Annals Journal Club: The Course of Fatigue

Article for Discussion

Nijrolder I, van der Windt DAWM, van der Horst HE. Prognosis of fatigue and functioning in primary care: a 1-year follow-up study. Ann Fam Med. 2008;6(6):519–527.

Discussion Tips

This article describes a practice-based cohort study of patients with fatigue. It might be interesting for participants to reflect upon or even to review the medical records of some of their patients with fatigue before the journal club.

Discussion Questions

• What questions are addressed by the article? Why do they matter? How do the questions fit with what already is known on this topic? How relevant are prior studies (often of referral samples of patients) to family medicine practice settings?

• How appropriate is the study design for answering the research questions?

• To what degree can the findings be accounted for by:

  1. How participants were selected? The exclusion criteria and drop outs? Are any biases likely to be important?

  2. How fatigue, comorbid symptoms, and conditions and outcomes were measured?

  3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?

  4. How information was interpreted?

  5. Chance?

• What are the main findings?

• How well do the 4 identified patterns of patients’ course reflect your clinical experience?

• How transportable are the findings to your clinical setting?

• How might these findings be used in clinical practice? What might be the intended and unintended consequences of sharing this prognostic information with patients?

• What are some next steps for applying the findings or answering other questions that this study raises?