Visual Problems are Associated with Long-Term Fatigue after Stroke

Abstract

Objective: Post-stroke fatigue may be associated with functioning even in patients with mild stroke. In order to guide rehabilitation, the aim of this study was to investigate the independent contribution of 12 function-related domains to severe long-term fatigue.Design: Observational follow-up study.Subjects: A total of 144 stroke survivors (mean age 67.3, standard deviation (SD) 10.9 years) were included.Methods: Fatigue 3–4 years post-stroke was measured with the Fatigue Severity Scale (cut-off ≥5). Independent variables were the multidimensional Stroke-Specific Quality of Life scale with 12 domains, demographics, and baseline stroke characteristics.Results: Most of the participants had mild and moderate stroke. Thirty-five percent (n = 51) reported severe fatigue 3–4 years after stroke. Those living with a significant other, and working participants reported significantly less fatigue. All domains of the Stroke-specific Quality of Life scale were significantly associated with the Fatigue Severity Scale. Adjusted for age, sex, marital status, and work status, the domains “energy”, “mood”, and, unexpectedly, the domain “vision”, were all variables independently associated with severe long-term fatigue.Conclusion: Stroke survivors with prominent self-reported visual problems were more likely to experience fatigue. This finding should be verified in further studies. Visual examination and visual rehabilitation may reduce fatigue in selected stroke survivors. LAY ABSTRACTPost-stroke fatigue presumes worse outcomes for rehabilitation and recovery after stroke. More knowledge of how specific long-term consequences relate to fatigue is needed to guide care and rehabilitation. The aim of this study is to investigate whether specific areas of function are related to fatigue 3–4 years after stroke. In total, 144 stroke survivors with predominantly initial mild and moderate stroke severity were included. Self-reported questionnaires with 12 function-related areas from a stroke-specific health-related quality of life measurement were tested in relation to a fatigue scale. This study found severe fatigue in 35% of participants. All functional areas were related to fatigue. When corrected for age, sex, and marital status the domains “energy”, “mood”, and “vision” were of particular importance for severe fatigue. The results of this study indicate that stroke survivors with prominent visual problems may especially be at risk of severe fatigue.

Metacognitive beliefs, mood symptoms, and fatigue four years after stroke: An explorative study

“…The stroke survivors included in the original study met the inclusion criteria of the National Norwegian Stroke Register, clinically defined according to the World Health Organization as acute ischaemic or haemorrhagic stroke (I.63 and I.61, respectively) in individuals aged ≥18 years (International Classification of Diseases–Tenth Revision). This study, the PostStrokeFatigue follow-up study [ 14 , 23 ], included stroke survivors who had completed questionnaires in the NorDenStroke study one year after a stroke ( n = 217). There were no exclusion criteria for the present study.…”

“…Long-term post-stroke fatigue (PSF) is common and present in 35%–37% of patients more than three years after a stroke [ 14 , 15 ]. PSF is commonly defined as a chronic subjective feeling of lack of energy, weariness, and aversion to effort [ 16 ].…”

Stroke and vision

“…Post stroke visual impairments include reduced visual acuity, visual field defects, eye movement disorders and a variety of visual perception disorders (Hepworth & Rowe, 2016). Visual impairments are associated with an increase in falls, difficulties with activities of daily living, fatigue, and poor rehabilitation outcomes (Pedersen et al, 2023;Terroni et al, 2012;White et al, 2015). Regardless of severity, much can be done through vision rehabilitation to aid recovery from post stroke visual impairments and improve visual functions Rowe et al, 2018).…”

Validation of the interdisciplinary Norwegian vision assessment tool KROSS in stroke patients submitted to hospital or rehabilitation services

“…VIs after stroke include visual eld defects, eye movement disorders, reduced visual acuity and perceptual disorders [3,4]. VIs after stroke are associated with increased depression, a higher risk of falls, decreased participation in activities and a reduced effect of general rehabilitation, among other issues [5][6][7]. Appropriate vision rehabilitation, provided at the right time, can assist in performing daily activities such as reading, driving, and walking.…”