Fatigue and measurement of fatigue: a scoping review protocol
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S YS T E M AT I C R E V I E W P R O T O C O L
Fatigue and measurement of fatigue: a scoping review
protocol
Stephen John Walters Cindy Stern Matthew Stephenson
Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
Review question/objective: The objectives of this review are to identify and present definitions of fatigue and
theoretical, conceptual and mechanistic models of fatigue, and to identify the commonly used instruments that
measure fatigue in humans and the settings in which they are used.
Specifically, the review questions are:
i) How is fatigue defined?
ii) What theories, conceptual and mechanistic models of fatigue that underpin the understanding of fatigue have
been posited?
iii) What are the most commonly used instruments that measure human fatigue and in which settings are they used?
Keywords Conceptual modelling; definition; fatigue; measurement instruments; mechanism
JBI Database System Rev Implement Rep 2019; 17(3):261–266.
Introduction issues, and the need for treatment or testing the
atigue is the state of weariness that may result efficacy of any treatment for fatigue. There are many
F from prolonged physical or mental effort, anxi-
ety and lack of adequate sleep or exposure to harsh
instruments available to measure fatigue, both psy-
chometric instruments, such as the Fatigue Severity
environments.1 Fatigue is both a normal response in Scale,36 and objective tests, such as the hand grip
healthy people and a symptom of illnesses such as strength dynamometer37 and Root Mean Square
cancer,2,3 multiple sclerosis,4-7 chronic fatigue syn- (RMS) value of electromyographic signals.38,39
drome8 and fibromyalgia syndrome.9,10 Fatigue is Fatigue may be conceptualized relative to differ-
broadly classified as acute/transient fatigue (e.g. ent biopsychosocial aspects and fatigue research may
after exercise), chronic fatigue (lasting unabated focus on a specific aspect. For example, research into
for more than six months) or chronic fatigue syn- the involvement of the brain in fatigue would con-
drome (chronic fatigue with co-morbidity). ceptualize fatigue relative to a pathophysiological
It is well recognized within the literature that the model and attempt to understand biological mecha-
level of human fatigue is correlated with perfor- nisms.40 In a contrasting example, the role of psy-
mance indicators such as athletic results and chological stress in causing fatigue conceptualizes
injury,11-17 work productivity, performance and fatigue as a symptom or consequence of the
injury,18-23 decision making/cognitive perfor- stressor.41,42 Although different, the two conceptu-
mance,24-28 and mistakes and accidents.29-35 There- alizations of fatigue are not mutually exclusive or
fore, it is important to understand the implications conflicting, but are instead connected. This current
and consequences of fatigue within various settings review will include research that focuses on any
and to minimize the impact of fatigue on cata- biopsychosocial aspect of fatigue using physiologi-
strophic outcomes. The ability to quantify fatigue cal, psychological or sociological models.
allows for the measurement of fatigue severity, and Physiological models may define fatigue as the loss
the subsequent identification of health and safety of force generating capacity during muscular activity
or relating to organ failure due to lack of physiological
substrates.43 Central models of fatigue are those that
Correspondence: Stephen John Walters, camroc@iinet.net.au are based on the involvement of the central nervous
There is no conflict of interest in this project. system’s contribution to fatigue.43 Imaging research
DOI: 10.11124/JBISRIR-2017-003699 suggests the significant involvement of the brain in
JBI Database of Systematic Reviews and Implementation Reports ß 2019 THE JOANNA BRIGGS INSTITUTE 261
©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.SYSTEMATIC REVIEW PROTOCOL S.J. Walters et al. fatigue. For example, Brodmann’s area 10/11 is asso- within a knowledge domain, clarifying definitions of ciated with fatigue sensation and motivation.44 These terms, and defining the boundaries of the knowledge models contrast with peripheral models that empha- domain. Therefore, scoping reviews are useful in size the metabolic exhaustion of the muscles or identifying key concepts and gaps in knowledge. involve impaired motor-neuron end plate deficits, A search of PubMed and the JBI Database of for example.43,45 Other models propose a model of Systematic Reviews and Implementation Reports complexity that includes control over fatigue pro- using the search term ‘‘fatigue’’ revealed no current cesses which places the brain as a governor of exercise scoping reviews about fatigue, fatigue modelling or fatigue (Central Governor Theory).46,47 fatigue measurement. A systematic review published Psychological fatigue is different to mental fatigue in 2009 considered fatigue measurement instru- in that mental fatigue relates to weariness that devel- ments,57 looking at validity of instruments assessing ops as a result of cognitive or mental work.48 Psy- fatigue in chronic illnesses but it is not a scoping chological fatigue is associated with stress and review, does not address the broader criteria of this emotions and has been defined as a ‘‘. . .feeling of current scoping review and is not current. A biblio- fatigue caused by things such as lack of exercise, graphic study of fatigue measurement scales was boredom, or mental stress that results in lack of conducted by Hjollund et al.58 and is also not cur- energy and depression.’’49(para.1) It has been shown rent. Therefore, this current scoping review is timely. that depression may increase the risk of unexplained fatigue and the presence of unexplained fatigue may Inclusion criteria cause depression.50 Participants Loriol places the study of fatigue into a sociologi- Articles that include humans may be included in this cal perspective: ‘‘...fatigue must be studied as a current review. Participants can be from any popu- subjective feeling of tiredness related in complex lation, age, gender and with any health status. and diverse manners to physical muscular effort, motivation processes and performances, and subject Concept to socio-historical framing.’’51(p.2),52 This point of The concept of interest is the definition of fatigue, view alludes to the influence of social settings and the theoretical, conceptual and mechanistic models history on the meaning of fatigue. Therefore, it is upon which fatigue is understood, and the measure- important to consider any study of fatigue in the ment of fatigue. This current review will consider context of the social setting in which the study took any of the different classifications of human fatigue, place. The meaning of fatigue will be shaped by each but not fatigue related to materials (‘‘...[material] unique social setting. For example, fatigue in avia- damage accumulate[d] due to the repetitive applica- tors (setting ¼ workplace/health and safety)53 has a tion of loads...’’),59(p.1) auditory fatigue (temporary different meaning and consequence than fatigue in loss of hearing sensitivity resulting from exposure to children with cancer (setting ¼ healthcare/family).54 a loud tone)60 or fatigue related to other disciplines This review seeks to scope the scientific literature such as engineering and physics etc. related to the conceptual, theoretical and mechanis- tic knowledge of fatigue and identify instruments Context used to measure fatigue. This is intended to inform Articles will be considered for inclusion in this the future development of a theoretical model of review within the context of biological/physiological fatigue and a systematic review of the measurement mechanisms, psychological expression or causes or properties of instruments. To achieve these objec- the effect of fatigue on human function in social tives, a scoping review of the literature is proposed. settings, such as the workplace or sports arena. The procedure and method for conducting a Articles examining fatigue in states of health or scoping review is published in the Joanna Briggs illness may be included. Institute Reviewer’s Manual55,56 upon which this scoping review will be founded. Essentially, scoping Types of studies reviews are conducted to map specific knowledge Systematic reviews, any quantitative or qualitative domains. The purpose of a scoping review can research studies, and expert opinion articles will include (one or all): the mapping of key concepts be considered. JBI Database of Systematic Reviews and Implementation Reports ß 2019 THE JOANNA BRIGGS INSTITUTE 262 ©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
SYSTEMATIC REVIEW PROTOCOL S.J. Walters et al.
Methods through evaluation of titles and abstracts and full
Search strategy text articles. This includes text defining fatigue,
The search strategy will aim to find published and information describing the development of fatigue
unpublished articles using a three-phase strategy. theories including history, pivotal commentaries,
The first phase was a limited search of PubMed and mechanisms central to fatigue physiology. Data
and Web of Science followed by analysis of the text about measurement instruments and test methods
words contained in the title and abstract and of the will be extracted from the second search results
index terms used to describe the articles. This through assessment of the contents of titles and
informed the development of the search strategy abstracts or the full citation record. An Excel spread-
which will be tailored for each information source sheet will be used to collect information, including:
(second phase). the name of the measurement instrument or test
The results of each search will be loaded into method; the number of articles mentioning each
EndNote V X.8 (Clarivate Analytics, PA, USA). instrument or test method; the range of years of
A third-phase search will look at the references in publications relative to each measurement instru-
the articles included into the review for further articles. ment or test method; diagnostic categories based
Articles with titles and abstracts published in on World Health Organization Classification of
English will be included. Articles published in any Diseases (ICD-11)63 for which a specific psychomet-
year may be included because the development of ric instrument was applied; the settings in which the
theories and models of fatigue has publication his- instrument or test method has been used; and the
tory as early as the late 1800 s.61 The chronological definition of specific test methods.
history of fatigue research is useful to identify the
evolving understanding from an earlier reductionist Data presentation
model towards a biopsychosocial-complexity model. Data will be presented using, but not limited to:
A full search algorithm for PubMed is detailed in tables, figures, citation maps, word clouds, concept
Appendix I. network maps and glossaries. In addition to this
presentation, a discussion of the data and the signif-
Information sources icance of the findings will be given.
The databases/sources to be searched include:
PubMed, Scopus, Web of Science, Cochrane Library, Acknowledgements
Embase, PsycINFO, JBI Database of Systematic This study contributes to the Doctor of Philosophy
Reviews and Implementation Reports. (Medicine) at the University of Adelaide for SJW.
The search for unpublished articles will include:
EThOS (Electronic Thesis Online Service), ProQuest
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©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.SYSTEMATIC REVIEW PROTOCOL S.J. Walters et al. Appendix I: Search strategy for PubMed Search 1: (((((((‘‘fatigue’’[mh:noexp] OR ‘‘mental fatigue’’[mh:noexp] OR ‘‘muscle fatigue’’[mh] OR ‘‘fatigue syn- drome, chronic’’[mh] OR fatigu[ti] OR lack of energy[ti] OR lassitude[ti] OR weariness[ti])))) AND ((defin[ti] OR concept[ti] OR theor[ti] OR model[ti] OR mechanism))))) Search 2: (((((((‘‘fatigue’’[mh:noexp] OR ‘‘mental fatigue’’[mh:noexp] OR ‘‘muscle fatigue’’[mh] OR ‘‘fatigue syndrome, chronic’’[mh] OR fatigu[ti] OR lack of energy[ti] OR lassitude[ti] OR weariness[ti])))) AND ((‘‘reproducibility of results’’[mh]) OR (measure[ti] OR valid[ti] OR reliab[ti] OR tool[ti] OR instrument[ti] OR questionnaire[ti] OR assess[ti] OR scale[ti] OR score[ti])) JBI Database of Systematic Reviews and Implementation Reports ß 2019 THE JOANNA BRIGGS INSTITUTE 266 ©2019 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
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