Review
Take Fatigue or Fatigues into Account in Physiotherapy Interventions? A Rapid Scoping Review
2025 年 28 巻 3 号 p. 157-173
詳細
2025 年 28 巻 3 号 p. 157-173
Fatigue is one of the most common symptoms encountered in rehabilitation and during physical therapy interventions. Although this phenomenon is known and experienced by everyone, its assessment is not straightforward. The lack of consensus on its definition, complex etiology, and multidimensional nature means that a large number of outcomes exist and continue to be reviewed. However, it seems essential that its assessment be better defined and standardized to understand the effects of physical therapy. To provide an initial exploratory overview, we conducted a rapid scoping review of the various fatigue assessments used in physiotherapy interventions or performed by physical therapists. A total of 139 articles published between 2020 and July 31, 2025 were included and explored. We found 43 different outcomes used across 46 population groups. While the most well-known chronic conditions such as cancer, multiple sclerosis (MS), and coronavirus disease 2019 (COVID-19) are representative, their assessment methods do not appear to be harmonized. These findings from the study support the idea that fatigue remains a complex phenomenon to assess. However, it appears that the lack of justification for the choice of an outcome prevents a better understanding of the reproducible effects on fatigue in physiotherapy interventions.
Fatigue is a conscious sensation experienced by all individuals. Due to its multidimensional nature, there is currently no universal definition of fatigue. Angelo Mosso, one of the pioneers in the physiological description of fatigue, had already observed the following relationship more than a century earlier: the brain and the muscles alter their function during exercise and that fatigue is predominantly an emotion, part of a complex regulation, whose role is to protect the body from harm1). Although the etiology of fatigue is not yet well understood today, fatigue appears to be a universal phenomenon that can be experienced by any conscious individual. The global prevalence of general fatigue (fatigue lasting <6 months, or fatigue of unspecified duration) is 20.4% in adults, 11.7% in minors, and 42.3% in specific occupations2). In the medical field, one-fifth of family medicine patients present with fatigue, and one-third of adolescents report having fatigue at least 4 days per week3). This observation leads us to an initial reflection. On the one hand, fatigue is a phenomenon already familiar to individuals in their daily lives. On the other hand, the onset of a health problem could cause certain aspects of fatigue to appear or become more pronounced. In other words, the gap between the fatigue already experienced by the individual and the fatigue caused by an illness remains poorly understood. While the causes are diverse and can be physiological and/or psychological in origin, the consequences are often harmful to the individual. Fatigue is one of the most burdensome and disabling symptoms in a multitude of acute and chronic conditions across the lifespan4). Managing fatigue is both a challenge and a key goal in rehabilitation care to improve patients’ quality of life. It is essential to take this into account for rehabilitation follow-up, but the multidimensional nature of fatigue can make it difficult to assess. Appropriate measurement of fatigue allows the effectiveness of an intervention from a clinical perspective, but is also important from a scientific perspective when compared with other studies. Although numerous outcomes exist, including specific ones for certain pathologies, there appears to be no consensus on their use among both clinicians and researchers5,6). Particularly in studies investigating exercise programs performed and/or supervised by physical therapists, fatigue often appears as a primary or secondary outcome measure. A general overview of all the scales used in physiotherapy would contribute to the development of a consensus on fatigue assessment and also provide a conceptual reflection into fatigue assessment itself. For this purpose, our objective is to collect and map the various fatigue-related outcomes used by physical therapists in different areas of intervention. Given the exploratory nature of our study and the heterogeneity of the various parameters we aim to collect, we conducted a rapid scoping review to answer the following 2 questions: What outcomes are used to evaluate fatigue in physiotherapy interventions? And are our fatigue assessments standardized across similar fields?
A scoping review protocol was prepared and registered on the Open Science Framework (osf.io/vcjde), and was guided by established scoping review and rapid review methodologies7,8). This project was conducted over a 14-week timeframe (April 28–August 15, 2025) and was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement (Appendix 1)9). We provide the search string strategies for each database in Appendix 2.
Literature searchOne researcher (S.T.) conducted a literature search across 6 databases on July 31, 2025, to access a comprehensive list of sources. The search was guided by the JBI Manual for Evidence Synthesis10). Six databases, PubMed (National Library of Medicine), Cochrane Library, CINAHL (EBSCO), Embase (Elsevier), and Web of Science (Clarivate), and LiSSA (a French Health Science Database), were chosen for their inclusion of randomized clinical trials and broad clinical scope. These databases also use controlled vocabularies for physical therapist, rehabilitation, and fatigue (Medical Subject Headings [MeSH], Emtree, CINAHL Subject Headings), which supplement keyword searches for terms appearing in titles, abstracts, and author-selected keywords. Appendix 2 provides the search string strategies for each database. We limited the scope to English-language articles published primarily between 2015 and 2025 to capture current discussion. Publications meeting search criteria were transferred into Rayyan, a web-based systematic review application that was used to assist in screening11).
Inclusion criteriaUsing the PICOS tool, our inclusion criteria were defined as follows:
Articles were eligible for inclusion if they were written in English. Although our research was primarily focused on articles published from 2015 onwards, older articles and articles without date labeling were found during the screening process (Fig. 1). First, we eliminated articles published before 2015 and retained only those that used a fatigue outcome in the context of rehabilitation involving physical therapy or a physical therapist. This included articles presenting different types of studies ranging from case studies to qualitative studies. Articles were excluded when fatigue was not explicitly sought in the outcome measures or if it was only reported by a quality of life questionnaire or mentioned as an adverse event. Terms that could be interpreted as synonyms, such as exacerbation or dyspnea, were also excluded to retain articles in which the authors explicitly mentioned fatigue in their work.
Literature screening was conducted independently by both authors using Rayyan (Qatar Computing Research Institute, Doha, Qatar), to review all articles and to confirm eligibility at each stage; conflicts were resolved through discussion and consensus. First, titles and abstracts were screened, then the articles were retrieved, and full texts were assessed for eligibility. The screening process was piloted at each stage to clarify eligibility criteria (i.e., refine exclusion criteria). Protocol articles without results, posters, and conference presentations were excluded during this phase because fatigue outcomes were not always specified. Due to the large number of articles meeting eligibility criteria and resource considerations, only studies published in 2020 or later were included in the final set for collecting and mapping the targeted data (Fig. 2).
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
All articles in the final set were uploaded into the Zotero reference manager (version 7.0.13; Corporation for Digital Scholarship, Vienna, VA, USA). Both authors reread each article and highlighted the following data: population, the criterion(s) used to assess fatigue, and the type of study. The data were entered and classified in a table using Excel software (version 1808; Microsoft, Redmond, WA, USA) to obtain an overview of the different fatigue scales used in different populations. Each author checked the table to validate the final version (Table 1).
| Population | Outcomes for fatigue | Study type | References | Year |
|---|---|---|---|---|
| Acute ankle sprains | VAS | Longitudinal cohort study | Correia et al. | 2021 |
| Acute burn injuries | Hooper’s Index | Interventional study | Page et al. | 2025 |
| Amyotrophic lateral sclerosis | FSS | Interventional study | Gonçalves et al. | 2022 |
| Amyotrophic lateral sclerosis | MFIS; FSS; NFI-MND | Systematic review | Silva et al. | 2024 |
| Amyotrophic lateral sclerosis | FSS; BRS | Systematic review | Souza et al. | 2025 |
| Beta thalassemia major | FSS | Case report | Choubisa et al. | 2022 |
| Bronchiectasis (adult) | HRQoL | Delphi study | Hamzeh et al. | 2024 |
| Cancer | FACT-F; BFI; Fatigue (not specified) | Systematic review | Al-Mhanna et al. | 2022 |
| Cancer | EORTC QLQ-C-30 | Feasibility study | Christensen et al. | 2025 |
| Cancer | FSS | Feasibility study | Denti et al. | 2024 |
| Cancer | MFI; EORTC QLQ-C30; PROMs | Systematic review | Gauchez et al. | 2024 |
| Cancer | PipFS; MFI; EORTC QLQ-C30 | Scoping review | Goncalves Leite Rocco et al. | 2024 |
| Cancer | FACIT-F; PedsQL | Systematic review | Hao et al. | 2023 |
| Cancer | EORTC QLQ-C30 | Interventional study | Ibrahim et al. | 2024 |
| Cancer | BFI | Retrospective cohort study | Mack et al. | 2021 |
| Cancer | CFQ | Interventional study | Nilsson et al. | 2020 |
| Cancer | MFI; EORTC QLQ-C30; RPS; FACIT-F; FACT-F; LASA; FAS; FAQ; PROMIS | Systematic review | Penna et al. | 2023 |
| Cancer | PipFS-R; MFI; FACT-F; BFI; FACIT-F | Interventional study | Trommer et al. | 2023 |
| Cancer | MFI; EORTC QLQ-C30; FQ; VAS; BFI | Systematic review | Vira et al. | 2021 |
| Cancer (breast and prostate) | PipFS; FACIT-F; FACT-F; MFI; FAQ | Systematic review | Cano-Uceda et al. | 2025 |
| Cancer (breast and prostate) | MFI | Randomized trial | Van de Wiel et al. | 2021 |
| Cancer (breast) | FSS; EORTC QLQ-C30 | Case–control study | Alaca et al. | 2024 |
| Cancer (breast) | FIS | Interventional study | Bahçaci et al. | 2024 |
| Cancer (breast) | BFI; EORTC QLQ-C30 | Pilot study | Invernizzi et al. | 2020 |
| Cancer (breast) | PipFS | Randomized trial | Mur-Gimeno et al. | 2024 |
| Cancer (breast) | MFI-SF ; PipFS | Systematic review | Mur-Gimeno et al. | 2022 |
| Cancer (breast) | EORTC QLQ-C30 | Randomized trial | Rashid et al. | 2025 |
| Cancer (breast) | BFI | Pilot study | Tay et al. | 2024 |
| Cancer (breast) | PipFS | Systematic review | Wang et al. | 2022 |
| Cancer (colorectal) | EORTC QLQ-C30 | Interventional study | Finch et al. | 2024 |
| Cancer (gliomas) | HRQoL | Randomized trial | Hansen et al. | 2020 |
| Cancer (gynecologic) | Not specified | Case report | Coughenour et al. | 2024 |
| Cancer (gynecologic) | MFIS | Interventional study | Wood et al. | 2022 |
| Cancer (head and neck) | EORTC QLQ-C30 | Interventional study | Felser et al. | 2025 |
| Cancer (head and neck) | FSS | Survey | Krishna Alaparthi et al. | 2022 |
| Cancer (head and neck) | FACT-F | Randomized trial | McNeely et al. | 2024 |
| Cancer (hematologic) | FACIT-F | Randomized trial | Accogli et al. | 2022 |
| Cancer (lung with spinal cord injury) | FACIT-F | Case report | Kelch et al. | 2022 |
| Cancer (lymphoma) | Not specified | Systematic review | Jerbi et al. | 2022 |
| Cancer (myeloma) | FACIT-F | Randomized trial | McCourt et al. | 2023 |
| Cancer (esophageal) | MFI; EORTC QLQ-C30 | Randomized trial | Van Vulpen et al. | 2021 |
| Cancer (esophagogastric) | Not specified | Qualitative study | O'Neill et al. | 2021 |
| Cancer (pediatrics acute lymphoblastic leukemia) | PedsQL | Randomized trial | Elnaggar et al. | 2025 |
| Cancer (pediatrics and adolescents) | Not specified | Cross-sectional survey | Ospina et al. | 2020 |
| Cancer (pediatrics and adolescents) | PedsQL; MFS; CCFS; FS-C; FS-A | Literature review | Ospina et al. | 2021 |
| Cancer (survivor) | FACIT-F; PipFS-R | Systematic review | Gray et al. | 2024 |
| Cancer (urinary bladder) | PipFS | Randomized trial | Porserud et al. | 2024 |
| Cerebral Palsy (children) | PedsQL | Interventional study | Celikel et al. | 2023 |
| Charcot–Marie–Tooth disease | FSS; CIS-20R | Scoping review | Tedeschi et al. | 2025 |
| Chronic advanced diseases (palliative) | 3LNQ | Cross-sectional study | Høgdal et al. | 2020 |
| Chronic back pain | Not specified | Pilot study | You et al. | 2021 |
| Chronic low back pain | FACIT-F | Randomized trial | Dilekçi et al. | 2020 |
| Chronic obstructive pulmonary disease | FSS | Randomized trial | Kovelis et al. | 2020 |
| Chronic widespread pain | CFQ | Interventional study | Thompson et al. | 2022 |
| Coronary artery bypass graft | Not specified | Survey | Hong et al. | 2020 |
| Coronary artery disease | MBS | Interventional study | Saklıca et al. | 2024 |
| COVID-19 | MBS; Quality of life (not specified) | Systematic review | Beqaj et al. | 2022 |
| COVID-19 | MBS | Randomized trial | Fereydounnia et al. | 2022 |
| COVID-19 | FSS | Randomized trial | Paneroni et al. | 2024 |
| COVID-19 | VAS | Systematic review | A.M.C. et al. | 2023 |
| COVID-19 (long) | FSS | Pilot study | Deodato et al. | 2024 |
| COVID-19 (long) | mMRC; FSS | Systematic review | Mass Kokolevich et al. | 2024 |
| COVID-19 (long) | CIS-Fatigue | Randomized trial | Volckaerts et al. | 2023 |
| COVID-19 (post) | VAS | Interventional study | Tăbîrță et al. | 2023 |
| COVID-19 (post) | MPFSDQ | Controlled open study | Campos et al. | 2024 |
| COVID-19 (post) | Not specified | Systematic review | Dillen et al. | 2023 |
| COVID-19 (post) | Fatigue outcomes were limited and could not be synthesized | Systematic review | Pouliopoulou et al. | 2023 |
| COVID-19 (post) | MBS | Randomized trial | Şahın et al. | 2023 |
| COVID-19 (post) | FSS | Pilot study | Sarmento et al. | 2024 |
| COVID-19 (post) | BRS; CFS-11; VAS; mMRC | Systematic review | Valverde-Martínez et al. | 2023 |
| COVID-19 (post) | FSS | Observational study | Weigl et al. | 2024 |
| COVID-19 pneumonia (severe) | FSS; CFQ; FACIT-F | Interventional study | Asimakos et al. | 2023 |
| Fibromyalgia | PipFS-R | Randomized trial | Fonseca et al. | 2021 |
| Fibromyalgia | MAF | Randomized trial | Yoo et al. | 2022 |
| Functional neurological disorder | PROMIS | Case series | Mowry et al. | 2025 |
| Guillain–Barré syndrome | FSS | Survey | Davidson et al. | 2022 |
| Guillain–Barré syndrome | FSS | Randomized trial | Shah et al. | 2022 |
| Healthy male | Self-reported perceived muscle fatigue | Experimental interventional study | Lim et al. | 2024 |
| Healthy workers | Not specified | Experimental interventional study | Vitoulas et al. | 2022 |
| Hematological diseases | Not specified | Interventional study | Morais et al. | 2023 |
| Hereditary cerebellar ataxia | FSS | Randomized trial | Milne et al. | 2025 |
| Hereditary neuromuscular diseases | FSS | Cross-sectional study | Andries et al. | 2022 |
| Hereditary neuromuscular diseases | Not specified | Survey | Stępień et al. | 2022 |
| Hip fracture surgery | VRS | Randomized trial | Zilmer et al. | 2024 |
| Hypermobility spectrum disorder | CIS-subscale fatigue | Feasibility study | Liaghat et al. | 2020 |
| Inflammatory arthritis | NRS | Randomized trial | Nordén et al. | 2024 |
| Interstitial lung disease | FACIT-F | Case report | Dasouki et al. | 2023 |
| Juvenile myasthenia gravis | PedsQL | Randomized trial | Mohamed et al. | 2022 |
| Long-term musculoskeletal conditions | NRS | Feasibility study | Minns Lowe et al. | 2020 |
| Marfan syndrome | FSS | Case report | Bhagwatkar et al. | 2024 |
| Multiple sclerosis | MFIS; WEIMuS; FIS; FSI; FSS | Scoping review | Adnan et al. | 2024 |
| Multiple sclerosis | MFIS | Systematic review | Amedoro et al. | 2020 |
| Multiple sclerosis | FIS | Interventional study | Andrejeva et al. | 2023 |
| Multiple sclerosis | FSS; MBS | Randomized trial | Blázquez-Fernández et al. | 2024 |
| Multiple sclerosis | FSS; MFIS | Randomized trial | Bonnyaud et al. | 2025 |
| Multiple sclerosis | MFIS | Pilot study | Chanpimol et al. | 2020 |
| Multiple sclerosis | MFIS | Interventional study | Dastan et al. | 2025 |
| Multiple sclerosis | FSS | Interventional study | Drużbicki et al. | 2021 |
| Multiple sclerosis | MFIS | Systematic review | Elhusein et al. | 2024 |
| Multiple sclerosis | WEIMuS | Randomized trial | Flachenecker et al. | 2020 |
| Multiple sclerosis | FSS | Interventional study | Ghosh et al. | 2024 |
| Multiple sclerosis | FSS | Interventional study | Hendricksen et al. | 2024 |
| Multiple sclerosis | MFIS | Interventional study | Hrušková et al. | 2024 |
| Multiple sclerosis | MFIS | Randomized trial | Karakas et al. | 2025 |
| Multiple sclerosis | FSS | Interventional study | Knapova et al. | 2025 |
| Multiple sclerosis | MFIS | Interventional study | Kumar et al. | 2024 |
| Multiple sclerosis | FSS; MFIS | Randomized trial | Lamberti et al. | 2020 |
| Multiple sclerosis | FAS | Randomized trial | Lysogorskaia et al. | 2023 |
| Multiple sclerosis | MSQOL-54; MFIS; WEIMuS; FIS; FSS | Systematic review | Najafi et al. | 2025 |
| Multiple sclerosis | MFIS | Pilot study | Ozdogar et al. | 2022 |
| Multiple sclerosis | FSS | Randomized trial | Ozsoy-Unubol et al. | 2022 |
| Multiple sclerosis | FSS | Interventional study | Petracca et al. | 2024 |
| Multiple sclerosis | FSS; MFIS; CIS-20R; FSMC | Systematic review | Taul-Madsen et al. | 2021 |
| Multiple sclerosis | FSS | Observational study | Torchio et al. | 2025 |
| Multiple sclerosis | FIS; FSMC; FSS; MFIS; PROMIS; WEIMuS; RFT | Systematic review | Torres-Costoso et al. | 2022 |
| Multiple sclerosis | FSS | Randomized trial | Yazgan et al. | 2020 |
| Multiple sclerosis | FSS; FIS | Randomized trial | Yucekaya et al. | 2025 |
| Multiple sclerosis (pediatric onset) | FSS | Interventional study | Vural et al. | 2023 |
| Multiple sclerosis with Parkinson disease | FIS | Case report | Sütçü et al. | 2021 |
| Myalgic encephalomyelitis/chronic fatigue syndrome | CFQ; CIS; FSS; PROMs | Systematic review | Wormgoor et al. | 2021 |
| Myalgic encephalomyelitis/chronic fatigue syndrome (adolescents) | Self-reported | Randomized trial | Anderson et al. | 2020 |
| Myotonic dystrophy type 1 | PROMIS | Single subject experimental design | Fossmo et al. | 2024 |
| Older adults | FSS | Randomized trial | Garbin et al. | 2024 |
| Parkinson disease | ParkFS | Feasibility study | Cooley Hidecker et al. | 2022 |
| Parkinson disease | ParkFS; MFIS; VAS; FSS; PipFS-R; KFSS | Systematic review | Ernst et al. | 2023 |
| Pediatric hematopoietic stem cell transplant | PROMIS | Randomized trial | Smith et al. | 2022 |
| People with disabilities | Not specified | Randomized trial | Ravesloot et al. | 2022 |
| Persisting post-concussive Symptoms | FSS | Randomized trial | Mercier et al. | 2025 |
| Pituitary adenoma | FSS | Randomized trial | Dülger et al. | 2022 |
| Postconcussion symptoms | BFI | Randomized trial | Nguyen et al. | 2023 |
| Primary biliary cholangitis | PBC-40 fatigue domain | Clinical trial | Freer et al. | 2024 |
| Pulmonary hypertension | FSS | Systematic review | Luo et al. | 2022 |
| Refractory dyspnea | CRQ | Pilot study | Clark et al. | 2025 |
| Spinal cord injury | FAS | Feasibility study | Postol et al. | 2021 |
| Stroke (early) | Dyspnea fatigue score | Systematic review | Zhang et al. | 2024 |
| Stroke (minor) and transient ischemic attack | FSS | Randomized trial | Deijle et al. | 2022 |
| Stroke (subacute, mild to moderate) | MFI | Feasibility study | Clague-Baker et al. | 2022 |
| Systemic sclerosis | NRS | Randomized trial | Yakut et al. | 2021 |
| Transverse myelitis | FAS | Case report | Choubisa et al. | 2022 |
3LNQ, 3-Levels-of-Needs Questionnaire; BFI, Brief Fatigue Inventory; BRS, Borg Rating Scale; CCFS, Childhood Cancer Fatigue Scale; CFS-11, Chalder Fatigue Score; CFQ, Chalder Fatigue Questionnaire/Scale; CIS, Checklist of Individual Strength; CIS-20R, Checklist Individual Strength-Revised; CRQ, Chronic Respiratory Questionnaire; EORTC QLQ-C-30, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30; FACIT-F; Functional Assessment of Chronic Illness Therapy - Fatigue Scale; FACT-F, Functional Assessment of Cancer Therapy-Fatigue Scale; FAQ, Fatigue Assessment Questionnaire; FAS, Fatigue Assessment Scale; FIS, Fatigue Impact Scale; FQ, Fatigue Questionnaire; FS-A, Fatigue Scale for adolescents; FS-C, Fatigue Scale for a child; FSI, Fatigue Symptom Inventory; FSMC, Fatigue Scale for Motor and Cognitive functions; FSS, Fatigue Severity Scale; HRQoL, Health-Related Quality of Life; KFSS, Krupp Fatigue Severity Scale; LASA, Linear Analog Scale Assessment; MAF, Multidimensional Assessment of Fatigue; MBS, Modified Borg Scale; MFI, Multidimensional Fatigue Inventory; MFIS, Modified Fatigue Impact Scale; MFI-SF, Multidimensional Fatigue Inventory Short Form; MFS, Multidimensional Fatigue Scale; mMRC, Modified British Medical Research Council; MPFSDQ, Modified Pulmonary Functional Status and Dyspnea Questionnaire; MSQOL-54, Multiple Sclerosis Quality of Life-54; NFI-MND, Neurological Fatigue Index-motor neuron disease; NRS, Numerical Rating Scale; ParkFS, Parkinson’s Fatigue Scale; PBC-40, primary biliary cholangitis-40 fatigue domain; PedsQL, Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale; PipFS, Piper Fatigue Scale; PipFS-R, Revised Piper Fatigue Scale; PROMIS, Patient-Reported Outcomes Measurement Information System; PROMs, Patient-Reported Outcomes Measures; RFT, Rotten fatigue test; RPS, Revised Piper Fatigue Scale; VAS, Visual Analogue Scale; VRS, Verbal Rating Scale; WEIMuS, the Würzburg Fatigue Inventory for Multiple Sclerosis
A total of 139 articles met the criteria for our research12–150). We found 43 different outcomes (distinguishing modified versions for certain scales) and 46 different population groups, which we categorized into 6 distinct fields: neurology and neuromuscular; cancer (all types); pneumology (including coronavirus disease 2019 [COVID-19]); musculoskeletal; cardiovascular; other fields (rare disease, healthy population, etc.).
The number of publications per field was as follows: 40 publications for cancer (29%); 29 on multiple sclerosis (MS) (21%) and 24 on other pathologies (17%) for neurology and neuromuscular; 21 publications including 16 on COVID-19 for Pneumology (15%); 8 publications for musculoskeletal (6%); 6 publications for cardiovascular (4%); and 11 publications for other fields (8%) (Fig. 3).
COVID-19, coronavirus disease 2019; MS, multiple sclerosis
The number of publications per study type was as follows: 41 publications for randomized trial (29%); 30 publications including 27 systematic review and 3 scoping review for literature review (22%); 27 publications for interventional study (19%); 8 publications for pilot study (6%); 8 publications for case report and case series (6%); 7 publications for feasibility study (5%); 4 publications for survey (3%); and 14 publications for other types (10%) (Fig. 4).
Since our research period included lockdown periods, 23 articles used or mentioned remote intervention techniques (e.g., tele-rehabilitation or tele-physiotherapy)14,19,21,27,28,39–41,51,56,72,81,99,117,121,122,129–132,136,142,148).
Unsurprisingly, and in accordance with the literature, the 3 most commonly represented diseases were studies involving patients with cancer, MS, and post-COVID-19151,152). For the latter, we investigated further what different outcomes were used and whether some of them were more representative (Figs. 5–7).
BFI, Brief Fatigue Inventory; CCFS, Childhood Cancer Fatigue Scale; CFQ, Chalder Fatigue Questionnaire/Scale; EORTC QLQ-C-30, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30; FACIT-F; Functional Assessment of Chronic Illness Therapy - Fatigue Scale; FACT-F, Functional Assessment of Cancer Therapy-Fatigue Scale; FAQ, Fatigue Assessment Questionnaire; FAS, Fatigue Assessment Scale; FIS, Fatigue Impact Scale; FS-A, Fatigue Scale for adolescents; FS-C, Fatigue Scale for a child; FSS, Fatigue Severity Scale; LASA, Linear Analog Scale Assessment; MFI, Multidimensional Fatigue Inventory; MFIS, Modified Fatigue Impact Scale; MFI-SF, Multidimensional Fatigue Inventory Short Form; MFS, Multidimensional Fatigue Scale; PedsQL, Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale; PipFS, Piper Fatigue Scale; PipFS-R, Revised Piper fatigue scale; PROMIS, Patient-Reported Outcomes Measurement Information System; PROMs, Patient-Reported Outcomes Measures; VAS, Visual Analogue Scale
CIS-20R, Checklist Individual Strength-Revised; FAS, Fatigue Assessment Scale; FIS, Fatigue Impact Scale; FSI, Fatigue Symptom Inventory; FSMC, Fatigue Scale for Motor and Cognitive functions; FSS, Fatigue Severity Scale; MBS, Modified Borg Scale; MFIS, Modified Fatigue Impact Scale; MS, mutiple sclerosis; MSQOL-54, Multiple Sclerosis Quality of Life-54; PROMIS, Patient-Reported Outcomes Measurement Information System; RFT, Rotten fatigue test; WEIMuS, The Würzburg Fatigue Inventory for Multiple Sclerosis
BRS, Borg Rating Scale; CFQ, Chalder Fatigue Questionnaire/Scale; CFS-11, Chalder Fatigue Score; CIS-F, fatigue severity subscale of the Checklist of Individual Strength; COVID-19, coronavirus disease 2019; FACIT-F, Functional Assessment of Chronic Illness Therapy – Fatigue Scale; FSS, Fatigue Severity Scale; MBS, Modified Borg Scale; mMRC, Modified British Medical Research Council; VAS, Visual Analogue Scale; MPFSDQ, Modified Pulmonary Functional Status and Dyspnea Questionnaire
In cancer, we found 21 different outcomes across the 40 publications20,23,25,31,33,34,47,48,53,56,66,69,70,72,74,75,80,82,84,86,87,93,94,102.105,109,110,116,120,122,123,124,126,128,130,133,144,147). In one of the articles, although it is a similar scale, the authors distinguish between the fatigue scale for children and adolescents. The most representative scales are the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30(EORTC QLQ-C-30; 12 articles), Multidimensional Fatigue Inventory (MFI; 8 articles), Functional Assessment of Chronic Illness Therapy – Fatigue Scale (FACIT-F; 8 articles), and 8 articles including the Piper Fatigue Scale (PipFS-R) and Revised Piper Fatigue Scale (RPS). We also noted that the Piper Fatigue Scale, designed to assess fatigue in women with breast cancer, was used in only 4 of the 10 articles dealing with this topic.
In MS, we found 12 different outcomes across the 29 publications14,19,21,24,27,37,39–41,46,50,62,63,65,67,71,85,89,91,92,97,100,129,131,135,138,139,143,150). The most representative scale was the Fatigue Severity Scale (FSS; 17 articles), followed by the Modified Fatigue Impact Scale and its original version (17 articles including 14 MFIS and 6 Fatigue Impact Scale [FIS]). Although certain fatigue scales are appropriate for the MS population (notably the FIS, MFIS, FSS, and the Würzburg Fatigue Inventory for Multiple Sclerosis [WEIMuS]), we have noted that there is disparity in their use.
In COVID-19, we found 11 different outcomes across the 16 publications16,17,22,51,59,68,81,95,111,115,118,119,132,134,142,148). The most representative scale was FSS (6 articles), followed by the Modified Borg Scale (MBS; 3 articles) and Visual Analogue Scale (VAS; 3 articles). The choice of these scales appears to be a consequence of the pulmonary involvement and the context in which the assessments were conducted.
We also noted that some literature reviews included both unidimensional and multidimensional outcomes of fatigue, some of which addressed different time periods of symptoms experienced by patients (at the time, since a week, since last 4 weeks, etc.)19,29,33,47,66,69,75,92,96,101,103,107,108,110,116,119,124,128,129,132,141,142,144).
A total of 139 articles published between 2020 and mid-July 2025 met the eligibility criteria for this scoping review. To our knowledge, this is the 1st exploratory study to examine fatigue assessments performed by physical therapists. Although the COVID-19 pandemic is likely influencing our interest in fatigue in the field of rehabilitation, it appears that these topics have always been studied in light of our initial findings during the screening phase (Fig. 1). Although our research was not intended to describe every scale of fatigue, the variety of different outcomes appeared to us to be very large. This initial observation leads us to a notion that is not new but is nevertheless evident in practice: fatigue is a multidimensional and complex phenomenon that is challenging to assess.
In the research field, some instrumental methods can be used to objectivize certain dimensions of fatigue through performance tests, such as neuromuscular or cognitive fatigability153,154). However, these measures are limited by the experimental conditions, conducted in controlled environments, which do not necessarily reflect the nature and experience of fatigue in subjects’ everyday lives. This perception, known as subjective fatigue, is assessed in most cases by a general or specific questionnaire, based on the respondent’s self-estimation. However, if a primary impairment (pathology) can modify an individual’s perception of fatigue, it would seem difficult to consider its dominance over other influencing factors. This is probably why many outcomes have been developed and continue to be revised and modified, as the symptoms are not always clinically describable. Several theories indicate that the sensation of fatigue must be associated with the anatomical brain structures responsible for conscious perception, rather than with a single peripheral physiological disturbance or altered metabolic state155).
According to Joseph Levine’s theory, there could be an explanatory gap in the fatigue perceived by an individual before and after a change in their health status156). Knowing an individual’s baseline level of fatigue perception could be a 1st step toward understanding which dimensions are most affected in an individual after illness. Conversely, in conditions affecting individuals from an early age (hereditary diseases, cerebral palsy, etc.), it is difficult to distinguish the role played by the disease in the perception of fatigue that children develop as soon as they become conscious. In other words, why do children with the same congenital condition not perceive or express fatigue in the same manner?
This consideration leads us to consider other factors that can significantly influence the perception of fatigue. Certain parameters have already been mentioned in various studies, such as anthropometric factors (gender, age), sociocultural factors, and professional factors157–159). These intra- and interpersonal experiences could contribute to the development of a representation of fatigue that is specific to each individual and in each dimension. However, this does not diminish the importance of assessing fatigue in patients who are limited in their daily activities and whose quality of life is impaired by this almost invisible, but clearly present symptom.
Due to its frequent occurrence in many chronic diseases, fatigue assessment has become essential in rehabilitation interventions. As we have seen in our study, this appears to be a significant outcome in protocols involving physical therapists. However, few studies argue for the choice of scale used to measure fatigue, nor do they hypothesize about which specific dimension or aspect of fatigue their intervention might improve. Positive results are reported in several studies, but they appear difficult to reproduce.
At the same time, its assessment appears less standardized in other areas such as musculoskeletal disorders. While physiotherapy can have beneficial effects on motor performance, it would seem a shame not to investigate further the subjective fatigue of individuals to better understand the relationship between performance and perception.
Finally, we have no explicit arguments regarding the disparity of the scales used. While some scales have been specifically developed for a particular pathology, some authors use generic scales in their work. However, we put forward 3 hypotheses that could explain this finding in line with the literature found160). The 1st is that the scales are not available or accessible. This may be the case when the use of assessments requires training or when they are not validated in the required language. The 2nd hypothesis is the field context. Some scales are longer or more complex to implement within the department. Due to time or resource constraints, the choice of scales may be reduced to the assessment of a single dimension or the shortest one to be administered. Finally, the last hypothesis relates to the design of the protocol. The physical therapist may be the evaluator in a trial with a predefined protocol. In this case, the choice of scale is predetermined and cannot be changed. On this last point, we considered the possibility that some protocols may choose, rightly or wrongly, a fatigue scale simply because it was designed for the target population. However, in light of all our comments above, we suggest that the scale chosen should not only reflect the specific characteristics of the population but also the variable of fatigue on which the intervention is supposed to be effective.
The key points that emerge from our exploratory study are as follows:
This comprehensive rapid scoping review has provided an initial overview of the various outcomes used in physical therapy and in different fields. We hope that this document will be a useful resource for improving the care of patients undergoing rehabilitation. Future work could build on these observations to develop recommendations and conduct studies using a more comprehensive fatigue assessment. Given the large number of potential articles in other areas of rehabilitation on this topic, a more extensive literature review would also be useful for the next stage.
This scoping review of the literature is time-bound: articles published before 2020 were not included. Articles without results (protocol design), posters, or conference presentations were also not included. Although fatigue is a phenomenon studied worldwide in physiotherapy, only articles in English were included in our research. Due to the exploratory nature of the study and the fact that we limited our research to physiotherapy interventions, our findings do not provide a comprehensive overview of fatigue assessments used in the rehabilitation field in general. Not all of the recommendations for conducting a scoping review could be met. In particular, the participation of a librarian would have helped to complete the research strategy for an exhaustive search on our topic7).
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
The authors declare that they have no conflicts of interest.
This is a scoping review that does not involve human research; no ethics committee approval is required.
Appendix 1: Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist.
Appendix 2: Search string strategies for each database.
