Four different patterns of fatigue in rheumatoid arthritis patients: results of a Q-sort study

Many patients with RA complain about fatigue. Whereas qualitative studies have covered the meaning of fatigue for RA patients, it was still unknown whether subgroups of patients could be distinguished. This study aimed to describe different perspectives on the experience of fatigue.

Participants were 30 outpatients with established controlled RA of the Medical Spectrum Twente, with a mean fatigue severity score of 4.67 (visual analogue scale 0-10). They evaluated 57 statements about fatigue according to Q-methodology. Data were analysed with PCQ for Windows (Portland, OR, USA), using centroid factor analysis with varimax rotation (i.e. the participants but not the items of a scale are the variables). Factor scores of statements on the different dimensions were calculated to investigate which items are relevant when describing and distinguishing fatigue experiences. Demographic and clinical patient characteristics were collected to describe each of the dimensions that resulted from centroid factor analysis.

After statistical and theoretical considerations, 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. Physical, psychological and social patient characteristics seemed to be associated with those experiences. The factors were labelled as: 'Little impact of fatigue'; 'Good coping and bad sleep'; 'Search for balance'; and 'High distress'.

Results indicated that fatigue experience is a complex phenomenon. Existing questionnaires to measure fatigue do not meet this complexity. Extensive research is warranted and new efforts to develop instruments that take into account all aspects of fatigue are indicated.