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De Doncker W, Kuppuswamy A. Lesioned hemisphere-specific phenotypes of post-stroke fatigue emerge from motor and mood characteristics in chronic stroke. Eur J Neurol 2024; 31:e16170. [PMID: 38069662 PMCID: PMC11141786 DOI: 10.1111/ene.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Post-stroke fatigue commonly presents alongside several comorbidities. The interaction between comorbidities and their relationship to fatigue is not known. In this study, we focus on physical and mood comorbidities, alongside lesion characteristics. We predict the emergence of distinct fatigue phenotypes with distinguishable physical and mood characteristics. METHODS In this cross-sectional observational study, in 94 first time, non-depressed, moderate to minimally impaired chronic stroke survivors, the relationship between measures of motor function (grip strength, nine-hole peg test time), motor cortical excitability (resting motor threshold), Hospital Anxiety and Depression Scale and Fatigue Severity Scale-7 (FSS-7) scores, age, gender and side of stroke was established using Spearman's rank correlation. Mood and motor variables were then entered into a k-means clustering algorithm to identify the number of unique clusters, if any. Post hoc pairwise comparisons followed by corrections for multiple comparisons were performed to characterize differences among clusters in the variables included in k-means clustering. RESULTS Clustering analysis revealed a four-cluster model to be the best model (average silhouette score of 0.311). There was no significant difference in FSS-7 scores among the four high-fatigue clusters. Two clusters consisted of only left-hemisphere strokes, and the remaining two were exclusively right-hemisphere strokes. Factors that differentiated hemisphere-specific clusters were the level of depressive symptoms and anxiety. Motor characteristics distinguished the low-depressive left-hemisphere from the right-hemisphere clusters. CONCLUSION The significant differences in side of stroke and the differential relationship between mood and motor function in the four clusters reveal the heterogenous nature of post-stroke fatigue, which is amenable to categorization. Such categorization is critical to an understanding of the interactions between post-stroke fatigue and its presenting comorbid deficits, with significant implications for the development of context-/category-specific interventions.
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Affiliation(s)
- William De Doncker
- Department of Clinical and Movement Neuroscience, Institute of NeurologyUniversity College LondonLondonUK
| | - Annapoorna Kuppuswamy
- Department of Clinical and Movement Neuroscience, Institute of NeurologyUniversity College LondonLondonUK
- Department of Biomedical SciencesUniversity of LeedsLeedsUK
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Pedersen SG, Anke A, Løkholm MT, Halvorsen MB, Kirkevold M, Heiberg G, Ørbo M, Friborg O. Change characteristics of health-related quality of life and its association with post-stroke fatigue at four-year follow-up. J Rehabil Med 2024; 56:jrm13389. [PMID: 38175175 PMCID: PMC10785687 DOI: 10.2340/jrm.v56.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To explore trajectories that describe change in post-stroke health-related quality of life with fatigue as outcome. DESIGN Observational and prospective study. SUBJECTS Stroke survivors (N = 144) with predominantly mild or moderate strokes. METHODS The multidimensional Stroke-Specific Quality of Life scale was used at 1 and 4 years, and the Fatigue Severity Scale at 4 years post-stroke. Latent class growth analyses were used as person-oriented analyses to identify meaningful trajectories. Socio-demographic and stroke-related covariables provided customary adjustment of the outcome, as well as prediction of class membership. RESULTS The latent class growth analysis models were estimated for "physical health", "visual-language", and "cognitive-social-mental" components of the Stroke-Specific Quality of Life scale, which extracted trajectories describing a variation in stable, deteriorating and improving functional patterns. The stable, well-functioning trajectory was most frequent across all components. More pronounced fatigue was associated with trajectories describing worse functioning, which was more prominent among females compared with males. Living alone implied more fatigue in the "cognitive-social-mental" component. Within the "visual-language" components' trajectories, younger and older participants reported more fatigue compared with middle-aged participants. CONCLUSION Most participants belonged to the stable, well-functioning trajectories, which showed a consistently lower level of fatigue compared with the other trajectories.
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Affiliation(s)
- Synne G Pedersen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Faculty of Health Sciences, Department of Clinical Medicine, UiT - The Arctic University of Norway
| | - Mari T Løkholm
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Marianne B Halvorsen
- Department of Pediatric Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Marit Kirkevold
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Guri Heiberg
- Department of Rehabilitation, University Hospital of North Norway, Harstad, Norway
| | - Marte Ørbo
- Faculty of Health Sciences, Department of Psychology, UIT - The Arctic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology, UIT - The Arctic University of Norway, Tromsø, Norway
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3
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Shao C, Wang Y, Gou H, Chen T. The factors associated with the deterioration of activities of daily life in stroke patients: A retrospective cohort study. Top Stroke Rehabil 2024; 31:21-28. [PMID: 36961229 DOI: 10.1080/10749357.2023.2194095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients. OBJECTIVE To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge. METHODS We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration. RESULTS Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge.Age (OR = 1.114, 95%CI = 1.045-1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189-8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011-6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386-0.606, p < 0.001). CONCLUSIONS Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration.
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Affiliation(s)
- Chenlan Shao
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Yongzheng Wang
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Hui Gou
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Tingting Chen
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
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Kuppuswamy A, Billinger S, Coupland KG, English C, Kutlubaev MA, Moseley L, Pittman QJ, Simpson DB, Sutherland BA, Wong C, Corbett D. Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:52-61. [PMID: 38156702 PMCID: PMC10798014 DOI: 10.1177/15459683231219266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF. METHODS This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms. CONCLUSION The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.
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Affiliation(s)
- Annapoorna Kuppuswamy
- Queen Square Institute of Neurology, University College London, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sandra Billinger
- Department of Neurology, University of Kansas Medical Center, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, MO, USA
| | - Kirsten G. Coupland
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J. Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dawn B. Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Brad A. Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TS, Australia
| | - Connie Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Brain and Mind Institute, University of Ottawa, Ottawa, ON, Canada
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Vratsistas-Curto A, Downie A, McCluskey A, Sherrington C. Trajectories of arm recovery early after stroke: an exploratory study using latent class growth analysis. Ann Med 2023; 55:253-265. [PMID: 36594373 PMCID: PMC9815231 DOI: 10.1080/07853890.2022.2159062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIM To investigate trajectories of recovery of motor arm function after stroke during inpatient rehabilitation. MATERIALS AND METHODS Data were available from 74 consecutively-admitted stroke survivors receiving inpatient rehabilitation from an inception cohort study. Heterogeneity of arm recovery in the first 4-weeks was investigated using latent class analysis and weekly Box and Block Test (BBT) scores. Optimal number of clusters were determined; characterised and cluster associated factors explored. RESULTS A 4-cluster model was identified, including 19 participants with low baseline arm function and minimal recovery ('LOWstart/LOWprogress', 26%), 15 with moderate function and low recovery ('MODstart/LOWprogress', 20%), 15 with low function and high recovery ('LOWstart/HIGHprogress', 20%), and 25 with moderate function and recovery ('MODstart/MODprogress', 34%). Compared to LOWstart/LOWprogress: LOWstart/HIGHprogress presented earlier post-stroke (β, 95%CI) (-4.81 days, -8.94 to -0.69); MODstart/MODprogress had lower modified Rankin Scale scores (-0.74, -1.15 to -0.32); and MODstart/LOWprogress, LOWstart/HIGHprogress and MODstart/MODprogress had higher admission BBT (23.58, 18.82 to 28.34; 4.85, 0.85 to 9.61; 28.02, 23.82 to 32.21), Upper Limb-Motor Assessment Scale (9.60, 7.24 to 11.97; 3.34, 0.97 to 5.70; 10.86, 8.77 to 12.94), Action Research Arm Test (31.09, 22.86 to 39.33; 12.69, 4.46 to 20.93; 38.01, 30.76 to 45.27), and Manual Muscle Test scores (10.64, 7.07 to 14.21; 6.24, 2.67 to 9.81; 11.87, 8.72 to 15.01). CONCLUSIONS We found unique patterns of arm recovery with distinct characteristics for each cluster. Better understanding of patterns of arm recovery can guide future models and intervention development.KEY MESSAGESArm recovery early after stroke follows four distinct trajectories that relate to time post stroke, initial stroke severity and baseline level of motor arm function.Identification of recovery patterns gives insight into the uniqueness of individual's recovery.This study offers a novel approach on which to build and develop future models of arm recovery.
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Affiliation(s)
- Angela Vratsistas-Curto
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Aron Downie
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia.,Health and Human Sciences, Faculty of Medicine, Macquarie University, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,StrokeEd Collaboration, Sydney, Australia
| | - Catherine Sherrington
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
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Bhimani R, Xiong J, Anderson L. Fatigue Experiences in People With Stroke. Rehabil Nurs 2023; 48:200-208. [PMID: 37733016 DOI: 10.1097/rnj.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Fatigue is a major symptom in patients with stroke. Because fatigue is an overarching multidimensional phenomenon, it is important to understand how the characteristics of fatigue change over time. The purpose of this study was to explore how fatigue characteristics change over time in patients with stroke. DESIGN This study used a mixed-method observational design. METHODS This study is a secondary analysis of data from a previous study, the results of which indicated fatigue to be a prominent symptom. Participants in that study were patients with stroke who met eligibility criteria and provided informed consent. This secondary analysis used data from numeric rating scale scores for fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores, fatigue descriptors, and participant comments about fatigue gleaned from transcribed interviews. RESULTS Twenty-two patients participated in the study. Thirteen characteristics of fatigue were evaluated. Seven characteristics showed significant improvement ( p < .05) from admission to 1 month follow-up, and six characteristics did not change significantly. CONCLUSIONS Fatigue experiences vary over time and have both physical and mental aspects to them. CLINICAL RELEVANCE TO REHABILITATION NURSING Nurses may consider providing a quiet environment for physical rest, which may allow the brain to not be distracted by multiple stimuli.
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Affiliation(s)
- Rozina Bhimani
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Jiayue Xiong
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Lisa Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
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Jolly AA, Zainurin A, Mead G, Markus HS. Neuroimaging correlates of post-stroke fatigue: A systematic review and meta-analysis. Int J Stroke 2023; 18:1051-1062. [PMID: 37485902 PMCID: PMC10614177 DOI: 10.1177/17474930231192214] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Fatigue is a common and disabling symptom following stroke, but its underlying mechanisms are unknown. Associations with a number of imaging features have been proposed. AIMS We aimed to assess whether neuroimaging parameters could better inform our understanding of possible causes of post-stroke fatigue (PSF) through systematic review and meta-analysis. METHODS Using a predefined protocol registered with PROSPERO (ID: CRD42022303168), we searched EMBASE, MEDLINE, PubMed, and PsycInfo for studies assessing PSF and computerized tomography (CT), magnetic resonance (MR), positron emission tomography (PET) imaging, or diffusion tensor imaging (DTI). We extracted neuroimaging parameters and narratively analyzed study results to assess any association with PSF. Where there were 3+ similar studies, we carried out a meta-analysis using inverse-variance random-effects model to estimate the total association of each neuroimaging parameter on PSF. The risk of bias was assessed using the Newcastle and Ottawa Scale. RESULTS We identified 46 studies (N = 6543); in many studies, associations with fatigue were secondary or subanalyses (28.3%). Imaging parameters were assessed across eight variables: lesion lateralization, lesion location, lesion volume, brain atrophy, infarct number, cerebral microbleeds, white matter hyperintensities (WMHs), and network measures. Most variables showed no conclusive evidence for any association with fatigue. Meta-analysis, where possible, showed no association of the following with PSF; left lesion lateralization (OR: 0.88, 95% CI (0.64, 1. 22) (p = 0.45)), infratentorial lesion location (OR: 1.83, 95% CI (0.63, 5.32) (p = 0.27)), and WMH (OR: 1.21, 95% CI (0.84, 1.75) (p = 0.29)). Many studies assessed lesion location with mixed findings; only one used voxel-symptom lesion-mapping (VSLM). Some small studies suggested an association between altered functional brain networks, namely frontal, fronto-striato-thalamic, and sensory processing networks, with PSF. CONCLUSION There was little evidence for the association between any neuroimaging parameters and PSF. Future studies should utilize advanced imaging techniques to fully understand the role of lesion location in PSF, while the role of altered brain networks in mediating PSF merits further research.
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Affiliation(s)
- Amy A Jolly
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Adriana Zainurin
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Gillian Mead
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Tsai MC, Wang YCL, Chan HY. Pubertal progression and its relationship to psychological and behavioral outcomes among adolescent boys. Dev Psychopathol 2023; 35:1891-1900. [PMID: 36205706 DOI: 10.1017/s0954579422000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Variations in pubertal timing and tempo have relevance to psychosocial development. Accounting for pubertal timing, tempo, and psychosocial development simultaneously in a model remains challenging. This study aimed to document the typology of pubertal development in a cohort of Taiwanese adolescent boys and then to examine how the associations between psychosocial variables across time vary by the patterns of pubertal development. A group of adolescent boys (n = 1,368) reported pubertal signs and psychosocial variables for 3 years since seventh grade. The growth mixture model revealed three major classes of pubertal transition: average pubertal growth, late-onset with rapid catch-up, and late-onset with slow catch-up. In a cross-lagged panel model, the multigroup analysis found the regression coefficients mostly invariant across all three classes, except those between deviant behavior and subsequent changes in depressive symptoms that were significantly positive only in the late-onset with slow catch-up group. Adolescent boys in this group were estimated to have the highest marginal level of depressive symptoms and deviant behavior in ninth grade among the three classes. Our study highlights the heterogeneity in boys' pubertal development and the role of the pubertal development pattern in their psychosocial development.
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Affiliation(s)
- Meng-Che Tsai
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City704, Taiwan
- Department of Medical Humanities and Social Medicine, College of Medicine, National Cheng Kung University, Tainan City701, Taiwan
| | - Yu-Chung Lawrence Wang
- Department of Guidance and Counseling, College of Education, National Changhua University of Education, Changhua City500, Taiwan
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, College of Education and Human Services, Texas A&M University-Commerce, Commerce, TX75429, USA
- Department of Industrial Education, College of Technology and Engineering, National Taiwan Normal University, Taipei City106, Taiwan
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9
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Li YT, Cheng HY, Liao Y, Liu J, Li LY, Sit JWH. Measuring poststroke fatigue: The psychometric properties of the Chinese version of multidimensional fatigue inventory. J Psychosom Res 2023; 172:111388. [PMID: 37307747 DOI: 10.1016/j.jpsychores.2023.111388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/14/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Poststroke fatigue (PSF) is a common and debilitating problem among stroke patients. Multidimensional fatigue inventory (MFI) has been recommended to assess fatigue related to acquired brain injury. This study aimed to examine the psychometric properties of the Chinese version of MFI among stroke patients. METHODS The study recruited 252 stroke patients in China. The internal consistency of the Chinese-version MFI was evaluated using Cronbach's α coefficients. The test-retest reliability was measured over a 5-day interval with intraclass correlation coefficient. Exploratory factor analysis was conducted to analyze the construct validity. The concurrent validity of MFI was examined by calculating the Pearson's correlation coefficient between the scores of MFI and the fatigue assessment scale (FAS). RESULTS The exploratory factor analysis of the Chinese-version of MFI showed that it captured three dimensions of PSF, namely, physical fatigue, mental fatigue, and level of activity. The Chinese-version MFI demonstrated satisfactory internal consistency with Cronbach's α ranging from 0.83 (mental fatigue) to 0.91 (total scale). The Chinese-version MFI showed adequate test-retest reliability with intraclass correlation coefficients of 0.70 for the total scale, 0.69 for physical fatigue, 0.66 for mental fatigue, and 0.62 for level of activity. The concurrent validity of the Chinese-version MFI was demonstrated by a significant positive correlation (r=0.49, p <0.001) with FAS. CONCLUSION This study findings showed that Chinese-version MFI has adequate internal consistency and test-retest reliability, and demonstrated its concurrent validity with FAS. The findings provide preliminary evidence of the three-factor structure of Chinese-version MFI by exploratory factor analysis.
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Affiliation(s)
- Ya Ting Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Ying Liao
- Nursing Department, Shijiazhuang People's Hospital, Shijiazhuang, Hebei Province, China
| | - Juan Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei Province, China
| | - Lai You Li
- Nursing Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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10
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Neely ML, Pieper CF, Gu B, Dmitrieva NO, Pendergast JF. Exploration of model misspecification in latent class methods for longitudinal data: Correlation structure matters. Stat Med 2023; 42:2420-2438. [PMID: 37019876 PMCID: PMC10777323 DOI: 10.1002/sim.9730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Modeling longitudinal trajectories and identifying latent classes of trajectories is of great interest in biomedical research, and software to identify latent classes of such is readily available for latent class trajectory analysis (LCTA), growth mixture modeling (GMM) and covariance pattern mixture models (CPMM). In biomedical applications, the level of within-person correlation is often non-negligible, which can impact the model choice and interpretation. LCTA does not incorporate this correlation. GMM does so through random effects, while CPMM specifies a model for within-class marginal covariance matrix. Previous work has investigated the impact of constraining covariance structures, both within and across classes, in GMMs-an approach often used to solve convergence problems. Using simulation, we focused specifically on how misspecification of the temporal correlation structure and strength, but correct variances, impacts class enumeration and parameter estimation under LCTA and CPMM. We found (1) even in the presence of weak correlation, LCTA often does not reproduce original classes, (2) CPMM performs well in class enumeration when the correct correlation structure is selected, and (3) regardless of misspecification of the correlation structure, both LCTA and CPMM give unbiased estimates of the class trajectory parameters when the within-individual correlation is weak and the number of classes is correctly specified. However, the bias increases markedly when the correlation is moderate for LCTA and when the incorrect correlation structure is used for CPMM. This work highlights the importance of correlation alone in obtaining appropriate model interpretations and provides insight into model choice.
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Affiliation(s)
- Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Carl F Pieper
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
- Center on Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Bida Gu
- Department of Quantitative and Computational Biology, Dana and David Dornsife College of Letters, Arts and Sciences, University Southern California, Los Angeles, California, USA
| | - Natalia O Dmitrieva
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jane F Pendergast
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
- Center on Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
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11
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Dornonville de la Cour FL, Schow T, Andersen TE, Petersen AH, Zornhagen G, Visser-Keizer AC, Norup A. Measurement Properties of the Dutch Multifactor Fatigue Scale in Early and Late Rehabilitation of Acquired Brain Injury in Denmark. J Clin Med 2023; 12:jcm12072587. [PMID: 37048671 PMCID: PMC10094862 DOI: 10.3390/jcm12072587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
Fatigue is a major issue in neurorehabilitation without a gold standard for assessment. The purpose of this study was to evaluate measurement properties of the five subscales of the self-report questionnaire the Dutch Multifactor Fatigue Scale (DMFS) among Danish adults with acquired brain injury. A multicenter study was conducted (N = 149, 92.6% with stroke), including a stroke unit and three community-based rehabilitation centers. Unidimensionality and measurement invariance across rehabilitation settings were tested using confirmatory factor analysis. External validity with Depression Anxiety Stress Scales (DASS-21) and the EQ-5D-5L was investigated using correlational analysis. Results were mixed. Unidimensionality and partial invariance were supported for the Impact of Fatigue, Mental Fatigue, and Signs and Direct Consequences of Fatigue, range: RMSEA = 0.07–0.08, CFI = 0.94–0.99, ω = 0.78–0.90. Coping with Fatigue provided poor model fit, RMSEA = 0.15, CFI = 0.81, ω = 0.46, and Physical Fatigue exhibited local dependence. Correlations among the DMFS, DASS-21, and EQ-5D-5L were in expected directions but in larger magnitudes compared to previous research. In conclusion, three subscales of the DMFS are recommended for assessing fatigue in early and late rehabilitation, and these may facilitate the targeting of interventions across transitions in neurorehabilitation. Subscales were strongly interrelated, and the factor solution needs evaluation.
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Affiliation(s)
- Frederik Lehman Dornonville de la Cour
- Cervello, 2800 Kongens Lyngby, Denmark
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
- Correspondence: ; Tel.: +45-38634628
| | | | | | | | - Gry Zornhagen
- Center for Communication Disorders, The Capital Region of Denmark, 2750 Ballerup, Denmark
| | | | - Anne Norup
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, 2600 Glostrup, Denmark
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12
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Potter T, Gange N, Whiteside E, Gyawali P. Scoping review of molecular biomarkers associated with fatigue, stress, and depression in stroke survivors: A protocol. PLoS One 2023; 18:e0281238. [PMID: 36735703 PMCID: PMC9897583 DOI: 10.1371/journal.pone.0281238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
The prevalence of stroke increases each year and while mortality from stroke has decreased, the prevalence of comorbidities such as anxiety, depression and fatigue affects as many as 75% of stroke survivors. The aetiology of post-stroke fatigue is not clear, although it has been shown to be interrelated with comorbidities such as stress and depression. Due to the interconnected nature of these comorbidities, it is important to improve the specificity of diagnosis and identify novel therapeutic targets to improve the quality of life for stroke survivors. The investigation of molecular biomarkers associated with post-stroke stress, fatigue, and depression may shed light on the relationships between comorbidities and also contribute to the development of novel diagnostics and therapies. Several biomarkers have been identified for stress, depression, and fatigue, some of which are specific to stroke survivors. However, there remain several gaps in understanding, particularly in relation to the physiological mechanisms underlying these side effects and molecular biomarkers associated with post-stroke fatigue. The aim of this scoping review protocol is to outline the methodologies that will be used to provide a comprehensive understanding of the current literature on biomarkers associated with post-stroke fatigue, stress, and depression, informing future research questions.
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Affiliation(s)
- Tarynn Potter
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Nisal Gange
- Geriatric Adult Rehabilitation and Stroke Service (GARSS), Darling Downs Health Service (DDHS), Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Eliza Whiteside
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Prajwal Gyawali
- School of Health and Medical Science, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
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13
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Clark LA, Reed R, Corazzini KN, Zhu S, Renn C, Jennifer Klinedinst N. COPD-Related Fatigue: A Scoping Review. Clin Nurs Res 2022; 32:914-928. [PMID: 36540028 DOI: 10.1177/10547738221141224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Millions of people worldwide have chronic obstructive pulmonary disease (COPD), and one of the most common and troublesome symptoms that must be managed is fatigue. While there are existing interventions to address COPD-related fatigue, not all patients experience benefit. A better understanding of the factors associated with COPD-fatigue could elucidate new approaches to address COPD-related fatigue, thereby offering relief to a greater number of patients. The purpose of this review was to identify the physiologic, psychologic, and situational factors associated with COPD-related fatigue. A total of four databases, PubMed, CINAHL, Scopus, and Google Scholar, were searched. Those that were peer reviewed, in English, and published between 2000 and 2021, were included in the review. A total of 25 articles were included in this scoping review. The following factors were related to fatigue in COPD: dyspnea, pain, anxiety, depression, and sleep. Fatigue is a debilitating symptom with factors influential to the symptom and outcomes. Research is indicated to explore targeted and personalized interventions addressing the factors related to fatigue to mitigate this widespread symptom.
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Affiliation(s)
- Lindsey A. Clark
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Robert Reed
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Cynthia Renn
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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14
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Klein I, Verhaak CM, Smeitink JAM, de Laat P, Janssen MCH, Custers JAE. Identifying trajectories of fatigue in patients with primary mitochondrial disease due to the m.3243A > G variant. J Inherit Metab Dis 2022; 45:1130-1142. [PMID: 36053898 PMCID: PMC9805089 DOI: 10.1002/jimd.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/31/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
Severe fatigue is a common complaint in patients with primary mitochondrial disease. However, less is known about the course of fatigue over time. This longitudinal observational cohort study of patients with the mitochondrial DNA 3243 A>G variant explored trajectories of fatigue over 2 years, and characteristics of patients within these fatigue trajectories. Fifty-three adult patients treated at the Radboud University Medical Center Nijmegen were included. The majority of the patients reported consistent, severe fatigue (41%), followed by patients with a mixed pattern of severe and mild fatigue (36%). Then, 23% of patients reported stable mild fatigue levels. Patients with a stable high fatigue trajectory were characterized by higher disease manifestations scores, more clinically relevant mental health symptoms, and lower psychosocial functioning and quality of life compared to patients reporting stable low fatigue levels. Fatigue at baseline and disease manifestation scores predicted fatigue severity at the 2-year assessment (57% explained variance). This study demonstrates that severe fatigue is a common and stable complaint in the majority of patients. Clinicians should be aware of severe fatigue in patients with moderate to severe disease manifestation scores on the Newcastle Mitochondrial Disease Scale, the high prevalence of clinically relevant mental health symptoms and overall impact on quality of life in these patients. Screening of fatigue and psychosocial variables will guide suitable individualized treatment to improve the quality of life.
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Affiliation(s)
- Inge‐Lot Klein
- Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial MedicineNijmegenThe Netherlands
| | - Christianne M. Verhaak
- Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial MedicineNijmegenThe Netherlands
| | - Jan A. M. Smeitink
- Department of PediatricsRadboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial MedicineNijmegenThe Netherlands
| | - Paul de Laat
- Department of PediatricsFranciscus Gasthuis & VlietlandRotterdamThe Netherlands
| | - Mirian C. H. Janssen
- Department of Internal MedicineRadboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial MedicineNijmegenThe Netherlands
| | - José A. E. Custers
- Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial MedicineNijmegenThe Netherlands
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15
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Ulrichsen KM, Kolskår KK, Richard G, Pedersen ML, Alnaes D, Dørum ES, Sanders AM, Tornås S, Maglanoc LA, Engvig A, Ihle-Hansen H, Nordvik JE, Westlye LT. No add-on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham-controlled trial combining tDCS with computerized cognitive training. Brain Behav 2022; 12:e2643. [PMID: 35666655 PMCID: PMC9304833 DOI: 10.1002/brb3.2643] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Fatigue and emotional distress rank high among self-reported unmet needs in life after stroke. Transcranial direct current stimulation (tDCS) may have the potential to alleviate these symptoms for some patients, but the acceptability and effects for chronic stroke survivors need to be explored in randomized controlled trials. METHODS Using a randomized sham-controlled parallel design, we evaluated whether six sessions of 1 mA tDCS (anodal over F3, cathodal over O2) combined with computerized cognitive training reduced self-reported symptoms of fatigue and depression. Among the 74 chronic stroke patients enrolled at baseline, 54 patients completed the intervention. Measures of fatigue and depression were collected at five time points spanning a 2 months period. RESULTS While symptoms of fatigue and depression were reduced during the course of the intervention, Bayesian analyses provided evidence for no added beneficial effect of tDCS. Less severe baseline symptoms were associated with higher performance improvement in select cognitive tasks, and study withdrawal was higher in patients with more fatigue and younger age. Time-resolved symptom analyses by a network approach suggested higher centrality of fatigue items (except item 1 and 2) than depression items. CONCLUSION The results reveal no add-on effect of tDCS on fatigue or depression but support the notion of fatigue as a relevant clinical symptom with possible implications for treatment adherence and response.
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Affiliation(s)
- Kristine M Ulrichsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Knut K Kolskår
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Geneviève Richard
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mads Lund Pedersen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Dag Alnaes
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Bjørknes College, Oslo, Norway
| | - Erlend S Dørum
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | - Anne-Marthe Sanders
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,Sunnaas Rehabilitation Hospital HT, Nesodden, Norway
| | | | - Luigi A Maglanoc
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Andreas Engvig
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | | | | | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Norway
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16
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Kim YH. Maternal Responsive Parenting Trajectories From Birth to Age 3 and Children's Self-Esteem at First Grade. Front Psychol 2022; 13:870669. [PMID: 35572234 PMCID: PMC9096869 DOI: 10.3389/fpsyg.2022.870669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
This paper examines the quality and stability of the responsive parenting practices of mothers with infants and the longitudinal links between these practices and children’s self-esteem. Using data presented by the Panel Study on Korean Children, this study identified Korean mothers’ responsive parenting trajectories from birth to age three and examined their associations with children’s self-esteem at first grade. Korean mothers developed one of three responsive parenting patterns from birth to age three: low (19.0%), moderate (66.0%), or high (15.0%). Children’s self-esteem differed according to their mother’s responsive parenting trajectory. First-graders with mothers displaying the low responsive parenting trajectory were more likely to have lower self-esteem than children of mothers with the moderate responsive parenting trajectory and children of mothers with the high responsive parenting trajectory. The longitudinal link between mother-reported responsive parenting patterns during infancy and child-reported self-esteem at first grade was verified. This finding highlights the significance of early responsive parenting from mothers as a predictor of the self-esteem of children in later developmental stages.
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Affiliation(s)
- Yeon Ha Kim
- Department of Child and Family Studies, Kyung Hee University, Seoul, South Korea
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17
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Spasticity, Pain, and Fatigue. Rehabil Nurs 2021; 47:60-71. [DOI: 10.1097/rnj.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Cotter G, Salah Khlif M, Bird L, E Howard M, Brodtmann A, Egorova-Brumley N. Post-stroke fatigue is associated with resting state posterior hypoactivity and prefrontal hyperactivity. Int J Stroke 2021; 17:17474930211048323. [PMID: 34569876 DOI: 10.1177/17474930211048323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown. AIM This observational study aimed to identify resting state brain activity markers of post-stroke fatigue. METHOD Sixty-three stroke survivors (22 women; age 30-89 years; mean 67.5 ± 13.4 years) from the Cognition And Neocortical Volume After Stroke study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischemic stroke, underwent brain imaging three months post-stroke, including a 7-minute resting state functional magnetic resonance imaging. We calculated the fractional amplitude of low-frequency fluctuations, which is measured at the whole-brain level and can detect altered spontaneous neural activity of specific regions. RESULTS Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. Fatigued compared to non-fatigued participants demonstrated significantly lower resting-state activity in the calcarine cortex (p < 0.001, cluster-corrected pFDR = 0.009, k = 63) and lingual gyrus (p < 0.001, cluster-corrected pFDR = 0.025, k = 42) and significantly higher activity in the medial prefrontal cortex (p < 0.001, cluster-corrected pFDR = 0.03, k = 45). CONCLUSIONS Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.
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Affiliation(s)
- Georgia Cotter
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- Dementia Theme, the Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Laura Bird
- Dementia Theme, the Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Mark E Howard
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Victorian Respiratory Support Service, Austin Health, Heidelberg, Australia
| | - Amy Brodtmann
- Dementia Theme, the Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Natalia Egorova-Brumley
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Dementia Theme, the Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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19
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Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021; 77:2860-2874. [PMID: 33650219 DOI: 10.1111/jan.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
AIMS Stroke is affecting an increasing number of young and middle-aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health-related quality of life (HRQOL) is likely to be negatively impacted during the immediate post-acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio-ecological perspective. DESIGN Longitudinal, convergent mixed methods design. METHODS HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub-themes identified from conventional content analysis using joint data displays. RESULTS Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post-stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta-inference could not be drawn as no quantitative data addressed these concepts. CONCLUSION A variety of factors intersecting across socio-ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. IMPACT This study identified individual-, family- and societal-level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.
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Affiliation(s)
| | | | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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20
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Su Y, Asamoto M, Yuki M, Saito M, Hasebe N, Hirayama K, Otsuki M, Iino C. Predictors and short-term outcomes of post-stroke fatigue in initial phase of transition from hospital to home: A prospective observational study. J Adv Nurs 2020; 77:1825-1838. [PMID: 33368578 PMCID: PMC8048815 DOI: 10.1111/jan.14731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
AIM To analyse the interactions of associated factors with post stroke fatigue (PSF) after discharge home and determine the predictors of PSF and their impact on stroke survivors. DESIGN A prospective observational study. METHODS A total of 94 patients with acute stroke were recruited between May 2019 -July 2020. The main outcomes were fatigue, depression, insomnia, sarcopenia, and health-related quality of life (HRQOL) and were assessed at admission and 1 month after discharge. Fatigue was measured using the Fatigue Assessment Scale. Depression and Insomnia were assessed using the Hospital Anxiety and Depression Scale-Depression and Insomnia Severity Index, respectively. Sarcopenia was measured using the SARC-F questionnaire, and HRQOL was assessed using the Short Form-8. RESULTS Acute phase PSF was an independent predictor of PSF after discharge home. Moreover the path analysis revealed that this effect is mediated through both the direct effect of acute-phase PSF on PSF after discharge home and through the indirect effect of interaction with pre-stroke SARC-F, acute phase depression, and acute phase insomnia, which remains a separate predictor of acute-phase PSF. In total, 17% of the survivors had persistent PSF. Persistent PSF was significantly associated with depression, insomnia, sarcopenia, and a lower quality of life scores. CONCLUSIONS Post-stroke fatigue may occur in the acute phase and persists after discharge, it will not only affect later depression, insomnia, and quality of life, but also sarcopenia. IMPACT Acute phase PSF was found to be an independent predictor of PSF after discharge home. In addition, the interaction with pre-stroke SARC-F, acute phase depression and insomnia had an indirect connection with PSF after discharge home, which remains a separate predictor of acute-phase PSF. Thus, early assessment and management of mental status, sleep problems, and sarcopenia during hospitalization might be an important step in post-stroke rehabilitation and home transition.
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Affiliation(s)
- Ya Su
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mitsuko Asamoto
- Nursing Department, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Michiko Yuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masaru Saito
- Nursing Department, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Naoko Hasebe
- Nursing Department, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - Kengo Hirayama
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Mika Otsuki
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Chieko Iino
- Nursing Department, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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