Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors

PM R. 2009 May;1(5):442-9. doi: 10.1016/j.pmrj.2009.03.003.


Objective: To determine the biopsychosocial correlates of general, physical, and mental fatigue in patients with postpoliomyelitis syndrome (PPS) by assessing the additional contribution of potentially modifiable factors after accounting for important nonmodifiable disease-related factors. It was hypothesized that disease-related, behavioral, and psychosocial factors would contribute in different ways to general, physical, and mental fatigue in PPS and that a portion of fatigue would be determined by potentially modifiable factors.

Design: Cross-sectional study.

Setting: A tertiary university-affiliated hospital post-polio clinic.

Patients: Fifty-two ambulatory patients with PPS who were not severely depressed were included.

Assessment of risk factors: Potential correlates for fatigue included disease-related factors (acute polio weakness, time since acute polio, PPS duration, muscle strength, pain, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, body mass index, disability, fibromyalgia), behavioral factors (physical activity, sleep quality), and psychosocial factors (depression, stress, self-efficacy).

Main outcome measurements: Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI; assesses fatigue on 5 subscales) and the Fatigue Severity Scale (FSS).

Results: Multivariate models were computed for MFI General, Physical, and Mental Fatigue. Age-adjusted multivariate models with nonmodifiable factors included the following predictors of (1) MFI General Fatigue: maximum inspiratory pressure, fibromyalgia, muscle strength; (2) MFI Physical Fatigue: maximum expiratory pressure, muscle strength, age, time since acute polio; and (3) MFI Mental Fatigue: none. The following potentially modifiable predictors made an additional contribution to the models: (1) MFI General Fatigue: stress, depression; (2) MFI Physical Fatigue: physical activity, pain; and (3) MFI Mental Fatigue: stress.

Conclusions: PPS fatigue is multidimensional. Different types of fatigue are determined by different variables. Potentially modifiable factors account for a portion of fatigue in PPS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Fatigue / etiology*
  • Fatigue / psychology*
  • Female
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Neuropsychological Tests
  • Pain / etiology
  • Pain / psychology
  • Postpoliomyelitis Syndrome / complications*
  • Postpoliomyelitis Syndrome / physiopathology
  • Postpoliomyelitis Syndrome / psychology*
  • Pulmonary Ventilation
  • Risk Factors
  • Severity of Illness Index
  • Stress, Psychological / complications