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Fatigue och återhämtning efter hjärtinfarkt
University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.ORCID iD: 0000-0003-0339-2671
2015 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fast and efficient acute medical treatment of myocardial infarction (MI) has developed during recent years and has resulted in a reduced number of days spent in hospital and increased survival. To optimize persons’ recovery, secondary preventive strategies are important. Fatigue has been reported to be the most bothersome symptom in 50% of persons treated for MI and was described as incomprehensible due to its unpredictable occurrence and unknown cause. Today, in cardiac rehabilitation programs there are typically few or no recommendations at all concerning strategies for dealing with fatigue after MI. The main focus was to explore how self-reported fatigue after MI could be measured in a psychometrically valid manner and to describe the symptom of fatigue in relation to other concurrent symptoms, how the heart attack was handled and its consequences in everyday life two months after MI. With a view to creating opportunities to identify and measure fatigue post-MI, the first specific aim was to validate the usefulness of the questionnaire Multidimensional Fatigue Inventory-20 (MFI-20). A psychometric method called Rasch analysis was used. The results showed that the MFI-20 can be used to obtain a global score reflecting an underlying unidimensional trait of fatigue; and transformation of the summarized raw scale scores into interval scale scores was possible. Also, four of the five original dimensions separately fitted the Rasch model and could be used to identify general fatigue, physical fatigue, mental fatigue and reduced activity. One of the specific aims was to examine persons’ experiences of fatigue consequences and strategies used to manage fatigue two months after the heart attack. Interviews were conducted (n= 18) and analyzed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category was I’ve lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Another specific aim was to explore fatigue levels two months after myocardial infarction (MI) and examine associations with other concurrent symptoms, sleep quality and the coping strategies used to handle the MI. The results showed that a global fatigue score two months post-MI was associated with concurrent symptoms, such as breathlessness and stress, and coping strategies, such as change of values, intrusion, and isolation. In comparisons of present fatigue dimension levels (general fatigue, physical fatigue, reduced activity and mental fatigue) two months post-MI and baseline measurements (first week in hospital), the results showed that levels of fatigue dimensions had decreased. In comparisons with levels of fatigue four months post-MI in a reference group, we found lower levels of fatigue two months post-MI. In the final study, the aim was to validate a single-item measure of stress symptoms and to explore its association with fatigue in a sample of persons treated for MI. The results confirmed the convergent validity of the single-item measure of stress symptoms. In analyses of relations between stress and fatigue, it was found that the single-item stress measure was strongly associated with both the global fatigue score and all four fatigue dimension scores (general, physical and mental fatigue as well as reduced activity). In conclusion, fatigue two months post-MI had significant consequences because it restricted informants’ potential to function in daily life as they had done previously. The present thesis showed that post-MI fatigue could be identified both globally and multidimensionality. The results could serve as the basis for a future recovery intervention aimed at preventing and relieving post-MI fatigue and based on managing daily life in relation to personal experiences. By facilitating identification of fatigued persons using quantitative measurements and personal narratives about the consequences of fatigue, such an intervention would enable health-care professionals to tailor fatigue relief support during the recovery period. Elaboration of this intervention is a question for further research.

Place, publisher, year, edition, pages
Göteborg: Institutionen för vårdvetenskap och hälsa vid Sahlgrenska akademin, Göteborgs universitet , 2015. , 57 p.
Keyword [en]
Coping strategies, fatigue, grounded theory, myocardial infarction, nursing, person-centeredness, psychometric evaluation, Rasch analysis, stress, symptom assessment, symptom experience, symptom research, The Multidimensional Fatigue Inventory-20 (MFI-20)
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-7636ISBN: 9789162893248 (print)ISBN: 978-91-628-9325-5 (print)OAI: oai:DiVA.org:hv-7636DiVA: diva2:815704
Supervisors
Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2015-06-01Bibliographically approved
List of papers
1. The single-item measure of stress symptoms after myocardial infarction and its association with fatigue.
Open this publication in new window or tab >>The single-item measure of stress symptoms after myocardial infarction and its association with fatigue.
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2015 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, 345-353 p.Article in journal (Refereed) Published
Abstract [en]

Surviving a myocardial infarction (MI) can be a stressful event entailing challenges in daily life during the recovery period. Experiencing fatigue symptoms post-MI has been described as bothersome and occurs in nearly half of patients four months and two years after MI. The aetiology of fatigue disorder is unclear, but research has shown that fatigue plays an important role in the relationship between stress and perceived poor health. Previous findings indicate that having access to an easily administered stress measurement is worthwhile both in the clinic and in research. The single-item measure of stress symptoms has not been validated in persons treated for MI. The aim was to validate the single-item measure of stress symptoms and to explore its association with fatigue in a sample of persons treated for MI. Methods: 142 respondents completed the questionnaires of the Multidimensional Fatigue Inventory-20, the single-item measure of stress symptoms and the Perceived Stress Scale-10 (PPS-10) two months post-MI. Correlation analysis and t-tests were used to validate the single-item stress measure and its association with post-MI fatigue. Results: The convergent validity of the single-item measure of stress symptoms was confirmed. In analyses of relations between stress and fatigue, it was found that the single-item stress measure was strongly associated with both the global fatigue score and all four fatigue dimension scores (general, physical and mental fatigue as well as reduced activity). Conclusion: The single-item measure of stress symptoms was found to be a valid measure of post-MI stress. Also, the measure was useful in assessing associations between stress and fatigue and could therefore indicate that post-MI fatigue experiences should be further explored in full using multidimensional fatigue assessmen

Keyword
Myocardial Infarction, Fatigue, Stress, Symptom Research
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-7635 (URN)10.4236/ojn.2015.54037 (DOI)
Note

Ingår i avhandling

Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2016-11-21Bibliographically approved
2. Psychometric analysis of the Multidimensional Fatigue Inventory in a sample of persons treated for myocardial infarction
Open this publication in new window or tab >>Psychometric analysis of the Multidimensional Fatigue Inventory in a sample of persons treated for myocardial infarction
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2015 (English)In: Journal of Nursing Measurement, ISSN 1061-3749, Vol. 23, no 1, 154-167 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
New York: Springer, 2015
Keyword
FATIGUE, MYOCARDIAL INFARCTION, NURSING, PERSON-CENTERED CARE, PSYCHOMETRIC EVALUATION, RASCH ANALYSIS
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-7633 (URN)10.1891/1061-3749.23.1.154 (DOI)
Note

Background and Purpose: Fatigue after myocardial infarction is a frequent and distressing symptom in the early recovery phase. The purpose of this study is to psychometrically evaluate the Multidimensional Fatigue Inventory (MFI-20). Methods: The MFI-20 was evaluated using Rasch analysis. Results: The result showed that the MFI-20 can be used to obtain a global score reflecting an underlying unidimensional trait of fatigue; a transformation of the summarized raw scale scores into interval scale scores could be made. Also, 4 of the 5 original dimensions separately fitted the Rasch model. Conclusions: Calculation of a global score increases the possibility of identifying persons experiencing fatigue after myocardial infarction, and using the MFI-20 dimension scores increases the possibility of determining each person's specific fatigue profile.

Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2016-06-09Bibliographically approved
3. Fatigue two months after MI and its relationships with other concurrent symptoms, sleep quality and coping strategies
Open this publication in new window or tab >>Fatigue two months after MI and its relationships with other concurrent symptoms, sleep quality and coping strategies
(Swedish)Article in journal (Refereed) Submitted
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-7634 (URN)
Note

Ingår i avhandling

Available from: 2015-06-01 Created: 2015-06-01 Last updated: 2016-06-09Bibliographically approved
4. I've lost the person I used to be-Experiences of the consequences of fatigue following myocardial infarction
Open this publication in new window or tab >>I've lost the person I used to be-Experiences of the consequences of fatigue following myocardial infarction
2013 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, 20836- p.Article in journal (Refereed) Published
Abstract [en]

Fatigue has been found to be the most frequent and bothersome symptom after myocardial infarction (MI), influencing health-related quality of life negatively. Moreover, fatigue after MI has been described as incomprehensible due to its unpredictable occurrence and lack of relationship to physical effort. The aim of this study is therefore to explore persons' experiences of consequences of fatigue and their strategies for dealing with it 2 months after MI. In total, 18 informants, aged 42-75 years, participated in the study. Interviews were conducted and analysed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category, was: I've lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Furthermore, attempts to relieve fatigue were limited. These findings indicate that patients with symptoms of fatigue should be supported in developing relief strategies, for example, rest and sleep hygiene as well as physical activity. In conclusion, the results show that fatigue can be understood in light of the concepts "comprehensibility" and "manageability." They also indicate that, working from a person-centered perspective, health-care professionals can support patients experiencing post-MI fatigue by giving them opportunities to straighten out the question marks and by inviting them to discuss involuntary thoughts and feelings of being restricted in their daily life functioning.

Keyword
Fatigue, grounded theory, myocardial infarction, symptom experience, person-centered care, sense of coherence, chronic heart-failure, quality-of-life, coherence, sense
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-5570 (URN)10.3402/qhw.v8i0.20836 (DOI)000320441000001 ()2-s2.0-84880267563 (Scopus ID)
Available from: 2013-08-22 Created: 2013-08-13 Last updated: 2015-06-01Bibliographically approved

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