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Fatigue has been reported to be the most common symptom experienced by patients receiving hemodialysis (HD) therapy. Fatigue can lead to a reduction in their ability to engage in both routine and self-care activities, which can negatively affect their self-confidence and quality of life. This study aimed to determine the level of fatigue and the factors that affecting its level among patients receiving uHD., Methods: A cross-sectional design was utilized to explore the level of fatigue among patients receiving maintenance HD using the Mul-tidimensional Assessment of Fatigue (MAF) scale. Data were collected from four dialysis centers in two Saudi Arabia cities, Hail and Al-Qassim, between January 2022 and October 2022., Results: The questionnaire was completed by 236 patients. Older patients, male patients, and retired pa-tients reported significantly higher levels of fatigue ( p  < 0.001). In contrast, marital status, educational level, and financial status did not significantly affect the level of fatigue among patients ( p  = 0.193, 0.285, and 0.126, respectively). Patients who had seven or more dependents reported more fatigue than those who had lower levels of fatigue or who did not have dependents ( p  = 0.004). In addition, patients who had a regular exercise regimen reported significantly lower fatigue than those who did not have an exercise regimen ( p  = 0.011). Multiple linear regression demonstrated that employment status (student), comorbidity condition (one chronic disease), dialysis duration, satisfaction with dialysis time, and dialysis time were found to affect the fatigue scores (R2 = 0.302, p ˂ 0.001)., Conclusion: The findings of this study gives a broader understanding of factors influencing fatigue among patients with HD that will help to develop strategies of more focused interventions to reduce fatigue among patients with HD.

Objectives: The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda., Methods: This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue., Results: The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life., Conclusion: Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.

Background and Objectives: Cognitive impairment, fatigue, and mood disorders are common in multiple sclerosis (MS), but their interplay and neurologic substrates are not well understood. This study aims to identify atrophy patterns in patients with MS with varying levels of cognitive impairment, fatigue, anxiety, and depression., Methods: A cross-sectional cohort study enrolling patients with relapsing-remitting MS meeting the 2017 McDonald criteria and healthy controls (HCs), with similar age, sex, and education, was conducted. Participants completed cognitive assessments across 5 domains and inventories for fatigue, anxiety, and depression. Disability was quantified using the Expanded Disability Status Scale (EDSS). K-means clustering grouped patients with MS based on cognitive performance, fatigue, anxiety, and depression, accounting for disability. Group surface analysis from FreeSurfer, corrected for multiple comparisons, was used to assess cortical atrophy ( p < 0.05). Deep gray matter and infratentorial atrophy were defined by a regional volumetric z -score <-1.5, with intergroup comparisons using Bayesian multinomial logistic regression (95% CI)., Results: One hundred and two patients with relapsing-remitting MS (67 women; mean age 37 ± 10 years; mean disease duration 9.8 ± 6.5 years; mean EDSS score 2.2 ± 1.73) and 98 HCs (63 women; mean age 36 ± 12 years) were included. K-means clustering identified 4 MS patient clusters: K1 (n = 26): cognitively preserved (CP) without fatigue, anxiety, and depression; K2 (n = 31): CP with fatigue, anxiety, and depression; K3 (n = 18): cognitively impaired (CI) without fatigue, anxiety, and depression; K4 (n = 27): CI with fatigue, anxiety, and depression. Dimension-1 (cognitive tests) explained 34.7% of the variability; Dimension-2 (fatigue, anxiety, and depression) explained 18.7%. EDSS score correlated more with Dimension-2 (loading = 0.32) and was higher in K2 and K4 ( p < 0.05). K2 and K3 had similar cortical atrophy, but K3 showed more unilateral hippocampus (log odds = 2.47, p = 0.023) and amygdala (log odds = 1.79, p = 0.003) atrophy, compared with K1. K4 had widespread bilateral cortical atrophy, with more bilateral thalamus (log odds = 1.28, p = 0.023), amygdala (log odds = 2.57, p = 0.003), and basal ganglia (log odds = 1.44, p = 0.01) atrophies. Cerebellar atrophy was significant in K2 (log odds = 17.68, p < 0.001) and K4 (log odds = 18.05, p < 0.001), compared with K1., Discussion: Cognitive impairment, fatigue, anxiety, and depression in patients with MS can coexist or present independently. Our findings suggest a stronger association between cognitive impairment and deep gray matter atrophy while fatigue, anxiety, and depression are more strongly associated with cerebellar atrophy. The accumulation of cognitive impairment, fatigue, anxiety, and depression is associated with increasing global cortical and deep gray matter atrophy.

Background: The aim of this study was to investigate lower extremity performance, balance, fatigue and pain in individuals with Systemic Lupus Erythematosus and compare them with healthy controls., Methods: 41 participants (Systemic Lupus Erythematosus n = 21 and mean age = 38.33 ± 13.37; healthy group n = 20 and mean age = 38.95 ± 12.62 years) were included in the study. Lower extremity performance was evaluated with timed up and go test and 30 s sit-to-stand test, static and dynamic balance with Sensamove Miniboard, fatigue levels with Visual Analog Scale and Fatigue Severity Scale and pain intensity with Visual Analog Scale., Findings: Significant differences were found in favor of the healthy group in the sit-to-stand test (p = 0.001), timed up and go test (p = 0.001), static balance-center (p = 0.020), front (p = 0.001), back (p = 0.002), left (p = 0.001), right (p = 0.001); proprioception-left (p = 0.004), reaction time-front (p = 0.002) and left (p = 0.016); travel time-front (p = 0.001), back (p = 0.001), left (p = 0.001) and right (p = 0.001), Fatigue Severity Scale (p = 0.001); Visual Analog Scale-fatigue (p = 0.001) and Visual Analog Scale-pain (p = 0.001). In Systemic Lupus Erythematosus, timed up and go test had low correlation with travel time-back (r = -0.449; p = 0.041). Visual Analog Scale-fatigue had low correlation with proprioception-left (r = 0.484; p = 0.026) and proprioception-right (r = 0.461; p = 0.035). Visual Analog Scale-pain had moderate correlation with proprioception-back (r = 0.521; p = 0.015) and low correlation with proprioception-right (r = 0.441; p = 0.045)., Interpretation: Compared to healthy, individuals with Systemic Lupus Erythematosus had worse lower extremity performance, static/dynamic balance, fatigue, and pain. Dynamic balance-back was related to lower extremity performance. Fatigue was related to left-right proprioception, and pain was related to back-right proprioception., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Cancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by people affected by cancer. A breakdown of the clinician-patient partnership and suboptimal clinician communication has been identified as a significant barrier to implementing into clinical practice effective self-management strategies for CRF. This study examined the use and impact of communication practices employed by trained cancer nurse counsellors when providing CRF self-management support to cancer survivors., Methods: Interactions from 41 telehealth consultations between three nurse counsellors and 23 cancer survivors in a CRF self-management support clinic in Queensland, Australia were recorded and analysed using conversation analysis methods., Results: Analysis found that in instances where nurses established the agenda of a consultation from the outset of a session (e.g., focusing on fatigue self-management support), cancer survivors displayed clearer understandings of their self-management role, the tasks, and goals of a session; and displayed less difficulty engaging in supportive care discussions. Furthermore, clinicians used formulation practices, such as summarising dialogue, to sustain focus on fatigue during consultations, and to close discussion matters not ostensibly pertinent to fatigue self-management planning supporting the goals of the CRF SMS clinic consultations., Conclusion: For supportive care sessions targeting fatigue management, clinicians should ideally focus discussion on CRF support early, by clearly introducing the agenda at the outset of the consultation while also asking for client agreement. Periodically summarising patient's talk allows clinicians to maintain a focus on matters relevant for self-management fatigue planning and provide support within the typically constrained timeframes allocated for addressing CRF., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Raymond Chan reports financial support was provided by Princess Alexandra Research Foundation. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background & Aims: Post-COVID-19 Syndrome (PCS) is characterized by symptoms including fatigue, reduced physical performance, dyspnea, cognitive impairment, and psychological distress. The mechanisms underlying the onset and severity of PCS point to mitochondrial dysfunction as significant contributor. This study examined fat oxidation as a function of mitochondrial capacity during exercise., Methods: Single-center prospective cohort study during inpatient rehabilitation. Cardiopulmonary exercise testing and assessment of fatigue using questionnaires were performed at admission and discharge. Detailed spirometric breath-by-breath data were used to calculate substrate oxidation rates., Results: Patients (N = 187; 38 % women; 49.7 ± 11.4 years) were referred to rehabilitation 253.4 ± 130.6 days after infection. Lead symptoms included fatigue/exercise intolerance (79.9 %), shortness of breath (77.0 %), and cognitive dysfunction (55.1 %). Fat oxidation capacity was disturbed in PCS patients overall (AUC: 11.3 [10.7-11.9]) compared to healthy controls (p < 0.0001), with hospitalization during acute infection predicting the level of disturbance (p < 0.0001). Low exercise capacity and high fatigue scores resulted in reduced fat oxidation (both p < 0.0001). In particular, younger males were affected by significantly reduced fat oxidation capacity (sex: p = 0.002; age: p < 0.001). Metabolic disturbance was significantly improved during exercise-based rehabilitation (AUC: 14.9 [14.4-15.4]; p < 0.0001), even for the group of younger impaired males (+44.2 %; p < 0.0001). Carbohydrate oxidation was not impaired., Conclusions: PCS-specific restrictions in fat oxidation may indicate persistent mitochondrial dysfunction. Clinical assessment of PCS patients should include detailed breath-by-breath analysis during exercise to identify metabolic alterations especially in the group of younger males identified in this report. Exercise-based rehabilitation results in improved exercise capacity and fat oxidation and thus likely mitochondrial function., Clinical Trials: NCT06468722., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Fatigue is prevalent in patients with inflammatory bowel disease (IBD) in remission. Previously, we showed that fatigued IBD patients experienced a significant decrease in fatigue after receiving mindfulness-based cognitive therapy (MBCT). The current study examined to what extent these short-term beneficial effects of MBCT on fatigue were maintained over nine months follow-up, and whether patient characteristics were associated with clinically relevant improvement in fatigue., Methods: A randomized controlled trial, including an MBCT and waiting-list control condition, was performed in fatigued IBD patients in remission. For this study, we analysed long-term outcomes of 108 patients who received MBCT (either directly or after three months waiting). The primary outcome was fatigue, assessed with the Checklist Individual Strenght-20. Secondary outcomes included fatigue interference, depression, anxiety, and quality of life., Results: The reduced level of fatigue post-treatment did not change significantly during follow-up (F(2,76) = 1.68, p = 0.19). In total, 29% of patients reported clinically relevant improvement from pre-treatment to nine months follow-up. We found few significant differences in baseline characteristics between those reporting clinically relevant improvement and those not, except that patients who improved were significantly more often unemployed (χ 2 (1, n = 73) = 4.40, p = 0.04). Secondary outcomes, which did not change significantly during MBCT, also remained stable during follow-up., Conclusion: Findings suggest that reductions in IBD-related fatigue after receiving MBCT are sustained over nine months follow-up, with around one-third of patients reporting clinically relevant improvement from pre-treatment to follow-up. Employment status might be related to improvements in fatigue. Future research is needed to confirm these long-term outcomes., Preregistration: ClinicalTrials.gov ID: NCT03162575., Competing Interests: Declaration of competing interest All authors have completed the Unified Competing Interest form as required by the International Committee of Medical Journal Editors (ICMJE) and declare the following competing interests: Gerard Dijkstra reports grant from DSM Nutritional Products LTD and speakers fees from Janssen Pharmaceuticals, AbbVie and Takeda, outside the submitted work. Marijn Visschedijk reports speakers fee from Janssen-Cilag and Galapagos, and participation in the advisory board of Ferring bv, outside the submitted work. The other authors declare that they have no conflicts of interest to report., (Copyright © 2024. Published by Elsevier Inc.)

Background: Lymphangioleiomyomatosis (LAM) is a rare (twenty-one per million female inhabitants) neoplastic cystic lung disease that impairs health-related quality of life (HRQoL). However, the factors associated with impaired quality of life in patients with LAM are poorly understood., Objective: To assess the clinical, psychosocial, and functional characteristics associated with impaired quality of life in patients with LAM., Methods: This was a cross-sectional study performed on two nonconsecutive days. HRQoL (SF-36 and CRQ), lung function tests, anxiety and depression symptoms (HADS), maximal (CPET and ISWT), and submaximal exercise capacity (6MWT) were assessed. Linear associations among outcomes were assessed using Pearson's correlation and multivariate tests., Results: Forty-five women with LAM (46 ± 10.years; FEV 1, 74%pred) were evaluated. The lowest SF-36 scores were observed for general health and vitality and the highest for the physical and social domains. The lowest CRQ scores were observed for dyspnea and fatigue, and the highest were for the emotional function and self-control domains. Sixteen (35%) women had anxiety, and 8 (17%) had depression symptoms. Most of the SF-36 and CRQ domains were associated with anxiety and depression symptoms (from r = 0.4 to r = 0.7; p < 0.05) and exercise capacity (from r = 0.3 to r = 0.5; p < 0.05). Lung function parameters were weakly or not associated with quality of life domains. After multiple linear regression, HRQoL was independently associated with depression symptoms and physical capacity but not with lung function., Conclusion: Our results show that aerobic capacity and depression symptoms are the main factors, rather than lung function, related to quality of life in patients with LAM., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: We aimed to assess the role of the COVID-19 pandemic in the association of clinical, physical, and psychological factors with pain in Rheumatoid Arthritis (RA) patients., Methods: We included 103 RA patients (81.6% females; mean age 56.1 ± 13.8 years). Patients filled out the VAS-pain, GAD-7, PHQ-9, MFI-20, and B-IPQ. Paired sample t-tests, correlations, and multiple regression analyses were used to analyse the data., Results: Our results showed significantly worsened pain in the data collected post-pandemic (p ≤ 0.05). Pre-pandemic, the final regression models showed an association between functional disability (β = 0.24; p ≤ 0.05), illness perception (β = 0.34; p ≤ 0.05) and pain. In post-pandemic models, significant associations were found between fatigue (β = 0.33; p ≤ 0.01) and illness perception (β = 0.36; p ≤ 0.01) with pain. Positive illness perception was able to alleviate the associations between fatigue and depression with pain before and after the pandemic., Conclusion: Findings indicate that patients with RA may have been negatively affected by the COVID-19 pandemic given their vulnerability. Even though pharmacological treatment was not interrupted, post-pandemic results showed significantly higher levels of experienced pain. Therefore, in addition to biological therapy, non-pharmacological interventions, including psychological support aimed at diminishing negative illness perception, may be beneficial in reducing RA-related pain, especially when dealing with a crisis., (© 2024 John Wiley & Sons Ltd.)

Objective: To synthesise available evidence on the effects of a prescribed exercise programme in People with Metastatic Breast Cancer (PwMBC)., Data Sources: Medline, Embase, CINAHL, Web of Science and Scopus were searched up to January 2024., Study Selection: Randomised controlled trials (RCTs) recruiting PwMBC to an exercise intervention were included. The primary outcome was Quality of Life (QOL). Secondary outcomes included physical performance, muscle health, cancer-related fatigue (CRF) and physical activity (PA)., Study Appraisal and Synthesis Methods: Meta-analysis was not possible due to the low number of included studies. We calculated the effect size (ES), with 95% confidence intervals (95% CIs) of individual studies, adjusting for small sample size. Cohen's criteria for small (0.2 to 0.5), moderate (0.5 to 0.8) and large (>0.8) describe the size of the effect. Risk of bias (ROB) was assessed using the Cochrane (ROB) version 1 tool., Results: Three RCTs (n = 149 PwMBC) were included. Results showed no significant between-group effects in the primary outcome, QOL. Whilst effects in favour of prescribed exercise were observed in CRF (ES 1.3, 95% CI 0.06 to 2.35) and PA (ES 0.83, 95% CI 0.14 to 1.42) in two separate studies, as the lower bound of the 95% CI did not reach Cohen's threshold, there is considerable uncertainty regarding the treatment effect., Conclusions: There is currently insufficient evidence to support the use of prescribed exercise to improve QOL, physical performance, muscle health, CRF and PA in PwMBC. Further high-quality trials are required to investigate the effectiveness of exercise interventions in PwMBC., Systematic Review Registration Number: PROSPERO CRD42022304528. CONTRIBUTION OF THE PAPER., Competing Interests: Competing interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Fibromyalgia syndrome (FMS) is a chronic disorder characterized commonly by widespread musculoskeletal pain and fatigue, predominantly affecting women, with its complexity often leading to underdiagnosis and complicating treatment effectiveness. Transcranial magnetic stimulation (TMS) metrics are potential markers to optimize FMS treatments; however, evidence is limited. Our study aimed to explore the relationship between cortical excitability and inhibition, assessed through TMS markers, and clinical characteristics in patients with FMS. This presented cross-sectional study employed baseline data from a clinical trial with 108 FMS patients, mostly female (88.8%), and mean age of 47.3 years old (SD = 12.06). Our analysis showed that decreased short-intracortical inhibition (SICI) was associated with gabapentinoids use, nicotine history, and increased fatigue levels, suggesting its connection with compensatory mechanisms for non-painful FMS features. Increased motor intracortical facilitation (ICF) was linked with greater pain severity and shorter FMS duration, implying its relationship with a reorganization of sensorimotor pathways due to chronic pain. Additionally, higher resting motor threshold (rMT) was associated with less effective pain modulation (lower conditioned pain modulation [CPM]), indicating a disruption of pain compensatory mechanism. Given the role of SICI in indexing homeostatic brain mechanisms and its association with fatigue, a hallmark characteristic of FMS-induced behavioral changes, these results suggest that FMS likely has a deleterious effect on brain inhibitory function, thus providing a potential novel insight for FMS mechanisms. In addition, it seems that this compensatory mechanism's disruption is enhanced by pharmacological agents such as gabapentioids and nicotine., Competing Interests: Declarations Ethics approval and consent to participate This study obeys the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) of Partners Healthcare at Mass General Brigham under the protocol approval number 2017P002524. Informed consent was obtained from all participants. Consent for publication All authors give their consent for this study to be published in Experimental Brain Research journal. Competing interests All authors disclose no potential conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction/aims: Persons with spinal muscular atrophy (pwSMA) report progressive muscle weakness but also reduced endurance when performing repetitive tasks in daily life, referred to as "performance fatigability" (PF). Data regarding the effects of the new disease-modifying drugs on PF are scarce. Thus, our main objective was to examine PF in adult ambulatory pwSMA treated long-term with nusinersen., Methods: Six-minute walk test (6MWT) data from 14 adult pwSMA treated with nusinersen for up to 70 months were retrospectively analyzed to determine PF. Performance fatigability was defined as the percentage change in the distance covered between the last and first minute of the 6MWT. In addition, relationships between PF and other clinical features were assessed., Results: Performance fatigability was found in 12/14 pwSMA (85.7%) prior to treatment. The mean distance walked in the sixth minute (71.1 m) was shorter than the distance covered in the first minute (81.8 m), corresponding to a mean PF of 13.1% (95% confidence interval (CI): 6.5-19.6, p = .0007). During treatment with nusinersen, there was a mean reduction in PF of 5.6% (95% CI: -10.0 to -1.3, p = .0148). We found no relationship between PF and fatigue as measured by the Fatigue Severity Scale., Discussion: This study demonstrates the presence of PF as an independent component of motor impairment and as a potential therapeutic target in our cohort of adult ambulatory pwSMA. Furthermore, the observations in our cohort suggest that nusinersen may have a beneficial effect on PF., (© 2024 The Author(s). Muscle & Nerve published by Wiley Periodicals LLC.)

Background: People with Multiple Sclerosis (PwMS) often experience imbalance, gait dysfunction, and fatigue. Circuit Training (CT) can be viable for improving balance, gait, and fatigue in MS. To the author's knowledge, no studies have systematically reviewed the existing literature evaluating the effectiveness of CT in PwMS., Objectives: To investigate the effectiveness of CT in improving balance, gait, and reducing fatigue in PwMS and provide a quantitative and qualitative synthesis of Randomized Controlled Trials (RCTs)., Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Google Scholar, and PEDro Database (Dec 2021 to May 2024)., Study Selection: RCTs using CT in PwMS including balance, gait, or fatigue outcomes., Data Synthesis: Search inclusion criteria were: i) available full text, ii) CT rehabilitation, iii) balance, gait, or fatigue measured as outcomes, and iv) articles in English. Full text articles were analyzed by two screeners. If there was disagreement regarding inclusion, a further reviewer was consulted. No discrepancies were found., Results: We identified 878 studies, 14 studies were eligible including 716 PwMS with a mean (standard deviation) age of 49.9 (10.9) years, disease duration of 10.8 (7.2) years, and Expanded Disability Status Scale score of 4.3 (0.9) points. RevMan 5.4.1 was used to run the meta-analysis. We found a significant overall effect on Berg Balance Scale (Mean Difference (MD) = 6.07 points, 95%CI:1.40,10.75; p = 0.01) and in Fatigue Severity Scale (MD = 0.98 points, 95%CI:0.30,1.66; p = 0.005) in favor of CT. We did not find a significant effect in Timed Up and Go (MD = 0.46 second, 95%CI:-0.04,0.96; p = 0.07), in Six-Minute Walk Test (MD = 17.46 m, 95%CI:-8.06,42.97; p = 0.18), and in Modified Fatigue Impact Scale (MD = 3.34 points, 95%CI:-0.41,7.09; p = 0.08) in favor of CT. We assessed methodological quality using RoB 2.0, and quality of evidence using GRADE., Limitations: Small number of studies, all identifying having some risk of bias., Conclusion: Circuit training can have positive effects on PwMS in terms of increasing balance, gait, and reducing fatigue. Further research is needed., Systematic Review Registration Number: PROSPERO CRD42021286834. CONTRIBUTION OF THE PAPER., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objectives: Our study endeavoured to develop an online self-management programme facilitated by an interdisciplinary team and to assess its impact on the quality of life, sleep patterns, pain perception, and fatigue levels among individuals diagnosed with scleroderma., Methods: Twenty-nine individuals with scleroderma completed the programme. The study spanned 8 weeks during which participants received weekly 45-min video sessions. Assessment tools included the Scleroderma Health Assessment Questionnaire (SHAQ) for disease severity and pain intensity, the Self-Efficacy Scale for Chronic Disease Patients for self-management evaluation, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, the Fatigue Severity Scale for measuring fatigue severity, and the Short Form-12 Quality of Life Scale (SF-12) for evaluating quality of life., Results: Self-management score increased significantly, while fatigue score decreased significantly. Feedback from participants indicated a positive perception of the programme and its content, suggesting its usefulness in managing their condition. Feedback from participants indicated a positive perception of the programme and its content, suggesting its usefulness in managing their condition., Conclusions: The self-management programme, developed collaboratively by an interdisciplinary team and implemented via telerehabilitation, yielded beneficial outcomes concerning self-management skills and fatigue severity among individuals with scleroderma. Strengthening the interdisciplinary composition of the study team by incorporating diverse healthcare professionals may enhance future investigations. Additionally, we advocate for the repetition of the study employing randomised methodologies and implementing long-term follow-up assessments to further elucidate the programme's efficacy and sustainability over time., (© 2024 John Wiley & Sons Ltd.)

Background: Cancer-related fatigue is the most common symptom of subjective and persistent nature in cancer patients, which almost runs through the whole process of disease and treatment and rehabilitation, seriously affects the effect of anti-tumor treatment and reduces the quality of life of patients. Non-pharmacological management is one of the key links to relieve cancer-related fatigue, however, there are many types of non-pharmacological management and the related guidelines do not recommend the optimal nursing program for cancer-related fatigue. In our study, Network Meta-analysis was used to compare the effectiveness of different non-pharmacological therapies in Cancer-related fatigue to make their treatment and care more clinically valuable., Methods: Randomized controlled trials about non-pharmacological therapies for cancer-related fatigue were searched in Chinese and English databases including China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese Scientific Journal database, Chinese Biomedical Database, Google Scholar, Pubmed, Web of science, Cochrane Library, Sci-Hub, ScienceDirect, and other relevant medical websites including Medlive and DingXiangYuan. The search time was from the establishment of the database to December 2023. The quality of the included Randomized controlled trials was evaluated by two trained researchers using the Cochrane Risk of Bias Assessment Tool, and data were independently extracted from the included literature and analyzed by reticulated Meta-analysis using Stata 18.0 statistical software., Results: A total of 49 studies with 24 non-drug management methods, and 3887 patients were included. The results of network meta-analysis showed that the use of massage therapy to improve cancer-related fatigue had a more significant advantage over conventional nursing measures and other non-pharmacological therapies in cancer patients, followed by infrared laser moxibustion and ginger-isolated moxibustion with traditional Chinese medicine characteristics, while the worst effect was strengthening excise., Conclusions: The existing evidence shows that massage therapy has the best effect in the intervention of cancer-related fatigue. However, due to the diversity of non-pharmacological therapies and the small number of studies included in each therapy, the coverage of this study is insufficient, and more large-sample, multi-center and high-quality randomized controlled trials are needed for further verification in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Parkinsonian syndromes are disabling neurodegenerative diseases resulting in reduced muscle function/performance and sarcopenia, but clinical manifestations could be systemic, including deterioration of cognitive function. As studies have reported an association between muscle dysfunction and cognitive decline yet no information on these syndromes is available, we investigated the relationship between sarcopenia, its components, and cognitive function, fatigue, and quality of life (QoL)., Methods: Consecutive patients affected by parkinsonian syndromes were assessed for the presence of sarcopenia using the European Working Group on Sarcopenia in Older People-2 algorithm: low strength (handgrip strength: <27 kg [men]; <16 kg [women]) and low appendicular skeletal muscle index by impedance (<7.0 kg/m 2 [men]; <6.0 kg/m 2 [women]). Cognitive function was evaluated using the Montreal Cognitive Assessment, the Mini Mental State Examination and the Frontal Assessment Battery. Fatigue and QoL were assessed using the 16-item Parkinson's Disease Fatigue Scale and the 39-item Parkinson's Disease Questionnaire, respectively., Results: In total, 314 patients were included: 198 presented with low strength (63.0% probable sarcopenia); 68 (21.7%) of these were diagnosed with sarcopenia. After adjusting for multiple confounders, we observed a significant effect (poorer score) of both low strength only and sarcopenia on Montreal Cognitive Assessment, Mini Mental State Examination, and QoL. Only reduced muscle strength had a relevant impact on the outcomes considered., Conclusions: Sarcopenia is associated with worse cognitive functions and QoL in patients with parkinsonian syndromes, with muscle dysfunction playing a major role. The prognostic impact of sarcopenia and its components should be addressed in prospective studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: New cases of lymphoma are rising, and the symptom burden, like cancer-related fatigue (CRF), severely impacts the quality of life of lymphoma survivors. However, clinical diagnosis and treatment of CRF are inadequate and require enhancement., Objective: The main objective of this study is to construct machine learning-based CRF prediction models for lymphoma survivors to help healthcare professionals accurately identify the CRF population and better personalize treatment and care for patients., Methods: A cross-sectional study in China recruited lymphoma patients from June 2023 to March 2024, dividing them into two datasets for model construction and external validation. Six machine learning algorithms were used in this study: Logistic Regression (LR), Random Forest, Single Hidden Layer Neural Network, Support Vector Machine, eXtreme Gradient Boosting, and Light Gradient Boosting Machine (LightGBM). Performance metrics like the area under the receiver operating characteristic (AUROC) and calibration curves were compared. The clinical applicability was assessed by decision curve, and Shapley additive explanations was employed to explain variable significance., Results: CRF incidence was 40.7 % (dataset I) and 44.8 % (dataset II). LightGBM showed strong performance in training and internal validation. LR excelled in external validation with the highest AUROC and best calibration. Pain, total protein, physical function, and sleep disturbance were important predictors of CRF., Conclusion: The study presents a machine learning-based CRF prediction model for lymphoma patients, offering dynamic, data-driven assessments that could enhance the development of automated CRF screening tools for personalized management in clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Fatigue is commonly observed in pediatric multiple sclerosis (pedMS) patients, but its underlying mechanisms remain largely unexplored. We evaluated whether resting-state (RS) functional connectivity (FC) abnormalities in monoaminergic networks contributed to explain fatigue in pedMS., Methods: Fifty-five pedMS and twenty-three matched healthy controls (HC) underwent clinical and RS functional MRI assessment. Patients with Fatigue Severity Scale (FSS) score ≥ 4 were classified as fatigued (F). Patterns of dopamine-, noradrenaline- and serotonin-related RS FC were derived by constrained independent component analysis, using PET atlases for dopamine, noradrenaline, and serotonin transporters obtained in HCs' brain., Results: Compared to non-fatigued (NF)-pedMS patients and HC, F-pedMS patients (15/55, 27.3%) showed decreased dopamine-related RS FC in the right postcentral gyrus. They also showed decreased dopamine-related RS FC in the left insula vs. HC and increased dopamine-related RS FC in the left middle temporal gyrus and cerebellum (lobule VI) vs. NF patients. In the noradrenaline-related network, F-pedMS patients showed decreased RS FC in the left superior parietal lobule and increased RS FC in the right thalamus vs. HC and NF-pedMS. Compared to HC, F-pedMS patients also showed decreased RS FC in the right calcarine cortex and increased RS FC in the right middle frontal gyrus. In the serotonin-related network, F-pedMS patients showed decreased RS FC in the right angular gyrus and increased RS FC in the right postcentral gyrus vs. NF-pedMS patients., Discussion: In pedMS, fatigue is associated with specific monoaminergic network abnormalities, providing pathological markers for this bothersome symptom and putative targets for its treatment., Competing Interests: Declarations. Conflict of interest: M. Margoni reports grants and personal fees from Sanofi Genzyme, Merck Serono, Novartis and Almiral. She was awarded a MAGNIMS-ECTRIMS fellowship in 2020. P. Valsasina and D. Mistri have nothing to disclose. L. Moiola received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Sanofi Genzyme, Novartis, Teva, Merck Serono, Biogen, Roche, and Excemed. Prof. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi Genzyme; he receives research support from Biogen Idec, Merck Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. Prof. M.A. Rocca received consulting fees from Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche; and speaker honoraria from AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. She receives research support from the MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders. Ethical standards: Approval was received from the local ethical standards committee on human experimentation (Protocol ID: 25/2007). Written informed consent was obtained from all subjects prior to study participation according to the Declaration of Helsinki., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Patients with advanced prostate cancer (PC) commonly experience fatigue related to the disease itself and its treatment, which affects their quality of life. There are limited real-world data available on patients' experiences of fatigue while receiving PC treatment and its management., Patients and Methods: This was a cross-sectional, noninterventional qualitative study involving individual concept-elicitation interviews with patients in the United States. Patients with advanced PC aged ≥18 years who had experienced fatigue and were on androgen-deprivation therapy in combination with second-generation androgen receptor pathway inhibitors were interviewed and their experiences quantified., Results: Of the 143 patients screened, 13 qualified and 11 completed the interview. Most patients used the term "fatigue" (n = 8) to describe their experiences of tiredness, exhaustion, lack of energy, and weakness. Most patients (n = 8) did not receive any form of educational support from their healthcare providers (HCPs), but some expressed an interest in receiving this support (pamphlets, n = 4; discussion with HCPs, n = 4; online resources, n = 3). Most patients (n = 9) self-discovered fatigue-management strategies over the course of their disease and treatment. Patients found that rigorous exercise (n = 5), regular naps (n = 2), increased rest (n = 3), and a healthy diet (n = 3) were the most effective approaches for managing their fatigue., Conclusion: Tools are needed to support HCPs with counseling patients with PC for effective management of disease- and treatment-related fatigue., Competing Interests: Disclosure Stephen Freedland is a consultant for Astellas Pharma Inc., AstraZeneca, Bayer, Eli Lilly, Pfizer Inc., Janssen, Merck, Sanofi, Myovant, and Novartis, and has received compensation for consultation. He has also received speakers’ bureau fees from AstraZeneca, Astellas Pharma Inc., Pfizer Inc., and Sanofi. Marty Chakoian is an advisor for Pfizer Inc. and has received support for the present manuscript. He is also an advisor for the University of Washington Medical Center and has received consulting fees for this. Additionally, he has received travel support for attending congresses and is a member of the patient advocacy group, ZERO Prostate Cancer. Ted Wells and Alexandra Colon are employees of IQVIA, USA. Dina Elsouda is an employee of Astellas Pharma Inc. Agnes Hong is a former employee of Astellas Pharma Inc. and received support for this manuscript. She holds stocks in Veru Inc. and Revance Therapeutics Inc. Nader El-Chaar is an employee of Astellas Pharma Inc., has received support from Astellas Pharma Inc. for the present publication, and holds stocks in Tonix Pharmaceuticals Holding Corp., Recursion Pharmaceuticals, Inc., Soligenix, Inc., and Bionano Genomics, Inc., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study aims to investigate the factors that influence fatigue in hemodialysis (HD) patients and to develop and validate a nomogram to estimate the probability of fatigue in this population., Methods: This cross-sectional study collected 453 patients who underwent HD at the tertiary hospital in Hubei, China, from April to December 2023. They were randomly divided into a 70% training group ( n  = 316) and a 30% validation group ( n  = 137). In the training set, factors influencing fatigue were screened using multivariate logistic regression analysis, and a nomogram was developed to estimate fatigue probability in HD patients. The discrimination and calibration of the nomogram were validated in both the training and validation sets through the area under the receiver operating characteristic (ROC) curve (AUC) and the Hosmer-Lemeshow (H-L) test., Results: In the training group, logistic regression showed that age, dialysis vintage, inter-dialysis weight gain, hemoglobin, depression, insomnia, and social support were variables associated with fatigue in HD patients. Based on these factors, a nomogram for assessing fatigue probability in HD patients was developed. The AUC was 0.955 (95% CI: 0.932-0.977) and 0.979 (95% CI: 0.961-0.997) in the training and validation sets. The results from the H-L test indicated a good fit., Conclusion: The nomogram can evaluate fatigue probability in HD patients and may serve as a convenient clinical tool.

Background and Purpose: Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS-related fatigue., Methods: This was a systematic review and meta-analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue., Results: In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS-related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy-conservation-based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow-up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference -0.28; 95% confidence interval -0.53 to -0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference -0.21; 95% confidence interval -0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long-term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses., Conclusion: Educational interventions for people with MS-related fatigue may be effective in reducing fatigue in the short term. More research is needed on long-term effects and the importance of specific intervention components, delivery and context., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Introduction: Colorectal cancer (CRC) survivors often struggle with side effects following treatment such as reduced quality of life, fatigue and psychological distress and need therefore efficient comprehensive interventions. The aim of this qualitative study was to explore CRC survivors' expectations before the yoga intervention as well as their unique experiences beyond those reported with standard questionnaires., Methods: Interpretative phenomenological approach was used in this qualitative study. Semi-structured interviews were conducted before and after a 10-week yoga program (90 min once a week, Hatha Yoga) with CRC survivors enrolled in a randomized controlled trial. Thematic analysis was used to uncover themes present in participants' accounts., Results: Nine patients participated in the interviews, mean interview duration was 27.49 min (SD = 7.71) before and 38.41 min (SD = 15.93) after the intervention. Our analysis identified following themes: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention; (4) differences between the study yoga intervention and other physical activities. The superordinate theme regarding effects of intervention included aspects of intervention at multiple levels such as emotional, physical, behavioral and spiritual., Conclusions: This qualitative study provides valuable insight regarding CRC survivors' expectations and experiences following a 10-week yoga intervention. While expectations varied from skepticism to specific symptom improvement, the majority of participants had a positive, open attitude towards yoga. Consistent with participants' experiences, yoga may represent a promising intervention for CRC survivors if the groups' specific concerns are taken into account.

There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients., Competing Interests: Declarations. Conflict of interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Background: Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear., Objectives: This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke., Methods: The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods., Results: The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia ( p  = 0.011) and quality of life ( p  = 0.009) are significant determinants of active energy expenditure and quality of life ( p  = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods ( p  > 0.05)., Conclusions: The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.

Post COVID-19 conditions (PCC) present with a wide range of symptoms. Headache is one of the most frequently reported neurological symptoms by patients with PCC. We aimed to assess the prevalence of headache in patients with PCC who attended the Post-COVID LMU outpatient department at LMU University Hospital in Munich. We hypothesized that headaches occur more frequently in patients with PCC than in the control group. Patients answered a questionnaire containing sociodemographic characteristics, their current symptoms, and prior psychiatric and somatic diagnoses, the WHO Quality of Life assessment (WHOQOL-BREF), 9-item Patient Health Questionnaire (PHQ-9), and the Fatigue Severity Scale (FSS). 188 PCC patients were included in this study and compared to a control group of patients with a history of COVID-19 or a different infectious disease - but no consecutive post-infectious condition (n c =27). 115 (61%) of our PCC patients were female. The median age was 41 years. 60 (32%, p = 0.001) had a pre-existing psychiatric diagnosis. PCC was associated with worse outcomes in all four domains of the WHOQOL-BREF (p < 0.001), high levels of fatigue (FSS; p < 0.001), and a higher likeliness for symptoms of depression (PHQ-9; p < 0.001). We were able to confirm that psychiatric disorders are more frequently associated with headaches in PCC patients. Headache should be assessed and treated in the context of PCC not only by neurologists but by multi-professional teams and regarding all PCC symptoms., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval for the study was obtained from the Ethics Committee of the Medical Faculty of LMU Munich (21-1165). All potentially eligible participants were informed about the research in oral and written form. Furthermore, participants had to sign an informed consent form stating that all data would be treated anonymously. The Post-COVID-Care study was registered with the Deutsches Register Klinischer Studien (DRKS; registration number DRKS00030974). Consent for publication: All participants gave written informed consent. Conflict of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest., (© 2024. The Author(s).)

Background: While Reddy proposed the H2FPEF diagnostic algorithm to aid in diagnosing heart failure with preserved ejection fraction (HFpEF), certain parameters like age and obesity are not suitable for Asian population, especially given the increasing incidence of HFpEF in younger individuals. Therefore, this study aimed to develop an easy-to-use nomogram with non-invasive indices that can be used in outpatient clinics in Taiwan to quickly estimate the probability of HFpEF and help decide whether further invasive cardiopulmonary exercise test (CPET) is needed., Methods: Outpatients with unexplained dyspnea and fatigue were recruited divided into HFpEF (n = 64) and non-HFpEF (n = 34) groups based on invasive CPET and echocardiography. Multivariate logistic regression analyses identified independent noninvasive variables for developing an HFpEF nomogram. The nomogram's performance was assessed and validated using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis., Results: Multivariate logistic regression analyses identified five independent noninvasive variables for developing an HFpEF nomogram, including dyslipidemia (OR = 5.264, p = 0.010), diabetes (OR = 3.929, p = 0.050), left atrial area (OR = 1.130, p = 0.046), hemoglobin <13 g/dL (OR = 5.372, p = 0.010), and NT-proBNP ≥245 pg/mL (OR = 5.108, p = 0.027). The nomogram showed good discriminatory ability (C-index = 0.842) and calibration performance (p = 0.873) and high net benefit (0.1-0.95). Notably, the HFpEF nomogram showed better diagnostic accuracy than the H 2 FPEF score model in predicting Taiwanese HFpEF patients (AUC: 0.873 vs. 0.608, p = 0.0006)., Conclusion: The noninvasive HFpEF nomogram provides a preliminary estimation of the probability of HFpEF in Taiwanese outpatients with unexplained dyspnea and fatigue, which may help the decision-making on further invasive CPET., Competing Interests: Declaration of Competing interest All authors declare that there is no conflict of interest., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Objective: To explore the potential categories and influencing factors of fatigue trajectory in maintenance haemodialysis patients., Methods: Between June 2023 and December 2023, a convenience sample of 306 maintenance haemodialysis patients in a tertiary hospital haemodialysis centre in Zhenjiang City was selected as the study population, and patient information was collected monthly after the baseline survey using the General Information Questionnaire, Pittsburgh Sleep Quality Scale, Piper Fatigue Revision Scale, Collaborative Social Support Scale, Patient Health Questionnaire Depression Scale, Comprehensive Economic Toxicity Rating Scale, and Fear of Disease Progression Simplified Scale, for a total of six follow-up visits. In addition, the potential category growth model was used to identify the developmental trajectory of fatigue, and univariate analysis and binary logistic regression were used to analyse its determinants., Results: The 6 month fatigue trajectory of maintenance haemodialysis patients could be divided into two categories: persistent low-fatigue group (59.8%) and fluctuating high-fatigue group (40.2%). Age, surgical history, level of social support, sleep, economic toxicity, and changes in ultrafiltration volume during dialysis were the influencing factors for repeated fatigue in maintenance haemodialysis patients (p < 0.05)., Conclusion: The fatigue trajectory of maintenance haemodialysis patients is heterogeneous, suggesting that clinical workers should focus on the haemodialysis patients with repeated fatigue and make targeted interventions to improve their fatigue status and reduce the occurrence of adverse events in patients., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes., Objectives: We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke., Methods: In this cross-sectional study CRF was measured as peak oxygen uptake (VO 2peak ) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS)., Results: The sample (n=74, mean age 64±13 years, 36% women) had a mean VO 2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization's recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8.  Patients with impaired CRF (VO 2peak <80% of predicted) had higher body-fat-percent (p<0.01), less moderate-to-vigorous PA (MVPA) (p<0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004)., Conclusions: Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.

Post-COVID syndrome (PCS) is characterized by a variety of non-specific symptoms. One of the leading symptoms is fatigue. So far, there is no evidence-based causal therapy established and treatment of PCS is primarily symptom-oriented. The Clinic for Internal and Integrative Medicine in Bamberg, Germany, offers a comprehensive multimodal integrative inpatient therapy for PCS patients. Within a prospective uncontrolled observational study, the results of N = 79 patients were analysed. Post-COVID fatigue patients were hospitalized for up to 14 days. The treatment consists of individual modules depending on the patient's needs. It includes a wide range of integrative non-pharmacological treatment modalities. Outcomes were assessed before and after the inpatient treatment as well as 6 months after discharge from the hospital. Results show that fatigue of post-COVID patients in this study (M = 76.30, SD = 10.18, N = 64) was initially significantly higher than in the subsample "women aged 60-92 years" of the general German population (M = 51.5, Schwarz et al. [Schwarz et al. in Onkologie 26:140-144, 2003]; T(63) = 19.50, p < .001). Fatigue was significantly and clinically relevant reduced directly after discharge (M T1  = 76.21, SD = 11.38, N = 42; M T2  = 66.57, SD = 15.55, N = 42), F(1, 41) = 19.80, p < .001, partial eta squared = .326, as well as six months after discharge (M T3  = 65.31, SD = 17.20, N = 42), F(1, 41), p < .001, partial eta squared = .371. Additionally, self-reported ability to work (NRS, 0-10) improved significantly from admission (M T1  = 2.54, SD = 2.23, N = 39) to discharge (M T2  = 4.26, SD = 2.60, N = 39), F(1, 38) = 26.37, p < .001, partial eta squared = .410), as well as to six months later (M T3  = 4.41, SD = 3.23, N = 39), F(1, 38) = 15.00, p < .001, partial eta squared = .283. The study showed that patients suffering from chronic post-COVID syndrome for several months can achieve a significant improvement in their leading fatigue symptoms and a significant improvement in the subjective assessment of their ability to work through a comprehensive two-week multimodal integrative inpatient program., Competing Interests: Declarations. Conflict of interest: None., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: The aim of this study was to investigate the development of fatigue and mental illness between 3 and 12 months after critical COVID-19 and explore risk factors for long-lasting symptoms. Study Design and Methods: A prospective, multicenter COVID-19 study in southern Sweden, including adult patients (≥18 years) with rtPCR-confirmed COVID-19 requiring intensive care. Survivors were invited to a follow-up at 3 and 12 months, where patient-reported symptoms were assessed using the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist version 5 (PCL-5). The development between 3 and 12 months was described by changes in relation to statistical significance and suggested values for a minimally important difference (MID). Potential risk factors for long-lasting symptoms were analyzed by multivariable logistic regression. Results: At the 3-month follow-up, 262 survivors (87%) participated, 215 (72%) returned at 12 months. Fatigue was reported by 50% versus 40%, with a significant improvement at 12 months (MFIS; median 38 vs. 33, P  < .001, MID ≥4). There were no significant differences in symptoms of mental illness between 3 and 12 months, with anxiety present in 33% versus 28%, depression in 30% versus 22%, and posttraumatic stress disorder in 17% versus 13%. A worse functional outcome and less sleep compared to before COVID-19 were risk factors for fatigue and mental illness at 12 months. Conclusions: Fatigue improved between 3 and 12 months but was still common. Symptoms of mental illness remained unchanged with anxiety being the most reported. A worse functional outcome and less sleep compared to before COVID-19 were identified as risk factors for reporting long-lasting symptoms., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep-related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep-related health outcomes between afloat and ashore naval personnel. Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high-performing naval personnel., (© 2024 Leidos Inc. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Purpose: To investigate the extent to which three systematic approaches for prioritizing symptoms lead to similar treatment advices in cancer survivors with co-occurring fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue., Methods: Psychological treatment advices were was based on three approaches: patient preference, symptom severity, and temporal precedence of symptoms based on ecological momentary assessments. The level of agreement was calculated according to the Kappa statistic., Results: Overall, we found limited agreement between the three approaches. Pairwise comparison showed moderate agreement between patient preference and symptom severity. Most patients preferred treatment for fatigue. Treatment for fear of cancer recurrence was mostly indicated when based on symptom severity. Agreement between temporal precedence and the other approaches was slight. A clear treatment advice based on temporal precedence was possible in 57% of cases. In cases where it was possible, all symptoms were about equally likely to be indicated., Conclusions: The three approaches lead to different treatment advices. Future research should determine how the approaches are related to treatment outcome. We propose to discuss the results of each approach in a shared decision-making process to make a well-informed and personalized decision with regard to which symptom to target in psychological treatment., Implications for Cancer Survivors: This study contributes to the development of systematic approaches for selecting the focus of psychological treatment in cancer survivors with co-occurring symptoms by providing and comparing three different systematic approaches for prioritizing symptoms., (© 2023. The Author(s).)

Purpose: This study examined the relationships between a single-nucleotide polymorphism (SNP) of brain-derived neurotrophic factor (BDNF) rs6265 and psychoneurological (PN) symptoms in female cancer survivors., Methods: This secondary analysis examined 393 study participants. In addition to demographic variables, self-reported PN symptom scores (anxiety, bodily pain, depression, fatigue, neuropathic pain, and sleep disturbance) were collected using the Patient-Reported Outcomes Measurement Information System and 36-Item Short-Form Health Survey. Buccal swab samples were collected to obtain genotypes for BDNF rs6265 (Val/Val, Val/Met, or Met/Met). The PN symptom scores were compared across genotypes, and the relationships were examined using a regression model. We also explored correlations between different symptoms within each genotype., Results: Participants with the Met/Met genotype reported significantly worse cancer-related fatigue and neuropathic pain, which was confirmed by rank-based regression analysis. In addition, cancer-related fatigue was correlated with other PN symptoms, particularly depression. These correlations were stronger in study participants with the Met/Met genotype than those with other genotypes., Conclusion: Our study suggests that female cancer survivors with the Met/Met genotype of BDNF rs6265 are likely to experience worse cancer-related fatigue and neuropathic pain and that cancer-related fatigue is a good predictor of co-occurring PN symptoms in this population., Implications for Cancer Survivors: Our findings advance the scientific community's understanding of cancer-related PN symptoms experienced by female cancer survivors, especially the unique role of BDNF rs6265 polymorphism in these symptoms. Our findings offer valuable insights for clinical practice that the symptom experience among female cancer survivors may vary based on BDNF genotypes., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Rationale: In interstitial lung disease (ILD), symptoms drive impairments in health-related quality of life. Patient-reported outcome measures (PROMs) can assess whether interventions change symptom severity. The meaningfulness of change in a PROM score is estimated by anchoring it to a related variable for which meaningful change has been previously established. Patient global impressions of severity (PGISs) are single-item PROMs that may make trustworthy anchors, but, for ILD, the meaningfulness of change in PGIS items for shortness of breath (SOB), cough, and fatigue/low energy are unknown. Objectives: To improve understanding of how patients with ILD rate and categorize symptoms, how differing levels of symptom severity affect lived experiences, and how patients derive and apply meaningfulness to change in symptoms. Methods: We used one-on-one interviews and an electronic survey to collect data from patients with various forms of ILD. Interviews were conducted to provide richness and context to survey responses. We conducted certain analyses with respondents stratified by supplemental oxygen use. Results: Interviewees ( N  = 18) confirmed SOB, cough, and fatigue/low energy as the most bothersome symptoms of ILD. Among 298 survey respondents, on a PGIS for SOB with a 0-4 numeric rating scale, on average, those who used supplemental O 2 had more severe SOB than nonusers, and most respondents considered a 2-point change meaningful for worsening (45.5%) or improvement (47.2%). On a PGIS with a five-option ordinal response scale, for SOB, most considered a 1-category change meaningful for worsening (49.8%) and a 2-category change meaningful for improvement (42.3); for cough frequency, most respondents considered a 1-category change on the five-option ordinal response scale meaningful for worsening (48.2%) or improvement (45.0%). Survey responses for SOB at the present time versus 3 months earlier (patient global impressions of change) were biased toward the present state. Conclusions: PGISs can be used as anchors for meaningful change analyses of PROMs that assess SOB or cough in patients with ILD. Patient global impressions of change demonstrate present-state bias and should not be used. Patients' descriptions paint a vivid picture of lived experience with varying levels of symptom severity and can help contextualize change scores.

Background: In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management., Methods: The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis., Results: In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients., Conclusions: This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.

A significant proportion of patients after SARS-CoV-2 infection suffer from long-lasting symptoms. Although many different symptoms are described, the majority of patients complains about neuropsychological symptoms. Additionally, a subgroup of patients fulfills diagnostic criteria for ME/CFS. We analyzed a registry of all patients presenting in the out-patients clinic at a German university center. For patients with more than one visit, changes in reported symptoms from first to second visit were analyzed. A total of 1022 patients were included in the study, 411 of them had more than one visit. 95.5% of the patients reported a polysymptomatic disease. At the first visit 31.3% of the patients fulfilled ME/CFS criteria after a median time of 255 days post infection and and at the second visit after a median of 402 days, 19.4% still suffered from ME/CFS. Self-reported fatigue (83.7-72.7%) and concentration impairment (66.2-57.9%) decreased from first to second visit contrasting non-significant changes in the structured screening. A significant proportion of SARS-CoV-2 survivors presenting with ongoing symptoms present with ME/CFS. Although the proportion of subjective reported symptoms and their severity reduce over time, a significant proportion of patients suffer from long-lasting symptoms necessitating new therapeutic concepts., Competing Interests: Declarations. Conflict of interest: All authors report no conflict of interest regarding the content of the manuscript., (© 2023. The Author(s).)

Background: Cancer-related fatigue (CRF) is one of the most common symptoms associated with cancer and its treatment. Different types of exercise have demonstrated beneficial effects on CRF. Previous evidence syntheses provided promising but inconclusive results when focusing on the effects of resistance training., Objectives: To evaluate the effects of resistance training on CRF in people with cancer and, specifically, to compare the effects of resistance training with no training on CRF at: different periods of treatment in relation to anticancer therapy (before, during, or after anticancer therapy); different periods of assessment (up to 12 weeks after the intervention, between more than 12 weeks and less than six months after the intervention, or six months or longer after the intervention). Moreover, we wanted to compare the effects of resistance training with no training on quality of life (QoL), adverse events, depression, and anxiety., Search Methods: We performed an extensive literature search in eight databases including CENTRAL, Medline, and Embase in October 2023. We searched trial registries for ongoing studies, and we integrated results from update searches of previously published Cochrane reviews., Selection Criteria: We included randomised controlled trials (RCTs) that compared resistance training with no training in adults with any type of cancer who received resistance training initiated before, during, or after anticancer therapy. Eligible RCTs needed to evaluate CRF or QoL. Resistance training had to be structured, last for at least five sessions, and include face-to-face instruction. We excluded studies that randomised fewer than 20 participants per group., Data Collection and Analysis: We used standard Cochrane methodology. For analyses, we pooled short-term, medium-term, and long-term effects (i.e. up to 12 weeks, between more than 12 weeks and less than six months, and six months or longer, after the intervention). We assessed risk of bias and certainty of the evidence using Cochrane's risk of bias tool (RoB 1), and the GRADE approach, respectively., Main Results: We included 21 RCTs with a total of 2221 participants, with diverse types of cancer, who received resistance training initiated during (14 studies), or after (7 studies) anticancer therapy. None of the studies investigated the effects of resistance training initiated before anticancer therapy. Here, we present the results on CRF, QoL, and adverse events. Results on depression and anxiety are reported in the full review. Resistance training during anticancer therapy Resistance training probably has a beneficial effect compared with no training on short-term CRF (mean difference (MD) on Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-Fatigue) 3.90, 95% confidence interval (CI) 1.30 to 6.51; scale from 0 to 52, higher values mean better outcome, minimal important difference (MID) 3; 12 RCTs, 1120 participants; moderate-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on medium-term CRF (MD on Multidimensional Fatigue Inventory -8.33, 95% CI -18.34 to 1.68; scale from 20 to 100, higher values mean worse outcome, MID 11.5; 1 RCT, 47 participants; very low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on long-term CRF (MD on FACIT-Fatigue -0.70, 95% CI -4.16 to 2.76; 1 RCT, 133 participants; very low-certainty evidence). Resistance training may have a small beneficial effect compared with no training on short-term QoL (MD on EORTC QoL Questionnaire C30 - global health (QLQ-C30) 4.93, 95% CI 2.01 to 7.85; scale from 0 to 100, higher values mean better outcome, MID 10; 12 RCTs, 1117 participants; low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on medium-term QoL (MD on QLQ-C30 6.48, 95% CI -4.64 to 17.60; 1 RCT, 42 participants; very low-certainty evidence). The evidence is very uncertain about the effect of resistance training compared with no training on long-term QoL (MD on Functional Assessment of Cancer Therapy - Anemia (FACT-An) 0.50, 95% CI -8.46 to 9.46; scale from 0 to 188; higher values mean better outcome, MID 7; 1 RCT, 133 participants; very low-certainty evidence). Only two RCTs (116 participants) reported data on adverse events for both the resistance training and the control arm. The evidence is very uncertain about the effect of resistance training compared with no training on the occurrence of adverse events (very low-certainty evidence). Resistance training after anticancer therapy The evidence is very uncertain about the effect of resistance training compared with no training on short-term CRF (MD on Chalder Fatigue Scale -0.27, 95% CI -2.11 to 1.57; scale from 0 to 33, higher values mean worse outcome, MID 2.3; 3 RCTs, 174 participants; very low-certainty evidence). Resistance training may have a small beneficial effect or no effect compared with no training on short-term QoL (MD on QLQ-C30 3.87, 95% CI -1.22 to 8.97; 4 RCTs, 243 participants; low-certainty evidence). None of the studies reported data on medium-, or long-term effects on CRF or QoL. Only three RCTs (238 participants) reported data on adverse events for both the resistance training and the control arm. The evidence is very uncertain about the effect of resistance training compared with no training on the occurrence of adverse events (very low-certainty evidence)., Authors' Conclusions: Our review demonstrates beneficial effects of resistance training during anticancer therapy compared with no training on short-term CRF and QoL for people with cancer. Resistance training after anticancer therapy may also have a small beneficial effect on short-term QoL. Data on medium-, and long-term effects are sparse. In order to facilitate evidence syntheses beyond a narrative report of the data, investigators of resistance training programmes should report adverse events more consistently and completely for all study arms, including control groups., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Purpose: Pain-fatigue-sleep disturbance symptom cluster (PFS) was common in patients with lung cancer and seriously affected the life quality of patients. However, the heterogeneity and subgroups of PFS were unclear in lung cancer patients after chemotherapy. This study was conducted to identify distinct subgroups of PFS in patients with lung cancer after chemotherapy, and explore the differences and risk factors of PFS subgroups., Methods: Lung cancer patients after chemotherapy were recruited. Data were collected using the Chinese version of the Brief Pain Inventory, the Cancer Fatigue Scale, and the Pittsburgh Sleep Quality Index. The latent profile analysis (LPA) was used to identify the subgroups of PFS. Univariate analysis was used to identify the differences among all subgroups. Logistic regression and restricted cubic splines were used to investigate predictors of the PFS subgroups., Results: Based on LPA, 512 participants were divided into four subgroups (Class 1: low pain-fatigue-sleep disturbance; Class 2: moderate pain-moderate fatigue-low sleep disturbance, Class 3: low pain-high fatigue-high sleep disturbance, and Class 4: high pain-fatigue-sleep disturbance). The univariate analysis showed that gender, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, leukocyte, neutrophils, platelet, C-reactive protein, stress, anxiety, depression, and social support were associated with PFS. The logistic regression analysis revealed that patients in Class 2 and Class 3 were more likely to experience great stress than those in Class 1. Additionally, compared to Class 1, females, lower BMI, stress, anxiety, and depression were independent predictors of Class 4., Conclusion: This study successfully identified subgroups of PFS in patients with lung cancer after chemotherapy. Based on the results of this study, medical workers can identify patients with high risks for PFS and conduct more targeted interventions to improve symptom management., Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Jiangnan University (approval no. JNU20220901IRB05). Consent to participate: Informed consent was obtained from all participants included in the study. Consent to publish: All of the authors read the final version of the paper and approved its submission for publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To describe the prevalence of fatigue in adults with colorectal cancer (CRC). Additionally, to explore the associations and correlations between fatigue and sociodemographic and clinical characteristics., Methods: Patients with CRC at various phases of the disease were evaluated for fatigue using the Brief Fatigue Inventory (BFI), independence in activities of daily living using the Barthel index, perception of pain using the Visual Analogue Scale (VAS), and performance status using the Eastern Cooperative Oncology Group criteria in a Chilean public hospital. Descriptive analyses were used to describe the variables. Chi-square and Spearman tests were utilized to evaluate associations between fatigue and other variables., Results: Among 241 patients participate (mean age 68.9 ± 12.2 years) and colon cancer was most common (66.4%). Fatigue was present in all disease phases, with moderate fatigue most prevalent (49.3%), followed by mild (24.2%) and severe (13.6%). Newly diagnosed patients had a higher proportion of severe fatigue (p = 0.04). Women experienced more moderate fatigue than men (p < 0.05). Patients with over three comorbidities and severe pain had higher severe fatigue (p < 0.05). Mood disorders were linked to more severe fatigue, while their absence was related to milder fatigue (p = 0.02). Musculoskeletal disorders correlated with moderate fatigue, while their absence correlated with mild fatigue (p < 0.01). Small positive correlations existed between fatigue and age (Rho = 0.15) and pain (Rho = 0.23) (p < 0.05)., Conclusion: Cancer-related fatigue (CRF) is highly prevalent in individuals with CRC and can be present throughout all phases of the disease. Early screening and management are recommended, prior to surgical treatment., Competing Interests: Declarations. Ethical approval and informed consent: Approved by the Scientific ethics committee of the Metropolitan East Health, Chile, Resolution on May 28,  2019. Conflict of interests: The authors declare they have no financial interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Little is known about the impacts of fatigue after cancer treatment, including whether cancer-related fatigue impacts people's use of healthcare. This study sought to examine how cancer-related fatigue impacts healthcare use after completing cancer treatment. A population-based survey was administered in Nova Scotia, Canada, to examine survivors' experiences and needs after completing cancer treatment. Respondents included survivors of breast, melanoma, colorectal, prostate, hematologic, and young adult cancers who were 1-3 years post-treatment. Survey responses were linked to cancer registry, physicians' claims, hospitalization, and ambulatory care data. Data were analyzed descriptively and using regression models. The final study cohort included 823 respondents. Younger respondents reported higher levels of cancer-related fatigue compared to older respondents. More females than males reported cancer-related fatigue. Upon adjusted analyses, those with cancer-related fatigue had lower odds of being discharged to primary care for their cancer-related follow-up (odds ratio = 0.71, p = 0.029). Moreover, those with cancer-related fatigue had 19% higher primary care use (incidence rate ratio = 1.19, p < 0.0001) and 37% higher oncology use (incidence rate ratio = 1.37, p < 0.016) during the follow-up period compared to those without cancer-related fatigue. Providers (oncology and primary care) may require additional support to identify clinically relevant fatigue and refer patients to appropriate resources and services.

Background: Cancer-related fatigue symptoms persist throughout the radiotherapy period in patients with esophageal cancer and show a continuous worsening trend, which seriously affects the quality of survival of patients. Therefore, monitoring patients' fatigue status promptly, recognizing highly fatigued patients, and providing physical and psychological support are essential for improving their quality of life. As a positive psychological trait, self-efficacy can influence the level of fatigue in patients undergoing radiotherapy for esophageal cancer. However, the pathways by which self-efficacy affects cancer-related fatigue remain unclear., Objective: The aim of this study is to investigate the factors influencing cancer-related fatigue in patients undergoing radiation therapy for esophageal cancer and to investigate the role of social support as a mediator between self-efficacy and cancer-related fatigue using the theory of unpleasant symptoms., Methods: The study used a descriptive survey approach, and data were collected at a tertiary hospital in Nanjing between October 2022 and May 2023. A total of 225 patients with esophageal cancer undergoing radiotherapy completed the Demographic Characteristics Scale, Cancer-Related Fatigue Scale, Self-Efficacy Scale, and Social Support Rating Scale. The data were statistically analyzed using SPSS version 26.0 (IBM, CHINA) and SPSS PROCESS 3.3 plug-in., Results: The cancer-related fatigue score of Chinese patients undergoing radiotherapy for esophageal cancer was 27.27 ± 7.26, which shows a high level of fatigue. Social support partially mediates the relationship between self-efficacy and cancer-related fatigue., Conclusion: The findings may help medical personnel identify factors that influence cancer-related fatigue in patients undergoing radiotherapy for esophageal cancer and develop reasonable management strategies., Competing Interests: Declarations Competing Interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Patients with multiple myeloma (MM) experience significant symptom burden. We used a symptom monitoring app to longitudinally characterize the MM treatment experience in detail based on line of therapy (LOT)., Methods: Adults with MM on active treatment completed weekly symptom monitoring surveys. Patients on their 4th LOT or greater were considered heavily pretreated. We characterized moderate to very severe (MOD-VS) symptom prevalence, weekly symptom burden, symptom bother (FACT-GP5), and health-related quality of life (HR-QoL) (EORTC QLQ-C30 Item 30) per LOT., Results: We considered 109 patients on LOT < 4 and 47 on LOT ≥ 4. The top MOD-VS symptoms were fatigue (71.6% of patients), muscle pain (59.8%), general pain (51.6%), numbness/tingling (48.4%), and insomnia (47.6%). More patients on LOT ≥ 4 experienced numbness/tingling (66.7% vs. 41.3%; OR 2.84, 95% CI 1.27-6.37; p = 0.0098) and fatigue (83.3% vs. 65.6%; OR 2.60, 95% CI 0.96-7.09; p = 0.0557). Some symptoms (fatigue, muscle pain, anxiety) persisted for months among patients on LOT ≥ 4, but patients on LOT < 4 also had unmet longitudinal needs (numbness/tingling, dyspnea). Patients on LOT ≥ 4 had more weeks with ≥ 3 MOD-VS symptoms (27.1% of weeks vs. 15.7%; OR 2.56, 95% CI 1.07-6.08; p = 0.0337) and experienced high symptom bother more often (39.1% of surveys vs. 30.0%; OR 4.23, 95% CI 1.37-13.10; p = 0.0123). HR-QoL was similar between groups., Conclusion: Heavily pretreated patients experienced greater symptom burden and bother, but patients at earlier LOTs also had unmet needs. Interventions are needed to improve symptom management in MM regardless of LOT, but most pressingly for heavily pretreated patients., Competing Interests: Declarations Ethics approval This study was performed in accordance with the Declaration of Helsinki. This study utilized a prospectively collected database of electronic patient-reported outcomes; we obtained approval from the Institutional Review Board at Duke University Medical Center for analysis of these data (Pro00108428). Consent to participate Informed consent was obtained from all individual participants included in the study. Competing interests Mihir N. Patel has received royalties from Prepped Health (Agreement #012617, HOPE). Suzanne Johnson and Julie Scott are employees of and hold stock or stock options in Carevive Systems, Inc. Thomas W. LeBlanc has received honoraria for consulting/advisory boards from AbbVie, Agilix, Agios/Servier, Apellis, Astellas, AstraZeneca, Beigene, BlueNote, BMS/Celgene, Genentech, GSK, Lilly, Meter Health, Novartis, and Pfizer; speaking related honoraria from AbbVie, Agios, Astellas, BMS/Celgene, GSK, Incyte, and Rigel; equity interest in Dosentrx and ThymeCare (stock options in a privately-held company); royalties from UpToDate; research funding from AbbVie, American Cancer Society, AstraZeneca, BMS, Deverra Therapeutics, Duke University, GSK, Jazz Pharmaceuticals, the Leukemia and Lymphoma Society, the National Institute of Nursing Research/ National Institutes of Health, and Seattle Genetics. All other authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To explore distributed characteristics and identify research focus and emerging trends related to cancer-related fatigue (CRF) in the nursing field., Methods: Data were collected from the Web of Science Core Collection database between January 2012 and December 2021 using an advanced search strategy. Data were extracted and analyzed using CiteSpace and Microsoft Excel., Results: A total of 967 articles were included in this study. The number of published nursing studies on CRF has increased with slight fluctuations. Keyword co-occurrence analysis and timeline view indicated that CRF is closely related to quality of life, and there is a correlation between CRF and other symptoms. Moreover, increasing attention has been paid to CRF nursing interventions. The assessment tools and their different language versions, risk factors and reviews of CRF were the research frontiers in recent years with citation bursts., Conclusions: In the field of nursing, the focus of CRF research is still on risk factors, adverse outcomes and nursing management. Assessment tools will continue to be developed and additional risk factors will be studied in the future., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Hypermobile Ehlers-Danlos syndrome (EDS) is an inherited condition marked by joint hypermobility, instability, chronic pain and fatigue, significantly impacting quality of life and autonomy. Management focuses solely on symptom alleviation. After experiencing a rapid decline in functional abilities, a patient in late adolescence with hypermobile EDS underwent hippotherapy rehabilitation (30 hours). She saw substantial improvements in fatigue, chronic pain and regained walking abilities. Hippotherapy played a crucial role in refining her postural balance, motor skills, proprioception, muscle function and endurance. It also positively affected her cognitive and emotional regulation by stimulating sensory inputs that activate neural pathways, providing relief from pain and fatigue. Notably, the patient transitioned from wheelchair reliance to walking with crutches, and then greatly enhanced both gait quality and speed. These findings demonstrate the relevance of hippotherapy for the rehabilitation of hypermobile EDS, reducing the need for pharmacological interventions and fostering a proactive approach to future challenges., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest., Methods: For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians' knowledge, and Mann‒Whitney U tests were performed., Results: Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1-6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops., Conclusion: Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines., Trial Registration: Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021., Competing Interests: Declarations Ethics approval The survey was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Faculty of Medicine, Heidelberg University (S-526/2018). Written informed consent was obtained from all participants before completing the survey. Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish N/A. Competing interests Imad Maatouk, Karen Steindorf and Martina Schmidt received funding for projects related to fatigue as institutional payments from the German Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF). Karen Steindorf further received personal fees for lectures with some relation to fatigue. For the remaining authors, no competing interests were declared., (© 2024. The Author(s).)

Protracted fatigue and other symptoms can occur after Lyme disease and other infections, with numerous possible drivers. Studies on posttreatment Lyme disease have been inconclusive, with no confirmed biomarker emerging. Prolonged antibiotic therapy provides no benefit. Thus, a holistic approach toward understanding and treating this complex disease is necessary.

Introduction: Cancer-related fatigue (CRF) is one of the most common and painful symptoms in patients with prostate cancer (PCa). Moreover, PCa patients who receive the androgen deprivation therapy (ADT) are more likely to develop CRF. Baduanjin exercise has been shown to improve CRF in some cancers. However, such effects have not been verified in patients with PCa treated with the ADT. So, this study was designed as a randomised controlled trial (RCT) to explore the effects of Baduanjin exercise on CRF in PCa patients treated with the ADT., Methods and Analysis: This study will be a single-centre, assessor and statistician blinded, RCT consisting of a 12 week intervention and 12 week follow-up. Patients with PCa who meet the inclusion criteria will be recruited from Shanghai Hudong Hospital. Participants will be randomly assigned to Baduanjin exercise group (n=42) and the control group (n=42), performing 12 weeks of Baduanjin exercise or reeiving the standard care. The primary outcome will be the clinical effect of Baduanjin exercise on CRF in PCa patients, which will be measured using the Piper Fatigue Self-Assessment (PFS) scale, a multidimensional measure of CRF using three different dimensions: somatic, emotional and cognitive. The secondary outcome will be the clinical effect of the Baduanjin exercise on the patient's level of fatigue, sleep, depression and life quality at the time, which will be assessed by the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI) and the Functional Assessment of Cancer Therapy-Prostate (FACT-P)., Ethics and Dissemination: This study has been approved by Shanghai Hudong Hospital Ethics Committee, Shanghai province (2022 SHHDKY08). The trial results will be submitted to conferences and peer-reviewed journals., Trail Registration Number: ChiCTR2300074293., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cancer-related fatigue is a pervasive symptom, affecting up to 90% of cancer patients throughout their illness, and can persist well after treatment has ended. Despite its prevalence, no definitive evidence-based treatment exists, leading to an abundance of proposed alternatives, including natural supplements. To further explore the potential effects of guaraná on cancer-related fatigue, a systematic review with meta-analysis was conducted and registered on the International Prospective Register of Systematic Reviews (CRD42023484144)., Methods: A thorough search of PubMed/MEDLINE and Cochrane Library was conducted using MeSH terms and related keywords for cancer-related fatigue and guaraná. Eligible studies were selected according to predetermined criteria and assessed for quality in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers, with any discrepancies resolved by a third researcher., Results: In total, 4 full articles and 1 abstract, encompassing a total of 229 patients from 2009 to 2023, were included in the meta-analysis. Despite high heterogeneity between studies (I2=78%, ꭓ2=18.51, df=4, p=0.0010), the analysis revealed a significant benefit of using guaraná to alleviate cancer-related fatigue, with a standard mean difference of -0.77 (95%CI -1.34, -0.21) and a test for the overall effect of Z=2.68 (p=0.007)., Conclusion: This meta-analysis provides support for the use of guaraná in the treatment of cancer-related fatigue. However, further investigation through larger prospective randomized controlled trials is necessary to validate these findings.

Background: Kinesiophobia, an irrational fear-avoidance behaviour, can significantly impact the quality of life and prognosis of peritoneal dialysis patients. This study aimed to assess the prevalence of kinesiophobia in patients undergoing peritoneal dialysis and to analyse its influencing factors., Methods: A total of 291 patients who visited the outpatient and ward of peritoneal dialysis in 7 tertiary hospitals in Jiangsu Province from December 2023 to March 2024 were selected as research subjects via the convenience sampling method. A cross-sectional survey was conducted using a general data questionnaire, the Tampa Kinesiophobia-11 Scale, the Chinese Version of the Multidimensional Fatigue Symptom Scale, and the Simplified Coping Style Questionnaire., Results: The score obtained using the Tampa Scale for kinesiophobia in patients with peritoneal dialysis was 22.44 ± 7.46, with a prevalence rate of 69.1%. Binary logistic regression analysis revealed that no complications, daily exercise before illness, and positive coping styles were protective factors (p < 0.05), whereas fatigue and negative coping styles were risk factors for kinesiophobia in patients receiving peritoneal dialysis (p < 0.05)., Conclusions: The prevalence of kinesiophobia in patients receiving peritoneal dialysis was high but at a mild level. Medical staff should combine influencing factors to identify high-risk groups as early as possible, formulate targeted interventions to reduce the occurrence of kinesiophobia and mitigate adverse effects on peritoneal dialysis patients., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (2023NL-277-02). Informed consent was obtained from all the subjects involved in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)