Fatigue affects all areas of life for patients with ankylosing spondylitis (AS), including their ability to participate in professional and social activities, and hence their quality of life. But AS patients are often left alone in coping with fatigue, the third most common AS symptom after stiffness and pain.
Fatigue is one of the most common symptoms in AS patients, but it is often neglected in clinical practice. Also, the number of studies on the impact that AS-caused fatigue has on a patient’s work and everyday life is limited. In a recent study, Irish scientists have now investigated the influence of severe fatigue on patients' participation in professional life as well as on their leisure activities and quality of life.
The study participants are patients of an AS outpatient clinic of an urban hospital in the Dublin area, Ireland. Inclusion criteria were being over 18 years of age and having a confirmed AS diagnosis. Patients with additional chronic diseases associated with fatigue were excluded. Of 58 patients who were eligible to participate during the study period, 50 fully completed the questionnaires, a rate of 86.2% of successful completion.
The following nine questionnaires were presented to the patients (the first three are specifically on fatigue):
36 study participants were men and 14 women. The mean age was 46.5 (26-76) years and the mean duration of the disease 14.5 years. 60% were employed at the time of the survey. In the FSS and in the BASDAI, about 65% of the patients showed a pronounced ("significant") fatigue. In the MAF-GFI, however, only 38% of the patients exceeded the critical threshold above which fatigue is to be classified as "significant". According to FAI, the patients were frequently active, with the lowest values in the leisure/work area. In the BASDAI and the PtGA the mean value just exceeded the threshold value of high disease activity, with medium to strong effects of AS on physical functioning (BASFI), pain (NRS), quality of life (ASQoL) and well-being (BAS-G).
Severe fatigue according to MAF-GFI and BASDAI was significantly associated with impairments in all parameters (p=0.041 - p=0.001). Patients with mild and severe fatigue were also significantly different (p=0.015 - p<0.001). Patients with severe fatigue had higher disease activity, more pain and a poorer quality of life. At work, they were also more limited than patients with mild fatigue.
19 patients took part in an in-depth interview. The interview asked about the influence of fatigue on productivity and participation in social life. They were also asked what strategies they used to manage fatigue and to what extent they were trained by medical staff. Some participants reported that they had withdrawn socially because of fatigue. A reinforcement of fatigue due to housework and shopping is also reported. With regard to the influence of fatigue on specific activities, there were indications of impairments to driving ability, concentration, and memory.
The strategies used to manage fatigue were varied, including the division of daily activities, changing work routines or shortening working hours, regular physical activity and including rest periods during the day. However, most of the strategies had been developed by the patients themselves after they had received no support from health professionals. According to the study authors, occupational therapists had the ability to support such interventions.
As the study authors admit, this is a study with few patients from only one clinic. However, it shows the influence of fatigue on the participation of patients in professional life. Many results are also consistent with findings from previous studies that show a link between fatigue, disease activity, and various aspects impacting patients’ quality of life.
Severe fatigue is a common symptom in patients with AS, associated with reduced participation in work and leisure activities. Early fatigue management strategies could help to reduce the impairments associated with fatigue in professional and social life. However, the study participants had received very little support from health professionals. Instead, they had developed strategies to cope with fatigue on their own, if at all. The authors encourage further studies to find out which interventions are helpful and when best to use them.
Source:
Connolly D, Fitzpatrick C, O'Shea F. Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis. Occup. Ther. Int. 2019; doi: 10.1155/2019/3027280