Predictors and short-term outcomes of post-stroke fatigue in initial phase of transition from hospital to home: A prospective observational study

Ya Su, Mitsuko Asamoto, Michiko Yuki, Masaru Saito, Naoko Hasebe, Kengo Hirayama, Mika Otsuki, Chieko Iino, Ya Su, Mitsuko Asamoto, Michiko Yuki, Masaru Saito, Naoko Hasebe, Kengo Hirayama, Mika Otsuki, Chieko Iino

Abstract

Aim: To analyse the interactions of associated factors with post stroke fatigue (PSF) after discharge home and determine the predictors of PSF and their impact on stroke survivors.

Design: A prospective observational study.

Methods: A total of 94 patients with acute stroke were recruited between May 2019 -July 2020. The main outcomes were fatigue, depression, insomnia, sarcopenia, and health-related quality of life (HRQOL) and were assessed at admission and 1 month after discharge. Fatigue was measured using the Fatigue Assessment Scale. Depression and Insomnia were assessed using the Hospital Anxiety and Depression Scale-Depression and Insomnia Severity Index, respectively. Sarcopenia was measured using the SARC-F questionnaire, and HRQOL was assessed using the Short Form-8.

Results: Acute phase PSF was an independent predictor of PSF after discharge home. Moreover the path analysis revealed that this effect is mediated through both the direct effect of acute-phase PSF on PSF after discharge home and through the indirect effect of interaction with pre-stroke SARC-F, acute phase depression, and acute phase insomnia, which remains a separate predictor of acute-phase PSF. In total, 17% of the survivors had persistent PSF. Persistent PSF was significantly associated with depression, insomnia, sarcopenia, and a lower quality of life scores.

Conclusions: Post-stroke fatigue may occur in the acute phase and persists after discharge, it will not only affect later depression, insomnia, and quality of life, but also sarcopenia.

Impact: Acute phase PSF was found to be an independent predictor of PSF after discharge home. In addition, the interaction with pre-stroke SARC-F, acute phase depression and insomnia had an indirect connection with PSF after discharge home, which remains a separate predictor of acute-phase PSF. Thus, early assessment and management of mental status, sleep problems, and sarcopenia during hospitalization might be an important step in post-stroke rehabilitation and home transition.

Keywords: depression; fatigue; insomnia; nursing; quality of life; sarcopenia; stroke.

Conflict of interest statement

No conflict of interest has been declared by the authors.

© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Final version of the path model analysis of PSF at 1 month after discharge. ameasured at the acute phase; bmeasured at 1 month after discharge; *p<0.05; **p<0.01. Model fitness: χ2/df=1.482; p=0.205; GFI=0.976; CFI=0.981; TLI=0.953; NFI=0.947; REMSEA=0.072. Indirect effect: PSF at follow‐up<‐‐‐Pre‐stroke SARC‐F (β=0.112*); PSF at follow‐up <‐‐‐Depression at baseline (β=0.204**); PSF at follow‐up <‐‐‐Insomnia at baseline (β=0.205**)
FIGURE 2
FIGURE 2
Follow‐up outcomes of the patients with post‐stroke fatigue. *Adjusted using Bonferroni correction for multiple tests [Colour figure can be viewed at wileyonlinelibrary.com]

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