The impact of fatigue on communication in multiple sclerosis. The insider's perspective

Purpose. The aim of this study was to investigate the relationship between fatigue and communication in people with MS. Method. A phenomenological approach was used in in-depth interviews with 10 people with MS to gain insight into the lived experience of the interaction between MS fatigue and communication. Themes were derived from inductive analysis of verbatim transcripts of the interviews. Results. Participants framed their observations around three major themes. In the first 'revealing communication changes' an increase in the severity of communication symptoms and the onset of new communications symptoms when experiencing fatigue were reported. In the second 'concealing and coping' a range of covert and overt strategies employed to manage fatigue and communication changes were described. Finally the complex interplay between symptoms of fatigue and communication, strategies employed to manage these symptoms and societal attitudes was reported in 'barriers to participation'. Conclusions. Fatigue impacts on communication impairment, activity and participation. Self reports have an important role to play in clinical assessment of fatigue and communication in MS. Multidisciplinary team input is vital for the effective management of clients with MS fatigue and communication change. Further research into the impact of fatigue on different aspects of communication is required.