Quality of Life Research

, Volume 20, Issue 9, pp 1447–1456 | Cite as

A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model

  • Anners Lerdal
  • Anders Kottorp
  • Caryl Gay
  • Bradley E. Aouizerat
  • Carmen J. Portillo
  • Kathryn A. Lee



To examine the psychometric properties of the 9-item Fatigue Severity Scale (FSS) using a Rasch model application.


A convenience sample of HIV-infected adults was recruited, and a subset of the sample was assessed at 6-month intervals for 2 years. Socio-demographic, clinical, and symptom data were collected by self-report questionnaires. CD4 T-cell count and viral load measures were obtained from medical records. The Rasch analysis included 316 participants with 698 valid questionnaires.


FSS item 2 did not advanced monotonically, and items 1 and 2 did not show acceptable goodness-of-fit to the Rasch model. A reduced FSS 7-item version demonstrated acceptable goodness-of-fit and explained 61.2% of the total variance in the scale. In the FSS-7 item version, no uniform Differential Item Functioning was found in relation to time of evaluation or to any of the socio-demographic or clinical variables.


This study demonstrated that the FSS-7 has better psychometric properties than the FSS-9 in this HIV sample and that responses to the different items are comparable over time and unrelated to socio-demographic and clinical variables.


Fatigue HIV Psychometrics Symptoms Quality of life 



Acquired immune deficiency syndrome


Body mass index


Differential item functioning


Daytime sleepiness subscale


Fatigue severity scale


General sleep disturbance scale


Human immunodeficiency virus


Principal component analysis


Standard error



This research was supported by a grant from the National Institute of Mental Health (NIMH, 5 R01 MH074358). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Data collection was supported by the General Clinical Research Center in the UCSF CTSA (1 UL RR024131). Dr. Lerdal has received funding from the Research Council of Norway (Grant # 19256), the Norwegian Nurses Organization and the U.S.–Norway Fulbright Foundation. Dr. Aouizerat is supported by an NIH Roadmap K12 (KL2 RR024130). Authors wish to acknowledge the contributions to the study from Traci Coggins, Skip Davis, Ryan Kelly, Yeonsu Song, Kristen Nelson, and Matthew Shullick.


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Anners Lerdal
    • 1
  • Anders Kottorp
    • 2
  • Caryl Gay
    • 3
  • Bradley E. Aouizerat
    • 4
  • Carmen J. Portillo
    • 5
  • Kathryn A. Lee
    • 3
  1. 1.Lovisenberg Deaconal University CollegeOsloNorway
  2. 2.Division of Occupational Therapy, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
  3. 3.Department of Family Health Care NursingUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Physiological Nursing and Institute for Human GeneticsUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Community Health SystemsUniversity of California, San FranciscoSan FranciscoUSA

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