Fatigue and Disability

The most common and troublesome secondary condition reported by women with physical disabilities is fatigue.

Fatigue is a secondary condition affecting many women with physical disabilities and chronic health conditions. Fatigue was the most frequently reported secondary condition endorsed by 78 percent of the women with functional disabilities participating in one study.

Fatigue can have a profound impact on the physical, psychological, and social functioning of women with disabilities. In one study, fatigue was found to account for 65 percent of the disability experienced by participants with Multiple Sclerosis. Fatigue can also lead to unemployment and is associated with psychological distress, a sense of loss of control, and low positive affect.

Despite its prevalence and its profound impact on the population, fatigue has not been well studied and has been virtually overlooked in some disabling conditions.

Fatigue is associated with a number of disabling health conditions, including MS, systemic lupus erythematosus (SLE), postpolio syndrome (PPS), rheumatoid arthritis, fibromyalgia, Parkinson's disease, stroke, and numerous other disabling conditions.

Among women with MS, fatigue occurs even in those with mild disease and may be one of the initial presenting symptoms. Research has found a majority of patients with MS considered fatigue to be either their worse or one of their worse symptoms. Similarly, a study on persons with SLE found a majority of participants described fatigue as their most disabling symptom.

Postpolio syndrome is another disabling condition in which fatigue is a nearly universal experience. Some investigators have argued that fatigue is the most commonly reported, most debilitating, and least studied sequelae affecting polio survivors.

Although similarities have been noted in mean fatigue scores across several disability groups, the causes and triggers of fatigue may differ by disability type. For example, fatigue in persons with MS appears to be exacerbated by heat and mitigated by cool temperature more often than among persons with other disabilities.

Fatigue is a complex phenomenon that may result from a variety of causes, including disease pathology, decreased muscle strength and endurance, overexertion, comorbid conditions, environmental conditions, poor sleep, depression, and anxiety.

Most recently, investigators have begun differentiating physical and mental components of fatigue. Because these two components appear to have different correlates (e.g., only mental fatigue is related to depression and anxiety), some have suggested that making such distinctions can have implications for the treatment of fatigue, allowing intervention strategies to be tailored to the type of fatigue experienced.

Treatment for fatigue has lagged behind because of a lack of attention to this common, debilitating secondary condition. Recently, however, some investigators have begun to address the need for effective treatment recommendations as the following:

• A multidisciplinary approach to treatment of fatigue has been recommended.
• With regard to MS, it has been recommended that treatment begin with more cost-effective, nonpharmacologic interventions, moving to pharmacologic treatment when fatigue is severe or when individuals fail to respond to less costly strategies.
• Several drugs have been determined to be effective in the treatment of fatigue in MS.
• Other strategies that may be helpful include exercise, timed or scheduled periods of rest, making lifestyle adjustments, improving one's sleep, and avoiding heat exposure.

Despite the fact that fatigue is such a common, debilitating secondary condition, there remains a dearth of literature on the causes, consequences, and effective treatments for fatigue secondary to a wide range of chronic disabling health conditions. Some investigators attribute this to the fact that health professionals have typically focused on specific abilities without appreciating that people actually perform multiple tasks concurrently and that their impact is cumulative over time. Clearly additional research is needed on this phenomenon that has such a profound impact on the quality of life of women with physical disabilities.