Multidimensional Fatigue Symptom Inventory—Short Form
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  2. Multidimensional Fatigue Symptom Inventory—Short Form

Multidimensional Fatigue Symptom Inventory—Short Form

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Purpose

A 30-item self-report instrument designed to measure general fatigue, physical fatigue, emotional fatigue, mental fatigue, and vigor.

Link to Instrument

Acronym MSFI-SF

Area of Assessment

Activities of Daily Living
Life Participation
Cognition
Strength
Sleep

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

Free

Populations

Healthy Adults
Organ Transplant
Non-Specific Patient Population
Cancer

Key Descriptions

  • The MFSI-SF consists of 30 statements designed to assess the multidimensional nature of fatigue.
  • Respondents indicate the extent to which they have experienced each symptom during the preceding one-week period. Each item is rated on a five-point Likert scale from 0 (not at all) to 4 (extremely).
  • The first four MFSI-SF subscales (General Fatigue, Emotional Fatigue, Physical Fatigue, and Mental Fatigue) are summed, and the last subscale (Vigor) is subtracted to create a Fatigue Total Score.
  • Total MFSI-SF scores range from 24 to 96, with a higher score indicating a higher fatigue level.

Number of Items

30

Equipment Required

  • Paper & Pencil

Time to Administer

5 minutes

Required Training

No Training

Required Training Description

No Training

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Eliza Tilson

Jing Cao MS, MSEd, University of Wisconsin-Madison

Stuart Rumrill, MS, University of Wisconsin-Madison

Susan Miller Smedema, Ph.D., CRC, LPC, University of Wisconsin-Madison

ICF Domain

Activity
Participation
Body Function
Body Structure

Measurement Domain

Motor

Considerations

  • Since its development, MFSI-SF has been used to describe fatigue in a variety of clinical and nonclinical populations and as a patient-reported outcome measure in clinical studies.
  • The psychometric properties of the MFSI-SF were originally established in women with a diagnosis of breast cancer and women with no history of cancer.

Cancer

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Standard Error of Measurement (SEM)

Breast Cancer: (Chan et al., 2018b; N = 201; Breast Cancer patients of Asian descent)

  • Mean SEM = 10.79
    • SEM baseline [T1] = 11.72, SEM follow-up [T2] = 11.55, SEM change from baseline to follow-up = 9.10

Minimally Clinically Important Difference (MCID)

Breast Cancer: (Chan et al., 2018b; N = 201; Breast Cancer patients of Asian descent)

 

  • EORTC-FA-anchored MCID = 8.69 points (95% CI: 4.03-13.34)
  • MCID from ROC curve = 4.50 points (sensitivity: 68.8%; specificity: 64.1%)
  • One-third of the SD, MCID = 5.39
  • Half of the SD, MCID = 8.99

Normative Data

Breast Cancer: (Banthia et al., 2006; N = 25; mean age (SD) = 53.72 (12.6) years, range 32-83 years; 80% White, 8% Black, 12% Hispanic; Breast cancer stage at diagnosis: 25% Stage I, 58.4% Stage II, 8.3% Stage III, 8.3% Stage IV)

  • Mean daily fatigue in mm (SD) = 43.2 (25.6)
  • General fatigue: mean (SD) = 12.99 (5.68)
  • Physical fatigue: mean (SD) = 6.47 (5.62)
  • Mental fatigue: mean (SD) = 9.97 (4.49)
  • Emotional fatigue: mean (SD) = 6.64 (4.72)
  • Vigor: mean (SD) = 10.34 (4.49)

Internal Consistency

Cancer, Mixed: (Stein et al., 2004; N = 304; mean age (SD) = 54.9 (11.46) years; (11; 80% female; 89% White; 68% married; 65% college graduates; diagnoses included breast cancer (61%), lung cancer (17%), ovarian cancer (7%), colon cancer (4%), lymphoma (3%), prostate cancer (2%), endometrial cancer (2%))

  • Excellent internal consistency within each MFSI-SF subscale:
    • General Fatigue (Cronbach’s alpha = 0.96)
    • Emotional Fatigue (Cronbach’s alpha = 0.92)
    • Physical Fatigue (Cronbach’s alpha = 0.87)
    • Mental Fatigue (Cronbach’s alpha = 0.91)
    • Vigor (Cronbach’s alpha = 0.90)

Breast Cancer: (Banthia et al., 2006; N = 25; mean age (SD) = 53.72 (12.6) years, range 32-83 years; 80% White, 8% Black, 12% Hispanic; 25% Stage I, 58.4% Stage II, 8.3% Stage III, 8.3% Stage IV)

  • Excellent internal consistency within each subscale:
    • General (Cronbach’s alpha = 0.95)
    • Emotional (Cronbach’s alpha = 0.82)
    • Physical (Cronbach’s alpha = 0.81)
    • Mental (Cronbach’s alpha = 0.84)
    • Vigor (Cronbach’s alpha = 0.79)

 

Breast Cancer and Lymphoma: (Chan et al., 2018a; 91.5% Breast Cancer, 8.5% Lymphoma; 93.5% female; mean age (SD) = 53.4 (10.0) years)

  • Excellent internal consistency of English and Chinese versions of MSFI-SF (N = 246)
    • General (Cronbach’s alpha = 0.91)
    • Physical (Cronbach’s alpha = 0.86)
    • Emotional (Cronbach’s alpha = 0.91)
    • Mental (Cronbach’s alpha = 0.92)
    • Vigor (Cronbach’s alpha = 0.94)
  • Excellent internal consistency of English version of MSFI-SF (n = 160)
    • General (Cronbach’s alpha = 0.92)
    • Physical (Cronbach’s alpha = 0.89)
    • Emotional (Cronbach’s alpha = 0.92)
    • Mental (Cronbach’s alpha = 0.93)
    • Vigor (Cronbach’s alpha = 0.94)
  • Excellent internal consistency of Chinese version of MSFI-SF (n = 86)
    • General (Cronbach’s alpha = 0.90)
    • Physical (Cronbach’s alpha = 0.75)
    • Emotional (Cronbach’s alpha = 0.89)
    • Mental (Cronbach’s alpha = 0.89)
    • Vigour (Cronbach’s alpha = 0.92)

 

Construct Validity

Convergent validity

 

Cancer, Mixed: (Stein et al., 2004; N = 304; mean age (SD) = 54.9 (11.46) years; (11; 80% female; 89% White; 68% married; 65% college graduates; diagnoses included breast cancer (61%), lung cancer (17%), ovarian cancer (7%), colon cancer (4%), lymphoma (3%), prostate cancer (2%), endometrial cancer (2%))

  • Excellent convergent validity between MFSI-SF Total Score and FSI Average Fatigue (r = 0.74)
  • Adequate to excellent convergent validity between MFSI-SF subscales and FSI Average Fatigue
    • MFSI-SF General Fatigue subscale (r = 0.82)
    • MFSI-SF Emotional Fatigue subscale (r = 0.36)
    • MFSI-SF Physical Fatigue subscale (r = 0.58)
    • MFSI-SF Mental Fatigue subscales (r = 0.50)
  • Adequate to excellent convergent validity between MFSI-SF subscales with SF-36 Vitality subscale
    • MFSI-SF General Fatigue subscale (r = -0.82),
    • MFSI-SF Emotional Fatigue subscale (r = -0.43),
    • MFSI-SF Physical Fatigue subscale (r = -0.53),
    • MFSI-SF Mental Fatigue subscale (r = -0.48)
  • Excellent convergent validity between MFSI-SF Vigor subscale with SF-36 Vitality subscale (r = 0.74)
  • Adequate convergent validity between MFSI-SF Vigor subscale with SF-36 Physical Component subscale (r = 0.48)
  • Excellent convergent validity between MFSI-SF Total Score with SF-36 Vitality subscale (r = -0.78)
  • Adequate convergent validity between MFSI-SF Total Score with SF-36 Physical Component Score (r = -0.55)
  • Adequate convergent validity between MFSI-SF subscales with SF-36 Physical Component Score
    • MFSI-SF General Fatigue subscale (r = -0.55)
    • MFSI-SF Physical Fatigue subscale (r = -0.56)
    • MFSI-SF Mental Fatigue subscale (r = -0.34)
  • Adequate convergent validity between MFSI-SF Vigor subscale with FSI Average Fatigue (r = -0.60)
  • Poor convergent validity between MFSI-SF Emotional Fatigue subscale and SF-36 Physical Component Score (r = -0.21)

Responsiveness

Breast Cancer: (Chan et al., 2018b; N = 201; Breast Cancer patients of Asian descent)

 

EORTC-FA Category

Mean MSFI-SF Change Score (SD)

Effect Size

Fatigue Improvement

-8.38 (21.40)

Moderate (-0.35)

Minimal fatigue improvement

-0.67 (11.92)

Small (-0.03)

No change

-0.56 (12.75)

Small (-0.03)

Minimal fatigue deterioration

8.13 (9.68)

Moderate (0.54)

Fatigue deterioration

11.57 (13.73)

Moderate (0.54)

Healthy Adults

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Normative Data

Community: (Cordero et al., 2012; N = 334; 47.3% Hispanic, 52.7% Anglo)

 

  • Mean (SD) MFSI-SF subscale scores for participants with Hispanic ethnicity:
    • Physical fatigue: 4.68 (4.88)
    • Mental fatigue: 5.41 (4.77)
    • Emotional fatigue: 5.38 (5.71)
    • General fatigue: 5.61 (5.06)
    • Vigor: 13.16 (5.33)
  • Mean (SD) MFSI-SF subscale scores for participants with Anglo ethnicity: 
    • Physical fatigue: 4.02 (4.44)
    • Mental fatigue: 4.23 (4.12)
    • Emotional fatigue: 4.02 (4.58)
    • General fatigue: 7.28 (5.90)
    • Vigor: 13.75 (5.55)

Community: (Asvat et al., 2014; N = 340; 65.9% female; Mean Age (SD) = 41.88 (13.98) years; African American participants)

  • Mean (SD) MFSI-SF scores:
    • General/Emotional Fatigue: 9.18 (9.58)
    • Mental Fatigue: 5.14 (5.24)
    • Physical Fatigue: 3.55 (4.46)
    • Vigor: 7.41 (3.88)
  • Mean (SD) MFSI-SF scores for males:
    • General/Emotional Fatigue: 8.96 (9.17)
    • Mental Fatigue: 5.15 (5.03)
    • Physical Fatigue: 3.28 (3.84)
    • Vigor: 7.48 (3.78)
  • Mean (SD) MFSI-SF scores for females:
    • General/Emotional Fatigue: 9.30 (9.82)
    • Mental Fatigue: 5.13 (5.37)
    • Physical Fatigue: 3.70 (4.76)
    • Vigor: 7.38 (3.95)

Internal Consistency

Community: (Asvat et al., 2014; N = 340; 65.9% female; Mean Age (SD) = 41.88 (13.98) years; African American participants)

  • General/Emotional Fatigue: Excellent (Cronbach’s alpha = .94)
  • Physical Fatigue: Excellent (Cronbach’s alpha = .84)
  • Mental Fatigue: Excellent (Cronbach’s alpha = .88)
  • Vigor: Adequate (Cronbach’s alpha .76)
  • Total Fatigue: Excellent (Cronbach’s alpha = .92)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Community: (Asvat et al., 2014; N = 340; 65.9% female; Mean Age (SD) = 41.88 (13.98) years; African American participants)

  • Poor concurrent validity between age and physical fatigue in women (r = 0.20)

Construct Validity

Convergent validity:

 

Community: (Asvat et al., 2014; N = 340; 65.9% female; Mean Age (SD) = 41.88 (13.98) years; African American participants)

 

  • Adequate convergent validity between General/Emotional Fatigue and Negative Affect (r = 0.58).
  • Adequate convergent validity between Mental Fatigue and Negative Affect (r = 0.46).
  • Adequate convergent validity between Physical Fatigue and Negative Affect (r = 0.38).
  • Adequate convergent validity between Vigor and Positive Affect (r = 0.50).
  • Poor convergent validity between General/Emotional subscale, Mental subscale, and Physical Fatigue with Positive Affect (rs ranged from -0.19 to -0.25)

Organ Transplant

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Normative Data

Kidney Transplantation: (Rodrigue et al., 2011; N = 200; 50% pre-transplant, 50% post-transplant; mean pre-transplant age (SD) = 52.1 (12.2); pre-transplant gender = 38% female; pre-transplant race = 54% White, 37% Black, 7% Hispanic, 2% other; mean post-transplant age (SD) = 53.1 (11.3); post-transplant gender = 46% female; post-transplant race = 82% White, 17% Black, 1% Hispanic)

Mean (SD) scores for pre-transplant participants:

  • General fatigue: 11.46 (7.0)
  • Physical fatigue: 8.33 (5.9)
  • Emotional fatigue: 5.81 (5.4)
  • Mental fatigue: 5.62 (5.0)
  • Vigor: 10.10 (4.8)
  • Total: 21.12 (21.5)

 

Mean (SD) scores for post-transplant participants:

  • General fatigue: 8.77 (6.7)
  • Physical fatigue: 5.10 (4.3)
  • Emotional fatigue: 4.32 (4.6)
  • Mental fatigue: 3.75 (3.9)
  • Vigor: 12.27 (5.9)
  • Total: 9.66 (19.3)

Interrater/Intrarater Reliability

Kidney Transplantation: (Rodrigue et al., 2011; N = 200; 50% pre-transplant, 50% post-transplant; mean pre-transplant age (SD) = 52.1 (12.2); pre-transplant gender = 38% female; pre-transplant race = 54% White, 37% Black, 7% Hispanic, 2% other; mean post-transplant age (SD) = 53.1 (11.3); post-transplant gender = 46% female; post-transplant race = 82% White, 17% Black, 1% Hispanic)

  • Excellent internal consistency: Cronbach’s alpha = 0.89

Non-Specific Patient Population

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Normative Data

Orofacial pain: (De Leeuw et al., 2005; N = 110; 50% patients with orofacial pain, 50% healthy volunteers)

Mean (SD) scores for patients with orofacial pain:

  • General fatigue:10.71 (6.9)
  • Physical fatigue: 6.20 (5.8)
  • Emotional fatigue: 6.27 (5.3)
  • Mental fatigue: 4.76 (5.0)
  • Vigor: 8.55 (5.8)

 

Mean (SD) scores for healthy volunteers:

  • General fatigue: 6.95 (6.3)
  • Physical fatigue: 2.09 (2.8)
  • Emotional fatigue: 3.67 (4.2)
  • Mental fatigue: 3.38 (3.7)
  • Vigor: 12.45 (5.0)

Internal Consistency

Orofacial pain: (De Leeuw et al., 2005; N = 110; 50% patients with orofacial pain, 50% healthy volunteers)

  • Excellent internal consistency for each subscale:
    • General fatigue: Cronbach’s alpha = 0.96
    • Physical fatigue: Cronbach’s alpha = 0.89
    • Emotional fatigue: Cronbach’s alpha = 0.89
    • Mental fatigue: Cronbach’s alpha = 0.90
    • Vigor: Cronbach’s alpha = 0.88

Bibliography

Asvat, Y., Malcarne, V. L., Sadler, G. R, & Jacobsen, P. B. (2014). Validity of the multidimensional fatigue symptom inventory-short form in an African-American community-based sample. Ethnicity & Health, 19(6), 631-644.

Banthia, R., Malcarne, V. L, Roesch, S. C, Ko, C. M, Greenbergs, H. L, Varni, James W, & Sadler, G. R. (2006). Correspondence between daily and weekly fatigue reports in breast cancer survivors. Journal of Behavioral Medicine, 29(3), 269-279.

Chan, A., Lew, C., Wang, X. J., Ng, T., Chae, J. W., Yeo, H.L., . . . Gan, Y. X. (2018). Psychometric properties and measurement equivalence of the Multidimensional Fatigue Syndrome Inventory- Short Form (MFSI-SF) amongst Breast Cancer and Lymphoma patients in Singapore. Health and Quality of Life Outcomes, 16(1), 20.

Chan, A., Yo, T.E., Wang, X. J., Ng, T., Chae, J. W., Yeo, H. L., . . . Gan, Y. X. (2018). Minimal clinically important difference of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) for fatigue worsening in Asian Breast Cancer patients. Journal of Pain and Symptom Management, 55(3), 992-997.e2.

Cordero, E. D., Loredo, J. S. , Murray, K. E. , Dimsdale, J. E. (2012). Characterizing fatigue: the effects of ethnicity and acculturation. Journal of Applied Biobehavioral Research, 17, 59–78.

De Leeuw, R., Studts, J. L., & Carlson, C. R. (2005). Fatigue and fatigue-related symptoms in an orofacial pain population. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 99(2), 168-174

Donovan, K. A., Stein, K. D., Lee, M., Leach, C. R., Ilozumba, O., & Jacobsen, P. B. (2015). Systematic review of the multidimensional fatigue symptom inventory-short form. Support Care Cancer, 23, 191-212.

Jacobsen, P. B. (2004) Assessment of fatigue in cancer patients. Journal of National Cancer Institute Monographs, 32, 93-97.

Rodrigue, J. R., Mandelbrot, D. A., & Hanto, D. W., Johnson, S. R., Karp, S. J., & Pavlakis, M. (2011). A cross-sectional study of fatigue and sleep quality before and after kidney transplantation. Clin Transplant, 25(1), E13-E21.

Stein, K. D., Jacobsen, P. B., Blanchard, C. M., & Thors, C. T. (2004). Further validation of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Journal of Pain and Symptom Management, 27, 14-23.

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