CJASN_Fatigue-Validation-19AUG_Clean Accepted.docx (120.88 kB)
Download file

Validation of a patient-reported outcome measure for fatigue in patients receiving hemodialysis: the SONG-HD Fatigue instrument

Download (120.88 kB)
journal contribution
posted on 28.09.2020, 11:34 by Angela Ju, Armando Teixeira-Pinto, Allison Tong, Alice C Smith, Mark Unruh, Sara N Davison, Juan Dapueto, Mary Amanda Dew, Richard Fluck, Michael J Germain, Sarbjit V Jassal, Gregorio T. Obrador, Donal O’Donoghue, Andrea K. Viecelli, Giovanni Strippoli, Marinello Ruospo, Delia Timofte, Ankit Sharma, Eric Au, Martin Howell, Daniel S.J. Costa, Samaya Anumudu, Jonathan C Craig, Claudia Rutherford
Background: Fatigue is a very common and debilitating symptom and identified by patients as a critically important core outcome to be included in all trials involving patients receiving hemodialysis. A valid, standardized measure for fatigue is needed to yield meaningful and relevant evidence about this outcome.
Objectives: To validate a core patient-reported outcome measure (PROM) for fatigue in hemodialysis.
Design: A longitudinal cohort study was conducted to assess the validity and reliability of a new fatigue measure (SONG-HD Fatigue).Eligible and consenting patients completed the measure at three time points: baseline, a week later and twelve days following the second time point. Cronbach’s α and Intraclass correlation coefficient were calculated to assess internal consistency and Spearman’s rho was used to assess convergent validity. Confirmatory factor analysis was also conducted.
Setting: Hemodialysis units in the United Kingdom, Australia and Romania participated in this study.
Participants: Adult patients aged 18 years and over, English-Speaking, and receiving maintenance hemodialysis were eligible to participate.
Measurements: SONG-HD Fatigue, visual analogue scale for fatigue, 12-Item Short Form survey, Functional Assessment of Chronic Illness Therapy-Fatigue were used.
Results: In total, 485 participants completed the study across the United Kingdom, Australia, and Romania. Psychometric assessment demonstrated that the SONG-HD Fatigue is internally consistent (Cronbach’s α =0.81- 0.86) and stable over a one-week period (Intraclass correlation coefficient =0.68-74). The measure demonstrated convergence with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and had moderate correlations with other measures that assessed related but not the same concept (12-Item Short Form Survey and Visual Analogue Scale). Confirmatory factor analysis supported the one-factor model. Conclusions: The SONG-HD Fatigue appears to be a reliable and valid measure to be used in trials involving patients receiving hemodialysis.



CJASN November 2020, 15 (11) 1614-1621; DOI: https://doi.org/10.2215/CJN.05880420

Author affiliation

Department of Health Sciences, University of Leicester


AM (Accepted Manuscript)

Published in

Clinical Journal of the American Society of Nephrology








American Society of Nephrology



Acceptance date


Copyright date


Available date




Usage metrics