Conceptualising post-stroke fatigue: a cross-sectional survey of UK-based physiotherapists and occupational therapists

Abstract

With survival after stroke improving, more people are discharged into the community with multiple and persistent deficits. Fatigue is a common unmet need for stroke survivors, but there are no evidence-based guidelines for its assessment and management. This study explored how UK-based therapists conceptualise post-stroke fatigue (PSF) in current practice.ObjectiveTo describe current understanding of PSF among physiotherapists (PT) and occupational therapists (OT).DesignA cross-sectional online survey using Qualtrics software (a survey creation and analysis programme) was sent to therapists working with stroke survivors in 2019. Responses to the open ended question, ‘How would you describe PSF if approached by another healthcare professional?’ were analysed thematically by two independent researchers.Participants137 survey respondents (71 PT and 66 OT) from a range of clinical settings (25 acute care, 24 sub-acute rehabilitation care, 3 primary care and 85 community care) with 7 months-36 years of experience working with stroke survivors completed the survey.ResultsRespondents stated that PSF should be regarded as an important medical condition because it is common and can be associated with severe symptoms. Symptoms were perceived to be highly variable and the syndrome was difficult to define objectively. It was felt to have both physical and cognitive components. A variety of different opinions were expressed with regard to causation, conceptualisation and best management.ConclusionTherapists working with stroke survivors conceptualise and manage PSF in different ways. Clinical practice is hampered by a lack of a widely adopted definition, and a small evidence base. Research into causes and management of PSF is a priority.

“I Give It Everything for an Hour Then I Sleep for Four.” The Experience of Post-stroke Fatigue During Outpatient Rehabilitation Including the Perspectives of Carers: A Qualitative Study

“…Interestingly, healthcare professionals rate post-stroke fatigue research implementation as a lower priority compared with consumers ( 45 ). If health professionals do provide knowledge about post-stroke fatigue they conceptualize it in divergent ways ( 46 ). This highlights a need to educate health professionals about post-stroke fatigue ( 34 , 46 ) to ensure rehabilitation services provide a consistent, structured, supportive and motivational environment for fatigue management.…”

“…If health professionals do provide knowledge about post-stroke fatigue they conceptualize it in divergent ways ( 46 ). This highlights a need to educate health professionals about post-stroke fatigue ( 34 , 46 ) to ensure rehabilitation services provide a consistent, structured, supportive and motivational environment for fatigue management. Recognition of fatigue through periodic screening is important ( 34 ), especially given lack of acknowledgment of fatigue by health professionals and family is a further burden for stroke survivors ( 12 ).…”

Efficacy of Qigong Exercise for Treatment of Fatigue: A Systematic Review and Meta-Analysis

“…Fatigue is also one of the most common symptoms in primary medical care. Approximately 10–20% of patients complain of fatigue ( 6 , 7 ), and 10–30% of patients consider fatigue an important accompanying symptom ( 8 , 9 ). Several drugs, such as anti-neoplastic agents ( 10 ) and antidepressants ( 11 ), may be associated with secondary fatigue, which is produced by the adverse effects of the administered treatment.…”

Developing a fatigue programme: Protocol for the Nottingham Fatigue After Stroke (NotFAST2) study

“…Although researchers have endeavoured to explain PSF mechanisms (De Doncker et al, 2018), these remain unclear. This may be due, in part, to the lack of a single accepted and widely adopted definition of post-stroke fatigue (Barker-Collo et al, 2007;Thomas et al, 2019) and also because of misunderstanding around the use of key terms such as fatigue and tiredness (Thomas et al, 2019). It is known that there are many contributing factors (Aali et al, 2020;Cumming et al, 2016;Mandliya et al, 2016) and it would seem that each previous research team has concentrated on specific issues: exercise, sleep, nutrition, medication and psychological interventions.…”