ARE THERE DIFFERENT FORMS OF FATIGUE EXPERIENCE IN RA AND LINKS TO PATIENT CHARACTERISTICS?

S. NikolausPsychology & Communication of Health & Risk, University of Twente, Enschede, NetherlandsPurpose: This study aimed to describe different perspectives on the experience of fatigue among patients with rheumatoid arthritis (RA). Methods: Outpatients with all levels of fatigue evaluated 57 statements about their fatigue, according to Q-methodology. Statements were formulated based on a previous interview study about the fatigue experience in RA patients, and fatigue measurement tools which are validated for RA. These covered 14 different fatigue related issues. Patients sorted cards with the statements on a worksheet with a Q-sort figure, to reflect his/her agreement with the statements during the last 7 days. This figure had 11 piles, ranging from strongly disagree (-6) to strongly agree (+6). The piles consisted of different numbers of squares, whereby most of the cards could be sorted in the neutral regions, and the fewest in the extremes. Q-methodology examines individual opinions by using ``by person factor analysis'', whereby not items of a scale, but the participants are the variables. The Q-sorts were analyzed using centroid factor analysis with varimax rotation (PCQ for Windows). Patients significantly loading on the same dimension share a common perspective on the experience of fatigue. Demographic and clinical patient characteristics were collected via questionnaires and related to these dimensions. Results: Participants were 13 men and 17 women, with a mean fatigue severity score of 4.67 (VAS; 0–10). A four-factor structure of the data was obtained. Each factor represented a perspective on the experience of fatigue, shared by a certain group of patients (see table). Types of patientsFatigue experienceRemarkable patient characteristics A. Little impact of fatigue (n=7)– good coping with fatigue– little impact of fatigue– fatigue passes after rest– most energy– oldest group (M=73 years)– fewest number of daily roles– low pain and fatigue scores on VAS– highest disease activity B. Good coping and bad sleep (n=5)– good coping with fatigue– little impact of fatigue– awaking during night– not refreshed in the morning– more women– average number of daily roles– least fatigue severity– longest disease duration C. Search for balance (n=6)– somewhat more impact of fatigue than group A and B– know how to deal with fatigue– but constant struggle to find balance between activity and rest– not refreshed in the morning– youngest group (M=51 years)– most daily roles– most of them had paid work– more fatigue and pain than group A and B D. High distress (n=2)– high impact of fatigue– difficult to accept fatigue– hard to concentrate when fatigued– awaking during night– most pain and fatigue on VAS– most co-morbidities– high anxiety and depression scores– shortest disease duration Conclusions: This study revealed different types of fatigue experience, and showed the match with patient characteristics. Results indicated that fatigue experience is a complex phenomenon; related to physical, psychological and social resources and competencies. In clinical practice, measurement instruments should be able to identify a patient's perspective on fatigue experience. Consequently, it would be possible to provide tailored support. Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 47Session: Fatigue: experience, course and intervention (Speaker Presentations )