M Worm-Smeitink1, M Gielissen2, L Bloot3, H W M van Laarhoven4, B G M van Engelen5, P van Riel6, G Bleijenberg7, S Nikolaus1, H Knoop8. 1. Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands. 2. Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 3. Department of Medical Psychology, Isala Klinieken, Zwolle, The Netherlands. 4. Department of Medical Oncology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands. 5. Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands. 6. IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands. 7. Radboud University Medical Center, The Netherlands. 8. Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Electronic address: hans.knoop@amc.uva.nl.
Abstract
OBJECTIVE: The Checklist Individual Strength (CIS) measures four dimensions of fatigue: Fatigue severity, concentration problems, reduced motivation and activity. On the fatigue severity subscale, a cut-off score of 35 is used. This study 1) investigated the psychometric qualities of the CIS; 2) validated the cut-off score for severe fatigue and 3) provided norms. METHODS: Representatives of the Dutch general population (n=2288) completed the CIS. The factor structure was investigated using an exploratory factor analysis. Internal consistency and test-retest reliability were determined. Concurrent validity was assessed in two additional samples by correlating the CIS with other fatigue scales (Chalder Fatigue Questionnaire, MOS Short form-36 Vitality subscale, EORTC QLQ-C30 fatigue subscale). To validate the fatigue severity cut-off score, a Receiver Operating Characteristics analysis was performed with patients referred to a chronic fatigue treatment centre (n=5243) and a healthy group (n=1906). Norm scores for CIS subscales were calculated for the general population, patients with chronic fatigue syndrome (CFS; n=1407) and eight groups with other medical conditions (n=1411). RESULTS: The original four-factor structure of the CIS was replicated. Internal consistency (α=0.84-0.95) and test-retest reliability (r=0.74-0.86) of the subscales were high. Correlations with other fatigue scales were moderate to high. The 35 points cut-off score for severe fatigue is appropriate, but, given the 17% false positive rate, should be adjusted to 40 for research in CFS. CONCLUSION: The CIS is a valid and reliable tool for the assessment of fatigue, with a validated cut-off score for severe fatigue that can be used in clinical practice.
OBJECTIVE: The Checklist Individual Strength (CIS) measures four dimensions of fatigue: Fatigue severity, concentration problems, reduced motivation and activity. On the fatigue severity subscale, a cut-off score of 35 is used. This study 1) investigated the psychometric qualities of the CIS; 2) validated the cut-off score for severe fatigue and 3) provided norms. METHODS: Representatives of the Dutch general population (n=2288) completed the CIS. The factor structure was investigated using an exploratory factor analysis. Internal consistency and test-retest reliability were determined. Concurrent validity was assessed in two additional samples by correlating the CIS with other fatigue scales (Chalder Fatigue Questionnaire, MOS Short form-36 Vitality subscale, EORTC QLQ-C30 fatigue subscale). To validate the fatigue severity cut-off score, a Receiver Operating Characteristics analysis was performed with patients referred to a chronic fatigue treatment centre (n=5243) and a healthy group (n=1906). Norm scores for CIS subscales were calculated for the general population, patients with chronic fatigue syndrome (CFS; n=1407) and eight groups with other medical conditions (n=1411). RESULTS: The original four-factor structure of the CIS was replicated. Internal consistency (α=0.84-0.95) and test-retest reliability (r=0.74-0.86) of the subscales were high. Correlations with other fatigue scales were moderate to high. The 35 points cut-off score for severe fatigue is appropriate, but, given the 17% false positive rate, should be adjusted to 40 for research in CFS. CONCLUSION: The CIS is a valid and reliable tool for the assessment of fatigue, with a validated cut-off score for severe fatigue that can be used in clinical practice.
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