Assessment of fatigue in postpartum women using patient-reported outcome measures: a systematic review utilising Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines

ABSTRACT

Background: Fatigue is a burden for a substantial proportion of women in the postpartum period. A wide array of patient-reported outcome measures (PROMs) are used for assessment, which makes comparison of data difficult.

Objective: To identify the best PROM for postpartum fatigue using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

Search strategy: We searched Web of Science, Embase, PubMed and CINAHL, with no date limiters, in July 2020 for validated PROMs used to assess fatigue in the postpartum period.

Selection criteria: Studies evaluating at least one author-defined domain of postpartum fatigue and one psychometric measurement property of a PROM.

Data collection and analysis: An overall rating was assigned based on COSMIN criteria and the quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Main results: We identified 49 validation studies using 18 PROMs in 21,209 women that evaluated postpartum fatigue. All three fatigue domains (Physical, Mental, Interference) were assessed by four PROMs: Fatigue Assessment Scale (FAS), Brief Fatigue Inventory (BFI), Checklist Individual Strength (CIS) and Fatigue Severity Scale (FSS). The FAS, which is freely available online, was the only PROM to demonstrate adequate content validity and at least a low level evidence of sufficient internal consistency, resulting in a Class A recommendation.

Conclusion: The FAS is the best available PROM to assess postpartum fatigue. However, it fails to assess important areas of postpartum recovery. Future studies should aim to develop a more specific PROM for postpartum fatigue.

KEYWORDS:

• Postpartum
• fatigue
• patient-reported outcome measure
• PROM
• COSMIN

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Dr Ciechanowicz had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: P. Sultan, B. Carvalho, S. Ciechanowicz, S. Van Damme, J. Taylor. Acquisition, analysis, or interpretation of data: S. Ciechanowicz, P. Pandal, P. Sultan, L. Blake, B. Carvalho. Drafting of the manuscript: S. Ciechanowicz, P. Sultan. Critical revision of the manuscript for important intellectual content: S. Ciechanowicz, P. Sultan, B. Carvalho, S. Van Damme, J. Taylor. Supervision: P. Sultan, B. Carvalho.

Additional information

Funding

This work was supported in part by an Arline and Pete Harman Endowed Faculty Scholar of the Stanford Maternal and Child Health Research Institute award to Dr P. Sultan. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Notes on contributors

S. Ciechanowicz

Sarah Ciechanowicz studied medicine at the University of Oxford and is a consultant anaesthetist at University College London Hospital, her sub-speciality interests include major cancer surgery, obstetric anaesthesia and enhanced recovery. She has a research interest in postpartum recovery and the development of outcome measures.

P. Pandal

Perman Pandal is a Clinical Research Associate at the Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical School. Dr Pandal has an research interest in postpartum recovery including the development of core outcome sets and patient-reported outcomes.

B. Carvalho

Brendan Carvalho is the Chief of Obstetric Anesthesia, Vice Chair of Faculty Development and Professor in the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, and Past President of the Society of Obstetric Anesthesia and Perinatology (SOAP) He has published extensively in the field of Obstetric Anesthesia and won research awards including three Best Research Papers at SOAP scientific meetings. Prof. Carvalho has won the Teacher of the Year award at SOAP and at Stanford University’s Departments of Anesthesia. His scholarly activities are focused on clinical and translational research in the field of cesarean and labor analgesia, postpartum recovery, perinatal pharmacology and immunology.

L. Blake

Lindsay Blake is an associate professor and clinical librarian at the University of Arkansas for Medical Sciences. Lindsay is currently the Clinical Services Coordinator working on the UAMS hospital with Family & Preventative Medicineas and Arkansas Children's Hospital with Pediatrics and Nursing Research to provide residents and staff with evidence-based information for patient care as well as assist with research and publication efforts.

S. Van Damme

Stefaan Van Damme is Associate Professor in the Department of Experimental-Clinical and Health Psychology at Ghent University, Belgium, where he got his PhD in 2004. His main area of research is the psychology of physical health, with a particular focus on pain. Within this domain, he has developed two research programs. A first program is on the role of cognitive–affective and motivational mechanisms in the perception of pain and bodily sensations. For example, Stefaan supervises several research projects focusing on the fascinating interplay between attention (hypervigilance) and somatosensory processing. The second program is on the self-regulation of bodily symptoms and (chronic) illness. For example, current research projects focus on how patients with a chronic disease cope with challenges to personal goals and how this may affect quality of life and functioning.

J. Taylor

Jan Taylor is a midwife and Adjunct Associate Professor at the Faculty of Health, University of Canberra, Australia. Dr Taylor is an expert in postpartum fatigue, having conducted research on the role of anxiety and other factors in the prediction of postpartum fatigue, as well exploring strategies used by women to manage fatigue after childbirth.

P. Sultan

Pervez Sultan is an Associate Professor of Obstetric Anesthesiology at the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine and also holds an Honorary Faculty position as Associate Professor at University College London. His research interests include defining, characterizing and measuring postpartum recovery. Pervez is an Arline and Pete Harman Endowed Faculty Scholar of the Stanford Maternal and Child Health Research Institute at Stanford University. He currently serves on the Annual Meeting and Live Events and Curriculum Steering Committees of the Society for Obstetric Anesthesia and Perinatology in addition to the American Society of Anesthesiologists’ Subcommittee for Obstetric Anesthesia and the International Anesthesia Research Society. He is a former recipient of the UK National Institute of Academic Anesthesia Research Award.