Post stroke fatigue (PSF) is a wide-spread and persistent symptom affecting approximately 40-74% of patients(2,4,6,7,9,12,21,25)
. In a recent study with 90 stroke patients, almost half of the patients reported fatigue symptoms within a year of stroke diagnosis(11,26)
. PSF prolongs the hospital stay and delays the rehabilitation and recovery of functional independence(6,10)
Similar to other studies on post stroke fatigue, we did not find any correlation with a demographic profile such as age, sex, education and marital status in relation to fatigue severity(2,6,9,11).
In a review by Ponchel et al. there was no gender-related evidence in 33 studies out of 46, whilst in 12 of them there was significant correlation with female gender and only 1 study revealed a positive relationship between males and PSF. The relationship of PSF with marital status is contradictory, but it is postulated to be more in patients living alone(6,15,16). In a study, it is highlightened that comorbid diseases existing with stroke aggravated the severity of fatigue(20). In our study group, we did not find any correlation with PSF and comorbidities except hypertension. This relationship of hypertension with fatigue was also observed in Harbison’s study(8). Our study and most recent studies did not show any significant correlation of the fatigue with side and extent of the lesion(2,9,25). However, higher National Institute of Health Stroke Scores (NIHSS) in association with fatigue was reported(28). And also, a significant correlation of right-sided lesions with tiredness was demonstrated(19).
In our study, there was not any relationship with VAS for pain and sleep sub-parameters and fatigue severity however we observed a positive correlation with VAS fatigue sub-parameter. In a study, a positive correlation between a general increased VAS with the intensity of fatigue was reported(17). Assessment of the daily living activities with mRS demonstrated a positive relationship with severity of fatigue and a negative relationship with Barthel index. Higher mRS values and low Barthel index scores are associated with worsening of fatigue. Similarly, assessment of the functional status with the Brunnstorm scores revealed a negative relationship with the intensity of the fatigue. Lower Brunnstorm scores were associated with increased fatigue. These findings are in line with the observations of similar preceding studies, especially when the neurological deficit and the functional status were severely affected, the PSF appeared proportionally affected(1,2,3,6). We observed a positive correlation between the quality of life and the severity of the fatigue. Measurement of quality of life with the Nottingham Health Profile showed, with exception of the pain score, significant correlations with all other parameters and the level of fatigue. Majority of studies with patients who develop PSF and subsequent poor quality of life scores, is leading to the conclusion that the severity of the fatigue is a good predictor for the quality of life(6,14,22,24,27).
Fatigue and depression are independent symptoms but at the same time they influence each other independently. When they are present in the same patient irrespective of the severity of the stroke, the mortality increases. Patients with post-stroke fatigue seem to have a higher incidence (29-34%) of depression(13,15,17,26,29). We also have noticed a higher incidence of depression and anxiety in relation to the severity of the fatigue. In our study, we grouped our patients as with fatigue and without fatigue. Both groups underwent the same assessments. The post-stroke fatigue group scored significantly lower on quality of life, daily living activities, emotional and functional status than the group without the fatigue.
The results are unfortunately limited due to the small size of patient population, short follow-up and the lack of a control group but on the other hand the distinctive part in our study is based on intensive assessment on different levels and comparing the fatigued vs. the non-fatigued patients.