Prevalence and Predictors of 6-Month Fatigue in Patients With Ischemic Stroke: A Population-Based Stroke Incidence Study in Auckland, New Zealand, 2002–2003

Background and Purpose— Although persistent and significant fatigue affects the daily life of stroke survivors, there are no population-based studies examining the prevalence of fatigue in 6-month survivors of ischemic stroke and few studies of predictors of poststroke fatigue. Methods— This article examined data from the Auckland Regional Community Stroke study conducted in Auckland, New Zealand, in 2002 to 2003. Presence of fatigue was evaluated at 6 months in 613 patients with ischemic stroke using a Short Form 36 Vitality Score (energy and fatigue) of ⩽47. Multivariate logistic regression analysis was used to determine predictors of fatigue development 6 months poststroke. Results— The prevalence of fatigue was 30% (28% in men and 33% in women). There was a clear association between increased prevalence of fatigue and advancing age. The only baseline variables independently associated with an increased risk of developing fatigue at 6 months poststroke were prestroke incontinence and being of New Zealand European ethnicity. Being independent and living alone at baseline were associated with significant reduction in the risk of being fatigued at 6 months poststroke. Severe depression at 6 months was significantly and independently associated with being fatigued. Conclusions— The prevalence of fatigue found in our study is at the lower level of range reported in other studies. The prevalence of fatigue increased with advancing age, as found in most previous studies. Because fatigue can have a negative impact on stroke recovery, particular attention needs to be paid to those who are older, incontinent before stroke, and those who report severe symptoms of depression at 6 months after stroke.

[1]  E. Glader,et al.  Poststroke Fatigue: A 2-Year Follow-Up Study of Stroke Patients in Sweden , 2002, Stroke.

[2]  I. McDowell,et al.  Measuring health: A guide to rating scales and questionnaires, 3rd ed. , 2006 .

[3]  V. Feigin,et al.  Trends in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003 , 2005, Stroke.

[4]  K. Michael Fatigue and stroke. , 2002, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[5]  K. Chan,et al.  Psychometric evaluation of the fatigue severity scale for use in chronic hepatitis C , 2004, Quality of Life Research.

[6]  V. Mok,et al.  Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly? , 2004, Journal of affective disorders.

[7]  C. Stefanis,et al.  GHQ‐28 as an aid to detect mental disorders in neurological inpatients , 1996, Acta psychiatrica Scandinavica.

[8]  Julien Bogousslavsky,et al.  Fatigue after Stroke: A Major but Neglected Issue , 2001, Cerebrovascular Diseases.

[9]  Jingwei Wu,et al.  Comparison of SF-36 vitality scale and Fatigue Symptom Inventory in assessing cancer-related fatigue , 2011, Supportive Care in Cancer.

[10]  S. Haslett,et al.  SF‐36 health survey reliability, validity and norms for New Zealand , 1999, Australian and New Zealand journal of public health.

[11]  S. Mody,et al.  Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference , 2007, Current medical research and opinion.

[12]  Byron J Gajewski,et al.  Exertion Fatigue and Chronic Fatigue Are Two Distinct Constructs in People Post-Stroke , 2010, Stroke.

[13]  J. Harbison,et al.  Estimated prevalence of fatigue following stroke and transient ischemic attack is dependent on terminology used and patient gender. , 2010, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[14]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[15]  L. Kappelle,et al.  Early neuropsychological evaluation in patients with ischaemic stroke provides valid information , 2005, Clinical Neurology and Neurosurgery.

[16]  Paul Dorman,et al.  Fatigue after Stroke: Baseline Predictors and Influence on Survival. Analysis of Data from UK Patients Recruited in the International Stroke Trial , 2011, PloS one.

[17]  Marleen H De Groot,et al.  Fatigue associated with stroke and other neurologic conditions: Implications for stroke rehabilitation. , 2003, Archives of physical medicine and rehabilitation.

[18]  Valery Feigin,et al.  Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002–2003 , 2006, The Lancet Neurology.

[19]  S. Pickard-Holley Fatigue in cancer patients: A descriptive study , 1991, Cancer nursing.

[20]  J. Bogousslavsky,et al.  Frequency, characterisation and therapies of fatigue after stroke , 2008, Neurological Sciences.

[21]  C. McHorney,et al.  The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Constructs , 1993, Medical care.

[22]  G. Bleijenberg,et al.  Experience of Severe Fatigue Long after Stroke and Its Relation to Depressive Symptoms and Disease Characteristics , 2001, European Neurology.

[23]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[24]  B. Garssen,et al.  Fatigue in cancer patients. , 1993, British Journal of Cancer.

[25]  A. Algra,et al.  Decreased capacity for mental effort after single supratentorial lacunar infarct may affect performance in everyday life , 1998, Journal of neurology, neurosurgery, and psychiatry.

[26]  M. Ketelaar,et al.  Poststroke fatigue: course and its relation to personal and stroke-related factors. , 2006, Archives of physical medicine and rehabilitation.

[27]  Post stroke fatigue--where is the evidence to guide practice? , 2007, The New Zealand medical journal.

[28]  M. Kirkevold,et al.  Dimensions of Post-Stroke Fatigue: A Two-Year Follow-Up Study , 2008, Cerebrovascular Diseases.

[29]  G. Mead,et al.  Evaluation of Fatigue Scales in Stroke Patients , 2007, Stroke.

[30]  A. Wingate,et al.  Defining and measuring fatigue. , 1999, Image--the journal of nursing scholarship.

[31]  A. Chaudhuri,et al.  Fatigue in neurological disorders , 2004, The Lancet.

[32]  P. Rothwell,et al.  A Population-Based Study of the Prevalence of Fatigue After Transient Ischemic Attack and Minor Stroke , 2009, Stroke.

[33]  G. Millet,et al.  Central and peripheral contributions to neuromuscular fatigue induced by a 24-h treadmill run. , 2010, Journal of applied physiology.

[34]  C. Blomstrand,et al.  Consequences of Mild Stroke in Persons <75 Years – A 1-Year Follow-Up , 2003, Cerebrovascular Diseases.

[35]  D Shinar,et al.  Reliability of the activities of daily living scale and its use in telephone interview. , 1988, Archives of physical medicine and rehabilitation.

[36]  R. Macko,et al.  Fatigue After Stroke: Relationship to Mobility, Fitness, Ambulatory Activity, Social Support, and Falls Efficacy , 2006, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[37]  G. Mead,et al.  Post-stroke fatigue: an important yet neglected symptom. , 2005, Age and ageing.

[38]  S. Kwon,et al.  Poststroke Fatigue: Characteristics and Related Factors , 2005, Cerebrovascular Diseases.

[39]  K. Brittain,et al.  Stroke and incontinence. , 1998, Stroke.

[40]  S. Phillips,et al.  Fatigue after stroke , 2005 .

[41]  G. Kwakkel,et al.  Is Fatigue an Independent Factor Associated with Activities of Daily Living, Instrumental Activities of Daily Living and Health-Related Quality of Life in Chronic Stroke? , 2006, Cerebrovascular Diseases.

[42]  D. Wilks,et al.  Comparison of Euroqol EQ-5D and SF-36 in patients with chronic fatigue syndrome , 2004, Quality of Life Research.

[43]  P. Appelros Prevalence and predictors of pain and fatigue after stroke: a population-based study , 2006, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.