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Validation of a patient-reported outcome measure for fatigue in patients receiving hemodialysis: the SONG-HD Fatigue instrument

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journal contribution
posted on 2020-09-28, 11:34 authored by Angela Ju, Armando Teixeira-Pinto, Allison Tong, Alice C Smith, Mark Unruh, Sara N Davison, Juan Dapueto, Mary Amanda Dew, Richard Fluck, Michael J Germain, Sarbjit V Jassal, Gregorio T. Obrador, Donal O’Donoghue, Andrea K. Viecelli, Giovanni Strippoli, Marinello Ruospo, Delia Timofte, Ankit Sharma, Eric Au, Martin Howell, Daniel S.J. Costa, Samaya Anumudu, Jonathan C Craig, Claudia Rutherford
Background: Fatigue is a very common and debilitating symptom and identified by patients as a critically important core outcome to be included in all trials involving patients receiving hemodialysis. A valid, standardized measure for fatigue is needed to yield meaningful and relevant evidence about this outcome.
Objectives: To validate a core patient-reported outcome measure (PROM) for fatigue in hemodialysis.
Design: A longitudinal cohort study was conducted to assess the validity and reliability of a new fatigue measure (SONG-HD Fatigue).Eligible and consenting patients completed the measure at three time points: baseline, a week later and twelve days following the second time point. Cronbach’s α and Intraclass correlation coefficient were calculated to assess internal consistency and Spearman’s rho was used to assess convergent validity. Confirmatory factor analysis was also conducted.
Setting: Hemodialysis units in the United Kingdom, Australia and Romania participated in this study.
Participants: Adult patients aged 18 years and over, English-Speaking, and receiving maintenance hemodialysis were eligible to participate.
Measurements: SONG-HD Fatigue, visual analogue scale for fatigue, 12-Item Short Form survey, Functional Assessment of Chronic Illness Therapy-Fatigue were used.
Results: In total, 485 participants completed the study across the United Kingdom, Australia, and Romania. Psychometric assessment demonstrated that the SONG-HD Fatigue is internally consistent (Cronbach’s α =0.81- 0.86) and stable over a one-week period (Intraclass correlation coefficient =0.68-74). The measure demonstrated convergence with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and had moderate correlations with other measures that assessed related but not the same concept (12-Item Short Form Survey and Visual Analogue Scale). Confirmatory factor analysis supported the one-factor model. Conclusions: The SONG-HD Fatigue appears to be a reliable and valid measure to be used in trials involving patients receiving hemodialysis.



CJASN November 2020, 15 (11) 1614-1621; DOI:

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Department of Health Sciences, University of Leicester


  • AM (Accepted Manuscript)

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Clinical Journal of the American Society of Nephrology








American Society of Nephrology



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