Treatment Of chronic Fatigue in patients with multiple sclerosis by paramedical disciplines

Fatigue assessed using the self report questionnaire Checklist individual strength (CIS-20R): 20 statements for which the participant has to indicate on a 7 point scale ranging from ‘Yes, that is true’ to ‘No, that is not true’ to what extent the particular statement applies to him or her, at baseline, 12 weeks and 24 weeks.

1. Modified Fatigue Impact Scale (MFIS): assesses the perceived impact of fatigue on the subscales physical, cognitive and psychosocial functioning during the past 4 weeks. Participants rate on a 5-point Likert scale, ranging from ‘Never’ to ‘Almost always’, their agreement with 21 statements.
2. Fatigue Severity Scale (FSS): a nine-item questionnaire to assess the severity of fatigue and its impact on an individual’s daily functioning using a seven-point rating scale. Participants rate their agreement with a statement ranging from one point, reflecting ‘strongly disagree’ to seven points representing ‘strongly agree’, depending on how appropriate they feel the statement applies to them
3. Functional Independence Measure (FIM): measures activities of daily living. It is an 18-item, generic seven-point rating scale to assess physical and cognitive disability in terms of burden of care.
4. Disability and Impact Profile (DIP): is a 39 item self-administered questionnaire regarding activities that may be restricted by a disabling disease. Each item is rated on a 0-10 point scale for its current disability and for the importance of that disability
5. Multiple Sclerosis Impact Scale (MSIS-29): disease-specific measure of the physical (20 items) and psychological (9 items) impact of MS from the patient’s perspective. The self-reported instrument measures disease impact due to limitations in the past 2 weeks, scored on 5 levels from ‘‘not at all’’ to ‘‘extremely.’’ Scores on the individual items are added and then transformed to a 0–100 scale, thereby generating two summary scores (for physical and psychological impact).
6. Impact on Participation and Autonomy (IPA): measures person-perceived participation. The IPA is a generic questionnaire that addresses 2 different aspects of participation: (1) perceived participation, reflected in 31 items in 5 domains (interior and exterior autonomy, family role, social relations and job and education) , and (2) the experience of problems for every aspect of participation, reflected in 8 problem experience scores (mobility, selfcare, activities around the house, looking after money, leisure, social life and relations, helping and supporting other people, paid for voluntary work, education and training).

All measures were assessed at baseline, 12 weeks and 24 weeks