Impact of fatigue on the health-related quality of life in persons with spinal cord injury

Objective: To study the impact of fatigue on health-related quality of life (HR-QOL) associated with spinal cord injury (SCI). Design: Matched group design with several independent measures. Setting: University-based laboratory. Participants: Persons with SCI (n=41) and an average 16.5 years duration of community living with SCI and a group of able-bodied controls (n=41) with similar sex ratio, age, and level of education. Participants with SCI were enrolled through rehabilitation unit contacts and through advertising in newsletters. Interventions: Not applicable. Main Outcome Measures: The main independent measures reported in this article include the Iowa Fatigue Scale and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: As expected, persons with SCI were found to have significantly lower HR-QOL. Fatigue was found to be more prevalent in the SCI group, and was associated with lower HR-QOL in both groups. Factorial analysis of variance indicated significant interactions in which persons with SCI with low fatigue levels had similar HR-QOL to the able-bodied controls regardless of their fatigue level, while persons with SCI with elevated fatigue had significantly reduced HR-QOL. Factors such as age, education, completeness and level of lesion, and community integration were not associated with increased fatigue levels. However, a shorter time since injury was found to be significantly associated with higher levels of fatigue. Conclusions: The Iowa Fatigue Scale data suggest over 50% of the SCI group had elevated fatigue, which was associated with significantly reduced HR-QOL. Research is needed that identifies factors that raise vulnerability to fatigue, and strategies designed to address the negative impacts of fatigue need to be evaluated.