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NINDS CDE Notice of Copyright
Multidimensional Assessment of Fatigue (MAF)
Availability
Please visit this website for more information about the instrument: Multidimensional Assessment of Fatigue.
Availability: Permission for use is obtained by contacting Basia Belza, PhD, RN (author): Department of Biobehavioral Nursing and Health Systems, Box 357266, University of Washington, Seattle, WA 98195-7266.
Classification
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
Purpose: The questionnaire contains 14 items that are rated on a numeric rating scale; two additional items contain multiple choice responses. The questionnaire assesses severity, distress, degree of interference in activities of daily living (ADL) and timing of fatigue. The scoring procedure includes calculation of the "Global Fatigue Index" (GFI), ranging from 1–50 with higher scores indicating more severe fatigue.
 
The MAF scale is easy to administer and score, and is relatively short in length. Items that do not apply can be omitted, making it a more accurate assessment of the impact of fatigue on ADL.
Comments/Special Instructions
Comments: No universally accepted cut-off point to indicate severity of fatigue; dividing the GFI scores into quartiles indicating “no,” “light,” “moderate” and “severe” fatigue.
 
Translation: The MAF was originally developed in US English. Several language-versions are available at the MAPI Research Institute (Lyon, France). To gain access to and information about a translated version contact MAPI at their website at http://mapigroup.com/.
 
Administration: The MAF is self-administered and takes less than five minutes to complete.
 
Permission to Use and Copyright: There is no charge for individual use of the MAF. Colleagues in industry who would like to use the MAF may be charged a nominal fee.
Scoring
Scores for the GFI range from 0 (no fatigue) to 50 (severe fatigue).
Calculating the GFI: Convert question #15 to a 0–10 scale by multiplying each score by 2.5 and then sum items #1, 2 and 3, average #s 4–14, and the converted item #15. If respondents select “no fatigue“ on #1, assign a zero to items #2–16. Question #16 is not included in the GFI.
A higher score indicates more fatigue or impact on ADL.
Rationale/Justification
Fatigue is an important issue with major influence on the ADL and quality of life in patients after SAH, as outlined by Kutlubaev et al. (2012). Measuring fatigue in SAH patients appears relevant for clinical use, as well as research. There are several instruments available to measure fatigue, of which the MAF and the Fatigue Severity Scale are the two most relevant. None of the two have been validated for use in SAH, but the MAF appears superior as it covers different aspects of fatigue including quantity, degree, distress, impact, and timing. For these reasons, the Swiss national standard of neuropsychological assessment after SAH includes the MAF.
References
Multidimensional Assessement of Fatigue User’s Guide
 
Belza B, Henke C, Yelin E, Epstein W, Gilliss C. Correlates of fatigue in older adults with rheumatoid arthritis. Nursing Research. 1993;42 (2):93–99.
 
Kutlubaev MA, Barugh AJ, Mead GE. Fatigue after subarachnoid haemorrhage: a systematic review. J Psychosom Res. 2012;72:305–310.
 
McNair D, Lorr M, Droppleman L.  Profile of Mood States. San Diego: Education and Industrial Testing Service, 1971.
 
Piper B, Lindsey A, Dodd, M, Ferketich S, Paul S, Weller, S. (1989). The development of an instrument to measure the subjective dimension of fatigue. In Funk S, Tornquist E, Champagne M, Wiese R (Eds.). Key aspects of comfort: Management of pain, fatigue, and nausea. New York: Springer, pp. 199–207.
 
Stienen MN, Zweifel-Zehnder AE, Chicherio M, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert R, Schatlo B, Bijlenga P, Schaller K, Monsch AU, on behalf of the Swiss SOS study group. Neuropsychological testing after aneurysmal subarachnoid hemorrhage. Swiss Medical Forum. 2015;15(48):1122–1127.
 
Tack B. Dimensions and correlates of fatigue in older adults with rheumatoid arthritis. Unpublished doctoral dissertation, School of Nursing, University of California, San Francisco, 1991.
 
Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU; Swiss SOS study group. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien). 2015;157(9):1449–1458.
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