Muscle Fatigability During a Sustained Index Finger Abduction and Depression Scores Are Associated With Perceived Fatigue in Patients With Relapsing-Remitting Multiple Sclerosis

Neurorehabil Neural Repair. 2015 Sep;29(8):796-802. doi: 10.1177/1545968314567151. Epub 2015 Jan 20.


Introduction: Fatigue is a common and debilitating symptom in patients with multiple sclerosis (MS). Self-reported levels of perceived fatigue are associated with both patient characteristics and clinical measures. Pilot analysis indicated that muscle fatigability combined with depression scores was highly associated with perceived fatigue in patients with MS. Studies that combine physiological and psychological constructs to explain MS-related fatigue are scarce. Therefore, the present study aimed to evaluate the robustness of the association between perceived fatigue, muscle fatigability, and depression scores in MS.

Methods: Eighty-six patients with relapsing-remitting MS completed 2 fatigue questionnaires (Fatigue Severity Scale [FSS] and Modified Fatigue Impact Scale [MFIS]) and a depression questionnaire (Hospital Anxiety and Depression Scale [HADS]). Maximal index finger abduction force (maximum voluntary contraction [MVC]) was measured, as well as muscle fatigability during a 2-minutes sustained maximal contraction. Multivariable regression analyses were used to analyze the association between perceived fatigue, and muscle fatigability and depression scores.

Results: Perceived fatigue was associated with depression, muscle fatigability, and, depending on the questionnaire, to sex or to MVC. The model explained 40% and 48% of the variation in perception of fatigue as indexed with FSS questionnaire (r(partial): HADS 0.45, muscle fatigability 0.45, MVC -0.14, sex 0.32), and MFIS physical questionnaire (r(partial): HADS 0.59, muscle fatigability 0.49, MVC -0.38), respectively.

Conclusions: The found association accentuates the importance of including both physiological fatigability-related and psychological mood-related constructs in models to explain perceived fatigue in patients with MS. The model also directs future research toward applying effortful conditions and emphasizes the importance of assessing different constructs when evaluating rehabilitation strategies to reduce MS-related fatigue.

Keywords: Fatigue Severity Scale (FSS); Hospital Anxiety and Depression Scale (HADS); force; motor task; multiple sclerosis; sense of fatigue.

MeSH terms

  • Adult
  • Aged
  • Depression / complications
  • Depression / drug therapy
  • Depression / physiopathology*
  • Female
  • Fingers / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / complications
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy
  • Multiple Sclerosis, Relapsing-Remitting / physiopathology*
  • Multiple Sclerosis, Relapsing-Remitting / psychology
  • Multivariate Analysis
  • Muscle Contraction / physiology*
  • Muscle Fatigue / physiology*
  • Perception*
  • Psychiatric Status Rating Scales
  • Regression Analysis
  • Severity of Illness Index
  • Sex Factors
  • Surveys and Questionnaires
  • Young Adult