Prediction of outcome in patients presenting with fatigue in primary care

Abstract

BACKGROUND: Although fatigue is a common problem presenting to primary care, few prospective studies have examined the contribution of a wide range of prognostic factors. AIM: To determine the combination of factors most strongly associated with a favourable or unfavourable course of fatigue, when fatigue is presented as a main symptom in primary care. DESIGN OF STUDY: Prospective, observational cohort study with a 1-year follow-up. SETTING: A total of 147 primary care practices in the Netherlands. METHOD: Patients presenting with fatigue as a main symptom completed questionnaires at baseline, and 1, 4, 8, and 12 months later. The prognostic value of potential predictors was assessed by applying multivariable logistic regression analysis. The outcome was severity of fatigue, defined as a combination of dichotomised scores on several repeated measurements with the Checklist Individual Strength. Separate models were used to predict either a favourable or an unfavourable course of fatigue. RESULTS: Baseline severity of fatigue and patient expectations of chronicity consistently predicted a poor outcome. Additional factors predicting a chronic course were baseline pain intensity and less social support. Baseline characteristics predicting a fast recovery were: male sex, not providing care for others (for example, for older people), better perceived health, and fewer (serious) prolonged difficulties. Both models had good reliability and discriminative validity (area under the receiver operating characteristic curve after internal validation: 0.78 and 0.79). CONCLUSION: The identified combination of predictors reflects the multidimensionality of fatigue, with a significant contribution of patient expectations of chronicity in the prediction of a poor prognosis. These negative perceptions are modifiable, and should receive more attention in the initial assessment of patients presenting with fatigue.