Fatigue in young patients with acquired brain injury in the rehabilitation setting: Categorizing and interpreting fatigue severity levels

Figures & data

Figure 1. Fatigue severity classification in a normal distribution curve.

* 0= equal to the mean score of the reference data

Figure 2. Distribution of participants from 10 Dutch rehabilitation centers.

*Missing participants: n=11 no official ABI diagnosis, n=12 incomplete questionnaires. #1; number of questionnaires filled out by the patient, the parents or both in total and per age group (children, adolescents and young adults). 2; number of questionnaires filled out by parents only in total and per age group (children, adolescents and young adults). 3; number of questionnaires filled out by patients only in total and per age group (children, adolescents and young adults). 4; number of questionnaires filled out by patients and their parents (paired samples) only in total and per age group (children, adolescents and young adults).

Table 1. Patient, family and injury characteristics of children, adolescents, and young adults with acquired brain injury (ABI) referred to an outpatient rehabilitation center.

Patient characteristics	Children5–12 years	Adolescents13–17 years	Young adults18–24 years	Total cohort5–24 years
Age (years) at admission: Age group, number (%) Mean (SD)	76 (29%) 9 (2.1)	141 (54%) 15 (1.4)	43 (17%) 19 (2.1)	260 (100%) 15 (3.5)
Sex Female, number (%)	40 (53%)	72 (51%)	23 (54%)	135 (52%)
Traumatic brain injury (TBI), number (%)	47 (62%)	110 (78%)	35 (81%)	192 (74%)
Severity level TBI (GCS*), number (%)
Mild	41 (88%)	83 (76%)	27 (77%)	151 (78%)
Moderate/Severe	3 (6%)	12 (11%)	5 (14%)	20 (10%)
Unknown^$	3 (6%)	15 (14%)	3 (9%)	21 (12%)
Non-traumatic brain injury, number (%)	29 (38%)	31 (22%)	8 (19%)	68 (26%)
Causes non-traumatic brain injury, number (%)
Stroke	2 (7%)	9 (29%)	5 (63%)	18 (25%)
Brain tumor	13 (45%)	13 (42%)	2 (25%)	27 (41%)
Encephalitis/meningitis	6 (21%)	4 (13%)	1 (12%)	12 (18%)
Hypoxia/intoxication	0 (0%)	2 (6%)	0 (0%)	2 (3%)
Other	6 (21%)	3 (10%)	0 (0%)	9 (13%)
Time (months) between ABI onset and referral to rehabilitation
Total: Median (IQR)	4 (1–21)	5 (1–18)	4 (2–19)	4 (1–18.5)
Group < 6 months
Number (%)	47 (62%)	83 (59%)	26 (60%)	156 (60%)
Median (IQR)	2 (1–4)	2 (1–3)	2 (1–4)	2 (1–3)
Group > 6 months
Number (%)	29 (38%)	58 (41%)	17 (40%)	104 (40%)
Median (IQR)	30 (14–54)	24 (10–64)	22 (11–58)	25 (12–57)
Health-related quality of life (HRQoL)#
Mean (SD) patient-reported Mean (SD) parent-reported				64.7 (17.4) 61.4 (16.9)

* GCS: Glasgow Coma Scale: “mild”13-15, “moderate” 9-12, “severe” < 8. If the GCS was unknown/not applicable for these patients, and if they had no history of consciousness loss at onset, the severity was equally considered as a “mild TB”. # PedsQLTM Generic Core Scales-4.0 for health-related quality of life (HRQoL) (Total score) 0-100, with lower scores indicating less quality of life.t

Table 2. Patient- and parent-reported fatigue in children, adolescents, and young adults with ABI compared to healthy Dutch peers.

Patient-reported data Total group 5-42yr	Patients with ABI n=223^$
	Mean	SD
Total fatigue	50.1	17.3
General fatigue	51.0	22.8
Sleep/rest fatigue	53.8	18.4
Cognitive fatigue	45.5	23.4
Parent-reported data Total group 5-42yr	Patients with ABI n=246^$
	Mean	SD
Total fatigue	53.5	19.2
General fatigue	49.5	24.4
Sleep/rest fatigue	58.7	23.4
Cognitive fatigue	52.3	25.3
Patient-reported data Children 5-12yr	Children with ABI n=54^$			Healthy Children, n=211^1
	Mean	SD	95% CI	Mean	SD	95% CI	Z	p-value
Total fatigue	57.5	14.0	53.7-61.2	77.6	20.4	74.9-80.4	-1.0	0.16
General fatigue	58.6	17.3	54.0-63.2	83.1	27.7	78.6-86.1	-0.9	0.19
Sleep/rest fatigue	64.3	15.2	60.2-68.3	76.8	26.0	72.3-79.3	-0.5	0.32
Cognitive fatigue	49.6	21.3	43.9-55.3	74.0	31.2	69.8-78.2	-0.8	0.22
Parent-reported data Children 5-12yr	Children with ABI n=76^$			Healthy Children n=232^1
	Mean	SD	95% CI	Mean	SD	95% CI	Z	p-value
Total fatigue	59.9	18.0	55.9-64.0	82.1	17.8	79.8-84.4	-1.2	0.11
General fatigue	55.9	23.0	50.7-61.0	83.4	19.2	80.9-85.8	-1.4	0.08
Sleep/rest fatigue	69.7	19.1	65.4-74.0	86.6	18.6	84.2-89.0	-0.9	0.18
Cognitive fatigue	54.3	29.1	47.8-60.9	76.4	26.9	72.9-79.8	-0.8	0.21
Patient-reported data Adolescents 13-17yr	Adolescents with ABI n=129^$			Healthy Adolescents n=155^1
	Mean	SD	95% CI	Mean	SD	95% CI	Z	p-value
Total fatigue	50.1	17.1	47.1-53.0	75.2	12.1	73.3–77.1	-2.1	0.02*
General fatigue	51.1	23.9	47.0-55.2	76.7	14.2	74.4–78.9	-1.8	0.04*
Sleep/rest fatigue	52.5	16.9	49.6-55.4	71.9	14.3	69.6–74.1	-1.4	0.08
Cognitive fatigue	46.7	24.2	42.5-50.8	77.2	15.4	74.7–79.6	-2.0	0.02*
Parent-reported data Adolescents 13-17yr	Adolescents with ABI n=134^$			Healthy Adolescents n=161^1
	Mean	SD	95% CI	Mean	SD	95% CI	Z	p-value
Total fatigue	51.7	18.7	48.6-54.9	79.2	14.1	77.0–81.4	-1.9	0.03*
General fatigue	47.4	24.7	43.2-51.5	77.7	16.1	75.2–80.2	-1.9	0.03*
Sleep/rest fatigue	55.6	22.3	51.8-59.3	80.9	15.2	78.5–83.2	-1.7	0.04*
Cognitive fatigue	52.3	23.8	48.3-56.3	78.9	18.1	76.1–81.7	-1.5	0.07
Patient-reported data Young adults 18-24yr	Young adults with ABI n=40^$			Healthy Young adults n=512^2
	Mean	SD	95% CI	Mean	SD	95% CI	Z	p-value
Total fatigue	40.2	17.5	34.8-45.6	71.8	14.6	70.5-73.0	-2.2	0.01*
General fatigue	40.6	22.3	33.7-47.5	70.4	18.2	68.9-72.0	-1.6	0.05
Sleep/rest fatigue	43.8	20.4	37.4-50.1	68.6	14.6	67.4-69.9	-1.7	0.04*
Cognitive fatigue	36.3	21.7	29.5-43.0	76.3	18.4	74.7-77.9	-2.2	0.01*
Parent-reported data ^Young adults 18-24yr	Young adults with ABI n=36^$
	Mean	SD	95% CI
Total fatigue	46.5	20.4	39.8-53.1
General fatigue	44.3	23.9	36.5-52.1
Sleep/rest fatigue	46.9	26.9	37.5-55.1
Cognitive fatigue	48.3	22.0	41.1-55.5

^$Total: n=246 parents, n=223 patients. ¹ Dutch reference data from healthy peers (self and parent-reported): ages 5-12 (children) and ages 13-17 (adolescents) years old. ² Dutch reference data from healthy peers (self-reported): ages >18 (young adults) years old. ^No parent-reported reference data available. ^#PedsQL^TM Multidimensional Fatigue Scale (MFS), 0-100, with lower scores indicating more fatigue. * p<0.05: statistically significant.

Figure 3. Percentages of children/adolescents/young adults with ABI per fatigue severity level category reported by patients and parents.1. GF: Domain score PedsQL MFS; General fatigue.2. SRF: Domain score PedsQL MFS; Sleep/Rest fatigue.3. CF: Domain score PedsQL MFS; Cognitive fatigue.

Figure 4. Patient-reported mean HRQoL total scores# per fatigue severity category in children/adolescents/young adults with ABI. # PedsQLTM Generic Core Scales-4.0 for Health-related Quality of Life (HRQoL), 0-100, with lower scores indicating diminished HRQoL.