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Examining fatigue in COPD: development, validity and reliability of a modified version of FACIT-F scale

Khaled Al-shair12*, Hana Muellerova3, Janelle Yorke4, Stephen I Rennard5, Emiel FM Wouters6, Nicola A Hanania7, Amir Sharafkhaneh8, Jørgen Vestbo19 and for the ECLIPSE investigators

Author Affiliations

1 University of Manchester, Medicines Evaluation Unit, NIHR Translational Research Facility, Manchester Academic Health Sciences Centre, University Hospital of South Manchester Foundation Trust, Wythenshawe, Manchester, UK

2 Hadhramout University of Science and Technology, College of Medicine, Hadhramout, Yemen

3 Worldwide Epidemiology, GlaxoSmithKline R&D at Stockley Park, Uxbridge, UK

4 University of Manchester, School of Nursing and Midwifery, Manchester, UK

5 University of Nebraska Medical Centre, Omaha, NE, USA

6 Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands

7 Section of Pulmonary and Critical Medicine, Baylor College of Medicine, Houston, TX, USA

8 Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA

9 Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark

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Health and Quality of Life Outcomes 2012, 10:100  doi:10.1186/1477-7525-10-100

Published: 23 August 2012



Fatigue is a disruptive symptom that inhibits normal functional performance of COPD patients in daily activities. The availability of a short, simple, reliable and valid scale would improve assessment of the characteristics and influence of fatigue in COPD.


At baseline, 2107 COPD patients from the ECLIPSE cohort completed the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scale. We used well-structured classic method, the principal components analysis (PCA) and Rasch analysis for structurally examining the 13-item FACIT-F.


Four items were less able to capture fatigue characteristics in COPD and were deleted. PCA was applied to the remaining 9 items of the modified FACIT-F and resulted in three interpretable dimensions: i) general (5 items); ii) functional ability (2 items); and iii) psychosocial fatigue (2 items). The modified FACIT-F had high internal consistency (Cronbach's α = 0.91) and it did not fit a uni-dimensional Rasch model, confirming the prior output from the PCA. The correlations between total score and each dimension were ≥ 0.64 and within dimensions ≥0.43 (p < 0.001 for all).

The original and modified FACIT-F had significant convergent validity; its scores were associated with SGRQ total score (0.69 and 0.7) and mMRC dyspnoea scores (0.48 and 0.47), (p = <0.001 for all). The scale had meaningful discriminating ability in identifying patients with poor exercise performance and more depressive symptoms.


The original and modified FACIT-F are valid and reliable scales in COPD. The modified version is shorter and measures not only total fatigue but also its sub-components in COPD.

Chronic obstructive pulmonary disease; Fatigue; Exercise capacity; Health status