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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Health and Quality of Life Outcomes 1/2018

Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20)

Health and Quality of Life Outcomes > Ausgabe 1/2018
Gloria-Beatrice Wintermann, Jenny Rosendahl, Kerstin Weidner, Bernhard Strauß, Andreas Hinz, Katja Petrowski
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12955-018-0862-6) contains supplementary material, which is available to authorized users.



Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients.


A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study.


The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37).


In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.

Trial registration

German Clinical Trials Registration DRKS00003386. Registered 13 December 2011, retrospectively registered.
Additional file 1: Table S3. MFI-20 models tested via Confirmatory Factor Analysis (CFA) in n = 91 patients six months post-ICU (t3). (DOCX 16 kb)
Additional file 2: Table S1. Medical comorbidities of the patients being followed-up (n = 113) and the non-participants (n = 239). Patients who could not be included or followed-up for different reasons were referred to as non-participants. (DOCX 17 kb)
Additional file 3: Table S2. Correlation coefficients of the MFI-20 items with the subscales. The item-subscale correlation coefficients are significant with **p < .01 or ***p < .001. (DOCX 15 kb)
Additional file 4: Figure S1. Bland and Altman plot comparing the five subscales and the total score of the MFI-20 between t2 (three months post-ICU) and t3 (six months post-ICU). Bold lines represent the mean differences, dotted lines represent the 95% limits of agreement (see Additional files). Differences and mean values were created using MFI-20 scores of t2 and t3. (JPEG 2516 kb)
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