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Prediction of Multidimensional Fatigue After Childhood Brain Injury
Alison J Crichton1, Franz Babl, Ed Oakley
1Murdoch Childrens Research Institute, Melbourne, Australia (Drs Crichton, Babl, and Anderson and Messrs Greenham, Hearps, and Delzoppo); Victorian Pediatric Rehabilitation Service, Monash Children's, Melbourne, Australia (Dr Crichton); University of Melbourne, Melbourne, Australia (Drs Crichton, Babl and Anderson and Messrs Oakley and Greenham); Royal Children's Hospital, Melbourne, Australia (Drs Babl and Anderson and Messrs Oakley and Delzoppo); Hospital for Sick Children Research Institute, Toronto, Canada (Dr Hutchison); and University of Montreal, Montreal, Canada (Dr Beauchamp).
Insights
Childhood brain injury often leads to fatigue, with higher rates than in healthy children. Depression and sleep issues predict fatigue, highlighting the need for comprehensive assessment from both child and parent viewpoints.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Clinical psychology
Background:
- Childhood brain injury (TBI) can result in persistent fatigue.
- Assessing fatigue in pediatric TBI populations is crucial for recovery.
- Existing fatigue measures may not fully capture the multidimensional nature of fatigue in children.
Purpose of the Study:
- Determine the prevalence and predictors of fatigue symptoms after childhood brain injury.
- Evaluate the feasibility, reliability, and validity of the PedsQL Multidimensional Fatigue Scale (MFS) in this population.
- Obtain both child and parent perspectives on fatigue.
Main Methods:
- Longitudinal prospective study involving 35 families with children (aged 8-18) who sustained TBI.
- Utilized the PedsQL Multidimensional Fatigue Scale (MFS) for child and parent ratings.
- Collected data on fatigue, mood, sleep, and pain at 6-week follow-up.
Main Results:
- Abnormal fatigue rates were higher in children with TBI (47% parent-reported, 29% child-reported) compared to normative data.
- Parent-reported fatigue was predicted by post-injury depression and sleep disturbance.
- The PedsQL MFS showed good feasibility and reliability, but poor to moderate interrater reliability between parent and child reports.
Conclusions:
- Fatigue is a significant issue for children following TBI.
- Assessing fatigue, sleep disturbances, and depression is essential.
- Utilizing both child and parent perspectives is recommended for comprehensive evaluation.
Objectives:
To determine (1) the presence of fatigue symptoms and predictors of fatigue after childhood brain injury and examine (2) the feasibility, reliability, and validity of a multidimensional fatigue measure (PedsQL Multidimensional Fatigue Scale [MFS]) obtained from parent and child perspectives.
Setting:
Emergency and intensive care units of a hospital in Melbourne, Australia.
Participants:
Thirty-five families (34 parent-proxies and 32 children) aged 8 to 18 years (mean child age = 13.29 years) with traumatic brain injury (TBI) of all severities (27 mild, 5 moderate, and 3 severe) admitted to the Royal Children's Hospital.
Design:
Longitudinal prospective study. Fatigue data collected at 6-week follow-up (mean = 6.9 weeks).
Main Outcome Measures:
Postinjury child- and parent-rated fatigue (PedsQL MFS), mood, sleep, and pain based on questionnaire report: TBI severity (mild vs moderate/severe TBI).
Results:
A score greater than 2 standard deviations below healthy control data indicated the presence of abnormal fatigue, rates of which were higher compared with normative data for both parent and child reports (47% and 29%). Fatigue was predicted by postinjury depression and sleep disturbance for parent, but not child ratings. Fatigue, as rated by children, was not significantly predicted by TBI severity or other symptoms. The PedsQL MFS demonstrated acceptable measurement properties in child TBI participants, evidenced by good feasibility and reliability (Cronbach α values >0.90). Interrater reliability between parent and child reports was poor to moderate.
Conclusions:
Results underscore the need to assess fatigue and associated sleep-wake disturbance and depression after child TBI from both parent and child perspectives.
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