PT - JOURNAL ARTICLE AU - Iris Nijrolder AU - Daniëlle A.W.M. van der Windt AU - Henriëtte E. van der Horst TI - Prognosis of Fatigue and Functioning in Primary Care: A 1-Year Follow-up Study AID - 10.1370/afm.908 DP - 2008 Nov 01 TA - The Annals of Family Medicine PG - 519--527 VI - 6 IP - 6 4099 - http://www.annfammed.org/content/6/6/519.short 4100 - http://www.annfammed.org/content/6/6/519.full SO - Ann Fam Med2008 Nov 01; 6 AB - PURPOSE Although fatigue is a common presenting symptom in primary care and its course and outcomes often remain unclear, cohort studies among patients seeking care for fatigue are scarce. We therefore aimed to investigate patterns in the course of fatigue and relevant secondary outcomes in a large cohort of patients who sought care for a main symptom of fatigue. METHODS We performed an observational cohort study in 147 primary care practices. Patients consulting their general practitioner for a new episode of fatigue were sent questionnaires at 1, 4, 8, and 12 months after baseline. We collected measures of fatigue, perceived health and functioning, absenteeism, psychological symptoms, and sleep using the Checklist Individual Strength, the 36-Item Short Form Health Survey, the Four-Dimensional Symptoms Questionnaire, and the Pittsburgh Sleep Questionnaire Inventory. Patients were classified into 4 subgroups based on fatigue severity scores over time. We assessed patterns in the course of all outcomes in these subgroups and in the total population, and tested changes over time and differences between subgroups. RESULTS A total of 642 patients were enrolled in the study. Response rates during follow-up ranged between 82% and 88%. For 75% of the patients, 4 distinct groups could be discerned: 26% of patients had continuously high scores for fatigue, 17% had a fast recovery, 25% had a slow recovery, and 32% initially improved but then had a recurrence of fatigue. Patterns for the secondary outcomes of symptoms and functioning were all similar to the pattern for fatigue within each of the subgroups. CONCLUSIONS The findings of this study suggest a longitudinal relationship between the severity of fatigue, impaired functioning, psychological symptoms, and poor sleep. Physicians should be aware that a substantial proportion of patients seeking care for fatigue have these additional health and psychosocial problems. Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.