Neurology

Brief Fatigue Inventory (BFI): A Full Guide for Researchers and Clinicians

Introduction

Fatigue profoundly affects quality of life, especially for cancer patients. Consequently, the Brief Fatigue Inventory (BFI), developed in 1999 by Tito R. Mendoza and colleagues at MD Anderson Cancer Center, and published by MD Anderson Cancer Center, University of Texas, offers a concise, reliable tool to measure fatigue severity and its impact on daily activities (Mendoza et al., 1999). Moreover, with over 2,000 citations on Google Scholar, the BFI stands as a cornerstone in oncology research, combining simplicity with robust psychometric properties to address a critical patient need.

This article explores the BFI’s key features, applications, and validation, providing actionable insights for researchers and clinicians.

Key Features of the Brief Fatigue Inventory (BFI)

Purpose and Use

The BFI assesses the severity and impact of fatigue, primarily in cancer patients. Additionally, it evaluates how fatigue disrupts daily life, making it invaluable for clinical screening and research. For example, clinicians use it to monitor treatment outcomes, while researchers apply it to study fatigue-related interventions, ensuring data-driven decisions.

Target Population

Designed for adults aged 18 and older, the BFI targets patients with fatigue, particularly those with cancer or undergoing cancer treatment. Furthermore, its flexibility suits young adults, middle-aged adults, and seniors, accommodating diverse patient demographics in clinical and research settings.

Structure

The BFI consists of 9 questions, divided into:

Severity Items (3 questions): Patients rate fatigue intensity on a 0–10 scale, from “no fatigue” to “fatigue as bad as you can imagine.”
Interference Items (6 questions): These measure fatigue’s impact on general activity, mood, walking ability, work, relationships, and enjoyment of life over the past 24 hours.

Each item uses a 0–10 rating scale, ensuring ease of use and quick administration.

Scoring Method

The BFI employs a 0–10 rating scale for each item, with the global fatigue score calculated as the average of all 9 items. As a result, scores are interpreted as:

1–3: Mild fatigue
4–6: Moderate fatigue
7–10: Severe fatigue

This clear scoring system allows clinicians to quickly assess fatigue severity and tailor interventions effectively.

Administration Format

The BFI takes less than 5 minutes to administer, making it highly efficient. It can be conducted via:

Paper-based forms
Digital (Online) platforms
Interview (In-person)

Its self-administered format, requiring no specialized training, enhances its practicality for busy clinical environments.

Applications of Brief Fatigue Inventory (BFI)

The BFI serves multiple roles in clinical and research settings:

Screening: Identifies patients with significant fatigue requiring intervention.
Monitoring: Tracks fatigue changes over time, particularly during treatment.
Treatment Planning: Guides clinicians in developing targeted fatigue management strategies.
Research: Supports clinical trials evaluating fatigue-related interventions in oncology.

These applications make the BFI a versatile tool for improving patient outcomes.

Languages and Availability

To enable global use, the BFI is available in multiple languages, including:

Arabic
English
Mandarin Chinese
Spanish
French
Russian
German
Portuguese
Japanese
Hindi

In addition to over 40 other languages.

This multilingual accessibility supports its application in international research and clinical environments.

The BFI is available for non-commercial use at no charge, provided that permission is obtained beforehand. For commercial use, applicable fees will apply. Additionally, the BFI is free for academic and research purposes, contingent upon receiving permission from MD Anderson. Noting that the BFI is also subject to a property license.

Reliability and Validity

The BFI is recognized as a highly reliable and valid instrument for assessing fatigue severity. Its psychometric strength is demonstrated by a Cronbach’s alpha ranging from 0.82 to 0.97, indicating excellent internal consistency. Additionally, it shows strong test-retest reliability, confirming its stability over time.

Validation Study:

- Original Validation Study: PubMed
- Indonesian Version Validation (PubMed): A 2016 study confirmed the BFI’s reliability in Indonesian cancer patients.
- Chinese Version Validation (PubMed): A 2004 study validated its effectiveness in Chinese populations.

Limitations and Considerations

However, despite its strengths, the BFI has a few limitations:

Self-report: Respondents may underreport due to social desirability bias.
Cultural Bias: Some items may require adaptation for cultural relevance.
Age Restrictions: Not suitable for children or adolescents under 18.
Social Desirability Bias: Respondents may minimize answers to meet perceived social expectations, reducing accuracy.
Limited Validation in Non-Cancer Populations: Its psychometric properties are less established outside oncology.

Additional Resources

For more information on the BFI and to access the full questionnaire, visit the following resources:

Access the Questionnaire: BFI English PDF
Official Website: MD Anderson BFI Page
Contact: Reach out to MD Anderson Cancer Center at symptomresearch@mdanderson.org.

Frequently Asked Questions (FAQ)

Who can use the BFI?
Clinicians, researchers, and healthcare providers use the BFI for patients aged 18 and older, particularly those with cancer-related fatigue.
How long does it take to complete the BFI?
Patients typically complete the BFI in less than 5 minutes, making it practical for clinical and research settings.
How is the BFI administered?
The BFI supports paper-based, digital, and interview formats, offering flexibility for diverse contexts.
Is there any cost to using the BFI?
The BFI is free for non-commercial use, though permission is required for commercial applications.

A word from ResRef about Brief Fatigue Inventory (BFI)

The Brief Fatigue Inventory (BFI) is a robust, quick, and reliable tool for assessing fatigue severity and impact, particularly in cancer populations. Its concise 9-item structure and validated design make it highly practical for clinical practice and research studies. By integrating the BFI, researchers and clinicians can gain critical insights into patients’ fatigue experiences, enabling targeted interventions that improve quality of life. Nevertheless, its validation is limited in non-cancer populations, so researchers should consider complementary tools for broader applications. Ultimately, the BFI empowers healthcare professionals to address fatigue effectively, enhancing patient care and research outcomes. Explore the BFI today to elevate your approach to fatigue management.

References

Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., & Huber, S. L. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. Cancer, 85(5), 1186–1196. (link)
Paramita, N., Nusdwinuringtyas, N., Nuhonni, S. A., Atmakusuma, T. D., Ismail, I., Mendoza, T. R., & Cleeland, C. S. (2016). Validity and reliability of the Indonesian version of the Brief Fatigue Inventory in cancer patients. Journal of Pain and Symptom Management, 52(5), 744–751. (link)
Wang, X. S., Hao, X. S., Wang, Y., Guo, H., Jiang, Y. Q., Mendoza, T. R., & Cleeland, C. S. (2004). Validation study of the Chinese version of the Brief Fatigue Inventory (BFI-C). Journal of Pain and Symptom Management, 27(4), 322–327. (link)