Background
Methods
Subjects and study design
Study procedure
Psychometric assessments of CRF
MFSI-SF
EORTC QLQ-C30
Statistical analysis
Validity
Reliability
Responsiveness
Measurement equivalence
Results
Demographic characteristics
Total (N = 246) | English Version (n = 160) | Chinese Version (n = 86) | P-value | |
---|---|---|---|---|
Demographic information | ||||
Age, mean (± SD) | 53.4 (±10.0) | 51.2 (± 10.3) | 57.4 (±8.0) | < 0.001# |
Gender, n (%) | 0.192 | |||
Female | 230 (93.5) | 152 (95.0) | 78 (90.7) | |
Male | 16 (6.5) | 8 (5.0) | 8 (9.3) | |
Race, n (%) | < 0.001# | |||
Chinese | 198 (80.5) | 114 (71.3) | 84 (97.7) | |
Non-Chinese | ||||
Malay | 26 (10.6) | 26 (16.3) | 0 (0.0) | |
Indians | 12 (4.9) | 12 (7.5) | 0 (0.0) | |
Others | 10 (4.1) | 8 (5.0) | 2 (2.3) | |
Marital Status, n (%) | ||||
Single | 45 (18.3) | 32 (20.0) | 13 (15.1) | 0.546 |
Married | 181 (73.6) | 116 (72.5) | 65 (75.6) | |
Divorced | 17 (6.9) | 11 (6.9) | 6 (7.0) | |
Widowed | 3 (1.2) | 1 (0.6) | 2 (2.3) | |
Education, n (%) | < 0.001# | |||
Low Education | 42 (17.1) | 6 (3.8) | 36 (41.9) | |
None | 9 (3.7) | 2 (1.3) | 7 (8.1) | |
Primary | 33 (13.4) | 4 (2.5) | 29 (33.7) | |
High Education | 204 (82.9) | 154 (96.3) | 50 (58.1) | |
Secondary | 111 (45.1) | 73 (45.6) | 38 (44.2) | |
Pre-University | 45 (18.3) | 37 (23.1) | 8 (9.3) | |
Graduate and Above | 48 (19.5) | 44 (27.5) | 4 (4.7) | |
Occupation, n (%) | 0.097 | |||
Employed | 130 (52.8) | 93 (58.1) | 37 (43.0) | |
Unemployed | 90 (36.6) | 53 (33.1) | 37 (43.0) | |
Student | 1 (0.4) | 1 (0.6) | 0 (0.0) | |
Retired | 25 (10.2) | 13 (8.1) | 12 (14.0) | |
Clinical Information | ||||
ECOG, n (%) | 0.030# | |||
0 | 221 (89.8) | 149 (93.1) | 72 (83.7) | |
1 | 15 (6.1) | 6 (3.8) | 9 (10.5) | |
Missing | 10 (4.1) | 5 (3.1) | 5 (5.8) | |
Menopausal status, n (%) | < 0.001# | |||
Pre-menopausal | 98 (39.8) | 79 (49.4) | 19 (22.1) | |
Post-menopausal | 129 (52.4) | 71 (44.4) | 58 (67.4) | |
Not Applicable | 16 (6.5) | 8 (5.0) | 8 (9.3) | |
Missing | 3 (1.2) | 2 (1.3) | ||
Cancer Diagnosis, n (%) | 0.427 | |||
Breast | 225 (91.5) | 148 (92.5) | 77 (89.5) | |
Lymphoma | 21 (8.5) | 12 (7.5) | 9 (10.5) | |
Cancer Stage, n (%) | 0.554 | |||
I | 34 (13.8) | 26 (16.3) | 8 (9.3) | |
II | 134 (54.5) | 87 (54.4) | 47 (54.7) | |
III | 50 (20.3) | 31 (19.4) | 19 (22.1) | |
IV | 23 (9.3) | 15 (9.4) | 8 (9.3) | |
Unknown | 5 (2.0) | 1 (0.6) | 4 (4.7) | |
Chemotherapy Regimen, n (%) | 0.819 | |||
Anthracycline containing | 132 (53.7) | 85 (53.1) | 47 (54.7) | |
Non-anthracycline containing | 114 (46.3) | 75 (46.9) | 39 (45.3) |
Validity
EORTC QLQ-C30 | MFSI-SF | |||||
---|---|---|---|---|---|---|
General Fatigue | Physical Fatigue | Emotional Fatigue | Mental Fatigue | Vigour | Total Score | |
Functional | ||||||
Physical | − 0.501a | − 0.524a | − 0.404a | − 0.347a | 0.358a | − 0.515a |
Role | − 0.507a | − 0.397a | − 0.412a | − 0.390a |
0.394
a
| − 0.501a |
Emotional | − 0.581a | − 0.492a | − 0.774a | − 0.482a | 0.488a | − 0.661a |
Cognitive | − 0.416a | − 0.383a | − 0.476a |
− 0.756
a
| 0.324a | − 0.519a |
Social | − 0.509a | − 0.421a | − 0.485a | − 0.500a | 0.478a | − 0.591a |
Global QOL | ||||||
Global health status (GHS) | − 0.559a | − 0.533a | − 0.492a | − 0.436a | 0.612a | − 0.667a |
Symptom scales | ||||||
Fatigue |
0.655
a
|
0.537
a
|
0.517
a
|
0.451
a
| − 0.463a |
0.627
a
|
Pain | 0.374a | 0.461a | 0.367a | 0.244a | − 0.230a |
0.378
a
|
Symptom Items | ||||||
Dyspnoea | 0.410a | 0.365a | 0.363a | 0.366a | − 0.287a |
0.419
a
|
Insomnia | 0.367a | 0.398a | 0.360a | 0.319a | − 0.234a |
0.386
a
|
Appetite loss | 0.365a | 0.378a | 0.323a | 0.232a | − 0.380a | 0.410a |
Constipation |
0.348
a
|
0.265
a
|
0.225
a
|
0.206
a
| − 0.267a |
0.323
a
|
Nausea & vomiting | 0.254a | 0.229a | 0.218a | 0.127b | − 0.221a | 0.272a |
Diarrhoea |
0.124
|
0.248
a
|
0.113
|
0.211
a
| − 0.089 |
0.176
a
|
Financial Difficulties | 0.392 | 0.364a | 0.416a | 0.324a | − 0.378a | 0.470a |
Subscales Median scores (IQR) | Breast cancer stagea | EORTC “Did you feel depressed” item 24 score | EORTC “Have you had trouble sleeping” item 11 scoreb | EORTC “Have you had pain” item 9 score | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
1–2 (n = 168) | 3–4 (n = 73) | Score difference | 1–2 (n = 232) | 3–4 (n = 13) | Score difference | 1–2 (n = 189) | 3–4 (n = 56) | Score difference | 1–2 (n = 220) | 3–4 (n = 26) | Score difference | |
General | 3.00 (1.00, 5.00) | 5.00 (1.00, 9.00) | 2.00# | 3.00 (1.00, 6.00) | 10.00 (8.50, 16.50) | 7.00# | 2.00 (0.50, 5.00) | 6.00 (3.00, 11.75) | 4.00# | 3.00 (1.00, 5.75) | 9.00 (4.00, 14.25) | 6.00# |
Physical | 2.00 (1.00, 5.75) | 4.00 (1.50, 6.50) | 2.00# | 2.00 (1.00, 5.75) | 9.00 (6.00, 13.00) | 7.00# | 2.00 (0.00, 4.50) | 6.00 (3.00, 9.00) | 4.00# | 2.00 (1.00, 5.00) | 8.50 (4.00, 15.00) | 6.50# |
Emotional | 1.00 (0.00, 5.00) | 2.00 (0.00, 5.00) | 1.00 | 1.00 (0.00, 5.00) | 12.00 (9.00, 13.00) | 11.00# | 1.00 (0.00, 5.00) | 4.00 (1.00, 8.75) | 3.00# | 1.00 (0.00, 5.00) | 6.50 (2.00, 10.50) | 5.50# |
Mental | 1.00 (0.00, 5.00) | 2.00 (0.00, 5.50) | 1.00 | 1.50 (0.00, 4.00) | 10.00 (5.50, 13.50) | 8.50# | 1.00 (0.00, 4.00) | 2.50 (0.25, 7.75) | 1.50# | 1.50 (0.00, 4.00) | 5.00 (0.75, 9.25) | 3.50# |
Vigour | 14.00 (8.00, 19.00) | 14.00 (10.00, 18.50) | 0.00 | 14.00 (9.25 19.00) | 4.00 (1.50, 8.50) | − 10.00# | 15.00 (10.00, 19.00) | 12.00 (6.00, 16.50) | − 3.00# | 14.00 (9.00, 19.00) | 11.00 (6.00, 15.25) | − 3.00# |
Total MFSI-SF score | − 3.00 (− 15.00, 9.00) | − 1.00 (− 11.00, 13.00) | 2.00 | − 3.00 (− 15.00, 8.75) | 35.00 (30.00, 54.50) | 38.00# | − 5.00 (− 15.00, 7.00) | 9.50 (− 5.75, 34.75) | 14.50# | − 4.00 (−15.00, 8.00) | 17.00 (1.00, 36.75) | 21.00# |
Reliability
Domain/Scale | Item | Content (Listed in English) | Total MFSI-SF score of English and Chinese versions (N = 246) | English version of MFSI-SF (n = 160) | Chinese version of MFSI-SF (n = 86) | |||
---|---|---|---|---|---|---|---|---|
Corrected item-to-domain correlationa | Cronbach’s α | Corrected item-to-domain correlation | Cronbach’s α | Corrected item-to-domain correlation | Cronbach’s α | |||
General (6 items) | 0.914 | 0.917 | 0.904 | |||||
10 | I feel pooped | 0.611 | 0.530 | 0.765 | ||||
12 | I feel worn out | 0.726 | 0.694 | 0.778 | ||||
14 | I feel fatigued | 0.758 | 0.769 | 0.715 | ||||
17 | I feel sluggish | 0.624 | 0.686 | 0.474 | ||||
18 | I feel run down | 0.732 | 0.761 | 0.747 | ||||
28 | I feel tired | 0.773 | 0.751 | 0.783 | ||||
Physical (6 items) | 0.863 | 0.889 | 0.749 | |||||
2 | My muscles ache | 0.614 | 0.685 | 0.463 | ||||
4 | My legs feel weak | 0.616 | 0.676 | 0.479 | ||||
6 | My head feels heavy | 0.477 | 0.491 | 0.450 | ||||
16 | My arms feel weak | 0.568 | 0.608 | 0.503 | ||||
19 | I ache all over | 0.632 | 0.702 | 0.476 | ||||
26 | My body feels heavy all over | 0.629 | 0.686 | 0.502 | ||||
Emotional (6 items) | 0.912 | 0.921 | 0.887 | |||||
3 | I feel upset | 0.746 | 0.737 | 0.764 | ||||
8 | I feel nervous | 0.676 | 0.699 | 0.632 | ||||
13 | I feel sad | 0.789 | 0.789 | 0.787 | ||||
21 | I feel depressed | 0.723 | 0.720 | 0.727 | ||||
23 | I feel tense | 0.685 | 0.732 | 0.600 | ||||
30 | I am distressed | 0.678 | 0.655 | 0.730 | ||||
Mental (6 items) | 0.921 | 0.928 | 0.889 | |||||
1 | I have trouble remembering things | 0.748 | 0.784 | 0.674 | ||||
11 | I am confused | 0.615 | 0.622 | 0.603 | ||||
15 | I have trouble paying attention | 0.729 | 0.780 | 0.635 | ||||
20 | I am unable to concentrate | 0.716 | 0.740 | 0.671 | ||||
25 | I make more mistakes than usual | 0.679 | 0.671 | 0.701 | ||||
27 | I am forgetful | 0.781 | 0.798 | 0.756 | ||||
Vigour (6 items) | 0.936 | 0.944 | 0.917 | |||||
5 | I feel cheerful | 0.833 | 0.827 | 0.844 | ||||
7 | I feel lively | 0.820 | 0.868 | 0.719 | ||||
9 | I feel relaxed | 0.790 | 0.839 | 0.690 | ||||
22 | I feel refreshed | 0.833 | 0.829 | 0.843 | ||||
24 | I feel energetic | 0.853 | 0.853 | 0.862 | ||||
29 | I feel calm | 0.803 | 0.833 | 0.749 |
Responsiveness
EORTC QLQ-C30 | MFSI-SF | |||||
---|---|---|---|---|---|---|
General Fatigue | Physical Fatigue | Emotional Fatigue | Mental Fatigue | Vigour | Total Score | |
Functional | ||||||
Physical | − 0.292a |
− 0.239
a
| − 0.156b | − 0.173a | 0.183a | − 0.297a |
Role | − 0.262a | − 0.202a | − 0.211a | − 0.203a |
0.202
a
| − 0.296a |
Emotional | − 0.236a | − 0.241a |
− 0.447
a
| − 0.243a | 0.219a | − 0.372a |
Cognitive | − 0.202a | − 0.205a | − 0.196a | − 0.361a | 0.183a | − 0.294a |
Social | − 0.231a | − 0.153a | − 0.180a | − 0.124 | 0.156b | − 0.228a |
Global QOL | ||||||
Global health status (GHS) | − 0.361a | − 0.286a | − 0.317 | − 0.180a | 0.302a | − 0.404a |
Symptom scales | ||||||
Fatigue |
0.412
|
0.368
a
|
0.406
a
|
0.277
a
| − 0.283a |
0.478
a
|
Pain | 0.221 | 0.350a | 0.113 | 0.127 | − 0.090 |
0.240
a
|
Symptom Items | ||||||
Dyspnoea | 0.170b | 0.275a | 0.302a | 0.226a | − 0.187a |
0.286
a
|
Insomnia | 0.266a | 0.309a | 0.191a | 0.200a | − 0.242a |
0.349
a
|
Appetite loss | 0.230a | 0.210a | 0.277a | 0.194a | − 0.345a | 0.354a |
Constipation |
0.099
|
0.063
|
0.083
|
0.006
| − 0.185a |
0.114
|
Nausea & vomiting | 0.089 | 0.076 | 0.127 | 0.163b | − 0.139b | 0.159b |
Diarrhoea |
0.098
|
0.153
b
| − 0.046 | − 0.079 |
0.005
|
0.029
|
Financial Difficulties | 0.132b | 0.095 | 0.141 | 0.143b | − 0.267a | 0.225a |
Measurement equivalence
(Theoretical Score Range) | Mean ± S.D. | English vs. Chinese | |||||
---|---|---|---|---|---|---|---|
Total (N = 236)e | English-version (n = 155) | Chinese-version (n = 81) | Equivalence margina (±0.25 S.D.) | Equivalence marginb (±0.5 S.D.) | 95% CI of Unadjusted difference | 95% CI of Adjusted differencec | |
Total MFSI-SF score | 0.720 (19.06) | 1.56 (20.32) | − 0.889 (16.36) | ± 4.59 | ± 9.17 | − 2.450 (− 7.599 to 2.698) | 0.095 (− 1.512 to 0.097) |
General | 4.34 (4.51) | 4.87 (4.74) | 3.33 (3.84) | ± 1.07 | ± 2.15 | − 1.538 (− 2.742 to − 0.333) | − 0.009 (− 1.327 to 1.148) |
Physical | 3.88 (4.11) | 4.22 (4.51) | 3.22 (3.15) | ± 0.96 | ± 1.91 | − 0.997 (− 2.103 to 0.109) | 0.023 (− 0.967 to 1.357) |
Emotional | 3.21 (4.25) | 3.34 (4.46) | 2.96 (3.83) | ± 1.04 | ± 2.07 | − 0.373 (− 1.522 to 0.777) | 0.096 (− 0.423 to 2.142)d |
Mental | 3.00 (3.91) | 3.32 (4.28) | 2.38 (3.01) | ± 0.91 | ± 1.82 | − 0.933 (− 1.985 to 0.118) | − 0.016 (− 1.274 to 1.017) |
Vigour | 13.70 (6.48) | 13.18 (6.61) | 12.79 (6.14) | ± 1.59 | ±3.19 | − 1.391 (− 3.134 to 0.353) | − 0.217 (− 4.922 to − 0.991)d |