Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights

Daniel J. H. Powell* (Corresponding Author), Christina Liossi, Wolff Schlotz, Rona Moss-Morris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)
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Studies investigating the prevalence, cause, and consequence of multiple sclerosis (MS) fatigue typically use single measures that implicitly assume symptom-stability over time, neglecting information about if, when, and why severity fluctuates. We aimed to examine the extent of moment-to-moment and day-to-day variability in fatigue in relapsing-remitting MS and healthy individuals, and identify daily life determinants of fluctuations. Over 4 weekdays, 76 participants (38 relapsing-remitting MS; 38 controls) recruited from multiple sites provided real-time self-reports six times daily (n = 1661 observations analyzed) measuring fatigue severity, stressors, mood, and physical exertion, and daily self-reports of sleep quality. Fatigue fluctuations were evident in both groups. Fatigue was highest in relapsing-remitting MS, typically peaking in late-afternoon. In controls, fatigue started lower and increased steadily until bedtime. Real-time stressors and negative mood were associated with increased fatigue, and positive mood with decreased fatigue in both groups. Increased fatigue was related to physical exertion in relapsing-remitting MS, and poorer sleep quality in controls. In relapsing-remitting MS, fatigue fluctuates substantially over time. Many daily life determinants of fluctuations are similar in relapsing-remitting MS and healthy individuals (stressors, mood) but physical exertion seems more relevant in relapsing-remitting MS and sleep quality most relevant in healthy individuals.
Original languageEnglish
Pages (from-to)772-783
Number of pages12
JournalJournal of Behavioral Medicine
Issue number5
Early online date9 Mar 2017
Publication statusPublished - Oct 2017

Bibliographical note

The preparation of this manuscript was supported by a UK Economic and Social Research Council (ESRC) PhD studentship (ES/1026266/1) awarded to DP. The study was funded by the Psychology Unit at the University of Southampton. The authors declare that they have no conflict of interest. The authors thank all participants of this study.
Open access via Springer Compact Agreement.


  • multiple sclerosis
  • fatigue
  • ecological momentary assessment
  • ambulatory assessment
  • psychological stress
  • affect


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