피로와 우울.불안증 환자에서 Fatigue Severity Scale의 임상적 유용성

Clinical Usefulness of Fatigue Severity Scale for Patients with Fatigue, and Anxiety or Depression

연구목적: 피로는 일차 진료에서 흔한 증상이지만 비특이적 주관적 특성상 명확한 정의와 객관적 평가가 어렵고, 특히 기질적 질환이 없는 피로의 평가는 더욱 힘들다. 이에 저자들은 기질적 질환이 없는 피로 환자에게 Fatigue severity scale (FSS) 을 적용하여 그 유용성을 알아보고자 하였다. 방법: 피로환자 44명, 우울 또는 불안증의 정신과 환자 43명과 대조군 45명에게 피로도, 스트레스, 우울 불안 척도를 이용하여 FSS의 신뢰도와 타당도를 조사하였다. 결과: FSS의 신뢰도 계수는 0.935이었고 재검사의 상관관계 계수는 0.916이었다 (p<0.01). FSS 점수는 피로 군에서 유의하게 가장 높았고 대조군에서 가장 낮았다 (p<0.01). FSS와 Chalder fatigue scale의 상관관계 계수는 0.782로 높았다 (p<0.01). 피로군과 대조군에 대한 FSS index의 최적의 절단점은 민감도 84.1%. 특이도 85.7%인 3.22로 조사되었다. 결론: FSS는 일차진료에서 기질적 질환이 없는 피로환자와 우울 또는 불안증 환자에서 피로도를 평가할 수 있는 유용한 도구이며, 향후 보다 많은 환자를 대상으로 한 연구가 필요하리라 생각된다.

Objectives : Fatigue is a common symptom in primary medical care and has nonspecific and highly subjective features. So it has been difficult to define and measure fatigue, especially those present without any organic diseases. This study was conducted to evaluate the validity of the Fatigue severity scale(FSS) in patients with persistent fatigue who were free of any organic diseases or psychiatric disorders of depression or anxiety. Methods : Subjects consisted of 45 controls, 44 fatigued patients and 43 psychiatric patients with depression or anxiety. They all completed the fatigue severity, modified Bepsi stress, and Hospital anxiety and depression scales. Chalder fatigue scale was administrated randomly in 30 of them. Data were analyzed for reliability and validity of the FSS. Results: Cronbach's a coeffient of FSS was 0.929, and the Pearson correlation coefficient for test-retest was 0.916(p<0.01). ANCOVA for discriminant validity revealed that there were significant differences in mean FSS values among the three groups. The fatigue group had significantly higher FSS value than the other two groups. The psychiatric group also had significantly higher FSS value than the control group. The Pearson correlation coefficient for convergent validity by comparing FSS with Chalder fatigue scale was 0.782(p<0.01). Using FSS index 3.22 as the cut-off point, sensitivity was 84.1% and specificity was 85.7% for the fatigue and control groups, respectively. Conclusion : Results suggested the clinical application of the FSS to be a useful measurement for distinguishing fatigue between patients with physiologic fatigue and psychiatric patients with depression or anxiety.