Exploring Fatigue in Multiple Sclerosis
: "Investigating objective metrics of ambulation and activity (biomarkers) alongside the patient’s perspective." - A Naturalised Phenomenological approach

  • Rebecca Faye Player

Student thesis: Doctoral Thesis


Multiple sclerosis (MS) fatigue is a multifaceted phenomenon that is difficult to describe, portray and monitor. The correspondence between fatigue and fatigability remains problematic; investigating and bridging different domains of fatigue will assist in the overall measurement and management of fatigue in MS.

This study used an interdisciplinary, naturalised phenomenological approach guided by Varela [1996] and Gallagher [2015]. Twelve people with MS (pwMS) and 11 older healthy volunteers were recruited. The timed 25-foot walk (T25FW) was repeated before and after the six-minute walk (6MW) with wearable sensors attached to the ankle, thigh and sternum. A descriptive phenomenological interview and analysis [Giorgi et al., 2017] was used to determine the overarching phenomenon of fatigue. The mean, median, standard deviation were calculated with parametric (unpaired t-test, ANOVA and Spearman’s correlation coefficient) and non parametric (rank-sum, Mann-Whitney U and Kruskal-Wallis) tests to investigate the velocity and peak angular velocity (ω) of each T25FW and minute of the 6MW.

Nonsignificant and variable results were detected in ambulatory measurements in pwMS in the 6MW. However, sensor-derived measurements of average ankle and thigh peak ω were higher in healthy participants (447.17 ± 63.88, 194.64 ± 72.68 degrees/second) when compared to pwMS (350.37 ± 85.72, 359.87 ± 93.91, 145.53 ± 54.09, 121.43 ± 57.44 degrees/second) in the 6MW of the dominant and weak leg, respectively. Walking velocity of pwMS post-6MW in the T25FW was significantly slower compared to the healthy group (5.83 ± 1.69, 4.19 ± 0.75) and pwMS displayed only a 0.08-second difference pre- to post-6MW in the T25FW. Fatigue was revealed as an allengrossing phenomenon that took captive unconscious facets of emotion, bodily and perceptive aspects of an individual’s everydayness and caused deep disruption to daily rhythm. Four constituents were established highlighting fatigue on a continuum of sensation: (1) familiar body falling away, (2) sweeping sudden fatigue towards stasis, (3) cloudiness of consciousness, and (4) managing the everydayness. A continuum was drawn up that began to reveal the confluence between fatigue and fatigability. Although the direct relationship remains unclear, this naturalised
phenomenological study highlights the interwoven nature of fatigue, fatigability and the potential role stigma and dignity play part to. Results suggest fatigue is a global and complex phenomenon.

This is an attempt to use a naturalised phenomenological approach and to assess its usefulness in this area of research. Phenomenological insights could provide useful insight for further measurement of fatigue. The findings from this research may support, guide and tailor management interventions for MS fatigue in multiple fields of healthcare.
Date of AwardApr 2021
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorKathleen Galvin (Supervisor) & Harry Witchel (Supervisor)

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