The Multidimensional Assessment of Fatigue (MAF) scale contains 16 items and measures four dimensions of fatigue: severity (#1-2), distress (#3), degree of interference in activities of daily living (#4-14), and timing (#15-16). Fourteen items contain numerical rating scales (#1-14) and two items have multiple-choice responses (#15-16). Respondents are asked to reflect on fatigue patterns for the past week. The MAF is a revision of the Piper Fatigue Scale, a 41-item measure of fatigue developed for research purposes and tested with oncology patients (Piper, Lindsey, Paul, & Weller, 1989).

Psychometric Properties
Psychometric properties of the original MAF (using visual analog scales) were tested with 133 respondents with rheumatoid arthritis (RA) (Tack, 1991; Belza et al., 1993). Cronbach’s alpha was computed for the MAF to determine internal consistency. The computed value of Cronbach’s alpha was 0.93, much higher than the criterion level of .70 for newly developed instruments. To determine concurrent validity of the MAF, respondents completed the Profile of Mood States (POMS). The POMS consists of 65 items measuring a broad, diverse set of mood states (McNair, Lorr, & Droppleman, 1971). Of particular interest are the two subscales of fatigue and vigor. Pearson correlations indicated that the MAF has convergent validity with the fatigue subscale and has divergent validity with the vigor subscale.

Scales on the MAF were changed to numerical rating scales and tested in 51 patients with RA and 26 age and gender matched controls (Belza, 1995). Cronbach’s alpha was 0.93. The change in the response format facilitated the scoring of the MAF, did not require interpretation of unclear markings on the VAS, and did not adversely affect the instrument’s reliability. Pearson correlations indicated the MAF has concurrent validity with the POMS fatigue subscale (r=0.84; p<0.01) and divergent validity with the POMS vigor subscale (r=-0.62; p<0.01). Stability of the MAF was determined by analyzing correlations of the MAF at three time points. The stability correlation ranged from a high of 0.73 for controls at time 1 to a low of 0.47 for the controls at time 3.

Since the initial testing of the MAF by Belza in healthy controls and patients with RA, the MAF has been tested in other chronic conditions such as HIV, multiple sclerosis, and cancer, and postpartum women. Refer to the list of published studies for the psychometric properties obtained in other samples. 

Strengths of the MAF
The MAF scale is a good choice when selecting an instrument to measure fatigue in chronic illness as it is: easy to administer and score, relatively short in length, and assesses the subjective aspects of fatigue including quantity, degree, distress, impact, and timing. The questionnaire allows patients to omit activity items that do not apply, thus making it a more accurate assessment of the impact of fatigue on activities of daily living (ADLs).

To yield reliable and valid responses, instructions are included on page one of the three-page instrument. The instructions read: “These questions are about fatigue and the effect of fatigue on how you have been feeling during the past week.” If no fatigue is reported, If respondents answer item #1 by indicating they have not had any fatigue in the past week, then they are instructed to stop.

The MAF was originally developed in US English. Over 40 language-versions are available at the MAPI Research Institute (Lyon, France) including but not limited to Spanish for Mexico, Spanish for USA, Spanish for Spain, Dutch for Belgium, Dutch for the Netherlands, French for Belgium, French for France, Mandarin for China, Croatian for Croatia, Danish for Denmark, Finnish for Finland, Czech for the Czech Republic, German for Germany, Turkish for Turkey, Swedish for Sweden, Afrikaans for South Africa, English for South Africa, Russian for Russia, Portuguese for Portugal, Portuguese for Brazil, Polish for Poland, Italian for Italy, Hungarian for Hungary, Hebrew for Israel, and Norwegian for Norway. Both forward and backward translations were used in the translation process. To gain access to and information about a translated version contact MAPI at their website noted below. 

The MAF is self-administered. Respondents are given the questionnaire and asked to complete it. It takes less than five minutes to complete. Individuals who administer the instrument should verify respondents have answered all of the items.

Permission to Use and Copyright
There is no charge for students or clinicians who request to use the MAF. Colleagues in industry who would like to use the MAF are charged a nominal fee. The MAF is copyrighted by Basia Belza.

To calculate the Global Fatigue Index (GFI): Convert item #15 to a 0-10 scale by multiplying each score by 2.5 and then sum items #1, 2, 3, average #4-14, and newly scored item #15.

Scores range from 1 (no fatigue) to 50 (severe fatigue). Do not assign a score to items #4-14 if respondent indicated they “do not do any activity for reasons other than fatigue.” If respondents select no fatigue on item #1, assign a zero to items #2-16. Item #16 is not included in the Global Fatigue Index.

Accessing the Multidimensional Assessment of Fatigue (MAF) Scale
The distribution of the MAF is handled by the MAPI Research Trust, on behalf of Basia Belza, developer and copyright owner of the MAF. Please contact the staff at MAPI Research Trust for information, translations and permission to use: MAPI Research Trust, Lyon, France. The MAF is housed in the PROQOLID database which is hosted by ePROVIDE database.