Modified Fatigue Impact Scale
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  2. Modified Fatigue Impact Scale

Modified Fatigue Impact Scale

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Purpose

The MFIS is a modified form of the Fatigue Impact Scale (Fisk et al., 1994) based on items derived from interviews with MS patients concerning how fatigue impacts their lives. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning.

Link to Instrument

Link to instrument

Acronym MFIS

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery
  • Multiple Sclerosis

Populations

Immune System Disorders
Stroke
Parkinson's Disease
Multiple Sclerosis
Brain Injury

Key Descriptions

  • The MFIS is a 21-item shortened version of the 40-item FIS and has been recommended for use by the Multiple Sclerosis Council for Clinical Practice Guidelines. It assesses the perceived impact of fatigue on the subscales physical, cognitive and psychosocial functioning during the past 4 weeks (Rietberg et al., 2010).
  • The MFIS is one of the components of the MSQLI.
  • The full-length MFIS has 21 items while the abbreviated version has 5 items. The full-length version has the advantage of generating subscales, while the abbreviated version is useful in case of limited time.
  • Participants rate their agreement with 21 statements on a 5-point Likert scale, from 0 = ‘Never’ to 4 = ‘Almost always’.
  • Total score (0‐84) and subscales for physical (0‐36), cognitive (0‐40) and psychosocial functioning (0‐8). The 5-item version is scored (0‐20). Higher numbers indicate greater impact of fatigue on a person's activities.
  • The scoring for Standard 21-item version is either represented as a total score by summing the totals from each subscale or by each individual subscale (see below).
  • Subscale scoring:
    1) Physical subscale (9 items): scores range from 0-36; Add raw scores on items: 4+6+7+10+13+14+17+20+21
    2) Cognitive subscale (10 items): scores range from 0-40; Add raw scores on items: 1+2+3+5+11+12+15+16+18+19
    3) Psychosocial subscale (2 items): scores range from 0-8; Add raw scores on items: 8+9
  • Scoring for 5-item version: Total score is the sum of items 1+9+10+17+19; scores range from 0-20

Number of Items

21
Abbreviated: 5

Equipment Required

  • Questionnaire
  • Pen

Time to Administer

2-10 minutes

Approximately 5-10 minutes for the full-length version and 2-3 minutes for the abbreviated version.

Required Training

Reading an Article/Manual

Required Training Description

Patients with visual or upper extremity impairments may need to have the MFIS administered as an interview. Interviewers should be trained in basic interviewing skills and in the use of this instrument.

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Tammie Johnson, PT, DPT, MS and the TBI EDGE task force of the Neurology Section of the APTA in 9/2012.

Updated 9/4/2024 by Master of Occupational Therapy students Kit Wa Chiu, Sarah Eden, Alicia Glenwell, Natalie Grazian, Amia-Lee Johnson, Amy M. Knutson, Erika Reinhardt, and Megan Sears under the direction of faculty mentor Danbi Lee, PhD, OTD, OTR/L, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle.

 

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Emotion
General Health
Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

UR

UR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

StrokEDGE

NR

NR

UR

UR

UR

TBI EDGE

NR

LS

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

R

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

Yes

Yes

No

StrokEDGE

No

No

Yes

Not reported

TBI EDGE

No

No

No

Not reported

Considerations

  • The MFIS is a shortened modification of the Fatigue Impact Scale, designed as a self-report measure to rate fatigue in Multiple Sclerosis.
  • The MFIS cannot be used to generate a single overall score of fatigue. The conceptual interaction between the two dimensions remains unclear, which poses problems when interpreting change scores in these individual scales. Studies in which a global MFIS score was used as either an outcome measure or selection tool may need to be re-evaluated (Mills et al., 2010).
  • An algorithm for treatment recommendations regarding general fatigue is available in the Evidence Based Management Strategies for Fatigue in Multiple Sclerosis (Multiple Sclerosis Council for Clinical Practice Guidelines).
  • A 5 item version is available if time is limited, but it is recommended to use the full 21 item version since it provides subscales.
  • The MFIS is a self-report questionnaire, but it can be used as an interview for people with visual or upper extremity dysfunction.
  • Total score can be calculated for general fatigue impact or scores can be used for calculating specific fatigue in regard to the subscales.
  • Many translations are available; however, not all of them have been linguistically, culturally, and/or psychometrically evaluated (Arabic, Bulgarian, Cantonese, Catalan, Croatian, Czech, Danish, Dutch, English, Finnish, French, Georgian, German, Greek, Hungarian, Italian, Lithuanian, Norwegian, Persian, Polish, Portuguese, Romanian, Russian, Serbian, Spanish, Ukrainian, and Urdu).
  • Clinicians should prioritize using a scale that has been culturally adapted. 

Do you see an error or have a suggestion for A instrument summary? Please e-mail us!

Multiple Sclerosis

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Standard Error of Measurement (SEM)

Multiple Sclerosis: (Learmonth et al., 2013; n = 86; mean age = 49.2 (9); female = 66 (77%); disease duration = 11.8 (8.2) years; median PDDS score = 3 (range = 0-6)) 

  • SEM for entire group (n = 86): 7.3

Multiple Sclerosis: (Alawami et al., 2021; n = 116; mean age = 34.7 (6.9) years; MS duration = 50.2 (46.2) months; Saudi Arabian sample; Arabic version MFIS-A) 

  • SEM for the total MFIS-A = 5.32
  • SEM for the physical/social subscale = 3.60
  • SEM for the cognitive subscale = 3.11

Multiple Sclerosis: (De Jesus et al., 2024; n = 30; age ≥ 18; mean age = 40.83 (10.61) years; female = 60%; duration of MS = 5.41 (4.86) years; administered via telephone; Brazilian sample) 

  • SEM for  the total MFIS-A = 0.71 
  • SEM for the physical subscale = 0.50
  • SEM for the psychosocial subscale = 0.29
  • SEM for the cognitive subscale = 0.49

Multiple Sclerosis: (calculated from Chung, et al., 2022; n = 149; patients with MS n = 51 (Relapsing Remitting MS, n = 46; Secondary Progressive MS, n = 5); mean age = 37.93 (10.75) years; Disease duration = 6.5 (5.3) years; Annualized Relapse Rate = 1.5 (2.8); Korean translation: MFIS-K)

  • SEM for patients with MS = 4.87

Minimal Detectable Change (MDC)

Multiple Sclerosis: (Learmonth, 2013)

  • MDC95 for entire group (n = 86): 20.2

Multiple Sclerosis: (Alawami et al., 2021) 

  • MDC95 for the total MFIS-A = 14.68 
  • MDC95 for the physical/social subscale = 9.94 
  • MDC95 for the cognitive subscale = 8.58

Multiple Sclerosis: (De Jesus et al., 2024)  

  • MDC for  the total MFIS = 1.97 
  • MDC95 for the physical subscale = 1.40  
  • MDC95 for the psychosocial subscale = 0.80  
  • MDC95 for the cognitive subscale = 1.36   

Multiple Sclerosis: (calculated from Chung, et al., 2022) 

  • MDC95 for patients with MS = 13.51

 

Minimally Clinically Important Difference (MCID)

Multiple Sclerosis: (Rietberg, 2010; n= 43; ambulatory patients with MS (mean age 48.7 years; SD 7 years; 30 women; median Expanded Disability Status Scale score 3.5) 

  • Smallest Detectable Change (SDC) = 16.2
  • Minimal Detectable Change (MDC) % = 19.3%

Multiple Sclerosis: (Greeke, 2017; n = 435, mean age at baseline = 43.4 (11.1), mean disease duration at baseline = 9.2 (8.1), median EDSS at baseline = 1.5 (range = 0.0-8.0))

  • Clinically meaningful range ≥ 38, number of subjects identified in clinically meaningful range = 136

Multiple Sclerosis: (Rooney et al., 2019; n = 365; mean age = 46.2 (11.6) years; mean time post diagnosis = 9.6 (8.7) years; PDDS = 3.1 (2.3)) 

  • MCID = 4 

Multiple Sclerosis: (Monjezi et al., 2020; n = 58; mean age = 39.05 (8.92) years; mean time since diagnosis = 10.14 years (6.01); Persian sample; Persian translation of MFIS) 

  • MCID = 4  

 

Cut-Off Scores

Multiple Sclerosis: (Oervik, 2017; n = 84 Danish patients; n = 309 German patients; n = 147 healthy controls; mean Danish age = 51.1 (9.4); mean German age = 43.4 (9.9); mean healthy control age = 41.7 (12.9); mean Danish EDSS score = 3.43 (1.8); mean German EDSS score = 3.68 (1.2))

  • ≥38 points (out of a possible 0-84 points) is the cut-off defining fatigue related to MS

Multiple Sclerosis: (Monjezi et al., 2020)

  • >4 indicates fatigue (sensitivity 82%; specificity 67%)

Multiple Sclerosis: (Alawami et al., 2021) 

  • >35.5 indicates fatigue for total MFIS (sensitivity 79.3%; specificity 89.8%) 
  • >18.5 indicates fatigue for the physical/social subscale (sensitivity 78.4%; specificity 81.4%)
  • >15.5 indicates fatigue for the cognitive subscale (sensitivity 71.6%; specificity 72.9%)

 

Normative Data

Multiple Sclerosis: (Tellez et al, 2005; 231 MS patients and 123 healthy controls, 164 patients with relapsing-remitting, 47 with secondary progressive, 12 with primary progressive) 

  • Median MFIS score= 33.0 (range 0-82)

Multiple Sclerosis: (Learmonth, 2013)

  • Mean overall total MFIS score in patients = 41 (19.4)

Multiple Sclerosis: (Ghajarzadeh, 2013, 120 patients with MS (mean age = 30.8 (8.1), female = 84%) and 75 age-matched healthy controls (mean age = 31.1 (8.6), female = 69%), 109 with relapsing remitting (RR) disease course and 11 secondary progressive (SP) disease course, EDSS for RR = 1.4 (1.3) and EDSS for SP = 5.8 (1.4); Persian translation: MFIS-P)

  • Mean total MFIS score in MS patients = 29.7

Multiple Sclerosis: (Bakalidou, 2014; 99 MS patients and 75 healthy controls; mean age = 43.2 (10.2), median EDSS = 2.4 (1.6), Greek translation of MFIS)

  • Mean score on MFIS for MS Patients = 33.8 (17.8)

Multiple Sclerosis: (Greeke, 2017)

  • Total MFIS score at baseline = 27.8 (17.9; range = 0-77)
  • pMFIS (physical subscale) score at baseline = 13.3 (9.0; 0-35)
  • cMFIS (cognitive subscale) score at baseline = 12.4 (8.7; 0-38)
  • psMFIS (psychosocial subscale) score at baseline = 2.1 (2.0; 0-8)

Multiple Sclerosis: (Oervik, 2017)

  • Mean total MFIS score in Danish patients = 40.57

Multiple Sclerosis: (Lopes, 2016; n = 210; median age = 39 (IQR = 29-50); female = 160 (76.1%); median disease duration = 5.25 (IQR = 2.25 – 9.95); Portuguese translation of MFIS)

  • Median total MFIS score in patients = 22 (IQR = 12-32.5)

Multiple Sclerosis: (Rooney et al., 2019)

MFIS   

?Mean (SD) 

Total  

54.5 (16) points

Physical 

25.3 (7.3) points

Cognitive  

23.6 (9.2) points

Psychosocial 

5.4 (2) points?

 

Multiple Sclerosis: (Alawami et al., 2021)

MFIS-A Items 

Mean (SD) 

MFIS-A total 

45.84 (19.0) 

MFIS-A Physical component 

25.28 (10.9) 

Coordination 

2.09 (1.1) 

Pace physical activity 

2.23 (1.1) 

Motivation – physical 

2.26 (1.2) 

Motivation – social 

2.13 (1.0) 

Outdoor activities 

2.23 (1.1) 

Maintain physical effort 

2.16 (1.1) 

Muscle weakness 

2.44 (1.1) 

Physically uncomfortable 

2.30 (1.1) 

Task completion – physical 

2.35 (1.1) 

Physical activities 

2.43 (1.1) 

Need to rest 

2.65 (1.1) 

MFIS-A Cognitive component 

20.56 (9.8) 

Alertness 

2.22 (1.1) 

Attention 

2.06 (1.2) 

Think clearly 

1.96 (1.1) 

Forgetful 

2.12 (1.1) 

Decision making 

1.85 (1.1) 

Motivation thinking 

2.07 (1.2) 

Task completion – thinking 

1.93 (1.1) 

Thought organization 

2.02 (1.2) 

Slow thinking 

2.07 (1.1) 

Concentration 

2.26 (1.0) 

Multiple Sclerosis: (Chung, et al., 2022) 

  • Mean total score for patients with MS = 33.8 (17.56)

Multiple Sclerosis: (De Jesus et al., 2024)

MFIS

Face-to-face application (Mean (SD))

1st telephone-based application (Mean (SD))

2nd telephone-based application (Mean (SD))

Total  

41.87 (19.42)

39.70 (18.79)

40.47 (18.35)

Physical 

20.23 (9.37)

19.23 (9.26) 

19.40 (9.19)

Cognitive  

17.63 (9.45)

16.93 (9.74) 

17.50 (9.92)

Psychosocial 

4.00 (2.27)

3.53 (2.38) 

3.57 (2.31)

 

 

Test/Retest Reliability

Multiple Sclerosis: (Rietberg, 2010; n= 43; ambulatory patients with MS (mean age 48.7 years; SD 7 years; 30 women; median Expanded Disability Status Scale score 3.5) 

  • Excellent test-retest reliability (ICC =0.85)

Multiple Sclerosis: (Gharjarzadeh, 2013; n = 20 patients completing the MFIS twice; MFIS-P)

  • Acceptable to Excellent test-retest reliability: ICC values for each of the 21 questions range from 0.80 to 0.95

Multiple Sclerosis: (Harirchian, 2013; 15 MS outpatients (mean age = 32.2 (8.1)), 15 hospitalized MS patients (mean age = 29.4 (11.2)) and 15 hospitalized patients without MS (mean age = 29.7 (8.9)), Persian translation: MFIS-Persian (P))

  • Acceptable to Excellent test-retest reliability for total MFIS-P scale: hospitalized subgroup, r = 0.984; out-patient subgroup,   r = 0.842; without MS group, r = 0.964
  • Acceptable to Excellent test-retest reliability for the physical subscale (pMFIS-P) scale: hospitalized subgroup, r = 0.878; out-patient subgroup, r = 0.952; without MS group, r = 0.901 
  • Acceptable test-retest reliability for the cognitive subscale (cMFIS-P) scale: hospitalized subgroup, r = 0.856; out-patient subgroup, r = 0.852; without MS group, r = 0.846 
  • Poor to Acceptable test-retest reliability for the psychosocial subscale (psMFIS-P) scale: hospitalized subgroup, r = 0.148; out-patient subgroup, r = 0.664; without MS group, r = 0.837 

Multiple Sclerosis: (Learmonth, 2013; tested at six months)

  • Acceptable test-retest reliability: ICC = 0.863

Multiple Sclerosis: (Bakalidou, 2014) 

  • Acceptable test-retest reliability at 1-week interval for groups, unacceptable test-retest reliability for individual clinical decision-making, (ICC = 0.861)

Multiple Sclerosis: (Smith, 2018; Study 1: n = 89, mean age = 45.31 (9.81) years, female = 76 (85%), disease duration (years) = 11.47 (7.75), EDSS = 3.07 (1.57); Study 2: n = 79, mean age = 48.06 (11.43), female = 79 (89%), disease duration (years) = 11.98 (9.23), PDDS = 2.23 (2.16); 5-item version of MFIS)

  • Acceptable test-retest reliability: Study 1: (r = 0.756, p < 0.01), Study 2: (r = 0.768, p < 0.01)

Multiple Sclerosis: (Alawami et al., 2021, n = 50; test-retest interval = 7 days) 

  • Excellent test-retest reliability for total MFIS-A (ICC = 0.92) 
  • Excellent test-retest reliability for physical/social subscale (ICC = 0.89) 
  • Excellent test-retest reliability for cognitive subscale (ICC = 0.90) 

Multiple Sclerosis: (Chung, et al., 2022; n = 20; test-retest interval = 2.7 weeks)  

  • Excellent test-retest reliability for total MFIS-K (ICC = 0.923) 
  • Excellent test-retest reliability for Cognitive subscale (ICC = 0.861)
  • Excellent test-retest reliability for Physical subscale (ICC = 0.896)
  • Excellent test-retest reliability for Psychosocial subscale (ICC = 0.946)

Multiple Sclerosis: (De Jesus et al., 2024; test-retest interval = 5 to 7 days between two telephone-based applications) 

  • Excellent test-retest reliability for total MFIS (ICC = 0.97) 
  • Excellent test-retest reliability for physical subscale (ICC = 0.96) 
  • Excellent test-retest reliability for psychosocial subscale (ICC = 0.91) 
  • Excellent test-retest reliability for cognitive subscale (ICC = 0.96) 

 

Interrater/Intrarater Reliability

Multiple Sclerosis: (Amtmann et al, 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week; mean age 50.7, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%) 

  • Excellent reliability: Cronbach’s alpha = 0.94-0.96 for total MFIS

Multiple Sclerosis: (Harirchian, 2013)

  • Mean difference of two MIFS measurements by two questioners, mean (p-value)
    • MFIS-P total scale: hospitalized subgroup, M = -3.67 (0.25); out-patient subgroup, M = -1.80 (0.15); without MS subgroup, M = -1.33 (0.07)
    • MFIS-P physical subscale: hospitalized subgroup, M = -2.13 (0.45); out-patient subgroup, M = -1.13 (0.16); without MS subgroup, M = -1.93 (0.01)
    • MFIS-P cognitive subscale: hospitalized subgroup, M = -1.60 (0.21); out-patient subgroup, M = -1.33 (0.31); without MS subgroup, M = 1.40 (0.10)
    • MFIS-P psychosocial subscale: hospitalized subgroup, M = 0.13 (0.81); out-patient subgroup, M = 0.07 (0.20); without MS subgroup, M = -1.93 (0.77)

 

Internal Consistency

Multiple Sclerosis: (Kos et al, 2005)

  • MFIS has been found to show change after intervention. 
  • After a 4‐week rehabilitation program, the MFIS did change, but the FSS did not.

Multiple Sclerosis: (Gharjarzadeh, 2013)

  • Excellent internal consistency for physical subscale (pMFIS-P): Cronbach’s alpha = 0.84
  • Excellent internal consistency for cognitive subscale (cMFIS-P): Cronbach’s alpha = 0.94*
  • Excellent internal consistency of psychosocial subscale (psMFIS-P): Cronbach’s alpha = 0.80

Multiple Sclerosis: (Bakalidou, 2014) 

  • Excellent: Cronbach’s alpha = 0.960 (ranging from 0.958 to 0.960 with individual items deleted)*

Multiple Sclerosis: (Chua, 2015; n = 537, mean age = 46.45 (11.23), mean disease duration (years) = 13.54 (7.95), median Expanded Disability Status Score = 1.50 (IQR = 2.50, range = 0.00-8.50))

  • Excellent internal consistency for factors in Exploratory Factor Analysis (EFA) “Mental Fatigue” subcategory, Cronbach’s alpha = 0.86

Multiple Sclerosis: (Alawami et al., 2021) 

  • Excellent internal consistency for the total MFIS-A (Cronbach’s alpha = 0.968*)
  • Excellent internal consistency for the physical/social subscale (Cronbach’s alpha = 0.967*)
  • Excellent internal consistency for the cognitive subscale (Cronbach’s alpha = 0.950*)

Multiple Sclerosis: (Chung, et al., 2022) 

  • Excellent internal consistency for the total MFIS-K (Cronbach's alpha = 0.957*); 
  • Excellent internal consistency for the cognitive subscale (Cronbach’s alpha = 0.946*); 
  • Excellent internal consistency for the physical subscale (Cronbach’s alpha = 0.924*); 
  • Excellent internal consistency for the psychosocial subscale (Cronbach’s alpha = 0.875)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Multiple Sclerosis: (Gharjarzadeh, 2013)

  • Adequate to excellent correlations of MFIS-P and subscales with Beck Depression Inventory (BDI) scores
    • Excellent between MFIS-P and BDI: B = 0.6, p < 0.001
    • Adequate between pMFIS-P and BDI: B = 0.44, p < 0.001
    • Excellent between cMFIS-P and BDI: B = 0.6, p < 0.001
    • Adequate between psMFIS-P and BDI: B = 0.4, p < 0.001
  • Poor to adequate correlations between MFIS-P and subscales with Kurtzke Expanded Disability Status Scale (EDSS), EDSS was only a predictor for physical subscale
    • Poor between MFIS-P and EDSS: B = 0.17, p < 0.03
    • Adequate between pMFIS-P and EDSS: B = 0.33, p < 0.001
    • Poor between cMFIS-P and EDSS: B = -0.05, p < 0.5
    • Poor between psMFIS-P and EDSS: B = 0.1, p < 0.05

Multiple Sclerosis: (Greeke, 2017)

  • Excellent correlations between total MFIS & subscales and between subscales (p < 0.01):
    • Total MFIS and pMFIS (r = 0.93)
    • Total MFIS and cMFIS (r = 0.91)
    • Total MFIS and psMFIS (r = 0.81)
    • pMFIS and cMFIS (r = 0.70)
    • pMFIS and psMFIS (r = 0.78)
    • cMFIS and psMFIS (r = 0.64)
  • Poor to excellent correlations between MFIS and subscales vs Center for Epidemiologic Studies-Depression Scale (CES-D) and subscales (p < 0.01):
    • Excellent: Total MFIS and total CES-D, r = 0.62
    • Adequate: Total MFIS and CES-D depressed subscale, r = 0.45
    • Adequate: Total MFIS and CES-D positive affect subscale, r = 0.46
    • Excellent: Total MFIS and CES-D somatic and retarded activity subscale, r = 0.71
    • Poor: Total MFIS and CES-D interpersonal subscale, r = 0.26
    • Adequate: pMFIS and total CES-D, r = 0.53
    • Adequate: pMFIS and CES-D depressed subscale, r = 0.36
    • Adequate: pMFIS and CES-D positive affect subscale, r = 0.41
    • Excellent: pMFIS and CES-D somatic and retarded activity subscale, r = 0.62
    • Poor: pMFIS and CES-D interpersonal subscale, r = 0.20
    • Adequate: cMFIS and total CES-D, r = 0.59
    • Adequate: cMFIS and CES-D depressed subscale, r = 0.43
    • Adequate: cMFIS and CES-D positive affect subscale, r = 0.41
    • Excellent: cMFIS and CES-D somatic and retarded activity subscale, r = 0.67
    • Poor: cMFIS and CES-D interpersonal subscale, r = 0.27
    • Excellent: psMFIS and total CES-D, r = 0.61
    • Adequate: psMFIS and CES-D depressed subscale, r = 0.50
    • Adequate: psMFIS and CES-D positive affect subscale, r = 0.51
    • Excellent: psMFIS and CES-D somatic and retarded activity subscale, r = 0.61
    • Poor: psMFIS and CES-D interpersonal subscale, r = 0.26

Concurrent validity:

Multiple Sclerosis: (Rietberg, 2010; n = 43; ambulatory patients with MS; mean age 48.7 (7) years; female = 30; median Expanded Disability Status Scale score 3.5)

  • Excellent: MFIS vs. Fatigue Severity Scale (FSS): r = 0.66; MFIS vs. the Checklist Individual Strength (CIS20R): r = 0.54 

Multiple Sclerosis: (Tellez et al, 2005; (231 MS patients and 123 healthy controls, 164 patients with relapsing-remitting, 47 with secondary progressive, 12 with primary progressive)

  • Excellent: between MFIS and FSS (r = 0.68, p < 0.0001)
  • Adequate to Excellent: between MFIS subscale and FSS
    • MFIS-physical: r = 0.75, p < 0.0001
    • MFIS-cognitive: r = 0.44, p < 0.0001
    • MFIS-psychosocial: r = 0.62, p < 0.0001

Multiple Sclerosis: (Gharjarzadeh, 2013)

  • MFIS-Persian vs Fatigue Severity Scale (FSS)
    • Excellent concurrent validity: MFIS-Persian vs FSS, r = 0.69, p < 0.001
    • Excellent concurrent validity: pMFIS-Persian vs FSS, r = 0.7, p < 0.001
    • Adequate concurrent validity: cMFIS-Persian vs FSS, r = 0.48, p < 0.001
    • Adequate concurrent validity: psMFIS-Persian vs FSS, r = 0.55, p < 0.001
  • Excellent concurrent validity: MFIS-Persian vs BDI, r = 0.68, p < 0.001
  • Adequate concurrent validity: pMFIS-Persian vs BDI, r = 0.59, p < 0.001
  • Adequate concurrent validity: cMFIS-Persian vs BDI, r = 0.59, p < 0.001
  • Adequate concurrent validity: psMFIS-Persian vs BDI, r = 0.49, p < 0.001
  • MFIS-Persian vs Kurtzke Expanded Disability Status Scale (EDSS)
    • Adequate concurrent validity: MFIS-Persian vs EDSS, r = 0.46, p < 0.001
    • By controlling BDI, the correlation between fatigue and EDSS decreased, r = 0.26, p < 0.004

Multiple Sclerosis: (Bakalidou, 2014)

  • Excellent concurrent validity between MFIS-Greek with the Fatigue Severity Scale (FSS), r = 0.772, p < 0.001.

Multiple Sclerosis: (Chua, 2015)

  • Excellent correlation between the BPRO-MS mental fatigue scale and the MFIS cognitive subscale (r = 0.91, n = 268)

Multiple Sclerosis: (Monjezi et al., 2020) 

  • Excellent correlation between the change of scores of MFIS and global rating scale (Gamma correlation coefficient = 0.80)

Multiple Sclerosis: (Chung, et. al., 2022; patients with MS, n = 51; healthy controls, n = 98) 

  • Mean difference of total MFIS-K between MS patients and healthy controls (mean difference = 11.33, p < 0.01)
  • Mean difference of cognitive subscale between MS patients and healthy controls (mean difference = 4.42, p < 0.01)
  • Mean difference of physical subscale between MS patients and healthy controls (mean difference = 5.19, p < 0.01)
  • Mean difference of psychosocial subscale between MS patients and healthy controls (mean difference = 1.72, p < 0.01)

Multiple Sclerosis: (De Jesus et al., 2024) 

  • Excellent correlation between face-to-face and 1st telephone-based application with a mean bias of 2.17 points for the total score (r = 0.87) 
  • Excellent correlation between face-to-face and 1st telephone-based application with a mean bias of 1.0 points for the physical domain (r = 0.85) 
  • Excellent correlation between face-to-face and 1st telephone-based application with a mean bias of 0.7 points for the cognitive domain (r = 0.88) 
  • Excellent correlation between face-to-face and 1st telephone-based application with a mean bias of 0.47 points for the psychosocial domain (r = 0.70) 

 

Construct Validity

Multiple Sclerosis: (Mills et al, 2010; n = 415)

  • Given the Rasch analysis, Mills et al. suggested that the physical and cognitive subscales should be used separately eliminating questions 4, 14, 17 from the physical and questions 1‐3, 5, and 11. In addition, the authors suggest the total score not be used.

Convergent validity:

Multiple Sclerosis: (Learmonth, 2013)

  • Excellent convergent validity between total MFIS and Fatigue Severity Scale (FSS) (r = 0.754)
    • Excellent convergent validity between pMFIS and FSS (r = 0.739)
    • Excellent convergent validity between cMFIS and FSS (r = 0.660)
    • Excellent convergent validity between psMFIS and FSS (r = 0.633)

Multiple Sclerosis: (Bakalidou, 2014) 

  • Excellent item convergent validity between cMFIS-Greek and cMFIS (cognitive subscale) (r = 0.699 - 0.894)
  • Excellent item convergent validity between pMFIS-Greek and pMFIS (physical subscale) (r = 0.651 - 0.884)

Multiple Sclerosis: (Oervik, 2017)

  • Excellent convergent validity between MFIS total and Fatigue Scale for Motor and Cognitive Functions (FSMC) total (r = 0.851, p < 0.01)

Multiple Sclerosis: (Alawami et al., 2021) 

  • Excellent correlation with Beck Depression Inventory (BDI-II) (r = 0.711) 
  • Excellent correlation with Fatigue Severity Scale (FSS) (r = 0.714)
  • Adequate correlation with Fatigue Visual Analogue Scale (VAS-F) (r = 0.457) 
  • Adequate correlation with Vitality Domain of the Short Form General Health Survey (SF-36V) (r = -0.548) 

Multiple Sclerosis: (Chung, et. al., 2022) 

  • Excellent correlations with Fatigue Severity Scale (FSS) (total MFIS-K r = 0.741; cognitive r = 0.612; physical r = 0.686; psychosocial r = 0.656)
  • Poor to adequate correlations with Pittsburgh Sleep Quality Index (PSQI) (total MFIS-K r = 0.319; cognitive r = 0.285; physical r = 0.260; psychosocial r = 0.307) 
  • Adequate to excellent correlations with Beck Depression Inventory (BDI) (total MFIS-K r = 0.607; cognitive r = 0.573; physical r = 0.465; psychosocial r = 0.522) 
  • Poor to excellent correlations with Short Form 36 Health Survey Physical Component Summary (SF-36 PCS) (total MFIS-K r = -0.509; cognitive r = -0.265; physical r = -0.687; psychosocial r = -0.466) 
  • Adequate correlations with Short Form 36 Health Survey Mental Component Summary (SF-36 MCS) (total MFIS-K r = -0.525; cognitive r = -0.375; physical r = -0.521; psychosocial r = -0.57) 

Discriminant validity: 

Multiple Sclerosis: (Gharjarzadeh, 2013)

  • Significant differences in MFIS scores between patients and controls (all p < 0.001)
    • MFIS-P total scores: patients 29.7 (17), controls 13.8 (14.1)
    • pMFIS-P scores: patients 15.1 (9), controls 5.6 (6.3)
    • cMFIS-P scores: patients 11.7 (8.5), controls 6.7 (7.3)
    • psMFIS-P scores: patients 2.7 (2.4), controls 1.5 (1.8)

Multiple Sclerosis: (Bakalidou, 2014)

  • Significant difference between the mean scores of the MS patients (33.0, SD 18.1) and the control group (18.1, SD 14.6), t = 5.833, p < 0.001

Multiple Sclerosis: (Kalron, 2016; n = 218; mean age = 43.2 (13.5), female = 133 (61%), mean disease duration 7.5 (7.7) years, EDSS = 3.1 (1.3) (minimal to moderate neurologic disability))

  • Poor correlation between MFIS total and the Four Square Step Test (FSST) (r = 0.210, p = 0.012)

Multiple Sclerosis: (Kalron, 2017; n = 285; mean age = 44.4 (13.4), female = 176 (62%), mean disease duration = 8.1 (8.1) years, all participants relapse free for at least 30 days prior to testing)

  • Poor correlation between MFIS total and the Timed Up-and-Go test (TUG) (r = 0.274, p < 0.001)

 

Content Validity

Multiple Sclerosis: (Amtmann et al., 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week. Mean age 507, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%)

  • Validity: Spearman Rank Correlation Fatigue Severity Scale to MFIS:
    • Excellent for MFIS total and subscales of physical and psychosocial (0.69-0.77) 
    • Adequate for MFIS cognitive subscale
  • IRT analyses indicate that the FSS is less precise in measuring both low and high levels of fatigue, compared with the MFIS. 
  • For those interested in measuring both physical and cognitive aspects of fatigue, and whose sample is expected to have higher levels of fatigue, the MFIS is a better choice even though it is longer.

Multiple Sclerosis: (Gharjarzadeh, 2013)

  • MFIS questionnaire was translated into the Persian language by two bilingual medical doctors in the field of medical research, translated again into English, and then compared with the original form by two neurologists (p. 1510).

Multiple Sclerosis: (Harirchian, 2013)

  • MFIS was translated to Persian by two different translators and then the Persian guidelines retranslated to English for comparison in which there was no significant difference between them (p. 33).

Multiple Sclerosis: (Bakalidou, 2014)

  • MFIS was translated into Greek and backwards translated by bilingual experts (p. 272).

Multiple Sclerosis: (Chua, 2015)

  • To choose between duplicated items, the content was assessed and the items chosen in the subsequent analysis were chosen based on the opinion of the team’s neuropsychologist (p. 599).

Floor/Ceiling Effects

Multiple Sclerosis: (Amtmann et al., 2012; n=1271 individuals with MS living in the community, 80% female, 36.2% reported being employed 20 or more hours a week; mean age 50.7, mean disease duration 13.2 years, MS severity as minimal (EDSS≤4.0) for 32.4% and intermediate (EDSS 4.5-6.5) for 47.9% and advanced (EDSS≥7.0) for 19.7%) 

  • Floor effects: (number of respondents with the lowest possible score)
    • MFIS total= 1.1% 
    • MFIS-phy=1.6%
    • MFIS-cog=2.7%
    • MFIS-psychosocial=7.4% 
  • Ceiling effect: (number of respondents with the highest possible score)
    • MFIS total= 0.7%
    • MFIS-phy=1.6%
    • MFIS-cog=0.9%
    • MFIS-psychosocial=9.0%

Multiple Sclerosis: (Alawami et al., 2021) 

  • Adequate ceiling effect for total MFIS = 0.9% 
  • Adequate floor effect for total MFIS =1.7%

 

Responsiveness

Multiple Sclerosis: (Greeke, 2017)

  • Significant decline in total MFIS score across all time points in comparison to baseline, Year X = estimated change from baseline, (95% CI), p-value
    • Total MFIS score
      • Year 1 = ?1.82, (?2.92, ?0.73), p = 0.001, 
      • Year 2 = ?1.61, (?2.76, ?0.46), p = 0.01, 
      • Year 3 = ?1.42, (?2.61, ?0.23), p = 0.02
    • Physical fatigue scores: 
      • Year 1 = ?0.86, (?1.43, ?0.30), p = 0.003, 
      • Year 2 = ?1.05, (?1.64, ?0.46), p = 0.001, 
      • Year 3 = ?0.72, (?1.33, ?0.11), p = 0.02
    • Cognitive fatigue scores: 
      • Year 1 = ?0.81, (?1.37, ?0.24), p = 0.01, 
      • Year 2 = ?0.49, (?1.09, 0.10), p = 0.10, 
      • Year 3 = ?0.67, (?1.28, ?0.05), p = 0.03
    • Psychosocial fatigue scores: 
      • Year 1 = ?0.17, (?0.33, ?0.01), p = 0.04, 
      • Year 2  = ?0.09, (?0.26, 0.08), p = 0.31, 
      • Year 3 = ?0.05, (?0.22, 0.12), p = 0.58

 

Brain Injury

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Cut-Off Scores

Traumatic Brain Injury: (Schiehser, 2015; n = 106, mean age = 32.2 (7.6) years, age range = 22-61, male = 101 (95.3%), months post injury = 76.5 (43.3), mild TBI: n = 97 (91.5%), moderate TBI: n = 9 (8.5%), Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf veterans)

  • Sensitivity and specificity analyses revealed cutoff score of 29.0 for the MFIS total score
  • Cutoff score of 18.5 for cognitive subscale
  • Cutoff score of 14.5 for physical subscales

 

Normative Data

Traumatic Brain Injury: (Sendroy-Terrill et al., 2010, n=243, 73% men, less than 5% of participants unconsciousness of < 1 day, 41 % showed LOC 1 day to 1 week, 31 % LOC from 1 week to 1 month, 24% had LOCs from 1 month to 1 year. Recived treatment in a comprehensive inpatient rehabilitation hospital. Cohorts based on years postinjury (1 to >30 years)) 

  • Mean for total MFIS= 23.7±21.1
  • Mean for MFIS - Physical= 10.2±9.6
  • Mean for MFIS - Cognitive=11.4±10.4
  • Mean for MFIS - Psychosocial= 2.0±2.0

Internal Consistency

Traumatic Brain Injury: (Schiehser, 2015)

  • Excellent internal consistency for MFIS Total (21 items), Cronbach’s alpha = 0.97*
  • Excellent internal consistency for cMFIS (11 items), Cronbach’s alpha = 0.95*
  • Excellent internal consistency for pMFIS (10 items), Cronbach’s alpha =  0.96*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Traumatic Brain Injury: (Sendroy-Terrill et al., 2010, n=243, 73% men, less than 5% of participants unconsciousness of < 1 day, 41 % showed LOC 1 day to 1 week, 31 % LOC from 1 week to 1 month, 24% had LOCs from 1 month to 1 year. Recived treatment in a comprehensive inpatient rehabilitation hospital. Cohorts based on years postinjury (1 to >30 years))

  • MFIS-physical: with each additional decade of age at time of injury, there was a 2 point increase on the MFIS-physical score (P=.02)
  • MFIS-psychosocial: with each additional decade of age at time of injury, there was a 0.5 point increase (P=.01)

Construct Validity

Convergent validity:

Traumatic Brain Injury: (Schiehser, 2015)

  • Excellent convergent validity between MFIS Total and Beck Depression Inventory II (BDI-II) (r = 0.72)
  • Excellent convergent validity between cMFIS and BDI-II (r = 0.63)
  • Excellent convergent validity between pMFIS and BDI-II (r = 0.71)

 

Parkinson's Disease

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Standard Error of Measurement (SEM)

Parkinson’s Disease: (Lopes, et al., 2020; n = 70; fatigued, n = 32; non-fatigued, n = 38; age ≥ 50; mean age = 68.40 (10.21) years; median disease duration = 56.50 (27.25-96.25) months; Brazilian sample, Brazilian Portuguese translation: MFIS-PD/BR) 

  • SEM for the total MFIS-PD/BR = 8.84
  • SEM for the cognitive subscale = 1.96
  • SEM for the physical subscale = 2.84
  • SEM for the psychosocial subscale = 1.12

 

Minimal Detectable Change (MDC)

Parkinson’s Disease: (calculated from Lopes, et al., 2020) 

  • MDC95 for the total MFIS-PD/BR = 24.50 
  • MDC95 for the cognitive subscale = 5.43
  • MDC95 for the physical subscale = 7.87
  • MDC95 for the psychosocial subscale = 3.10

 

Minimally Clinically Important Difference (MCID)

Parkinson’s Disease: (Kluger, 2017; n = 94; mean age = 65.4 years; age range = 40-99 years; male = 59 (63%))

  • MCID = 13.8 for MFIS total, 6.8 for MFIS cognitive, 6.2 for MFIS physical, 4.1 for Mills Modified MFIS cognitive, and 4.3 for Mills Modified physical scales

 

Cut-Off Scores

Parkinson’s Disease: (Lopes, et al., 2020) 

  • >29 indicates fatigue (sensitivity = 79.2%; specificity = 20%)

Normative Data

Parkinson’s Disease: (Schiehser, 2013; n = 100, mean age = 68.14 (7.3) years; male = 66 (66%); disease duration = 67.5 (62.5) months, median Modified Hoehn & Yahr stage = 2.0 (range = 0.0-5.0)  

  • Mean total MFIS score = 31.7 (16.6)

Parkinson’s Disease: (Lopez, 2018; n = 158; mean age = 67.6 (8.24) years; male = 108 (68.3%); disease duration = 65.8 (61.5) months; average Hoehn & Yahr stage = 2 (range = 0-5)) 

  • Mean total MFIS score = 33.1 (17.3)

Parkinson’s Disease: (Lopes, et al., 2020) 

  • Mean of total MFIS-PD/BR for the entire sample (n = 70) = 30.25 (17.81)
  • Mean of total MFIS-PD/BR for the fatigued (n = 32) = 42.87 (17.55)
  • Mean of total MFIS-PD/BR for the non-fatigued (n = 38) = 22.67 (13.19)

 

Test/Retest Reliability

Parkinson’s Disease: (Lopes, et al., 2020; test-retest interval = 7 days)

  • Excellent test-retest reliability for the Total MFIS-PD/BR (ICC = 0.93)
  • Acceptable test-retest reliability for the Physical subscale (ICC = 0.88)
  • Excellent  test-retest reliability for the Cognitive subscale (ICC = 0.96) 
  • Acceptable test-retest reliability for the Psychosocial subscale (ICC = 0.89) 

 

Interrater/Intrarater Reliability

Parkinson’s Disease: (Lopes, et al., 2020; two examiners administered separately one hour apart) 

  • Excellent interrater reliability for the total MFIS-PD/BR(ICC = 0.92)  
  • Excellent interrater reliability for the Physical subscale (ICC = 0.86)
  • Excellent interrater reliability for the Cognitive subscale (ICC = 0.92)
  • Excellent interrater reliability for the Psychosocial subscale (ICC = 0.84)  

 

Internal Consistency

Parkinson’s Disease: (Schiehser, 2013)

  • Excellent for MFIS total score: Cronbach’s alpha = 0.96*
  • Excellent for cMFIS: Cronbach’s alpha = 0.95* 
  • Excellent for pMFIS and psMFIS: Cronbach’s alpha = 0.95*

Parkinson’s Disease: (Lopes, et al., 2020) 

  • Excellent internal consistency for the total MFIS-PD/BR (Cronbach's alpha = 0.878)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

 

Construct Validity

Convergent validity:

Parkinson’s Disease: (Schiehser, 2013)

  • Adequate correlation with the PANAS-X fatigue subscale (r = 0.585, p < .001; n = 93)

Parkinson’s Disease: (Lopes, et al., 2020) 

  • Adequate convergent validity was established with the Fatigue Severity Scale (FSS) (r = 0.56) 
  • Excellent convergent validity with Parkinson Fatigue Scale (PFS-16) (r = 0.71).  

Discriminant validity:

Parkinson’s Disease: (Schiehser, 2013)

  • Adequate correlation with the State-Trait Anxiety Inventory (STAI)-State (r = 0.518, p < .001)
  • Adequate correlation with the Hamilton Depression Rating Scale (HAM-D) (r = 0.497, p < .001) 
  • Adequate correlation with the Geriatric Depression Scale (GDS) (r = 0.599, p < .001)
  • Adequate correlationwith the Apathy Scale (AS) (r = 0.564, p < .001)
  • Non-significant correlations between the MFIS and UPDRS-Part III score (r = 0.155, p = 0.12), Hoehn & Yahr stage (r = 0.176, p = 0.08), and Mattis Dementia Rating Scale (MDRS) score (r = ?0.124, p = 0.22)

Parkinson’s Disease: (Lopez, 2018)

  • Excellent correlation with Geriatric Depression Scale (GDS) ( r = 0.596, p < 0.01)

Parkinson’s Disease: (Lopes, et al., 2020) 

  • Poor to Excellent divergent validity on disease-related symptoms and disability with the Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) (Part I r = 0.64; Part II r = 0.33; Part III r = 0.29; Part IV r = 0.36; Total r = 0.51)
  • Adequate divergent validity on disease-related symptoms and disability with the Modified Hoehn & Yahr (HY), stage (r = 0.32) 
  • Adequate divergent validity on cognitive performance with the  Mini-Mental State Examination (MMSE) (r = -0.33) , Poor to Excellent divergent validity on psychological functioning with the Hospital Anxiety Depression Scale (HADS) (HADS anxiety r = 0.26; HADS depression r = 0.64; HADS total r = 0.52)
  • Adequate divergent validity on psychological functioning with the Geriatric Depression Scale (GDS) (r = 0.56)

 

Floor/Ceiling Effects

Parkinson’s Disease: (Lopes, et al., 2020) 

  • Adequate ceiling effects: 4.78% during first interview; 4.17% during retest 
  • Adequate floor effects: 3.86% during first interview; 3.74% during retest 

 

Immune System Disorders

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Standard Error of Measurement (SEM)

Systemic lupus erythematosus: (Junker et al., 2022; n = 61, mean age = 47.2 (14.4) years, Danish sample)

  • SEM for entire group = 6.83

Minimal Detectable Change (MDC)

Systemic lupus erythematosus: (Junker et al., 2022)

  • MDC95 for entire group = 18.94

Normative Data

Systemic lupus erythematosus: (Junker et al., 2022)

  • Mean (SD) MFIS total score = 37.2 (20.6) 

 

Test/Retest Reliability

Systemic lupus erythematosus: (Junker et al., 2022; n=29; Approximately 1-2 weeks between assessments)

  • Acceptable test-retest reliability (ICC = 0.89)

Internal Consistency

Systemic lupus erythematosus: (Junker et al., 2022)

  • Excellent internal consistency for complete scale (Cronbach's alpha = 0.97*)
  • Excellent internal consistency for cognitive subscale (Cronbach's alpha = 0.96*)
  • Excellent internal consistency for physical subscale (Cronbach's alpha = 0.95*)
  • Excellent internal consistency for psychosocial subscale (Cronbach's alpha = 0.88)

*Scores higher than .9 may indicate redundancy in the scale questions.

Construct Validity

Convergent validity:

Systemic lupus erythematosus: (Junker et al., 2022)

  • Excellent correlation with Short Form (SF-36) vitality scale (VT-SF36): r = -0.73

 

Discriminant validity:

Systemic lupus erythematosus: (Junker et al., 2022)

  • Poor discriminant validity with SF-36 mental health scale (MH-SF36): r = -0.70

Stroke

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Standard Error of Measurement (SEM)

Stroke: (Ng et al., 2022; n = 101; mean age = 63.82 (6.40) years; male = 57.4%; years since stroke = 6.74(4.42) years; Hong Kong Chinese sample; Chinese version MFIS-C) 

  • SEM for the total MFIS-C = 5.38 
  • SEM for the cognitive subscale = 2.71 
  • SEM for the physical and psychosocial subscale = 3.51

 

Minimal Detectable Change (MDC)

Stroke: (Ng et al., 2022) 

  • MDC95 for the total MFIS-C =14.86 
  • MDC95 for the cognitive subscale = 7.49 
  • MDC95 for the physical and psychosocial subscale = 9.70

Normative Data

Stroke: (Ng et al., 2022) 

  • Mean of total MFIS-C = 39.60 (13.48)
  • Mean of cognitive subscale = 16.85 (6.36)
  • Mean of physical/psychosocial subscale = 22.75 (8.21)

 

Test/Retest Reliability

Stroke: (Ng et al., 2022; n = 52; 1 week between assessments) 

  • Acceptable test-retest reliability for the total MFIS-C (ICC = 0.84)
  • Acceptable test-retest reliability for the cognitive subscale (ICC = 0.83)
  • Acceptable test-retest reliability for the physical/psychosocial subscale (ICC = 0.81)

 

Internal Consistency

Stroke: (Ng et al., 2022) 

  • Excellent internal consistency for the total MFIS-C (Cronbach's alpha = 0.92) 
  • Excellent internal consistency for the cognitive subscale (Cronbach's alpha = 0.85)
  • Excellent internal consistency for the  physical/psychosocial subscale (Cronbach's alpha = 0.89)

 

Content Validity

The content validity of the Modified Fatigue Impact Scale (MFIS-C) was assessed by a panel of experts established for the study. This panel reviewed the instrument to ensure that it accurately reflects the construct of fatigue for the target population of community-dwelling Hong Kong Chinese people with chronic stroke. From the results of this panel, Ng et al. (2022) concluded that the validity of each individual item and overall MFIS-C are satisfactory (p.5). 

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