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Juárez-Belaúnde A, Soto-León V, Dileone M, Orcajo E, León-Álvarez N, Muñoz A, Tornero J, Oliviero A. Early poststroke clinically significant fatigue predicts functional independence: a prospective longitudinal study. Front Neurol 2024; 15:1364446. [PMID: 38919969 PMCID: PMC11197430 DOI: 10.3389/fneur.2024.1364446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/15/2024] [Indexed: 06/27/2024] Open
Abstract
Background Poststroke fatigue is a prevalent issue among stroke survivors, significantly impeding functional recovery and diminishing their quality of life. Aim This prospective cohort study aims to investigate the association between poststroke fatigue and the extent of functional recovery in survivors of ischemic and hemorrhagic strokes. Additionally, it seeks to delineate the temporal progression of poststroke fatigue in these two stroke subtypes. Methods We assessed a cohort of 79 patients recovering from acute ischemic or hemorrhagic strokes. Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and the Numeric Rating Scale (NRSfatigue). Patients' condition was evaluated using the National Institute of Health Stroke Scale (NIHSS), and functional independence levels were determined using the Barthel Index for Activities of Daily Living (BIADL) and the Modified Rankin Scale (MRS). Depressive mood and pain were measured using the Beck Depression Inventory (BDI) and the Numeric Rating Scale for pain (NRSpain), respectively. Results Our primary findings indicate that the early manifestation of clinically significant fatigue (CSF) is predictive of a poorer trajectory in functional independence levels during recovery. Furthermore, we observed differing patterns of fatigue progression between ischemic and hemorrhagic strokes. Fatigue tends to ameliorate over time in hemorrhagic stroke cases, paralleling functional recovery, while it remains stable over time in ischemic stroke cases. Conclusion Our results underscore the detrimental impact of early poststroke fatigue on long-term outcomes. Furthermore, they highlight the imperative of managing poststroke fatigue, particularly during the subacute phase of stroke recovery.
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Affiliation(s)
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Michele Dileone
- Neurology Department, Hospital Nuestra Señora del Prado, SESCAM, Talavera de la Reina, Spain
- Department of Radiology, Faculty of Health Sciences, UCLM, Talavera de la Reina, Spain
| | - Elena Orcajo
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
| | | | - Alberto Muñoz
- School of Medicine, Universidad Complutense de Madrid, Madrid., Spain
| | - Jesus Tornero
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
| | - Antonio Oliviero
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
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Mulligan K, Harris K, Rixon L, Burls A. A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions. Disabil Rehabil 2024:1-18. [PMID: 38832888 DOI: 10.1080/09638288.2024.2353855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/04/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions. METHODS A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted. RESULTS The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials. CONCLUSION This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.
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Affiliation(s)
- Kathleen Mulligan
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katherine Harris
- Centre for Genomics and Child Health, the Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Lorna Rixon
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Amanda Burls
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
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3
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Zeng H, Yang J, Wu J, Ding Y, Yuan S, Wang R, Zhao W, Zeng X. The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study. PLoS One 2024; 19:e0302574. [PMID: 38820361 PMCID: PMC11142535 DOI: 10.1371/journal.pone.0302574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/08/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Post-stroke fatigue is a typical complication following stroke. However, existing research primarily focused on its underlying mechanisms, and its impact on rehabilitation outcomes has yet to be uncovered. OBJECTIVE This study aims to explore the impact of post-stroke fatigue on rehabilitation outcomes during hospitalization. METHOD This was a prospective multicenter observational study including 46 stroke patients receiving comprehensive rehabilitation treatment. Patients' basic information was recorded upon admission and patients' functional independence was assessed with Functional Independence Measure (FIM) both upon admission and discharge. One week after rehabilitation treatment, fatigue, positivity in daily activity, attention, and memory were assessed. Serum biochemical indicators and levels of C-reactive protein (CRP) were assessed weekly following admission. The pain scores were assessed during the first week of hospitalization to calculate the average. Correlation analysis, linear regression and propensity score matching (PSM) were used to analyze the impact of fatigue on FIM scores at discharge and length of hospital stay. RESULT The proportion of patients with low fatigue was 39.13% and significant improvement was revealed in FIM scores upon admissions and discharge [(50.67±18.61) vs. (75.13±21.04), P<0.05]. Positivity in daily activity, attention, and age are factors that influence post-stroke fatigue. After PSM, low-fatigue group (Fatigue score< 3) showed significant higher motor function independence at discharge [(54.39 ± 15.42) vs. (41.89 ± 14.90), P<0.05] and shorter hospital stay [(28.54±9.13)d vs. (37.32 ± 9.81)d, P<0.05] than high-fatigue group. There was a significant difference (P<0.05) in level of CRP between the first inpatient week and the third week, with declining trend. CONCLUSION Post-stroke fatigue can affect the rehabilitation outcomes regarding motor function independence and length of hospital stay.
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Affiliation(s)
- Hongji Zeng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jiaying Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfa Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yu Ding
- Department of Neurology, The Second Medical Center, PLA General Hospital, Beijing, China
| | - Shuya Yuan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weijia Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xi Zeng
- School of Public Health, Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
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4
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Green CE, Leeds JS, Leeds CM. Occupational effects in patients with post-COVID-19 syndrome. Occup Med (Lond) 2024; 74:86-92. [PMID: 38070493 DOI: 10.1093/occmed/kqad118] [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: 02/20/2024] Open
Abstract
BACKGROUND It is well recognized that some individuals experience persistent symptoms following an initial SARS-CoV-2 infection. Symptoms affect physical, cognitive and mental well-being and can adversely impact activities of daily living, including the ability to work. AIMS To examine the impact of post-COVID-19 syndrome with respect to effects on quality of life and impact on work in a cohort of people referred to a 'Long COVID' service. METHODS All triaged patients (over 18 years with symptoms more than 12 weeks since the initial infection) completed a symptom assessment questionnaire. Occupation and working status (at work, at work struggling with symptoms and off work) were also recorded. Impact on function and quality of life was assessed using the EQ5D5L questionnaire. RESULTS A total of 214 patients (median age 51.0 years, 135 females) were seen from January to September 2021. Analysis of occupational status showed: 18% were working, 40% were working but struggling and 35% had stopped working due to symptoms. Those unable to work reported significantly more fatigue, a greater perception of the need for support and lower quality-of-life scores. CONCLUSIONS This study shows the extensive impact of post-COVID-19 syndrome on the ability to return to work. Specific return-to-work guidance is needed to support a large proportion of those struggling with the condition. The involvement of the Occupational Health team should form part of the multidisciplinary, collaborative approach to support rehabilitation and improve long-term outcomes for this condition.
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Affiliation(s)
- C E Green
- Department of Occupational Health and Wellbeing, County Durham and Darlington NHS Foundation Trust, Darlington, UK
- Long COVID Service, County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - J S Leeds
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - C M Leeds
- Department of Occupational Health and Wellbeing, County Durham and Darlington NHS Foundation Trust, Darlington, UK
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Liu Z, Li J, Liu F, Guan N, Li Y, Zhang Y, Hou L, Jiang Q. Exploring the status and associated factors of the readiness for return-to-work in young and middle-aged stroke patients. Sci Rep 2024; 14:2841. [PMID: 38310121 PMCID: PMC10838315 DOI: 10.1038/s41598-024-53262-2] [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: 11/25/2022] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
Stroke increasingly affects individuals of working age. An accurate assessment of Readiness for Return-to-Work (RRTW) can help determine the optimal timing for RRTW and facilitate an early reintegration into society. This study investigates the current state of RRTW and the influencing factors among young and middle-aged stroke patients in China. A sample of young and middle-aged stroke patients hospitalized in a tertiary hospital in Henan Province between December 2021 and May 2022 were included in this study. A general information questionnaire and the Readiness for RRTW scale, the Social Support Rate Scale, the Stroke Self-Efficacy Scale, and the Fatigue Severity Scale were administered to the patients. Of the 203 patients successfully surveyed, 60 (29.6%) were in the pre-contemplation stage, 35 (17.2%) in the contemplation stage, 81 (39.9%) in the prepared for action-self-evaluative stage, and 27 (13.3%) in the prepared for action- behavior stage. Logistic regression analysis identified education level, monthly income, time to start rehabilitation therapy, social support, stroke self-efficacy, and fatigue severity as key factors affecting RRTW scale readiness in young and middle-aged stroke patients. The readiness of young and middle-aged stroke patients to Return-to-Work needs to be increased further. Healthcare professionals should consider the influencing factors of RRTW and design targeted intervention programs to facilitate a successful Return-to-Work and normal life.
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Affiliation(s)
- Ziwei Liu
- Nursing Department, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, No. 19 Renmin Road, Jinshui District, Zhengzhou, 450099, He Nan, China
| | - Jiaxin Li
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Fangli Liu
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Ningxiao Guan
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Ye Li
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Yu Zhang
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Linlin Hou
- Institute of Nursing and Health, Henan University, Kaifeng, 475000, He Nan, China
| | - Qiuhuan Jiang
- Nursing Department, Henan Provincial People's Hospital, No.7 Weiwu Road, Jinshui District, Zhengzhou, 45003, He Nan, China.
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Fallah S, Taghizadeh G, Parnain Z, Cheraghifard M, Taghavi Azar Sharabiani P, Yousefi M, Joghataei MT, Gholizade A. Persian version of the Chalder Fatigue Questionnaire and Multidimensional Fatigue Symptom Inventory-Short Form: psychometric properties in Iranian chronic stroke survivors. Top Stroke Rehabil 2023; 30:796-806. [PMID: 37723098 DOI: 10.1080/10749357.2023.2175421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/28/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Post-stroke fatigue is a disturbing condition with various physical and psychological facets, which needs to be assessed by meaningful and psychometrically valid and reliable tools. The Chalder Fatigue Questionnaire (CFQ) and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) have been designed to assess diverse dimensions of fatigue. OBJECTIVES The present study aimed to investigate the psychometric properties of the CFQ and MFSI-SF in people with chronic stroke. METHODS Both measures were translated according to forward-backward standard protocol. This cross-sectional study was conducted with 130 first-time stroke survivors. The multidimensional fatigue inventory, checklist individual strength, fatigue assessment scale, fatigue subscale of profiles of mood state, fatigue severity scale, visual analogue scale-fatigue, beck anxiety inventory, center for epidemiologic studies of depression scale, and 36-item short-form health survey were administered in addition to the CFQ and MFSI-SF. Reliability, precision, known-groups validity, and convergent validity were examined for the CFQ and MFSI-SF. RESULTS The results showed an acceptable (Cronbach's alpha = 0.81-0.97) internal consistency and test-retest reliability (intra-class correlation = 0.75-0.97). The CFQ and MFSI-SF revealed good ability (P < 0.001) to differentiate chronic stroke survivors with different disability levels. Significant high correlation (P = -0.61-0.87) was found between CFQ and MFSI-SF and other fatigue scales. CONCLUSIONS The results of this study showed that the CFQ and MFSI-SF have high reliability and validity for chronic stroke survivors.
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Affiliation(s)
- Soheila Fallah
- Department of Neurosciences, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Parnain
- Master of Sciences in Occupational Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Moslem Cheraghifard
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahin Yousefi
- bachelor of science in Occupational Therapy, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Innovation in Medical Education, Faculty of Medicine, Ottawa University
| | - Ali Gholizade
- Department of Psychiatry, school of Medicine, Tabriz University of Medical Science, Tabriz, Iran
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7
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Ehrenkranz R, Zhu X, Glynn NW, Bertolet M, Berman SB, Hengenius JB, Rosano C. Longitudinal Associations Between Higher Self-Reported Energy, Gait Speed, and Cognition in Older Adults With Fatigue. J Gerontol A Biol Sci Med Sci 2023; 78:2407-2414. [PMID: 37774505 PMCID: PMC10692418 DOI: 10.1093/gerona/glad234] [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: 08/01/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Older adults reporting higher energy levels have better physical function. It is not known if these associations persist among older adults reporting fatigue or if higher energy is associated with cognitive function. We examined longitudinal associations between self-reported energy, gait speed, and cognition, stratified by fatigue, in 2 613 participants (aged 74.6 ± 2.87 years) in the Health, Aging and Body Composition Study. METHODS Self-reported energy (0-10, dichotomized at median) and fatigue (present/absent) were measured at baseline. Usual and rapid-paced gait speed (m/s), modified Mini-Mental State Examination (3MS), and Digit Symbol Substitution Test (DSST) were measured at baseline and annually over 8 years. Linear mixed effect models compared changes in gait speed, 3MS, and DSST between higher and lower energy groups within fatigue strata. RESULTS At baseline, 724 participants (27%) were fatigued; 240 (33%) coreported higher energy (9% of total). The remaining 1 889 participants were fatigue-free (73%); 1 221 (65%) coreported higher energy (47% of total). Those with fatigue and higher energy had average rapid gait declines of 0.007 m/s per year (p = .04) after adjustment for demographics, comorbidities, depressive symptoms, and exercise. DSST declines were found among only fatigue-free participants (β = 0.17, p = .01). No statistically significant associations with energy were found for fatigue-free participants, or for usual gait or 3MS. CONCLUSIONS Asking about older adults' energy levels as well as fatigue may identify a subgroup of older adults protected against physical and cognitive decline, even among those with fatigue.
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Affiliation(s)
- Rebecca Ehrenkranz
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marnie Bertolet
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James B Hengenius
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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Paudel SK, Rolls K, Green H, Fernandez R. Prevalence and Impact of Poststroke Fatigue on Patient Outcomes in the First 6 Months After Stroke: A Systematic Review and Meta-analysis. J Neurosci Nurs 2023; 55:178-185. [PMID: 37450636 DOI: 10.1097/jnn.0000000000000716] [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: 07/18/2023]
Abstract
ABSTRACT BACKGROUND: Post-stroke fatigue (PSF) is one of the most pervasive and debilitating symptoms after stroke and has a negative impact on activities of daily living (ADLs) and health-related quality of life (HRQoL) of stroke survivors. However, to date, no study has systematically reviewed the prevalence of PSF at different points in time after stroke. OBJECTIVE: The aim of this study was to investigate the prevalence of PSF and its impact on ADLs and HRQoL in the first 6 months post stroke. METHOD: CINAHL, MEDLINE, Scopus, Google Scholar, and Index to Theses were searched from 1983 to August 2022 for studies published in English. Studies were included if they were conducted on adults 18 years and older, and were observational, correlational, and quantitative components of mixed methods reporting on PSF, ADLs, and HRQoL post stroke. RESULTS: Thirty studies were included in this review, and all had a high methodological quality. The pooled prevalence of PSF at 1 to 6 weeks was 49.5%; at 3 months, it was 41.9%; and at 6 months, it was 43.4%. A negative correlation between PSF and ADLs was observed at 1, 2, and 4 to 6 weeks, and at 3 and 6 months post stroke. A significant negative correlation between PSF and HRQoL was observed within the first week ( r = -0.40, P < .05) and at 3 and 6 months post stroke. The results at 3 and 6 months post stroke were inclusive. CONCLUSION : The prevalence of PSF in the first 6 weeks, particularly in the first 2 weeks after stroke, is high and has a significant negative impact on stroke survivors' ADLs and HRQoL. Only a limited number of studies assessed PSF within the first 2 weeks after stroke.
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Coutts E, Cooper K. Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators. JBI Evid Synth 2023; 21:1794-1837. [PMID: 37255032 DOI: 10.11124/jbies-22-00174] [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: 06/01/2023]
Abstract
OBJECTIVE This scoping review aimed to map the literature on interventions, factors, barriers, and facilitators for return to work for adults post-stroke with or without communication disorders. INTRODUCTION Difficulties in returning to work can significantly impact individuals following a stroke (eg, their sense of purpose and self-esteem), not only financially, but also as they adjust to the change in their situation. Such difficulties may arise from communication disorders as well as physical impairments. Previous reviews on return to work post-stroke have focused on specific aspects, such as interventions, or barriers and facilitators, but have not provided a comprehensive map of the field. Further, no systematic or scoping reviews to date have focused on literature addressing return to work for people with communication disorders post-stroke. INCLUSION CRITERIA This review considered literature that reported on interventions, barriers, and facilitators for return to work for adults (aged 16 years or older) following an ischemic or hemorrhagic stroke. Records focusing on transient ischemic attacks or acquired brain injury were excluded, as were those in which a comorbidity or disability (eg, learning disability, dementia, respiratory disorder) had a significant impact on the individual's ability to work. METHODS This review followed the JBI scoping review methodology. Primary research of any type, systematic and non-systematic reviews, and gray literature from developed countries written in English from 2010 to the present day were identified from 7 databases, 2 gray literature repositories, JBI Evidence Synthesis , and an internet search. Records were screened for relevance to the review topic by 2 independent reviewers, and data relevant to the review questions were extracted. Findings were presented as narrative supported by tables. RESULTS Of the 106 sources included, 61 addressed demographic-based, socioeconomic-based, impairment-based, or recovery-based factors related to return to work. One of these 61 sources, a narrative review, focused on communication disorders. Thirty-eight sources explored barriers and facilitators for return to work from different stakeholders' perspectives; 3 of these 38 sources, including 2 qualitative studies and 1 narrative review, focused on post-stroke communication disorders. Eleven sources focused on interventions, including 7 studies (reported across 9 sources) that developed or tested return-to-work interventions. Of these primary studies, 1 randomized controlled trial and 1 retrospective cohort study were identified. The remaining intervention studies were case studies or case series. None of these intervention studies addressed communication disorders. CONCLUSIONS While there has been extensive research on factors, barriers, and facilitators for return to work post-stroke, there is a lack of research on interventions supporting return to work. There is also a significant gap in the evidence base on returning to work with a post-stroke communication disorder, highlighting the need for further research in this important area.
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Affiliation(s)
- Emma Coutts
- Speech and Language Therapy, NHS Grampian, Fraserburgh UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Robert Gordon University, Aberdeen, UK
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Chen NYC, Dong Y, Kua ZZJ. Addressing mood and fatigue in return-to-work programmes after stroke: a systematic review. Front Neurol 2023; 14:1145705. [PMID: 37674875 PMCID: PMC10477595 DOI: 10.3389/fneur.2023.1145705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue. Method Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided. Results The search yielded 5 RCTs that satisfied the selection criteria (n = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies. Conclusion Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.
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Affiliation(s)
- Nicole Yun Ching Chen
- Changi General Hospital, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - YanHong Dong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zaylea Zhong Jie Kua
- Changi General Hospital, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Morgan KA, Wong AWK, Walker K, Desai RH, Knepper TM, Newland PK. A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing. JMIR Form Res 2022; 6:e40166. [PMID: 36542466 DOI: 10.2196/40166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person's needs.
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Affiliation(s)
- Kerri A Morgan
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kim Walker
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Rachel Heeb Desai
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Tina M Knepper
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Pamela K Newland
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, United States
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12
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Silviana M, Riasari NS, Mantikha FF. The Effect of Listening to Quran Recitation on Score of Post-Stroke Fatigue in Acute Ischemic Stroke Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: One of the common stroke complications is post-stroke fatigue (PSF) with the prevalence of 25–85%. PSF influences health-related quality of life, disability, dependence in daily activities, ability to return to work, and case fatality rate of stroke patients. Listening to Quran recitation can increase alpha waves in the brain, reduce stress and inflammatory biomarkers.
AIM: The purpose of this study was to identify the effect of listening to Quran recitation on PSF and find out the mean Fatigue Assessment Scale (FAS) score in acute ischemic stroke patients.
METHODS: This was an experimental study with one-group pretest-posttest design. Sixteen subjects were recruited by consecutive sampling in Sultan Agung Islamic Hospital, Semarang. The FAS score was assessed on the 1st day of study, then Quran recitation was played 2 sessions a day, 15 min/session, for 5 days. The FAS score was reassessed on the last day. The study was conducted from August to September 2021. The analysis test used was paired t-test.
RESULTS: The results showed a significant relationship between listening to Quran recitation with changes in FAS score in acute ischemic stroke patients (p < 0.05). Most of the subjects were <65 years old, male, had hypertension, did not have DM, and did not smoke.
CONCLUSION: Listening to Quran recitation had an effect on changes in FAS score.
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13
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Pedersen A, Almkvist E, Holmegaard L, Lagging C, Redfors P, Blomstrand C, Jood K, Samuelsson H, Jern C. Fatigue 7 years post-stroke: Predictors and correlated features. Acta Neurol Scand 2022; 146:295-303. [PMID: 35791041 PMCID: PMC9545687 DOI: 10.1111/ane.13665] [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: 02/02/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Background Post‐stroke fatigue (PSF) is common with great impact on quality of life. We explored predictive and cross‐sectionally correlated features in the long term after ischemic stroke. Methods This study comprises 430 participants of the prospective Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), aged 18–69 years at index stroke. Information on acute stroke severity and cardiovascular risk factors was collected at index stroke. After 7 years, PSF was assessed by the Daily Fatigue Impact Scale (D‐FIS). Cognitive, neurological, and functional outcomes, and symptoms of depression and anxiety, pain, insomnia, and physical activity were also assessed. Associations between baseline variables and PSF were analyzed by ordinal regression. Correlations between PSF and cross‐sectionally assessed variables, and between PSF and baseline variables, were analyzed with Spearman's or point‐biserial correlation for the whole sample and in sex‐stratified analyses. Results At 7 years post‐stroke, 80% of the participants reported some impact of fatigue. Female sex and stroke severity were independently associated with PSF, whereas no associations were detected with baseline cardiovascular risk factors. In cross‐sectional analyses at 7 years, we found correlations between PSF and poor functional, neurological, and cognitive outcomes, as well as depressive symptoms, anxiety, insomnia, pain, and low physical activity (p < .001 throughout). The correlation with insomnia was stronger in women than in men (two‐way ANOVA interaction test, p = .03). Conclusions Our findings confirm that PSF is common in the long term after ischemic stroke and show a complex interplay with sex and several other outcomes. Future studies should address causal relationships and interventions towards fatigue and coexisting features.
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Affiliation(s)
- Annie Pedersen
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emelie Almkvist
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Holmegaard
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Lagging
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Samuelsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Wang J, Gu M, Xiao L, Jiang S, Yin D, He Y, Wang P, Sun W, Liu X. Association of Lesion Location and Fatigue Symptoms After Ischemic Stroke: A VLSM Study. Front Aging Neurosci 2022; 14:902604. [PMID: 35847675 PMCID: PMC9277067 DOI: 10.3389/fnagi.2022.902604] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background:Poststroke fatigue (PSF) is a common symptom in stroke survivors, yet its anatomical mechanism is unclear. Our study was aimed to identify which brain lesions are related to the PSF in patients with acute stroke.MethodPatients with first-ever acute ischemic stroke consecutively admitted from the first affiliated hospital of the University of Science and Technology of China (USTC) between January 2017 and June 2020. Fatigue was scored using the Fatigue Severity Scale. All the participants were assessed by 3.0 T brain MRI including diffusion-weighted imaging. The infarct lesions were delineated manually and transformed into a standard template. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and the occurrence and severity of fatigue. The same analyses were carried out by flipping the left-sided lesions. Multivariate logistic regressions were applied to verify the associations.ResultsOf the 361 patients with acute stroke, 142 (39.3%) patients were diagnosed with fatigue in the acute phase and 116 (35.8%) at 6 months after the index stroke. VLSM analysis indicated clusters in the right thalamus which was significantly associated with the occurrence and severity of PSF at 6-month follow-up. In contrast, no significant cluster was found in the acute phase of stroke. The flipped analysis did not alter the results. Multivariate logistic regression verified that lesion load in the right thalamus (OR 2.67, 95% CI 1.46–4.88) was an independent predictor of 6-month PSF.ConclusionOur findings indicated that lesions in the right thalamus increased the risk of fatigue symptoms 6 months poststroke.
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Affiliation(s)
- Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shiyi Jiang
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dawei Yin
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ye He
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Peng Wang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Peng Wang
| | - Wen Sun
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Wen Sun
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Xinfeng Liu
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15
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Johansson B. Screening Method for Assessment of Work Ability for Patients Suffering From Mental Fatigue. Front Behav Neurosci 2022; 16:869377. [PMID: 35775012 PMCID: PMC9237561 DOI: 10.3389/fnbeh.2022.869377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Pathological mental fatigue adversely affects endurance in the performance of tasks over time, with negative impact on work ability. There are currently no methods for objectively assessing work ability for patients suffering from mental fatigue. In this study, work ability in relation to mental fatigue as a screening method was evaluated, using the Work Ability Index (WAI) and Mental Fatigue Scale (MFS). Included participants represented three patient groups commonly affected by mental fatigue; acquired brain injury (n = 49, traumatic brain injury, stroke), burn-out syndrome (55) and hypothyroidism (50). The results showed a significant correlation between WAI and MFS (r = –0.754) and status in the workplace (WAI r = 0.722, MFS r = –0.443) for all groups. The WAI and MFS were significant predictors for status in the workplace (p < 0.001) and explained 53% of the variance. This screening method can help health care professionals to identify people who are mentally fatigued with a reduced ability to work or return to work after illness, and who are in need of in-depth investigation. It is important to initiate treatment early with the aim of promoting a sustainable working life and general well-being of the individual.
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