Modified Fatigue Impact Scale (MFIS)

Assesses the impact of fatigue on patients diagnosed with multiple sclerosis.

In the text below the calculator there is more information on the two versions of the scale that are available, on their items and on how the result is interpreted.

The modified fatigue impact scale looks at how fatigue related symptoms affect the quality of life of patients suffering from multiple sclerosis.

The 21 items can be separated in three functioning dimensions to generate further insight into level of disability.

The MFIS belongs to the MS assessment tools in the Multiple Sclerosis Quality of Life Inventory (MSQLI).

The full (21 item) MFIS consists of three individual subscales:

■ Physical functioning (out of 36 points): items 4, 6, 7, 10, 13, 14, 17, 20, 21;

■ Cognitive functioning (out of 40 points): items 1, 2, 3, 5, 11, 12, 15, 16, 18, 19;

■ Psychosocial functioning (out of 8 points): items 8, 9.

The short version consists of 5 items (1, 9, 10, 17, 19) and provides a score out of 20.

The smallest detectable chance is 16.2 while the minimal detectable change (MDC) is 19.3%.

The scale is very useful for the longitudinal tracking of MS related fatigue and its interpretation remains at clinical judgment.

1I have been less alert
2I have had difficulty paying attention
3I have been unable to think clearly
4I have been clumsy and uncoordinated
5I have been forgetful
6I have had to pace myself in my physical activities
7I have been less motivated to do anything that requires physical effort
8I have been less motivated to participate in social activities
9I have been limited in my ability to do things away from home
10I have had trouble maintaining physical effort for long periods
11I have had difficulty making decisions
12I have been less motivated to do anything that requires thinking
13My muscles have felt weak
14I have been physically uncomfortable
15I have had trouble finishing tasks that require thinking
16I have had difficulty organizing things
17I have been less able to complete tasks that require physical effort
18My thinking has been slowed down
19I have had trouble concentrating
20I have limited my physical activities
21I have needed to rest more often or for longer periods of time
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!The shortened version of the MFIS uses questions 1, 9, 10, 17, and 19 from the longer version of the MFIS.
1I have been less alert
9I have been limited in my ability to do things away from home
10I have had trouble maintaining physical effort for long periods
17I have been less able to complete tasks that require physical effort
19I have had trouble concentrating
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Scale items

The MFIS is the modified form of the Fatigue Impact Scale and is specifically designed to incorporate symptoms that are related to MS fatigue and that can affect the patient’s quality of life.

As such, it is also incorporated in the assessment tools from the Multiple Sclerosis Quality of Life Inventory (MSQLI).

The result from the long, 21-item version is provided as a final score but also in three functional dimensions: Physical, Cognitive and Psychosocial.

There is also a short version, comprising of 5 items, which is often used when the assessment is time limited or does not require too much specificity.

Both versions of the MFIS are self-report and should take between 5 to 10 minutes (long version) and 2 to 3 minutes (short version).

The 21-item MFIS and the item separation in the three individual subscales is described below:

Functional dimension Items from the MFIS
Physical functioning (out of 36) 4. I have been clumsy and uncoordinated.
6. I have had to pace myself in my physical activities.
7. I have been less motivated to do anything that requires physical effort.
10. I have had trouble maintaining physical effort for long periods.
13. My muscles have felt weak.
14. I have been physically uncomfortable.
17. I have been less able to complete tasks that require physical effort.
20. I have limited my physical activities.
21. I have needed to rest more often or for longer periods of time.
Cognitive functioning (out of 40) 1. I have been less alert.
2. I have had difficulty paying attention.
3. I have been unable to think clearly.
5. I have been forgetful.
11. I have had difficulty making decisions.
12. I have been less motivated to do anything that requires thinking.
15. I have had trouble finishing tasks that require thinking.
16. I have had difficulty organizing things.
18. My thinking has been slowed down.
19. I have had trouble concentrating.
Psychosocial functioning (out of 8) 8. I have been less motivated to participate in social activities.
9. I have been limited in my ability to do things away from home.

The short version of the MFIS consists of questions 1, 9, 10, 17, and 19 from the long version:

■ I have been less alert;

■ I have been limited in my ability to do things away from home;

■ I have had trouble maintaining physical effort for long periods;

■ I have been less able to complete tasks that require physical effort;

■ I have had trouble concentrating.

Compared to other multiple sclerosis assessment models, such as the Beighton Score or the Modified Ashworth Scale, MFIS was found to evaluate better the cognitive and psychological dimension.

 

Score interpretation

In both versions of MFIS, the items are placed on an ordinal scale, with points from 0 to 4:

■ Never (0 points);

■ Rarely (1 point);

■ Sometimes (2 points);

■ Often (3 points);

■ Almost Always (4 points).

The total obtainable score in the long version is 84 whilst in the short version is 20.

In regard to interpretation, there isn’t a specific cut off point for fatigue severity impact and the interpretation remains open to clinical judgment. However, the scale is very useful in longitudinal tracking of MS related fatigue.

The fact that the scale lacks objective anchor points has been criticised, along with the fact that because the subscales often correlate with each other, they are of limited usability.

 

About the study

MFIS was created in 1984 by Freal et al. following a study on initially 656 patients with MS from which 309 returned a follow-up questionnaire on symptomatic fatigue.

90% of the 309 subjects reported defined fatigue as "tiredness or the need to rest" and in 48% of the subjects, fatigue was perceived as increasing the severity of other MS symptoms.

Daily occurrence of fatigue, especially in the late afternoon and evening, was reported by 66% of subjects. Environmental temperature or exercise were also found to increase symptom severity.

For most subjects, a planned daily schedule of activity and rest seemed to be partially effective in reducing fatigue.

 

Original source

Freal JE, Kraft GH, Coryell JK. Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil. 1984; 65(3):135-8.

Validation

Téllez N, Río J, Tintoré M, Nos C, Galán I, Montalban X. Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS? Mult Scler. 2005; 11(2):198-202.

Other references

1. Braley TJ, Chervin RD. Fatigue in Multiple Sclerosis: Mechanisms, Evaluation, and Treatment. Sleep. 2010; 33(8): 1061–1067.

2. Larson RD. Psychometric Properties of the Modified Fatigue Impact Scale. Int J MS Care. 2013; 15(1): 15–20.

Specialty: Rehabilitation Medicine

System: Nervous

Objective: Evaluation

Type: Scale

No. Of Items: 21 (O) / 5 (S)

Year Of Study: 1984

Abbreviation: MFIS

Article By: Denise Nedea

Published On: May 18, 2017 · 09:13 AM

Last Checked: May 18, 2017

Next Review: May 18, 2023