European Portuguese Version of the Multidimensional Fatigue Symptom Inventory-Short Form: Validation Study


  • Maria Inês Clara Center for Research in Neuropsychology and Cognitive and Behavioral Intervention. Universidade de Coimbra. Coimbra; Faculdade de Psicologia e Ciências da Educação. Universidade de Coimbra. Coimbra.
  • Kevin Stein Rollins School of Public Health. Emory University. Atlanta. Georgia; Maine Medical Center Research Institute. Center for Interdisciplinary Population and Health Research. Portland. Maine.
  • Maria Cristina Canavarro Center for Research in Neuropsychology and Cognitive and Behavioral Intervention. Universidade de Coimbra. Coimbra; Faculdade de Psicologia e Ciências da Educação. Universidade de Coimbra. Coimbra.
  • Ana Allen Gomes Center for Research in Neuropsychology and Cognitive and Behavioral Intervention. Universidade de Coimbra. Coimbra; Faculdade de Psicologia e Ciências da Educação. Universidade de Coimbra. Coimbra.



Chronic Disease, Fatigue, Neoplasms, Portugal, Psychometrics


Introduction: Appropriate management of fatigue relies upon comprehensive assessment instruments and timely delivery of targeted interventions. The aims of this study were to translate a commonly used English-language measure of fatigue in cancer patients (the Multidimensional Fatigue Symptom Inventory–Short-Form, or MFSI-SF) into European Portuguese and to evaluate the psychometric properties (internal consistency reliability, factorial structure, and discriminant, convergent and criterion concurrent validity) of the translated measure for use with Portuguese patients.
Material and Methods: After translation and adaptation of the MFSI-SF to European Portuguese, 389 participants (68.38% women), with a mean age of 59.14 years, completed the study protocol. This sample included 148 patients in active cancer treatment from a cancer center and a community sample composed of 55 cancer survivors, 75 patients with other chronic diseases, and 111 healthy controls.
Results: The European Portuguese version of the Multidimensional Fatigue Symptom Inventory-Short Form (IMSF-FR) showed strong internal consistency (Cronbach’s alpha = 0.97, McDonald’s omega = 0.95). An exploratory factor analysis indicated that the items loaded in a 5-factor model in subscales were similar to the original version. Strong correlations between the IMSF-FR and other measures of fatigue and vitality confirmed convergent validity. Discriminant validity was supported by weak-to-moderate correlations between the IMSF-FR and measures of sleepiness, propensity to sleep, and lapses of attention and memory. The IMSF-FR accurately distinguished cancer patients from healthy controls and was able to differentiate clinician rated levels of performance among cancer patients.
Conclusion: The IMFS-FR is a reliable and valid tool to assess cancer-related fatigue. By providing integrated comprehensive characterization of fatigue, this instrument may assist clinicians implementing targeted interventions.


Download data is not yet available.


Bower JE. Cancer-related fatigue - mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11:597-609. DOI:

Lawrence DP. Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. J Natl Cancer Inst Monogr. 2004;32:40-50. DOI:

Iop A, Manfredi A, Bonura S. Fatigue in cancer patients receiving chemotherapy: an analysis of published studies. Ann Oncol. 2004;15:712-20. DOI:

Kowalczyk L, Deutschmann C, Crevenna R, Konrad S, Singer CF, Farr A. Radiotherapy-induced fatigue in breast cancer patients. Breast Care. 2021;16:236-42. DOI:

Huang X, Zhang Q, Kang X, Song Y, Zhao W. Factors associated with cancer-related fatigue in breast cancer patients undergoing endocrine therapy in an urban setting: a cross-sectional study. BMC Cancer. 2010;10:453. DOI:

Köhler N, Gansera L, Holze S, Friedrich M, Rebmann U, Stolzenburg J. Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study. Support Care Cancer. 2014;22:2883-9. DOI:

Phillips KM, Pinilla-Ibarz J, Sotomayor E, Lee MR, Jim HS, Small BJ, et al. Quality of life outcomes in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: a controlled comparison. Support Care Cancer. 2012;21:1097-103. DOI:

Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18:743. DOI:

Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyeworitz BE, et al. Fatigue in long-term breast carcinoma survivors. Cancer 2006;106:751-8. DOI:

Servaes P, Gielissen MF, Verhagen S, Bleijenberg G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psychooncol. 2007;16:787-95. DOI:

Weis J. Cancer-related fatigue: prevalence, assessment and treatment strategies. Expert Rev Pharmacoecon Outcomes Res. 2011;11:441-4. DOI:

Poulson MJ. Not just tired. J Clin Oncol. 2003;21:112-3. DOI:

Ancoli-Israel S, Moore P, Jones V. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care. 2001;10:245-55. DOI:

Gupta D, Lis CG, Grutsch JF. The relationship between cancer-related fatigue and patient satisfaction with quality of life in cancer. J Pain Symptom Manag. 2007;34:40-7. DOI:

Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, et al. Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist. 2000;5:353-60. DOI:

Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrowa GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12:4-10. DOI:

Given C, Given B, Rahbar M, Sangchoon J, McCorkle R, Galecki BC, et al. Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol. 2004;22:507-16. DOI:

Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Ginecol Oncol. 2015;136:446-52. DOI:

Stein KD, Martin SC, Hann DM, Jacobsen PB. A multidimensional measure of fatigue for use with cancer patients. Cancer Pract. 1998;6:143-52. DOI:

Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat. 2007;105:209-19. DOI:

Stein KD, Jacobsen PB, Blanchard CM, Thors CT. Further validation of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). J Pain Symptom Manag. 2004;27:14-23. DOI:

Hambleton RK, Li S. Translation and adaptation issues and methods for educational and psychological tests. In: Frisby CL, Reynolds CR, editors. Comprehensive handbook of multicultural school psychology. New Jersey: John Wiley & Sons Inc; 2005. p. 881–903.

Padilla JL, Leighton JP. Cognitive interviewing and think aloud method. In: Zumbo B, Hubley AH, editors. Understanding and investigating response processes in validation research. Berlin: Springer; 2017. p. 211-28. DOI:

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria for the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649-55. DOI:

McNair DM, Lorr M, Droppleman LF. Manual for the profile of mood states. San Diego: Educational and Industrial Testing Service; 1971.

Viana MF, Almeida PL, Santos RC. Adaptação portuguesa da versão reduzida do Perfil de Estados de Humor - POMS. Anal Psicol. 2000;19:1.

Ware JE, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473-83. DOI:

Ferreira PL, Ferreira LN, Pereira LN. Medidas sumário física e mental de estado de saúde para a população portuguesa. Rev Port Saúde Pública. 2012;30:163-71. DOI:

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. DOI:

Santos CR. Avaliação da sonolência diurna excessiva: adaptação cultural e linguística da escala de sonolência de Epworth para a população portuguesa. Monografia de licenciatura em neurofisiologia. Porto: Escola Superior de Tecnologia do Porto; 2001.

Marques D, Gomes A, Azevedo MH. DSPS-4: a brief measure of perceived daytime sleepiness. Curr Psychol. 2017;38:3. DOI:

Broadbent D, Cooper P, FitzGerald P, Parkes K. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982;21:1-16. DOI:

Allen Gomes A. Questionário de falhas cognitivas (QFC). 2016. [cited 2022 May 13]. Available from:

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-70. DOI:

Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12:225-35. DOI:

Pallant J. SPSS survival manual: a step by step guide to data analysis using SPSS for Windows. 6th ed. Berkshire: Open University Press; 2016.

Donovan KA, Stein KD, Lee M, Leach CR, Ilozumba O, Jacobsen PB. Systematic review of the multidimensional fatigue symptom inventory-short form. Support Care Cancer. 2014;23:191-212. DOI:

Lukas PS, Krummenacher R, Biasiutti FD, Begré S, Znoj H, von Känel R. Association of fatigue and psychological distress with quality of life in patients with a previous venous thromboembolic event. Thromb Haemost. 2009;102:1219–26. DOI:




How to Cite

Clara MI, Stein K, Canavarro MC, Allen Gomes A. European Portuguese Version of the Multidimensional Fatigue Symptom Inventory-Short Form: Validation Study. Acta Med Port [Internet]. 2023 Feb. 22 [cited 2024 Apr. 25];36(11):723-30. Available from: