Fatigue in osteoarthritis: a qualitative study

J Denise Power¹^,2 , Elizabeth M Badley¹^,2 , Melissa R French³ , Angela J Wall³ and Gillian A Hawker²^,3^,4^,5

¹Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

²Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute Toronto, Ontario, Canada

³Canadian Osteoarthritis Research Program, Women's College Hospital, Toronto, Ontario, Canada

⁴Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

⁵Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada

author email corresponding author email

BMC Musculoskeletal Disorders 2008, 9:63doi:10.1186/1471-2474-9-63


Published:	1 May 2008

Abstract

Background

Fatigue is recognized as a disabling symptom in many chronic conditions including rheumatic disorders such as rheumatoid arthritis (RA) and lupus. Fatigue in osteoarthritis (OA) is not routinely evaluated and has only been considered in a very limited number of studies. To date, these studies have focused primarily on patients with OA under rheumatological care, which represent the minority of people living with OA. The purpose of this study was to increase our understanding of the fatigue experience in community dwelling people with OA.

Methods

In 2004, 8 focus groups were conducted with 28 men and 18 women (mean age 72.3) with symptomatic hip or knee OA recruited from a population-based cohort. Participants completed a self-administered questionnaire, which included demographics, measures of OA severity (WOMAC), depression (CES-D) and fatigue (FACIT). Sessions were audio taped and transcribed verbatim. Two researchers independently reviewed the transcripts to identify themes. Findings were compared and consensus reached.

Results

Mean pain, disability, depression and fatigue scores were 8.7/20, 27.8/68, 15.4/60, and 30.9/52, respectively. Participants described their fatigue as exhaustion, being tired and "coming up against a brick wall". Participants generally perceived fatigue as different from sleepiness and distinguished physical from mental fatigue. Factors believed to increase fatigue included OA pain and pain medications, aging, various types of weather and poor sleep. Mental health was identified as both affecting fatigue and being affected by fatigue. Participants described fatigue as impacting physical function, and their ability to participate in social activities and to do household chores. Rest, exercise, and avoiding or getting assistance with activities were cited as ways of coping. Participants generally did not discuss their fatigue with anyone except their spouses.

Conclusion

Participants with OA described experiencing notable amounts of fatigue and indicated that it had a substantial impact on their lives. Further research is required to better understand the role of fatigue in OA in order to identify strategies to reduce its impact.