Introduction
The Fatigue Severity Scale (FSS) was developed by Lauren B. Krupp, Nicholas G. LaRocca, Joseph Muir-Nash, and Alfred D. Steinberg. First published in 1989 in the Archives of Neurology, the FSS has since become a cornerstone in fatigue assessment. Indeed, its significance is underscored by over 7000 citations on Google Scholar, highlighting its widespread adoption and utility in both clinical and research settings. Consequently, professionals can leverage this tool to enhance patient care and advance research in conditions where fatigue is a prominent symptom.
This article offers an in-depth exploration of the FSS, providing researchers and clinicians with actionable insights into its structure, validation, applications, and overall value in understanding and managing fatigue.
Key Features of The Fatigue Severity Scale (FSS)
Purpose and Use
The primary purpose of the FSS is to measure the severity of fatigue and its effects on daily life, particularly for individuals with chronic conditions. For instance, clinicians utilize it to gauge fatigue levels in patients with multiple sclerosis (MS), systemic lupus erythematosus (SLE), and chronic fatigue syndrome (CFS). Furthermore, its application extends to other conditions like Parkinson’s disease and post-stroke fatigue. Researchers also frequently employ the FSS in clinical trials and epidemiological studies to track fatigue as an outcome measure.
Target Population
Developers validated the FSS for adults aged 18 and older. This includes:
Young Adults (18–24 years)
Middle-Aged Adults (25–44 years)
Older Adults (45–64 years)
Seniors (65+ years)
Specifically, it targets adults with chronic conditions where fatigue is a common symptom.
Structure
The FSS is a straightforward questionnaire comprising nine items. The main domain covered is Fatigue Assessment, which includes a subdomain that evaluates how fatigue interferes with:
Motivation
Exercise
Physical functioning
Daily responsibilities, including work and family life
Scoring Method
The FSS employs a 7-point Likert scale for each of its nine items, with responses ranging from 1 (strongly disagree) to 7 (strongly agree).
Clinicians derive the total score by summing the scores for each item. This results in a potential score range from 9 to 63. More commonly, they calculate the mean score of the 9 items instead.
Most studies and clinical interpretations use the mean score. Generally, a mean score of ≥ 4.0 is considered indicative of moderate to severe fatigue, which may warrant further evaluation or management. This clear cut-off helps in identifying clinically significant fatigue.
Administration Format
The FSS can be administered via:
Paper-based forms
Digital (online)
In-person interviews
Patients typically complete the questionnaire in less than 5 minutes, making it practical for busy environments.
Importantly, no special training is required for its administration or interpretation, as it is often self-administered.
Applications of The Fatigue Severity Scale (FSS)
The FSS serves several important functions in both clinical practice and research settings.
Screening: Clinicians can efficiently screen patients for the presence and severity of fatigue.
Monitoring: It proves valuable for monitoring changes in fatigue levels over time or in response to interventions.
Research: The FSS is extensively used in research to quantify fatigue and assess the efficacy of treatments aimed at alleviating fatigue.
Languages and Availability
To support its widespread international use, translators have adapted the FSS into numerous languages. These include:
Arabic
English
Spanish
French
German
Portuguese
Additional translations are also available to support its use in diverse clinical and research contexts.
The FSS is free to use and commonly used in academic research. However, it’s important to note that the FSS’s license type is considered proprietary.
Reliability and Validity
The FSS stands out as a highly reliable and valid instrument.
Studies consistently report Cronbach’s alpha values typically around 0.95. This high value demonstrates that the items collectively measure the same underlying construct effectively.
Researchers have validated the FSS across various patient populations, particularly those with chronic illnesses, thereby ensuring its psychometric soundness.
Limitations and Considerations
Despite its widespread use and numerous strengths, the FSS has a few limitations for users to consider:
Self-report measure: Patient responses may be influenced by personal interpretation or social desirability.
Social Desirability Bias: Some individuals might answer based on how they wish to be perceived rather than their true experience.
Cultural Bias: Although translated into many languages, nuances in cultural understanding of fatigue might affect responses.
Narrow Focus: While it effectively measures fatigue severity and impact, it may not capture all dimensions or qualitative aspects of fatigue.
Age Restrictions: The FSS is designed for adults (18+) and has not been validated for use in pediatric or adolescent populations.
Specificity to Certain Populations: Its performance may vary in patient groups not extensively studied.
Cut-off Score Variability: There isn’t a universally agreed-upon cut-off score to definitively differentiate between normal and pathological fatigue levels.
Other Versions and Related Questionnaires
It is useful for researchers to be aware of other versions of this scale, such as the FSS-5 (a shortened 5-item version) and other translated versions.
To provide a more comprehensive assessment of fatigue, the FSS is often used alongside other questionnaires like:
The Modified Fatigue Impact Scale (MFIS)
Multidimensional Fatigue Inventory (MFI)
Chalder Fatigue Scale
Additional Resources
For those looking to utilize or learn more about the FSS, the following resources are invaluable:
- The Original Validation Study. link
- You can access the questionnaire as a PDF through this link
- For inquiries, contact one of the original authors, Lauren B. Krupp, at: lauren.krupp@stonybrook.edu
Frequently Asked Questions (FAQ)
- Who can use the FSS?
Researchers, clinicians, and healthcare providers can use the FSS for adults aged 18 and older, particularly those with chronic conditions such as multiple sclerosis, systemic lupus erythematosus, chronic fatigue syndrome, Parkinson’s disease, and post-stroke fatigue. - How long does it take to complete the FSS?
Patients typically complete the FSS in less than 5 minutes. This brevity makes it highly suitable for busy clinical settings and for inclusion in larger research batteries. - How is the FSS administered?
Healthcare teams can administer the FSS using paper-based forms, digital online versions, or through in-person interviews, offering flexibility depending on the setting and patient needs. - Is there any cost to using the FSS?
The FSS is generally free to use, which contributes to its broad accessibility for clinical and academic research purposes.
A Word from ResRef about The Fatigue Severity Scale (FSS)
The Fatigue Severity Scale (FSS) is a concise, validated, and widely used self-report questionnaire designed to measure the severity of fatigue and its impact on daily functioning. It consists of 9 items rated on a 7-point Likert scale, with higher scores (typically ≥4) indicating clinically significant fatigue. Its widespread adoption underscores its reliability and relevance in both research and routine care for conditions characterized by fatigue.
References
- Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46(10), 1121–1123. link
