The Nottingham Fatigue After Stroke (NotFAST) study: results from follow-up six months after stroke

Abstract

Background Post-stroke fatigue is common and disabling. Objectives The aim of NotFAST was to examine factors associated with fatigue in stroke survivors without depression, six months after stroke. Methods Participants were recruited from four UK stroke units. Those with high levels of depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n = 109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n = 88), 61 (69%) continued to report fatigue. 'De novo' (new) fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions.

Testing the psychometric properties of the Chinese version of the Neurological Fatigue Index-Stroke

“…Although the exact mechanism is not clear, a previous study showed that higher self-efficacy is associated with proactive coping, 48 which may enable stroke survivors to better cope with fatigue. The correlation found between fatigue and depressive symptoms in this study was similar to those of previous studies, such as those conducted in Britain, 9 the Netherlands, 10 and Japan. 8 Ormstad and Eilertsen 4 have suggested that psychosocial and behavioral factors may play a role in the development of depression over time in stroke survivors with fatigue.…”

“…3 Fatigue can be sustained by psychosocial factors, 3,4 such as self-efficacy (r = −0.43 to −0.50), 5,6 which is a person's belief in his/her ability to control life's stressors, 7 and depressive symptoms (r = 0.21−0.61) in stroke survivors. [8][9][10] Fatigue exerts negative impacts on daily life, such as on instrumental activities of daily living, mobility, and social life. 11 Thus, alleviating fatigue is an important goal in clinical stroke rehabilitation.…”

How is poststroke fatigue understood by stroke survivors and carers? A thematic analysis of an online discussion forum.

“…Balasooriya-Smeekens et al ’s study also alluded to the frequency of individuals experiencing fatigue after a stroke event, with over half of the forum users posting about occupation difficulties also pinpointing fatigue as an important factor. Recent research has examined factors associated with PSF and found reduced independence in activities of daily living and higher anxiety levels had a direct association with level of fatigue 27…”

Stroke survivors’ perceptions of participating in a high repetition arm training trial early after stroke

“…This has led to calls for changes to practice so that patients receive much more intensive therapy during sub-acute stroke, and for trials to assess its effectiveness [2,8,9]. However, the emotional strain at this time after a stroke is severe [10] and the prevalence and severity of fatigue is increasingly recognised [11]. Therefore the prospect of participating in a trial which includes high repetition training, may feel daunting [12].…”