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Power JD, Badley EM, French MR, Wall AJ, Hawker GA. Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord. 2008 May 1;9:63. [Pub Med ID 18452607]


Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA.



In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached.



Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Five main themes were identified to summarize the focus groups: fatigue characteristics, factors affecting fatigue, impact of fatigue, methods of coping with fatigue and discussions about fatigue with others. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses.



Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact. /p>


List of Tables and Figures (in the publication)

  • Table 1. Focus group questions.
  • Table 2. Socio-demographic characteristics.
  • Table 3. Health status measures.
  • No figures for this paper.

Selected Tables from the Publication (with interpretation)

Identical questions were asked of each group in sessions lasting 2-2.5 hours.

All participants completed a questionnaire at the start of each focus group that included age, sex, education, race, as well as the WOMAC, FACIT, and the CES-D. Participants had moderate WOMAC pain and physical functioning scores. CES-D scores were right- skewed, with a mean and median of 15.4 and 14.5 respectively. Seventeen participants (37.0%) had CES-D scores over 16, which are considered indicative of significantly depressed mood. FACIT fatigue scores were approximately normally distributed with a mean and median of 31.