The Flinders Fatigue Scale - Perelman School of Medicine

4 downloads 1 Views 261KB Size Report
Independent samples t-tests were performed between good sleepers and poor ..... Gentile S, Delaroziere JC, Favre F, Sambuc R, San Marco JL. Vali- dation of ...

SCIENTIFIC INVESTIGATIONS

The Flinders Fatigue Scale: Preliminary Psychometric Properties and Clinical Sensitivity of a New Scale for Measuring Daytime Fatigue associated with Insomnia Michael Gradisar, Ph.D.1,2; Leon Lack, Ph.D.1,2; Hayley Richards, B.Psyc.(Hon.)1,2; Jodie Harris, B.Psyc.(Hon.)1,2; Julie Gallasch, B.Psyc.(Hon.)1; Michelle Boundy, B.Psyc.(Hon.)1; Anna Johnston, B.Psyc.(Hon.)1 School of Psychology, Flinders University, Adelaide, South Australia; 2Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia

1

Study objectives: To evaluate the psychometric properties and clinical VLJQL¿FDQFH RI D QHZ VFDOH IRU PHDVXULQJ GD\WLPH IDWLJXH DVVRFLDWHG with insomnia: The Flinders Fatigue Scale (FFS). Methods: The 7-item FFS was used in two separate studies. Study 1 was an on-line validation study involving 1093 volunteers (mean [SD] age = 38.6 [14.7] y, 626 poor sleepers, 467 good sleepers) in a crosssectional design; Study 2 investigated the clinical sensitivity of the FFS on 113 insomnia patients (mean [SD] age = 48.3 [15.0] y) in response to a 5-week cognitive-behavior therapy for insomnia (CBT-I) program. Results: The FFS had an internal consistency of 0.91; it comprised a single factor, accounting for 67% of the total variance. Poor sleepers in Study VFRUHGVLJQL¿FDQWO\KLJKHUWKDQJRRGVOHHSHUVRQWKH))6 S 

,Q6WXG\VLJQL¿FDQWUHGXFWLRQVLQ))6VFRUHVZHUHIRXQGLQUHVSRQVHWR &%7, S 7KHVHUHGXFWLRQVLQIDWLJXHFRUUHODWHGZLWKLPSURYHPHQWVRQVXEMHFWLYHVOHHSSDUDPHWHUV DOOS 7KH))6VKRZHG good discriminant validity with the Epworth Sleepiness Scale. Conclusions: The Flinders Fatigue Scale is a brief, clinically sensitive measure with strong psychometric properties. Keywords: Daytime fatigue, insomnia, daytime functioning, psychometrics, daytime sleepiness Citation: Gradisar M; Lack L; Richards H; Harris J; Gallasch J; Boundy 0 -RKQVWRQ $ 7KH ÀLQGHUV IDWLJXH VFDOH SUHOLPLQDU\ SV\FKRPHWULF properties and clinical sensitivity of a new scale for measuring daytime fatigue associated with insomnia. J Clin Sleep Med 2007;3(7):722-728.

I

DLVHSRRUDWWHQWLRQDQGFRQFHQWUDWLRQPHPRU\LPSDLUPHQWVRFLDO RUYRFDWLRQDOG\VIXQFWLRQLUULWDELOLW\PRRGGLVWXUEDQFHGD\WLPH VOHHSLQHVVODFNRIPRWLYDWLRQRUHQHUJ\SURQHWRDFFLGHQWVSK\VL FDO V\PSWRPV HJ KHDGDFKHV JDVWURLQWHVWLQDO FRPSODLQWV  DQG FRQFHUQVRUZRUULHVDERXWVOHHSZKLFKFDQOHDGWRDUHGXFHGTXDO LW\RIOLIH152IDOOWKHVHGD\WLPHV\PSWRPVIDWLJXHDSSHDUVWREH WKHPRVWSUHYDOHQWGD\WLPHFRPSODLQWDVHYLGHQFHGE\ERWKLWVHP SKDVLVLQWKHVFLHQWL¿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¶VIDWLJXHLQDYDULHW\RIVLWXDWLRQV HJ“I am easily fatigued,” “Exercise brings on my fatigue”  It is a UHODWLYHO\EULHIPHDVXUHFRQWDLQLQJRQO\LWHPVWKDWSURYLGHD JOREDOPHDVXUHRIIDWLJXHDQGZDVRULJLQDOO\GHYHORSHGRQFOLQL FDOVDPSOHV HJPXOWLSOHVFOHURVLVOXSXV ,QFRQWUDVWWKH0), FRQWDLQVLWHPVGLYLGHGLQWRVXEVFDOHVJHQHUDOIDWLJXH HJ “I feel tired” SK\VLFDOIDWLJXH HJ“Physically I feel only able to do a little” UHGXFWLRQLQDFWLYLWLHV HJ“I feel very active”  UHGXFWLRQLQPRWLYDWLRQ HJ“I dread having to do things” DQG PHQWDOIDWLJXH HJ“My thoughts easily wander” WKRXJKQR JOREDOIDWLJXHVFRUHLVSURYLGHG7KH0),ZDVSULPDULO\GHYHO RSHGWRPHDVXUHIDWLJXHLQFDQFHUSDWLHQWV%RWKPHDVXUHVSRV

QVRPQLDFDQEHFKDUDFWHUL]HGQRWRQO\E\GLI¿FXOW\LQLWLDWLQJ DQGRUPDLQWDLQLQJVOHHSOHDGLQJWRLQVXI¿FLHQWVOHHSEXWDOVR SRRUGD\WLPHIXQFWLRQLQJ7KH'LDJQRVWLFDQG6WDWLVWLFDO0DQXDO IRU0HQWDO'LVRUGHUVth edition1 and the recent second edition of WKH,QWHUQDWLRQDO&ODVVL¿FDWLRQRI6OHHS'LVRUGHUV ,&6'  both VSHFLI\WKDWDGLDJQRVLVRILQVRPQLDLQFOXGHVERWKSRRUVOHHSDQG DVVRFLDWHGGD\WLPHLPSDLUPHQW'HVSLWHWKHGXDOHPSKDVLVSODFHG RQERWKVOHHSDQGGD\WLPHFRQVHTXHQFHVIURPERWKRIWKHVHGLDJ QRVWLFV\VWHPVWUDGLWLRQDOO\WKHUHKDVEHHQDVWURQJHUHPSKDVLV RQWKHPHDVXUHPHQWRILQVRPQLDSDWLHQWV¶KDELWXDOVOHHSHSLVRGH )RULQVWDQFHLQVRPQLDSDWLHQWV¶VOHHSTXDOLW\KDVEHHQPHDVXUHG YLD VHOIUHSRUW TXHVWLRQQDLUHV VOHHS GLDULHV5 DFWLJUDSK\ SRO\VRPQRJUDSK\DQGFOLQLFDOLQWHUYLHZV10+RZHYHUWKHUHKDV EHHQUHODWLYHO\OLWWOHIRFXVRQWKHDVVHVVPHQWRILQVRPQLDSDWLHQWV¶ GD\WLPHIXQFWLRQLQJGHVSLWHWKLVEHLQJWKHFDXVHIRUPDQ\VHHN LQJWUHDWPHQW$VVXFKPDQ\H[SHUWZRUNLQJJURXSVKDYHQRZ UHFRPPHQGHGWKHUHVHDUFKRILQVRPQLDLQFOXGHWKHPHDVXUHPHQW RIGD\WLPHIXQFWLRQLQJ %RWK WKH '60,9 DQG WKH ,&6' LQGLFDWH D QXPEHU RI W\SL FDOGD\WLPHFRQVHTXHQFHVRILQVRPQLD7KHVHLQFOXGHIDWLJXHPDO Disclosure Statement This was not an industry supported study. The authors have indicated no ¿QDQFLDOFRQÀLFWVRILQWHUHVW Submitted for publication May, 2007 Accepted for publication September, 2007 Address correspondence to: Dr. Michael Gradisar, c/o Flinders University, School of Psychology, GPO Box 2100, Adelaide, S.A., Australia, 5001; Tel: )D[(PDLOJUDG#ÀLQGHUVHGXDX JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

722

Fatigue Measure for Insomnia

VHVVJRRGLQWHUQDOFRQVLVWHQF\ HJ)66Į 0),Į   FKDUDFWHULVWLFVHVVHQWLDOIRUDYDOLGGD\WLPHLPSDLUPHQWPHDVXUH LQWUHDWPHQWRXWFRPHVWXGLHV112QHFULWLFLVPRIWKH)66KRZHY HULVWKHVFDOH¶VTXHVWLRQDEOHYDOLGLW\ LHLWLQFOXGHV³IDWLJXH´LQ HDFKLWHPZLWKRXWSURYLGLQJDQLQLWLDOGHVFULSWLRQRIWKHWHUP  1RWRQO\GRVHOIUHSRUWHGPHDVXUHVUHTXLUHVWURQJSV\FKRPHWULF SURSHUWLHVEXWWKH\DOVRQHHGWREHVHQVLWLYHWRWUHDWPHQW11 Unfor WXQDWHO\UHFHQWWUHDWPHQWRXWFRPHVWXGLHVXVLQJWKHVHVFDOHVKDYH QRWGHOLYHUHGSURPLVLQJUHVXOWV/LFKVWHLQDQGFROOHDJXHVHPSOR\HG WKH )66 DPRQJ RWKHU PHDVXUHV WR DVVHVV GD\WLPH IXQFWLRQLQJ ZKHQFRPSDULQJYDULRXVWUHDWPHQWVRILQVRPQLDLQROGHUDGXOWV $OWKRXJKVOHHSGLDULHVGHPRQVWUDWHGWUHDWPHQWJDLQVRYHUWLPHIRU WKHKDELWXDOVOHHSSHULRG HJVOHHSODWHQF\ LPSURYHPHQWVZHUH QRWUHÀHFWHGLQWKHLUDVVRFLDWHGGD\WLPHIDWLJXH$VDUHVXOW/LFK VWHLQDQGFROOHDJXHVHQFRXUDJHG³IXUWKHUH[SORUDWLRQRIWKHUROHRI IDWLJXH DQG RWKHU GLPHQVLRQV RI GD\WLPH LPSDLUPHQW LQ LVRODWLQJ LQVRPQLD VXEW\SHV´ S   6LPLODUO\ 4XHVQHO DQG FROOHDJXHV XVHGWKH0),LQDVWXG\LQYHVWLJDWLQJWKHHI¿FDF\RIDFRJQLWLYH EHKDYLRUDO LQWHUYHQWLRQ IRU LQVRPQLD LQ ZRPHQ EHLQJ WUHDWHG IRU EUHDVWFDQFHU7KHLULQWHUYHQWLRQSURYHGSDUWLDOO\VXFFHVVIXOZLWK RIWKHVXEVFDOHV JHQHUDOIDWLJXHDQGSK\VLFDOIDWLJXH VKRZLQJ GHFUHDVHVDWSRVWWUHDWPHQW+RZHYHUWKHRWKHUVXEVFDOHV PHQWDO IDWLJXH PRWLYDWLRQ DQG DFWLYLWLHV  UHPDLQHG XQFKDQJHG GHVSLWH VLJQL¿FDQWLPSURYHPHQWVRIVOHHSGHPRQVWUDWHGZLWKVOHHSGLDULHV DQGSRO\VRPQRJUDSK\$PRUHUHFHQWVWXG\WKRXJKE\6DYDUGDQG FROOHDJXHVGLG¿QGVLJQL¿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

ZHUH LGHQWL¿HG DV SRRU VOHHSHUV 3DUWLFLSDQWV FRPSOHWHG ERWK WKH )OLQGHUV )DWLJXH 6FDOH DQG WKH 3LWWVEXUJK 6OHHS 4XDOLW\ ,Q GH[ 364, 7KH364,LVDUHOLDEOHVHOIUHSRUWPHDVXUHRIVOHHS GLVWXUEDQFHWKDWFRQVLVWVRIVHYHQIDFWRUVZKLFKZKHQVXPPHG \LHOGDJOREDO364,VFRUH+LJKHU364,VFRUHVLQGLFDWHJUHDWHU VOHHSGLVWXUEDQFH7KH364,KDVJRRGSV\FKRPHWULFSURSHUWLHV ZLWKDVHQVLWLYLW\RIDQGVSHFL¿FLW\RIRIGLVWLQJXLVKLQJ EHWZHHQSRRUDQGJRRGVOHHSHUVDQGDVHQVLWLYLW\RIDQG VSHFL¿FLW\RILQGLVFULPLQDWLQJSULPDU\LQVRPQLDFVYHUVXV KHDOWK\ JRRG VOHHSHUV 6XEMHFWV LQ 6WXG\  ZHUH FODVVL¿HG DV SRRU VOHHSHUV EDVHG RQ WKH VWDQGDUG FULWHULRQ RI D JOREDO 364, VFRUH!6XEMHFWVZHUHUHFUXLWHGYLDDVQRZEDOOVDPSOLQJPHWK RGDQGFRPSOHWHGRQOLQHYHUVLRQVRIWKH)OLQGHUV)DWLJXH6FDOH DQG 364, 7KH VWXG\ ZDV DSSURYHG E\ WKH )OLQGHUV 8QLYHUVLW\ 6RFLDODQG%HKDYLRXUDO(WKLFV&RPPLWWHH Study 2 PARTICIPANTS AND PROCEDURE 2QHKXQGUHGDQGVL[W\VHYHQLQVRPQLDSDWLHQWVFRQVHFXWLYHO\ HQUROOHGLQDZHHNFRJQLWLYHEHKDYLRUDOWKHUDS\IRULQVRPQLD &%7,  SURJUDP DW WKH 5HSDWULDWLRQ *HQHUDO +RVSLWDO LQ $G HODLGH6RXWK$XVWUDOLDSDUWLFLSDWHGLQ6WXG\3DUWLFLSDQWVZHUH H[FOXGHGIURPDQDO\VHVLIGLDJQRVHGZLWKLQVRPQLDVHFRQGDU\WRD FLUFDGLDQUK\WKPGLVRUGHU 1  LQVRPQLDFRPRUELGZLWKVOHHS GLVRUGHUHGEUHDWKLQJ 1 UHVSLUDWRU\GLVWXUEDQFHLQGH[•  UHVWOHVVOHJV\QGURPH 1  SHULRGLFOLPEPRYHPHQWVRIVOHHS 1  RUVXVSHFWHGQDUFROHSV\ 1  7KLVOHIWD¿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¶ VOHHSSDUDPHWHUV LHVOHHSRQVHWODWHQF\>62/@ZDNHDIWHUVOHHS RQVHW>:[email protected]WRWDOVOHHSWLPH>[email protected]DQGVOHHSHI¿FLHQF\>6(@  7KH (66 SURYLGHG D PHDVXUH RI GD\WLPH VOHHSLQHVV7KLV VFDOH ZDV LQFOXGHG DV GD\WLPH VOHHSLQHVV LV FRQVLGHUHG GLVWLQFW IURP GD\WLPHIDWLJXH7KH(66UHTXLUHVUHVSRQGHQWVWRLQGLFDWHKRZ OLNHO\WKH\ZRXOGIDOODVOHHSRUGR]H LH±ZRXOGneverGR]HWR ±highFKDQFHDWGR]LQJ LQVFHQDULRV HJVLWWLQJDQGUHDGLQJ  (66VFRUHVUDQJHIURPZLWKKLJKHUVFRUHVLQGLFDWLQJJUHDWHU GD\WLPHVOHHSLQHVV(66VFRUHVKLJKHUWKDQLQGLFDWHH[FHVVLYH GD\WLPHVOHHSLQHVV7KH(66LVFRQVLGHUHGDUHOLDEOHDQGYDOLG PHDVXUH 7KH VWXG\ ZDV DSSURYHG E\ WKH )OLQGHUV 8QLYHUVLW\ 6RFLDO DQG %HKDYLRXUDO (WKLFV &RPPLWWHH DQG WKH 5HSDWULDWLRQ *HQHUDO+RVSLWDO(WKLFV&RPPLWWHH

METHODS Study 1 PARTICIPANTS AND PROCEDURE 3DUWLFLSDQWVIURP6WXG\FRQVLVWHGRIYROXQWHHUV PHDQ >6'@DJH >@\PDOHVIHPDOHV RIZKRP JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

723

M Gradisar, L Lack, H Richards et al Table 1²)DFWRU ORDGLQJV IRU WKH VHYHQ LWHPV IURP WKH )OLQGHUV )DWLJXH6FDOH

Table 2²0HDQ 6' )DWLJXH6FRUHVIRUWKH,QVRPQLD3DUWLFLSDQWV IURP6WXG\

Item

Insomnia Subtype 3ULPDU\LQVRPQLD ,QVRPQLDGXHWRDPHQWDOGLVRUGHU ,QVRPQLDGXHWRDPHGLFDOFRQGLWLRQ ,QVRPQLDGXHWRDVXEVWDQFH

Factor loading ,WHP:DVIDWLJXHDSUREOHPIRU\RX"  ,WHP'LGIDWLJXHFDXVHSUREOHPVZLWK\RXUHYHU\GD\«  ,WHP'LGIDWLJXHFDXVH\RXGLVWUHVV"  ,WHP+RZRIWHQGLG\RXVXIIHUIURPIDWLJXH"  ,WHP$WZKDWWLPH V RIWKHGD\GLG\RXW\SLFDOO\«  ,WHP+RZVHYHUHZDVWKHIDWLJXH\RXH[SHULHQFHG"  ,WHP+RZPXFKZDV\RXUIDWLJXHFDXVHGE\SRRUVOHHS" 

Mean    

SD    1$

,QGHSHQGHQW VDPSOHV tWHVWV ZHUH SHUIRUPHG EHWZHHQ JRRG VOHHSHUVDQGSRRUVOHHSHUVRQWKHLUIDWLJXHVFRUHVIURP6WXG\ 7RGHWHUPLQHWKHVFDOHVVHQVLWLYLW\WRWUHDWPHQW LQWKLVFDVHFRJ QLWLYHEHKDYLRUWKHUDS\IRULQVRPQLD&%7, DRQHZD\UHSHDWHG PHDVXUHV$129$ ZDV SHUIRUPHG RQ WKH GD\WLPH IDWLJXH GDWD ZLWKWKHUHSHDWHGIDFWRU³WLPH´ LHSUHWUHDWPHQWSRVWWUHDWPHQW IROORZXS  ,I D VLJQL¿FDQW PDLQ HIIHFW IRU ³WLPH´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

Note &RPSOHWH VWDWHPHQWV IRU HDFK LWHP RI WKH )OLQGHUV )DWLJXH 6FDOHFDQEHIRXQGLQWKH$SSHQGL[

Flinders Fatigue Scale 6HYHQ LWHPV ZHUH GHYHORSHG IRU WKH )OLQGHUV )DWLJXH 6FDOH EDVHGRQUHSRUWVIURPLQVRPQLDSDWLHQWVLQRXUFOLQLFV7KHVFDOH LQFOXGLQJ WKH  LWHPV  ZHUH UHYLHZHG E\ DQ H[WHUQDO LQVRPQLD WKHUDSLVWUHVHDUFKHU 7KHVH LWHPV ZHUH SLORW WHVWHG RQ D VPDOO VDPSOHRILQVRPQLDSDWLHQWV 1  IRUUHDGDELOLW\EUHYLW\WLPH HI¿FLHQF\ DQG SV\FKRPHWULF SURSHUWLHV$OO SDWLHQWV FRPSOHWHG DOOLWHPVDQGDOOIRXQGWKHVFDOHXQGHUVWDQGDEOHDQGHDV\WRXVH ,QLWLDODQDO\VHVGHPRQVWUDWHGSURPLVLQJSV\FKRPHWULFSURSHUWLHV HJYHU\JRRGLQWHUQDOFRQVLVWHQF\ DQGFOLQLFDOVHQVLWLYLW\ LH VLJQL¿FDQWGHFUHDVHLQIDWLJXHVFRUHVLQUHVSRQVHWR&%7, 7KXV DOO  LWHPV DQG WKH VFDOH DV D ZKROH ZHUH UHWDLQHG DQG IXUWKHU WHVWHGRQWKHVDPSOHVSUHVHQWHGLQWKLVSDSHU 7KH )OLQGHUV )DWLJXH 6FDOH LV D LWHP VFDOH WKDW PHDVXUHV YDULRXV FKDUDFWHULVWLFV RI IDWLJXH HJ IUHTXHQF\ VHYHULW\  H[ SHULHQFHG RYHU WKH SDVW  ZHHNV VHH$SSHQGL[ 7KH LWHPV WDS LQWR FRPPRQO\ UHSRUWHG WKHPHV RI KRZ SUREOHPDWLF IDWLJXH LV WKH FRQVHTXHQFHV RI IDWLJXH IUHTXHQF\ VHYHULW\ DQG LQVRPQLD SDWLHQWV¶SHUFHSWLRQRIIDWLJXH¶VDVVRFLDWLRQZLWKVOHHS6L[LWHPV DUHSUHVHQWHGLQ/LNHUWIRUPDWZLWKUHVSRQVHVUDQJLQJIURP QRW DW DOO  WR  H[WUHPHO\  ,WHP  PHDVXUHV WKH WLPH RI GD\ ZKHQ IDWLJXH LV H[SHULHQFHG DQG XVHV D PXOWLSOHLWHP FKHFNOLVW 5H VSRQGHQWV FDQ LQGLFDWH PRUH WKDQ RQH UHVSRQVH IRU LWHP  DQG LWLVVFRUHGDVWKHVXPRIDOOWLPHVRIWKHGD\LQGLFDWHGE\WKHUH VSRQGHQW2QHLWHPH[SOLFLWO\DVNVIRUUHVSRQGHQWV¶LPSUHVVLRQRI ZKHWKHUWKH\DWWULEXWHWKHLUIDWLJXHWRWKHLUVOHHS7RWDOIDWLJXHLV FDOFXODWHGDVWKHVXPRIDOOLQGLYLGXDOLWHPV7RWDOIDWLJXHVFRUHV UDQJHIURPWRZLWKKLJKHUVFRUHVLQGLFDWLQJJUHDWHUIDWLJXH $FOHDUGHVFULSWLRQRIWKHWHUP³IDWLJXH´LVSURYLGHGLQWKHLQLWLDO LQVWUXFWLRQVWRWKHVFDOH

RESULTS Internal Consistency, Factor Structure, and Discriminant Validity )RUWKHWZRVDPSOHVWKHLQWHUQDOFRQVLVWHQF\RIWKH)OLQGHUV )DWLJXH 6FDOH ZDV  6WXG\   DQG  SUHWUHDWPHQW GDWD IURP 6WXG\   UHVSHFWLYHO\ 7KH H[SORUDWRU\ IDFWRU DQDO\VLV RI WKH IDWLJXH GDWD IURP 6WXG\  UHYHDOHG D VLQJOH IDFWRU WKDW H[ SODLQHGRIWKHYDULDQFHIRUWKH)OLQGHUV)DWLJXH6FDOH7D EOHSUHVHQWVWKHIDFWRUORDGLQJVIRUHDFKLWHPIURPWKH)OLQGHUV )DWLJXH6FDOH 1RVLJQL¿FDQWFRUUHODWLRQZDVIRXQGEHWZHHQWKHSUHWUHDWPHQW )OLQGHUV)DWLJXH6FDOHDQG(66IURP6WXG\U   S =  VXJJHVWLQJ JRRG GLVFULPLQDQW YDOLGLW\ EHWZHHQ WKHVH  PHDVXUHV Poor and Good Sleeper Differences 7KH PHDQ“6' IDWLJXH YDOXH IRU SRRU VOHHSHUV “  ZDV VLJQL¿FDQWO\ JUHDWHU WKDQ WKH YDOXH IRU WKH JRRG VOHHSHUV “ t S7DEOHSUHVHQWVWKHSUH WUHDWPHQW PHDQV DQG VWDQGDUG GHYLDWLRQV RI IDWLJXH VFRUHV IRU WKHYDULRXVLQVRPQLDGLVRUGHUVIURP6WXG\7KHUHZHUHQRVLJ QL¿FDQWGLIIHUHQFHVEHWZHHQWKHVHJURXSVRQWKHLUPHDQIDWLJXH VFRUHVF S 

Statistical Analyses 7R DVVHVV WKH )OLQGHUV )DWLJXH 6FDOH¶V LQWHUQDO UHOLDELOLW\ D &URQEDFKDOSKDFRHI¿FLHQWZDVFDOFXODWHGIURPWKHVDPSOHVIURP ERWK VWXGLHV 7R DVVHVV WKH IDFWRU VWUXFWXUH D SULQFLSOH FRPSR QHQWV IDFWRU DQDO\VLV ZLWK D YDULPD[ URWDWLRQ DQG D FULWHULRQ RI HLJHQYDOXHVJUHDWHUWKDQZDVXVHG$VIDFWRUDQDO\VLVW\SL FDOO\UHTXLUHVDUHODWLYHO\ODUJHVDPSOHVL]H30 the factor analysis ZDVSHUIRUPHGRQWKHIDWLJXHGDWDIURP6WXG\ 1  3HDU VRQ SURGXFWPRPHQW FRUUHODWLRQV ZHUH FDOFXODWHG EHWZHHQ WKH )OLQGHUV)DWLJXH6FDOHZLWKWKH(66DGPLQLVWHUHGDWSUHWUHDWPHQW WRWKHLQVRPQLDJURXSLQ6WXG\7KHFRUUHODWLRQVZHUHXVHGWR DVVHVVWKHGLVFULPLQDQWYDOLGLW\RIWKH)OLQGHUV)DWLJXH6FDOHZLWK WKH(66 JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

n    

Treatment Outcome Sensitivity 7DEOHSUHVHQWVWKHPHDQ 6' IDWLJXHVFRUHVDVZHOODV(66 DQGVOHHSGLDU\SDUDPHWHUVIRUWKHLQVRPQLDSDWLHQWVLQ6WXG\DW SUHWUHDWPHQWSRVWWUHDWPHQWDQGIROORZXS )RU WKH LQVRPQLD SDWLHQWV XQGHUJRLQJ WKH ZHHN &%7, WUHDWPHQW D VLJQL¿FDQW PDLQ HIIHFW IRU WLPH ZDV IRXQG IRU WKH )OLQGHUV)DWLJXH6FDOHF SZLWKDODUJHHI 724

Fatigue Measure for Insomnia Table 3²0HDQ 6' DQGRI'D\WLPH)DWLJXH6OHHSLQHVVDQG6OHHS3DUDPHWHUVIRUWKH,QVRPQLD3DWLHQWVDW3UHWUHDWPHQW3RVWWUHDWPHQWDQG 0RQWK)ROORZ8S Pretreatment                  

))6 (66 62/ PLQ  :$62 PLQ  767 KU  6(  

Posttreatment                  

Follow-up            

Note))6 )OLQGHUV)DWLJXH6FDOH(66 (SZRUWK6OHHSLQHVV6FDOH62/ VOHHSRQVHWODWHQF\:$62 ZDNHDIWHUVOHHSRQVHW767 WRWDO VOHHSWLPH6( VOHHSHI¿FLHQF\ FDOFXODWHGDVWRWDOVOHHSWLPH·WLPHLQEHG[ 

IHFWVL]HRI &RKHQ¶Vd 6SHFL¿FDOO\WKHUHZDVDVLJQL¿FDQW GHFUHDVH IURP SUHWUHDWPHQW WR SRVWWUHDWPHQW F   S  WKDWFRQWLQXHGWRGHFOLQHDWWKHPRQWKIROORZXSF  S7KHVHGHFUHDVHVLQGD\WLPHIDWLJXHVFRUHVZHUH FRLQFLGHQWZLWKGHFUHDVHVLQVOHHSRQVHWODWHQF\DQGZDNHDIWHU VOHHSRQVHW62/F S&RKHQ¶Vd  :$62F S&RKHQ¶Vd DQGVLJQL¿ FDQWLQFUHDVHVLQWRWDOVOHHSWLPHDQGVOHHSHI¿FLHQF\767F S&RKHQ¶Vd 6(F S &RKHQ¶Vd 2ILQWHUHVWWKHUHZDVDOVRDVLJQL¿FDQW PDLQHIIHFWIRUWLPHIRUWKH(66VFRUHVF S  LQFRUSRUDWLQJDVLJQL¿FDQWLQFUHDVHDWSRVWWUHDWPHQWF  S  DQG D VXEVHTXHQW VLJQL¿FDQW GHFUHDVH DW WKH PRQWK IROORZXSF S  $VDPRUHGLUHFWWHVWRIWKHDVVRFLDWLRQEHWZHHQVOHHSLPSURYH PHQWVDQGGD\WLPHIXQFWLRQLQJFRUUHODWLRQVEHWZHHQWKHVHPHD VXUHVGXULQJWUHDWPHQWZHUHSHUIRUPHG7KHGHFUHDVHVLQIDWLJXH IURPSUHWUHDWPHQWWRSRVWWUHDWPHQWZHUHVLJQL¿FDQWO\DVVRFLDWHG ZLWKGHFUHDVHVLQ62/U   S DQG:$62U   S DQGLQFUHDVHVLQ767U   S  DQG6(U   S +RZHYHUWKHGHFUHDVHVLQIDWLJXH ZHUHQRWFRUUHODWHGZLWKWKHLQFUHDVHVLQVOHHSLQHVVU    S!

JRRGIDFHYDOLGLW\IRUPHDVXULQJIDWLJXHLQLQVRPQLDDQGLVEULHI HUWKDQRWKHUPHDVXUHV²DFKDUDFWHULVWLFKLJKOLJKWHGLQJXLGHOLQHV IRUFOLQLFDOWULDOVRILQVRPQLDWUHDWPHQW11 7KH )OLQGHUV )DWLJXH 6FDOH DOVR SRVVHVVHV RWKHU VWURQJ SV\ FKRPHWULF SURSHUWLHV )RU LQVWDQFH LQ WZR VHSDUDWH VDPSOHV LW ZDVVKRZQWRKDYHJRRGLQWHUQDOFRQVLVWHQF\ &URQEDFKDOSKD  RIEHWZHHQDQG²¿JXUHVFRPSDUDEOHWRWKRVHIRXQGLQ WKH)66DQG0),7KHODUJHU&URQEDFKDOSKDRIFRXOGKDYH EHHQ SDUWO\ GXH WR WKH ODUJH VDPSOH VL]H LQ 6WXG\ 31 whereas IXWXUH VWXGLHV WKDW HPSOR\ WKH )OLQGHUV )DWLJXH 6FDOH DUH PRUH OLNHO\ WR XVH D VDPSOH VL]H HTXLYDOHQW WR WKDW XVHG LQ 6WXG\  1   ZKLFK VWLOO GHPRQVWUDWHG JRRG LQWHUQDO FRQVLVWHQF\ )XUWKHUWKHH[SORUDWRU\IDFWRUDQDO\VLVVKRZHGWKH)OLQGHUV)D WLJXH6FDOHLVFRPSRVHGRIDVLQJOHIDFWRUWKDWH[SODLQVRI WKHYDULDQFH2WKHUVWXGLHVLQQRQ±VOHHSGLVRUGHUHGVDPSOHVKDYH IRXQG WKDW WKH )66 LV DOVR FRPSULVHG RI D VLQJOH IDFWRU On WKH RWKHU KDQG WKH IDFWRU DQDO\VLV DSSOLHG WR WKH LWHP 0), E\ WKH RULJLQDO DXWKRUV IRXQG LW FRQVLVWHG RI PXOWLSOHVXEVFDOHV HJ JHQHUDO IDWLJXH SK\VLFDO IDWLJXH PHQWDO IDWLJXH PRWLYD WLRQ DQG DFWLYLWLHV  6LQFH WKH RULJLQDO IDFWRU DQDO\WLFDO VWXG\ IXUWKHU VWXGLHV KDYH IRXQG GLIIHUHQW UHVXOWV )RU LQVWDQFH WKH )UHQFKYHUVLRQRIWKH0),ZDVIRXQGWRKDYHIDFWRUV DOOEXWWKH ³SK\VLFDO IDWLJXH´ IDFWRU  0RUHRYHU D UHFHQW LQYHVWLJDWLRQ RI WKHIDFWRUVWUXFWXUHRIFRPPRQIDWLJXHPHDVXUHV LQFOXGLQJWKH 0), IRXQGWKDWDOOLWHPVIURPWKHVHPHDVXUHVVLPSO\ORDGRQWR IDFWRUV³GLVWUHVVHGIDWLJXH´RU³YLJRXU´ZLWKWKH0),PDLQO\ ORDGLQJRQWKHYLJRXUIDFWRU357KHVHDXWKRUVFRQFOXGHGWKDWXQL GLPHQVLRQDO PHDVXUHV RI IDWLJXH DUH DV HIIHFWLYH LQ PHDVXULQJ ³IDWLJXH´DVPXOWLGLPHQVLRQDOPHDVXUHV 7KHYDULRXV0),VXEVFDOHVPD\EHXVHIXOZKHQLQYHVWLJDWLQJ WKH GD\WLPH FRQVHTXHQFHV RI LQVRPQLD LQ FOLQLFDO VHWWLQJV :H QRWHWKDWWKHLWHPVIURPWKH)OLQGHUV)DWLJXH6FDOHDOVRSURYLGH XVHIXOFOLQLFDOLQIRUPDWLRQ LHIDWLJXHGXHWRVOHHSZKHQIDWLJXH LVH[SHULHQFHGGXULQJWKHGD\ :HVXJJHVWWKDWWKHQDWXUHRIWKH VLQJOH IDFWRU LQ WKH )OLQGHUV )DWLJXH 6FDOH FRXOG EH FRQVLGHUHG ³GD\WLPHIDWLJXH´²DWHUPVLPLODUWRRQHRIWKHVXEVFDOHVRIWKH 0), LH³JHQHUDOIDWLJXH´ DQGVRPHZKDWFRQFRUGDQWZLWKWKH QRWLRQRIGLVWUHVVHGIDWLJXH35+RZHYHUXQOLNHWKH0),DQG)66 WKH GD\WLPH IDWLJXH IDFWRU IURP WKH )OLQGHUV )DWLJXH 6FDOH ZDV IRXQGWREHVHQVLWLYHWRWUHDWPHQW ,Q WKH SUHVHQW VWXG\ LW ZDV IRXQG WKDW WKH )OLQGHUV )DWLJXH 6FDOHZDVUHVSRQVLYHWRFRJQLWLYHEHKDYLRUWKHUDS\IRULQVRP QLD &%7, 6SHFL¿FDOO\VLJQL¿FDQWUHGXFWLRQVLQIDWLJXHZHUH IRXQG IURP SUHWUHDWPHQW WR SRVWWUHDWPHQW DQG IXUWKHU UHGXF WLRQV ZHUH IRXQG IURP SRVWWUHDWPHQW WR D PRQWK IROORZXS 7KHVHFKDQJHVFRLQFLGHGZLWKDQGZHUHGLUHFWO\UHODWHGWRLP SURYHPHQWV RYHU WLPH LQ DOO VOHHS SDUDPHWHUV VOHHS RQVHW OD

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¶V FRQVWUXFWYDOLGLW\7KXVWKH)OLQGHUV)DWLJXH6FDOHSUHVHQWVZLWK JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

725

M Gradisar, L Lack, H Richards et al

WHQF\ ZDNH DIWHU VOHHS RQVHW WRWDO VOHHS WLPH DQG VOHHS HI¿ FLHQF\ $V 0RULQ VWDWHV LQ RUGHU ³WR EH FRQVLGHUHG FOLQLFDOO\ PHDQLQJIXOVOHHSLPSURYHPHQWVVKRXOGDOVROHDGWRDUHGXFWLRQ RIGD\WLPHIDWLJXH´ S 11,WZRXOGDSSHDUWKDWWKH)OLQGHUV )DWLJXH6FDOHKDVEHHQDEOHWRGHWHFWVXFKFOLQLFDOO\PHDQLQJ IXOFKDQJHVIRULQVRPQLDSDWLHQWVZKHUHSUHYLRXVPHDVXUHVKDYH QRW 7KXV WKH )OLQGHUV )DWLJXH 6FDOH LV WKH ¿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¿QGLQJZDVWKHODFNRIFRUUHVSRQGHQFHEHWZHHQ GD\WLPHIDWLJXHDQGGD\WLPHVOHHSLQHVV1RVLJQL¿FDQWFRUUHODWLRQ ZDVIRXQGEHWZHHQWKHVHPHDVXUHVDWSUHWUHDWPHQW)XUWKHUPRUH WKHVLJQL¿FDQWLPSURYHPHQWVLQGD\WLPHIDWLJXHDQGVOHHSSDUDP HWHUVZHUHQRWUHÀ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¿QLWLRQ RI IDWLJXH LQ WKH VOHHS PHGLFLQH OLWHUDWXUH )XUWKHUPRUH SUHYL RXVUHVHDUFKKDVIRXQGOLWWOHRYHUODSEHWZHHQREMHFWLYHPHDVXUHV RI VOHHSLQHVV LH WKH PXOWLSOH VOHHS ODWHQF\ WHVW  DQG VXEMHFWLYH IDWLJXH16 ZKLFK VXJJHVWV IDWLJXH DQG VOHHSLQHVV DUH FRQFHSWXDOO\ GLIIHUHQWIRUSHRSOHH[SHULHQFLQJLQVRPQLDUHJDUGOHVVRIZKHWKHU VOHHSLQHVVLVPHDVXUHGREMHFWLYHO\RUVXEMHFWLYHO\ *HQHUDOO\WKH)OLQGHUV)DWLJXH6FDOHZDVDEOHWRGLVFULPLQDWH EHWZHHQJRRGDQGSRRUVOHHSHUVZLWKSRRUVOHHSHUVVFRULQJVLJ QL¿FDQWO\KLJKHURQWKLVPHDVXUH1RVLJQL¿FDQWGLIIHUHQFHVZHUH IRXQG WKRXJK LQ IDWLJXH VFRUHV EHWZHHQ WKH YDULRXV LQVRPQLD GLVRUGHUSDWLHQWV,QWHUHVWLQJO\WKHPHDQYDOXHVRIWKHLQVRPQLD SDWLHQWV ZHUH KLJKHU WKDQ WKDW RI WKH SRRU VOHHSHUV LQ 6WXG\  7KLVPD\EHGXHWRDQXPEHURIUHDVRQV,WPD\EHWKDWSHRSOH ZLWKLQVRPQLDQRWRQO\UHSRUWJUHDWHUGD\WLPHIDWLJXHWKDQSHRSOH ZLWKRWKHUVOHHSGLVRUGHUV16EXWWKRVHZKRVHHNWUHDWPHQWUHSRUW JUHDWHUGD\WLPHIDWLJXH7KLVZRXOGEHFRQVLVWHQWZLWKWKH¿QGLQJ WKDWIDWLJXHLVRQHRIWKHPDLQUHDVRQVSHRSOHZLWKLQVRPQLDZLOO VHHNWUHDWPHQW11 $OWKRXJKWKHUHDUHDQXPEHURISRVLWLYHRXWFRPHVIURPWKLVSUH OLPLQDU\LQYHVWLJDWLRQRIWKH)OLQGHUV)DWLJXH6FDOHDQXPEHURI OLPLWDWLRQV PXVW DOVR EH DFNQRZOHGJHG )LUVW WKH WHVWUHWHVW UHOL DELOLW\RIWKH)OLQGHUV)DWLJXH6FDOHZDVQRWWHVWHGLQWKHSUHVHQW SDSHU7KHVWDELOLW\RIDVFDOHRYHUWLPHLVDQLPSRUWDQWSV\FKRPHW ULFSURSHUW\DQGFXUUHQWO\UHPDLQVXQNQRZQ/LNHZLVHFRQYHUJHQW YDOLGLW\LVDQRWKHULPSRUWDQWSV\FKRPHWULFSURSHUW\DQGWKLVZDV DOVRQRWWHVWHG)XWXUHZRUNLVQHHGHGWRWHVWWKH)OLQGHUV)DWLJXH 6FDOH¶VFRQYHUJHQWYDOLGLW\ZLWKRWKHUVXEMHFWLYH HJ)DWLJXH6H YHULW\6FDOH DQGREMHFWLYH HJFDUGLRSXOPRQDU\VWUHVVWHVW PHD VXUHVRIIDWLJXH:LWKUHJDUGWRLPSRUWDQWFOLQLFDOSDUDPHWHUVIX WXUHUHVHDUFKLVQHHGHGWRYDOLGDWHWKH)OLQGHUV)DWLJXH6FDOHDFURVV JCSM Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007

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± 1)XWXUHVWXGLHVVKRXOGGH YHORSQRUPDWLYHGDWDXVLQJPRUHUHSUHVHQWDWLYHVDPSOLQJPHWKRGV )RUH[DPSOHQRUPDWLYHGDWDRIJRRGVOHHSHUVZRXOGSURYLGHFOLQL FDOO\PHDQLQJIXOGDWDIRUFOLQLFLDQVWRDVVHVVZKHWKHUWKHLUSDWLHQWV¶ )OLQGHUV)DWLJXH6FDOHVFRUHVDIWHUWUHDWPHQWDUHZLWKLQWKHUDQJHRI JRRGVOHHSHUV)LQDOO\DOWKRXJKDOOLWHPVIURPWKH)OLQGHUV)DWLJXH 6FDOHORDGHGRQWRDVLQJOHIDFWRUWKHIDFWRUORDGLQJRILWHPZDV WKHORZHVW7KLVFRXOGLQGLFDWHWKLVLWHPLVRIDGLIIHUHQWQDWXUHWKDQ WKHRWKHULWHPV)XUWKHUZRUNLVUHTXLUHGWRGHWHUPLQHZKHWKHURU QRWLWHPVKRXOGEHLQFOXGHGDVDQLWHPRIWKHVFDOHRUDVDQDS SHQGDJHIRUFOLQLFDOXVH Summary 7KH)OLQGHUV)DWLJXH6FDOHUHSUHVHQWVWKH¿UVWEULHIDQGUHOL DEOHPHDVXUHYDOLGDWHGZLWKLQVRPQLDSDWLHQWV,WVVLQJOH³GD\WLPH IDWLJXH´IDFWRUZKLFKH[SODLQVRIWKHYDULDQFHDSSHDUVQRW RQO\VHQVLWLYHWRWKHHIIHFWVRIFRJQLWLYHEHKDYLRXUWKHUDS\DQGLV DOVRUHODWHGWRLPSURYHPHQWVLQVOHHSEXWLVDOVRGLVWLQJXLVKDEOH IURP GD\WLPH VOHHSLQHVV )XWXUH UHVHDUFK ZRXOG KHOS WR IXUWKHU DVVHVVWKHVFDOH¶VFRQYHUJHQWDQGGLVFULPLQDQWYDOLGLW\WHVWUHWHVW UHOLDELOLW\DVZHOODVSURYLGHQRUPDWLYHGDWDDQGSRWHQWLDOO\XVH IXOFOLQLFDOFXWRIIVFRUHV ACKNOWLEDGMENTS 7KH DXWKRUV ZLVK WR WKDQN WKH )DFXOW\ RI 6RFLDO 6FLHQFHV )OLQGHUV8QLYHUVLW\IRUWKHLU¿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

726

$PHULFDQ3V\FKLDWULF$VVRFLDWLRQ'LDJQRVWLFDQGVWDWLVWLFDOPDQ XDORIPHQWDOGLVRUGHUVIRXUWKHGLWLRQWH[WUHYLVLRQWKHG:DVK LQJWRQ'&$PHULFDQ3V\FKLDWULF$VVRFLDWLRQ $PHULFDQ $FDGHP\ RI 6OHHS 0HGLFLQH ,QWHUQDWLRQDO FODVVL¿FD WLRQ RI VOHHS GLVRUGHUV QG HG 'LDJQRVWLF DQG FRGLQJ PDQXDO :HVWFKHVWHU,/$PHULFDQ$FDGHP\RI6OHHS0HGLFLQH %DVWLHQ&+9DOOLHUHV$0RULQ&09DOLGDWLRQRIWKH,QVRPQLD6H YHULW\,QGH[DVDQRXWFRPHPHDVXUHIRULQVRPQLDUHVHDUFK6OHHS 0HG

Fatigue Measure for Insomnia 

%X\VVH'-$QFROL,VUDHO6(GLQJHU-'/LFKVWHLQ./0RULQ&0 5HFRPPHQGDWLRQVIRUDVWDQGDUGUHVHDUFKDVVHVVPHQWRILQVRPQLD 6OHHS  /LQHEHUJHU0'&DUQH\&((GLQJHU-'0HDQV0.'H¿QLQJLQ VRPQLD4XDQWLWDWLYHFULWHULDIRULQVRPQLDVHYHULW\DQGIUHTXHQF\ 6OHHS  %URRNV-2UG)ULHGPDQ/%OLZLVH'/

Suggest Documents