronic problem’.. Medisch Contact, 51, 123– 124Beurskens, A.J.H.M. Bültmann, U. Kant, I. Vercoulen, J. H.M.M. Bleijenberg, G., Swaen, G.M.H. (2000). Fatigue among working people: Validity of a questionnaire measure.. Occupational and Environmental Medicine, 57, 353– 357Bültmann, U. De Vries, M. Beurskens, A.J.H.M. Bleijenberg, G. Vercoulen, J.H.M.M., Kant, I. (2000). Measurement of prolonged fatigue in the working population: Determination of a cutoff point for the checklist individual strength.. Journal of Occupational Health Psychology, 5, 411– 416Cattell, R.B. (1966). The scree test for the number of factors.. Multivariate Behavioral Research, 1, 140– 1611999). De leefsituatie van de Nederlandse bevolking 1997. Deel 1: Gezondheid en arbeid ‘Life circumstances of the Dutch population 1997. Volume 1: Health and work’.. Voorburg/Heerlen, The Netherlands: CBS.
(Chalder, T. Berelowitz, G. Pawlikowska, T. Watts, L. Wessely, S. Wright, D., Wallace, E.P. (1993). Development of a fatigue scale.. Journal of Psychosomatic Research, 37, 147– 153David, A. Pelosi, A. McDonald, E. Stephens, D. Ledger, D. Rathbone, R., Mann, A. (1990). Tired, weak, or in need of rest: Fatigue among general practice attenders.. British Medical Journal, 30, 1199– 1202De Rijk, A.E. Schreurs, K.M.G., Bensing, J. (1999). Complaints of fatigue: Related to too much, as well as too little, external stimulation?. Journal of Behavioral Medicine, 22, 549– 573De Vries, J. (1998). Vermoeidheidsschaal ‘Fatigue scale’.. Tilburg, The Netherlands: Tilburg University.De Vries, J., Van Heck, G.L. (1995). Nederlandse WHOQOL-100 ‘Dutch WHOQOL-100’.. Tilburg, The Netherlands: Tilburg University.De Vries, J., Van Heck, G.L. (1997). The World Health Organization Quality of Life Assessment Instrument (WHOQOL-1000): Validation study with the Dutch version.. European Journal of Psychological Assessment, 13, 164– 178Deale, A. Chalder, T. Marks, I., Wessely, S. (1997). Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial.. American Journal of Psychiatry, 154, 408– 414Finkelman, J.M. (1994). A large database study of the factors associated with work-induced fatigue.. Human Factors, 36, 232– 243Fisk, J.D. Ritvo, P.G. Ross, L. Haase, D.A. Marrie, T.J., Schlech, W.F. (1994). Measuring the functional impact of fatigue: Initial validation of the Fatigue Impact Scale.. Clinical Infectious Diseases, 18, 579– 583Foets, M., Sixma, H. (1991). Een nationale studie van ziekten en verrichtingen in de huisartspraktijk. Basisrapport gezondheid en gezondheidsgedrag in de praktijkpopulatie ‘A national study concerning diseases and activities in the general practitioner-practice.. Report on health and health behavior in the GP-practice population’. Utrecht, The Netherlands: Nivel.Friedberg, F., Jason, L.A. (1998). Understanding chronic fatigue syndrome. An empirical guide to assessment and treatment. . Washington, DC: American Psychological Association.Gaillard, A.W.K. (1996). Stress: Produktiviteit en gezondheid ‘Stress: Productivity and health’.. Amsterdam, The Netherlands: Uitgeverij Nieuwezijds.Gaudron, J.P. (2000). The effects of computer anxiety on self-description with a computerized personality inventory.. European Review of Applied Psychology, 50, 431– 436Gawron, V.J. French, J., Funke, D. (2001). An overview of fatigue.. In P.A. Hancock & P.A. Desmond (Eds.), Stress, workload, and fatigue. Human factors in transportation (pp.581- 595). Mahwah, NJ: Erlbaum.Grandjean, E. (1979). Fatigue in industry.. British Journal of Industrial Medicine, 36, 175– 186Hemker, B.T. Sijtsma, K., Molenaar, I.W. (1995). Selection of unidimensional scales from a multidimensional item bank in the polytomous Mokken IRT model.. Applied Psychological Measurement, 19, 337– 352Kaiser, H.F. (1960). The application of electronic computers to factor analysis.. Educational and Psychological Measurement, 20, 141– 151Kline, P. (1987). Factor analysis and personality theory.. European Journal of Personality, 1, 21– 36Krupp, L.B. LaRocca, N.G. Muir-Nash, J., Steinberg, A.D. (1989). The Fatigue Severity Scale: Application to patients with multiple sclerosis and systemic lupus erythematosus.. Archives of Neurology, 46, 1121– 1123Lee, K.E. Hicks, G., Nino Murcia, G. (1993). Validity and reliability of a scale to assess fatigue.. Psychiatry Research, 36, 291– 298Lewis, G., Wessely, S. (1992). The epidemiology of fatigue: More questions than answers.. Journal of Epidemiology and Community Health, 46, 92– 97Maslach, C., Jackson, S.E. (1986). The Maslach burnout inventory. Manual (2nd ed.).. Palo Alto, CA: Sage.Meesters, C., Appels, A. (1996). An interview to measure vital exhaustion. I. Development and comparison with the Maastricht questionnaire.. Psychology and Health, 11, 557– 571Meijman, T.F. (1997). Psychische vermoeidheid ‘Mental fatigue’.. In T.F. Meijman, A. De Haan, H.G. Westra, J.M. Bensing, R.L. Hulsman, P.M.M.B. Soetekouw, M. De Vries, G. Bleijenberg, J.W.M. Van der Meer, & C.D.A. Brinkgreve (Eds.), Vermoeidheid ‘Fatigue’ (3rd ed., pp.5-51). Rotterdam, The Netherlands: Stichting Bio-wetenschappen en Maatschappij.Meijman, T.F., Schaufeli, W. (1996). Psychische vermoeidheid en arbeid. Ontwikkelingen in de A&O-psychologie ‘Mental fatigue and work. Developments in work and organizational psychology’.. De Psycholoog, 31, 236– 241Mitchell, D.L. Klein, G., Balloun, J.L. (1996). Mode and gender effects on survey data quality.. Information & Management, 30, 27– 34Mokken, R.J., Lewis, C. (1982). A nonparametric approach to the analysis of dichotomous item scores.. Applied Psychological Measurement, 6, 417– 430Molenaar, I.W. (1997). Nonparametric models for polytomous responses.. In W.J. van der Linden & R.K. Hambleton (Eds.), Handbook of modern item response theory (pp.369-380). New York: Springer.Molenaar, I.W., Sijtsma, K. (2000). User's manual. MSP5 for Windows. A program for Mokken Scale Analysis for polytomous items. . Groningen, The Netherlands: ProGAMMA.Nunnally, J.C. (1978). Psychometric theory. . New York: McGraw-Hill.Pennebaker, J.W. (1982). The psychology of physical symptoms. . New York: Springer.Ray, C. Weir, W.R.C. Philips, S., Cullen, S. (1992). Development of a measure of symptoms in chronic fatigue syndrome: The Profile of Fatigue-Related Symptoms (PFRS).. Psychology and Health, 7, 27– 43Rockwell, D.A., Burr, B.D. (1977). The tired patient.. The Journal of Family Practice, 5, 853– 857Rummel, R.J. (1970). Applied factor analysis. . Evanston, IL: Northwestern University Press.Saris, W.E. Ed. (1988). Variation in response behavior. A source of measurement error in survey research. . Amsterdam, The Netherlands: Sociometric Research foundation.Schaufeli, W., Van Dierendonck, D. (1994). Burnout, een begrip gemeten. De Nederlandse versie van de Maslach Burnout Inventory (MBI-NL) ‘Burnout, the measurement of a concept. The Dutch version of the Maslach Burnout Inventory (MBI-NL)’.. Gedrag & Gezondheid, 22, 153– 172Schwartz, J.E. Jandorf, L., Krupp, L.B. (1993). The measurement of fatigue: A new instrument.. Journal of Psychosomatic Research, 37, 753– 762Sijtsma, K. (1998). Methodology review: Nonparametric IRT approaches to the analysis of dichotomous item scores.. Applied Psychological Measurement, 22, 3– 31Sijtsma, K., Molenaar, I.W. (in press). Introduction to nonparametric item response theory. . Thousand Oaks, CA: Sage.Smets, E.M.A. (1997). Fatigue in cancer patients undergoing radiotherapy. . Unpublished master's thesis, University of Amsterdam, The Netherlands.Smets, E.M.A. Garssen, B. Bonke, B. Vercoulen, J.H.M.M., De Haes, J.C.J.M. (1995). Het vaststellen van vermoeidheid: De Multidimensionele Vermoeidheids Index (MVI) ‘The assessment of fatigue: The Multidimensional Fatigue Inventory (MFI)’.. Gedrag & Gezondheid, 23, 79– 85Studts, J.L. De Leeuw, R., Carlson, C.R. (2001). Symptom structure of fatigue: A multidimensional or unidimensional construct for behavioral medicine?. Psychosomatic Medicine, 63, 130–Van der Linden, W.J., Hambleton, R.K. (1997). Handbook of modern item response theory. . New York: Springer.Vercoulen, J.H.M.M. Swanink, C.M.A. Fennis, J.F.M. Galama, J.M.D. Van der Meer, J.W.M., Bleijenberg, G. (1994). Dimensional assessment of chronic fatigue syndrome.. Journal of Psychosomatic Research, 38, 383– 392Vercoulen, J.H.M.M. Alberts, M., Bleijenberg, G. (1999). The checklist individual strength.. Gedragstherapie, 32, 131– 136Vercoulen, J.H.M.M. Swanink, C.M.A. Fennis, J.F.M. Galama, J.M.D. Van der Meer, J.W.M., Bleijenberg, G. (1996). Prognosis in chronic fatigue syndrome. A prospective study on the natural course.. Journal of Neurology, Neurosurgery and Psychiatry, 60, 489– 494Vercoulen, J.H.M.M. Swanink, C.M.A. Galama, J.M.D. Fennis, J.F.M. Jongen, P.J.H. Hommes, O.R. Van der Meer, J.W.M., Bleijenberg, G. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model.. Journal of Psychosomatic Research, 45, 507– 517Vertommen, H., Leyssen, J. (1988). Vermoeidheid: Van onhanteerbaar symptoom tot diagnostisch waardevolle gemoedstoestand ‘Fatigue: From an unmanageable symptom to a diagnostically valuable state of mind’.. Tijdschrift voor de Klinische Psychologie, 18, 35– 59Ware, N.C. (1993). Society, mind and body in chronic fatigue: An anthropological view.. Ciba Foundation Symposium, 173, 62– 731998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment.. Psychological Medicine, 28, 551– 558
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