Research Poststroke fatigue: risk factors and its effect on functional status and health-related quality of life Yang-Kun Chen1*, Jian-Feng Qu1, Wei-Min Xiao1, Wan-Yi Li1, Han-Yu Weng1, Wei Li1, Yong-Lin Liu1, Gen-Pei Luo1, Xue-Wen Fang2, Gabor S. Ungvari3,4, and Yu-Tao Xiang5 Background Fatigue is a common problem in ischemic stroke survivors. The mechanisms of poststroke fatigue are uncertain yet. The effects of it on functional status have rarely been studied. Aims The aim of this study was to investigate the risk factors of poststroke fatigue and its effect on activities of daily living and health-related quality of life in Chinese patients with ischemic stroke. Methods Two hundred and eighteen patients with ischemic stroke formed the study sample. A comprehensive assessment, including the Fatigue Severity Scale, Hamilton Depression Rating Scale, Lawton activities of daily living scale, and the stroke-specific quality of life scale, was conducted threemonths after stroke. Magnetic resonance imaging scans focused on the evaluation of infarctions, white matter lesions, and brain atrophy. Results In the whole sample, with Fatigue Severity Scale as the dependent variable in a linear regression model, Hamilton Depression Rating Scale, prestroke fatigue, and the National Institutes of Health Stroke Scale score at admission were significant correlates of Fatigue Severity Scale, accounting for 36% of the variance of it. When subjects with depression (Hamilton Depression Rating Scale ≥ 20 or current usage of antidepressants) were excluded, only Hamilton Depression Rating Scale and prestroke fatigue remained significant correlates of Fatigue Severity Scale, accounting for 33% of the variance of Fatigue Severity Scale. No magnetic resonance imaging variables correlated with Fatigue Severity Scale. In bivariate correlation analyses, Fatigue Severity Scale was significantly correlated with both activities of daily living Correspondence: Yang-Kun Chen*, Department of Neurology, Dongguan People’s Hospital, No.3 South Wandao Road, Wanjiang District, Dongguan, Guangdong Province, China. E-mail: [email protected] 1 Department of Neurology, Dongguan People’s Hospital, Dongguan, Guangdong Province, China 2 Department of Radiology, Dongguan People’s Hospital, Dongguan, Guangdong Province, China 3 School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia 4 Medical School, The University of Notre Dame Australia/Marian Centre, Perth, Australia 5 Faculty of Health Sciences, University of Macau, Macau SAR, China Received: 3 June 2014; Accepted: 13 October 2014; Published online 3 December 2014 Conflict of interest: None declared. Funding: This study was supported by Medical Scientific Research Foundation of Guangdong Province, China (Grant No: B2011349), Research Foundation of Administration of Traditional Chinese Medicine of Guangdong Province, China (Grant No:20111075), and Dongguan Medical Science and Technology Fund, China (General Project, Grant No: 201110515001081). DOI: 10.1111/ijs.12409

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and stroke-specific quality of life. In linear regression models, Fatigue Severity Scale independently contributed to activities of daily living accounting for 27% of the variance. Fatigue Severity Scale was also a significant contributor to strokespecific quality of life accounting for 39% of the variance. Conclusion Depressive symptoms and prestroke fatigue are major correlates of poststroke fatigue while more severe poststroke fatigue is associated with poorer activities of daily living and health-related quality of life. Key words: fatigue, functional status, MRI, quality of life, rehabilitation, stroke

Introduction Fatigue following stroke (poststroke fatigue; PSF) is a common complaint (36–77%), even in patients with good functional recovery (1–3). PSF may lead to negative long-term outcomes, for example, to increased all-cause mortality (3). In recent years, a number of studies examined the predictors of PSF. Frequently reported determinants of PSF included, among others, depression (4–6), neurological deficits (4,5), infarction location (5–7), and pain (3). As biological mechanisms play a significant role in the development of PSF (8), neuroimaging features of PSF should be studied besides its social-psychological and clinical determinants. The only large-scale magnetic resonance imaging (MRI) study involving 334 stroke patients found that basal ganglia infarction was associated with PSF (4). Other studies (9–11) failed to confirm the association between PSF and brain lesions. Functional status, that is, the basic and instrumental activities of daily living (ADL) and health-related quality of life (HRQoL), are important outcomes of stroke. However, most early investigations on the functional status or HRQoL in stroke did not include PSF. Only a few small-scale studies (3,12) reported the correlation between PSF and poor HRQoL. Thus, the aim of this study was to investigate the risk factors of PSF and examine the effect of PSF on ADL and HRQoL in Chinese patients with ischemic stroke. We hypothesized that the severity of PSF is a significant factor independently contributing to poor ADL and HRQoL.

Methods Participants and setting The study was conducted at the Department of Neurology, Dongguan People’s Hospital between January 2011 and December 2012. Dongguan People’s Hospital is the largest public hospital in Dongguan, China, serving a population over 1 million. Patients were enrolled in the study if they: (1) were between 40 and 80 years of age; (2) had an acute first or recurrent ischemic stroke © 2014 World Stroke Organization

Y.-K. Chen et al. that occurred within seven-days prior to admission; and (3) agreed to participate in the study and were able to provide informed consent. Patients were excluded if they: (1) had a central nervous system disease other than stroke; (2) did not have an MRI scan; (3) had a severe stroke which was defined as National Institutes of Health Stroke Scale (NIHSS) (13) score of ≥15; (4) had significant aphasia or dysarthria; (5) were demented, defined as the Mini-Mental State Examination (MMSE) (14) score of

Poststroke fatigue: risk factors and its effect on functional status and health-related quality of life.

Fatigue is a common problem in ischemic stroke survivors. The mechanisms of poststroke fatigue are uncertain yet. The effects of it on functional stat...
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