Introduction
Fatigue is more than just feeling tired—it’s a multifaceted condition that impacts quality of life, especially in chronic illnesses like cancer or neurological disorders. Consequently, the Multidimensional Fatigue Inventory (MFI-20), developed by Els M. A. Smets, Bob Garssen, Bonke B., and J. C. J. M. De Haes in 1995, offers a robust solution for dissecting this complexity. With over 3,000 citations on Google Scholar, this 20-item questionnaire breaks fatigue into five key dimensions: general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation. For example, studies on cancer survivors and chronic fatigue syndrome patients underscore its ability to link fatigue profiles to clinical outcomes.
This article unpacks the MFI-20’s structure, applications, and value, providing researchers and clinicians with a clear roadmap to leverage its insights for better patient care and study design.
Key Features of the Multidimensional Fatigue Inventory (MFI-20)
Purpose and Use
The MFI-20 is designed to measure fatigue across multiple dimensions, making it a go-to tool for both clinical and non-clinical populations. Specifically, it targets the neurology subdomain of fatigue. Clinicians use it to identify intervention points, such as physical therapy for high physical fatigue, while researchers rely on it for longitudinal studies tracking fatigue’s impact on quality of life. Widely used in oncology, chronic illness, and general health research
-Robust across cultures (e.g., Dutch and Scottish samples). Recommended for both research and clinical monitoring of fatigue severity .
Target Population
Researchers and clinicians target the MFI-20 at adults aged 18 and older, including:
- Young adults (18-24)
- Middle-aged adults (25-44)
- Older adults (45-64)
- Seniors (65+)
- Clinical conditions (e.g., cancer, chronic fatigue syndrome, ME/CFS)
- Non-clinical populations (e.g., students, healthcare workers)
However, it lacks validation for children under 13 or adolescents (13-17). As a result, it’s a versatile fit for neurology clinics, oncology settings, and research cohorts studying fatigue-related disorders.
Structure
The MFI-20 consists of 20 items organized into five subscales, each containing four questions:
- General Fatigue (4 items): Captures overall exhaustion levels.
- Physical Fatigue (4 items): Assesses muscle weakness and energy depletion.
- Mental Fatigue (4 items): Evaluates cognitive difficulties, like poor concentration.
- Reduced Activity (4 items): Measures declines in daily task engagement.
- Reduced Motivation (4 items): Probes loss of drive or initiative.
Each item uses a 5-point Likert scale (1 = Yes, that is true to 5 = No, that is not true), with some items reverse-scored to reduce response bias. This structure ensures a comprehensive yet concise snapshot of fatigue’s diverse impacts.
Scoring Method
Scoring the MFI-20 is intuitive yet precise. Each item is rated on a 5-point Likert scale, with higher raw scores indicating more fatigue. To interpret, reverse-score items (subtract from 6), then sum each subscale for a range of 4-20, where higher adjusted scores reflect greater fatigue severity. For instance, a score of 16 on Mental Fatigue might signal cognitive therapy needs. While no universal cut-off scores exist, researchers often use normative benchmarks (e.g., means of 10-12 in healthy adults) or percentiles to flag clinical concerns. Importantly, avoid summing all 20 items for a total score, as it obscures dimensional insights.
Administration Format
The MFI-20 is quick, taking 5-10 minutes to complete, which suits fast-paced clinical or research environments. It can be administered through:
- Paper-based questionnaires for traditional settings.
- Digital platforms for remote access.
- In-person interviews or phone/video calls for personalized delivery.
No specialized training is needed, as it’s self-administered, making it accessible for busy teams.
Applications of the Multidimensional Fatigue Inventory(MFI-20)
The MFI-20 is a Swiss Army knife for fatigue assessment, supporting:
- Screening: Identifies high fatigue levels in patients, prompting early interventions.
- Monitoring: Tracks changes across treatment phases or study timepoints.
- Research: Fuels studies on fatigue’s impact in neurology, oncology, and beyond.
For example, a clinician might use elevated Physical Fatigue scores to adjust a patient’s rehab plan, while researchers could analyze Mental Fatigue trends in post-COVID cohorts. Its versatility makes it a cornerstone for both practice and science.
Languages and availability
To ensure global applicability, the MFI-20 is available in over 20 languages including:
- English
- Mandarin Chinese
- Spanish
- French
- Russian
- German
- Portuguese
Moreover,Hindi and Japanese are also available. Brazilian Portuguese is validated for Hodgkin’s lymphoma survivors, and Amharic has been used in Ethiopian cancer patients. However, translations like Hindi have limited validation, so researchers should verify cultural relevance for specific populations. The MFI-20 is free for non-commercial use through the Journal of Psychosomatic Research, but commercial applications require proprietary licensing—contact the publisher on: MedPsych or on –Email.
Reliability and Validity
The MFI-20’s psychometric strength is well-documented, with Cronbach’s alpha typically ranges from 0.78 to 0.93, with an average of 0.84 across various populations. across studies:
- The original validation study link.
- Validation of the French version link
- Validity of the Swedish version of the study
Overall, it’s a highly reliable and valid tool, though its Western-centric validations warrant caution in non-Western contexts.
Limitations and Considerations
Despite its strengths, the MFI-20 has a few limitations:
- Self-Report Bias: Responses may be swayed by social desirability or subjective recall.
- Cultural Bias: primarily validated in Western populations.
- No standardized clinical cut-off: The repeated measurement shows that the scale for General Fatigue is more sensitive than the other scales to differences in fatigue resulting from changes in circumstances.
- Social Desirability Bias: It may be socially undesirable for these individuals to report fatigue in general, or to report specific attributes of fatigue such as physical exhaustion.
Other Versions And Related Questionnaires
The MFI-20 maintains its 20-item structure without shorter or expanded variants, prioritizing brevity. However, it pairs well with complementary tools:
- Chalder Fatigue Scale: Offers a unidimensional fatigue snapshot.
- Fatigue Severity Scale (FSS): Focuses on fatigue intensity.
- Checklist Individual Strength (CIS): Emphasizes activity-related fatigue.
- Multidimensional Fatigue Symptom Inventory—Short Form (MFSI-SF): Deepens symptom analysis in cancer contexts.
Combining these tools can enrich multidimensional fatigue profiles for comprehensive assessments.
Additional Resources
For researchers and clinicians seeking deeper engagement, explore these curated resources:
- Original Validation Study: study link.
- Validation of the French version : study link.
- Validity of the Swedish version : study link.
- Access the questionnaire via the CDC-hosted MFI-20 PDF.
- For inquiries, contact Prof. Dr. Ellen M. A. Smets at email or through University of Amsterdam Address: PO Box 22660, 1100 DD Amsterdam, The Netherlands. or through -Website:(MedPsych).
Frequently Asked Questions (FAQ)
- Who can use the MFI-20? Clinicians, researchers, and healthcare providers use it for adults 18+ in neurology,oncology, or chronic illness contexts.
- How long does it take to complete the MFI-20? It takes 5-10 minutes, making it efficient for clinical visits or research protocols.
- How is the MFI-20 administered? Flexible options include paper, digital, interviews, suiting diverse settings.
- Is there any cost to using the MFI-20? Free for non-commercial use; commercial projects require publisher permission on-Email, or through University of Amsterdam Address: PO Box 22660, 1100 DD Amsterdam.or through MedPsych.
A Word from ResRef about the Multidimensional Fatigue Inventory (MFI-20)
- The MFI-20 is a gold-standard tool for multidimensional fatigue assessment, offering reliability and cultural adaptability. Its brevity and strong psychometric properties make it ideal for clinical and research settings, particularly in chronic illness populations.
References
- Smets, E. M. A., Garssen, B., Bonke, B., & De Haes, J. C. J. M. (1995). The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39(3), 315–325. link.
- Smets, E. M. A., Garssen, B., Cull, A., & De Haes, J. C. J. M. (1996). Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. British Journal of Cancer, 73(2), 241–245. link.
- Gentile, S., Delarozière, J. C., Favre, F., Sambuc, R., & San Marco, J. L. (2003). Validation of the French ‘multidimensional fatigue inventory’ (MFI 20). European journal of cancer care, 12(1), 58–64. link.
- Ericsson, A., & Mannerkorpi, K. (2007). Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20. Disability and rehabilitation, 29(22), 1665–1670. link.
