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American Journal of Nursing Research. 2019, 7(4), 550-560
DOI: 10.12691/ajnr-7-4-17
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Fatigue and Self-management among Multiple Sclerosis Patients

Afnan Seraj Jamal Shawli1, , Iman Abdallah Mohammed Abdulmutalib2 and Elham Abduallah Al Nagshabandi2

1Master Candidate of Medical-Surgical Nursing, King Abdulaziz University, Jeddah, KSA

2Medical-Surgical Nursing Department, Nursing Faculty, Ain Shams University, Cairo, Egypt

Pub. Date: May 27, 2019

Cite this paper:
Afnan Seraj Jamal Shawli, Iman Abdallah Mohammed Abdulmutalib and Elham Abduallah Al Nagshabandi. Fatigue and Self-management among Multiple Sclerosis Patients. American Journal of Nursing Research. 2019; 7(4):550-560. doi: 10.12691/ajnr-7-4-17


Fatigue is considered as the most revealed symptoms in multiple sclerosis patients, reported by 88% of patients and has significant impact on all stages of life such as altering in daily living activity or psychosocial/mental functions. The pathogenesis of fatigue remain poorly understood and how its impact on self-management. The aim of study was to assess fatigue and self management among multiple sclerosis patients. A quantitative descriptive correlational design was used in this study. The study was conducted at both King Abdulaziz University Hospital and King Fahad Armed Forces Hospitals in Jeddah City from January till March 2018, data collected from outpatients’ clinic and Inpatients’ medical-wards. A convenience sample of 50 Multiple Sclerosis patients. Data was collected through the main one tool, it consists of three parts; Part I, Socio-demographic and clinical data constructed by the researchers. Part П, Modified Fatigue Impact scale; to assess the Impact of fatigue on physical, cognitive, and psychosocial functioning in patient with Multiple Sclerosis.. Part ПІ, Multiple Sclerosis Self Management Scale Revised; to provide a multidimensional and psychometrically assessment of self-management knowledge and behavior among Multiple Sclerosis patients. The study results showed there was a statistically significant negative correlations between fatigue subscales and overall self-management among Multiple Sclerosis patients with p-value (.019). Also, there was a statistically significant negative correlations between self-management factor scales and overall fatigue among Multiple Sclerosis patients with p-value (.019). It was concluded that there was a negative correlations between overall fatigue and overall self-management among Multiple Sclerosis patients, whenever fatigue severity increases, self-management decreases. It was a recommendation to encourage governmental policy and other decision makers in the Saudi community to develop periodically structure health education training program regarding self-management in MS and provide appropriate environments or facilities to conduct such programs, where nurses play a key role through health education and cooperate with other health care system.

fatigue multiple sclerosis self-management

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[1]  Vijayasingham, L., & Mairami, F. F. (2018). Employment of patients with multiple sclerosis: The influence of psychosocial-structural coping and context. Degenerative Neurological and Neuromuscular Disease, Volume 8, 15-24.
[2]  Lariviere, M. (2011). Focusing-oriented art therapy in multiple sclerosis: A randomized controlled trial to enhance quality of life (Unpublished master's thesis). Notre Dame de Namur University, Belmont, Calif.
[3]  Alsaqaaby, M. F., Vaidya, V., Khreis, N., Khairallah, T. A., & Al-Jedai, A. H. (2017). Cost-effectiveness of oral agents in relapsing-remitting multiple sclerosis compared to interferon-based therapy in Saudi Arabia. Annals of Saudi Medicine, 37(6), 433-443.
[4]  Maslakpak, M. H., & Raiesi, Z. (2014). Effect of a Self-Management and Follow-Up Program on Self-Efficacy in Patients With Multiple Sclerosis: A Randomized Clinical Trial. Nursing and Midwifery Studies, 3(4).
[5]  Shamsaei, F., Vakili, R., Rezaie, A. A., Salavati, M., & Moghimbeigi, A. (2014). The Association of Self-Efficacy With General Health in Patients with Multiple Sclerosis. Jundishapur Journal of Chronic Disease Care, 3(4).
[6]  Tur, C. (2016). Fatigue Management in Multiple Sclerosis. Current Treatment Options in Neurology, 18(6), 26.
[7]  Thomas, S., Kersten, P., & Thomas, P. W. (2015). The Multiple Sclerosis-Fatigue Self–Efficacy (MS-FSE) scale: initial validation. Clinical rehabilitation, 29(4), 376-387.
[8]  Kalb, R., Giesser, B., & Costello, K. (2012). Multiple sclerosis for dummies. John Wiley & Sons Karbandi, S., Aghaei, N., Gorji, M. A., Golkhatmi, M. B., & Alizadeh, B. (2016). Social Support in Relation to Fatigue Symptoms Among Patients with Multiple Sclerosis. Indian journal of palliative care, 22(2), 163-7.
[9]  Bishop, M., & Frain, M. P. (2011). The Multiple Sclerosis Self-Management Scale: Revision and psychometric analysis. Rehabilitation Psychology, 56(2), 150-159.
[10]  Modi, A. C., Pai, A. L., Hommel, K. A., Hood, K. K., Cortina, S., Hilliard, M. E., . . . Drotar, D. (2012). Pediatric Self-management: A Framework for Research, Practice, and Policy. Pediatrics, 129(2), e473-e485.
[11]  Multiple Sclerosis International Foundation (MSIF). Atlas of MS 2013: mapping multiple sclerosis around the world. Mult Scler Int Fed, 1-28. Mult Scler Int Fed, 1-28. Available from:
[12]  Al-Asmi, A., Al-Rawahi, S., Al-Moqbali, Z. S., Al-Farsi, Y., Essa, M. M., El-Bouri, M., . . . Adawi, S. A. (2015). Magnitude and concurrence of anxiety and depression among attendees with multiple sclerosis at a tertiary care Hospital in Oman. BMC Neurology, 15(1), 131.
[13]  Bohlega, S., Inshasi, J., Tahan, A. R., Madani, A. B., Qahtani, H., & Rieckmann, P. (2013). Multiple sclerosis in the Arabian Gulf countries: A consensus statement. Journal of Neurology, 260(12), 2959-2963.
[14]  Mohammed, E. M. (2016). Multiple sclerosis is prominent in the Gulf states: Review. Pathogenesis,3(2), 19-38.
[15]  Budhwani, S. (2013). The Self-Management-Focused Chronic Care Model: A Conceptual Framework. Retrieved
[16]  Ontario: Preventing and managing chronic disease Ontario’s framework. In [S.l.]: Ministry of Health and Long-Term Care. 2007.
[17]  Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998; 1(1):2-4.
[18]  Greenhalgh, T. (2009). Patient and public involvement in chronic illness: beyond the expert patient. Bmj, 338, b49.
[19]  Mills, R. J., Young, C. A., Pallant, J. F., & Tennant, A. (2010). Rasch analysis of the Modified Fatigue Impact Scale (MFIS) in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 81(9), 1049-1051.
[20]  Fisk, J. D., Ritvo, P. G., Ross, L., Haase, D. A., Marrie, T. J., & Schlech, W. F. (1994). Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clinical Infectious Diseases, 18(Supplement_1), S79-S83.
[21]  Omrani, F., Sahraian, M., Saeen, A., Omrani, Z., & Hayeri, G. (2018). Early-onset multiple sclerosis: Reports of 300 patients from Iran. Journal of Pediatric Neurosciences, 13(2), 137.
[22]  Al Wutayd, O. A., Mohamed, A. G., Saeedi, J., Otaibi, H. A., & Jumah, M. A. (2018). Environmental exposures and the risk of multiple sclerosis in Saudi Arabia. BMC Neurology, 18(1), 86.
[23]  Ortona, E., Pierdominici, M., Maselli, A., Veroni, C., Aloisi, F., & Shoenfeld, Y. (2016). Sex-based differences in autoimmune diseases. Annali dell'Istituto superiore di sanita, 52(2), 205-212.
[24]  Alhazzani, A. A., Alshahrani, A., Alqahtani, M., Alamri, R., Alqahtani, R., Alqahtani, M., & Alahmarii, M. (2018). Insomnia among non-depressed multiple sclerosis patients: A cross-sectional study. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 54(1), 17.
[25]  Radmehr, M., Meghdadi, S., Bahmanzadeh, M., & Sabbagh, S. (2015). Prevalence, Demographics and Clinical Characteristics of Multiple Sclerosis in North of Khuzestan Province, Iran. Jentashapir Journal of Health Research, 6(5).
[26]  da Silva, N. L., Takemoto, M. L., Damasceno, A., Fragoso, Y. D., Finkelsztejn, A., Becker, J., . . . Boulos, F. C. (2016). Cost analysis of multiple sclerosis in Brazil: A cross-sectional multicenter study. BMC Health Services Research, 16(1), 102.
[27]  Dayapoğlu, N., & Tan, M. (2017). The care burden and social support levels of caregivers of patients with multiple sclerosis. Kontakt, 19(1), e17-e23.
[28]  Goodworth, M. R., Stepleman, L., Hibbard, J., Johns, L., Wright, D., Hughes, M. D., & Williams, M. J. (2014). Variables associated with patient activation in persons with multiple sclerosis. Journal of Health Psychology, 21(1), 82-92.
[29]  Ghafari, S., Fallahi-Khoshknab, M., Norouzi, K., & Mohamadi, E. (2014). Experiences of hospitalization in patients with multiple sclerosis: A qualitative study. Iranian journal of nursing and midwifery research, 19(3), 255-61.
[30]  Marrie, R. A., Elliott, L., Marriott, J., Cossoy, M., Tennakoon, A., & Yu, N. (2014). Comorbidity increases the risk of hospitalizations in multiple sclerosis. Neurology, 84(4), 350-358.
[31]  Lavery, A. M., Banwell, B. L., Liu, G., & Waldman, A. T. (2016). Hospital admission rates for pediatric multiple sclerosis in the United States using the Pediatric Health Information System (PHIS). Multiple Sclerosis and Related Disorders, 9, 5-10.
[32]  Garland, A., Metz, L. M., Bernstein, C. N., Peschken, C. A., Hitchon, C. A., & Marrie, R. A. (2017). Hospitalization is associated with subsequent disability in multiple sclerosis. Multiple Sclerosis and Related Disorders, 14, 23-28.
[33]  Berrigan, L. I., Fisk, J. D., Patten, S. B., Tremlett, H., Wolfson, C., Warren, S., . . . Marrie, R. A. (2016). Health-related quality of life in multiple sclerosis. Neurology, 86(15), 1417-1424.
[34]  Dayer, D., Abdollahzadeh, F., Nadery, Z., & Nasab, N. M. (2016). Prevalence of Diabetes Type 1 in Patients Suffered From Multiple Sclerosis. Jentashapir Journal of Health Research, 7(2).
[35]  Newland, P., Starkweather, A., & Sorenson, M. (2016). Central fatigue in multiple sclerosis: A review of the literature. The Journal of Spinal Cord Medicine, 39(4), 386-399.
[36]  Ayache, S. S., & Chalah, M. A. (2017). Fatigue in multiple sclerosis – Insights into evaluation and management. Neurophysiologie Clinique/Clinical Neurophysiology, 47(2), 139-171.
[37]  Blikman, L. J., Meeteren, J. V., Horemans, H. L., Kortenhorst, I. C., Beckerman, H., Stam, H. J., & Bussmann, J. B. (2015). Is Physical Behavior Affected in Fatigued Persons With Multiple Sclerosis? Archives of Physical Medicine and Rehabilitation, 96(1), 24-29.
[38]  Strober, L. B. (2015). Fatigue in Multiple Sclerosis: A Look at the Role of Poor Sleep. Frontiers in Neurology, 6.
[39]  Kessel, K. V., Babbage, D. R., Reay, N., Miner-Williams, W. M., & Kersten, P. (2017). Mobile Technology Use by People Experiencing Multiple Sclerosis Fatigue: Survey Methodology. JMIR MHealth and UHealth, 5(2).
[40]  Wilski, M., & Tasiemski, T. (2015). Illness perception, treatment beliefs, self-esteem, and self-efficacy as correlates of self-management in multiple sclerosis. Acta Neurologica Scandinavica, 133(5), 338-345.
[41]  Encarnacao, P., Oliveira, C. C., & Martins, T. (2018). Suffering, a Concept Present in Non-Cancer Patients: Multiple Sclerosis Patients. International Journal of Caring Sciences, 11(1), 572.
[42]  Zarei, B., Vagharseyyedin, S. A., & Gorganie, E. (2015). Relationship Between Spiritual Well-Being and Self-Management Among Iranian People With Multiple Sclerosis. Jundishapur Journal of Chronic Disease Care, 4(4).
[43]  Strober, L. B. (2016). Personality in multiple sclerosis (MS): Impact on health, psychological well-being, coping, and overall quality of life. Psychology, Health & Medicine, 22(2), 152-161.
[44]  Sanai, S. A., Saini, V., Benedict, R. H., Zivadinov, R., Teter, B. E., Ramanathan, M., & Weinstock-Guttman, B. (2016). Aging and multiple sclerosis. Multiple Sclerosis Journal, 22(6), 717-725.
[45]  Vijn, J., Mulder, B. C., & Nederland, M. V. Living with MS.
[46]  Tahajodi, R., Parvaneh, S., Ghahari, S., & Negarandeh, R. (2015). Exploring the self-Management strategies in people with multiple sclerosis. Nursing Practice Today, 2(3), 103-111.
[47]  Boogar, I. R., Talepasand, S., & Jabari, M. (2018). Psychosocial and Medical Determinants of Health-related Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis. Archives of Neuropsychiatry, 55(1), 29.
[48]  Bjørnevik, K., Riise, T., Benjaminsen, E., Celius, E. G., Dahl, O. P., Kampman, M. T., . . . Grytten, N. (2016). Level of education and multiple sclerosis risk over a 50-year period: Registry-based sibling study. Multiple Sclerosis Journal, 23(2), 213-219.
[49]  Rimkus, C. D., Avolio, I. M., Miotto, E. C., Pereira, S. A., Mendes, M. F., Callegaro, D., & Leite, C. D. (2018). The protective effects of high-education levels on cognition in different stages of multiple sclerosis. Multiple Sclerosis and Related Disorders, 22, 41-48.
[50]  Riemann-Lorenz, K., Eilers, M., Geldern, G. V., Schulz, K., Köpke, S., & Heesen, C. (2016). Dietary Interventions in Multiple Sclerosis: Development and Pilot-Testing of an Evidence Based Patient Education Program. Plos One, 11(10), e0165246.
[51]  Effat, S., Azzama, H., Shalashb, A., Elkatana, S., & Elrassasa, H. (2016). Self-reported quality of life of patients with multiple sclerosis with mild disability. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 53(3), 161.
[52]  Fiest, K., Walker, J., Bernstein, C., Graff, L., Zarychanski, R., Abou-Setta, A., . . . Marrie, R. (2016). Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Multiple Sclerosis and Related Disorders, 5, 12-26.
[53]  Mulligan, H., Wilkinson, A., & Snowdon, J. (2016). Perceived Impact of a Self-Management Program for Fatigue in Multiple Sclerosis. International Journal of MS Care, 18(1), 27-32.
[54]  Hubbard, E. A., Motl, R. W., & Fernhall, B. (2018). Sedentary Behavior and Blood Pressure in Patients with Multiple Sclerosis. International Journal of MS Care, 20(1), 1-8.
[55]  Baghbanian, S. M. (2016). Follow-up of hypertension in‎ patients with multiple sclerosis. Iranian journal of neurology, 15(3), 180-181.
[56]  Hou, W., Li, C., Chang, H., Sun, Y., & Tsai, C. (2017). A population-based cohort study suggests an increased risk of multiple sclerosis incidence in patients with type 2 diabetes mellitus. Journal of Epidemiology, 27(5), 235-241.
[57]  Ruiz-Argüelles, G., & Gomez-Almaguer, D. (2017). Hematopoietic stem cell transplants for persons with multiple sclerosis: Is this the best therapeutic option? Medicina Universitaria, 19(77), 208-209.
[58]  Rezapour, A., Kia, A. A., Goodarzi, S., Hasoumi, M., Motlagh, S. N., & Vahedi, S. (2017). The impact of disease characteristics on multiple sclerosis patients’ quality of life. Epidemiology and Health, 39.
[59]  Edwards, N. C., Munsell, M., Menzin, J., & Phillips, A. L. (2018). Comorbidity in US patients with multiple sclerosis. Patient Related Outcome Measures, Volume 9, 97-102.
[60]  Goldman, M. D., Koenig, S., Engel, C., Mccartney, C. R., & Sohn, M. (2017). Glucocorticoid-associated blood glucose response and MS relapse recovery. Neurology - Neuroimmunology Neuroinflammation, 4(5), e378.
[61]  Kidd, T., Carey, N., Mold, F., Westwood, S., Miklaucich, M., Konstantara, E., . . . Cooke, D. (2017). A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life. Plos One, 12(10), e0185931.
[62]  Kos, D., Duportail, M., Meirte, J., Meeus, M., D’Hooghe, M. B., Nagels, G., . . . Nijs, J. (2016). The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue. International Journal of Rehabilitation Research, 39(3), 255-262.
[63]  Rommer, P. S., König, N., Sühnel, A., & Zettl, U. K. (2018). Coping behavior in multiple sclerosis-complementary and alternative medicine: A cross-sectional study. CNS Neuroscience & Therapeutics, 24(9), 784-789.
[64]  Grech, L. B., Kiropoulos, L. A., Kirby, K. M., Butler, E., Paine, M., & Hester, R. (2018). Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis. International Journal of MS Care, 20(3), 109-119.
[65]  Dehghani, A., & Keshavarzi, A. (2018). Development and validation of a multidimensional health literacy questionnaire for multiple sclerosis patients. Multiple Sclerosis and Related Disorders, 25, 156-162.
[66]  Messina, M. J., Costa, G. D., Rodegher, M., Moiola, L., Colombo, B., Comi, G., & Martinelli, V. (2015). The Communication of Multiple Sclerosis Diagnosis: The Patients’ Perspective. Multiple Sclerosis International, 2015, 1-7.
[67]  Younus, Z., Vaughn, C. B., Sanai, S. A., Kavak, K. S., Gupta, S., Nadeem, M., . . . Weinstock-Guttman, B. (2017). Fatigue and Mood States in Nursing Home and Nonambulatory Home-Based Patients with Multiple Sclerosis. International Journal of MS Care, 19(6), 297-302.
[68]  Wendebourg, M. J., Heesen, C., Finlayson, M., Meyer, B., Pöttgen, J., & Köpke, S. (2017). Patient education for people with multiple sclerosis-associated fatigue: A systematic review. Plos One, 12(3), e0173025.
[69]  Faraji, F., Khosravi, S., Sajadi, M., Farahani, Z., & Rafiei, F. (2018). Effect of Self-Care Education on Social Adaptability in Patients with Multiple Sclerosis. Iranian Red Crescent Medical Journal, 20(1).