Study On The Relationship Between Post-stroke Fatigue And Stigma In Patients With Cerebral Ischemic Stroke

Objective and Significance:1.The Neurological Fatigue Index for stroke(NFI-Stroke)developed by foreign scholars was introduced and its reliability and validity were verified in hospitalized stroke patients.2.The two fatigue assessment criteria of Chinese version of NFI-Stroke and fatigue severity scale(FSS)were used to explore the influencing factors of post-stroke fatigue(PSF),and the differences between the two results were compared.3.To explore the correlation between post-stroke fatigue and stroke-related stigma,so as to provide theoretical basis and intervention direction for alleviating post-stroke fatigue and reducing stigma in patients in clinical nursing work.Methods:After the introduction of English NFI-Stroke,the Chinese version of the scale was confirmed by forward translation and back translation.The scale was adopted for cross-cultural debugging by Delphi expert consultation.The convenience sampling method was used to collect 370 patients with cerebral apoplexy from two tertiary hospitals in Yangzhou for reliability and validity test of the scale.In the same way,285 patients with first in-patient ischemic stroke were recruited to investigate the influence factors of post-stroke fatigue and the correlation between post-stroke fatigue and stigma.SPSS24.0 was used for descriptive analysis,exploratory factor analysis,non-parametric rank sum test,binary Logistic regression analysis and ROC curve analysis.Results:1.The 12 items of Chinese version NFI-Stroke were all reserved,and the correlation coefficient between each item and the total score of the scale was 0.527～0.808(P<0.01),the correlation coefficient between item 1-8 and the physical dimension was 0.730～0.819(P<0.01),and the correlation coefficient between item 9-12 and the cognitive dimension was 0.728～0.798(P<0.01).The I-CVI of the scale was 0.857～1.000,and S-CVI was 0.952.Exploratory factor analysis finally extracted two common factors,the contribution rate of cumulative variance was 61.684%,and the load of each item on the common factor was greater than 0.4.The correlation coefficient between NFI-Stroke and FSS was 0.729(P<0.01).Cronbach’s a of physical and cognitive dimensions and total scale were 0.907,0.795 and 0.912,respectively,and the reliability of retest was 0.877(P<0.01),0.863(P<0.01)and 0.879(P<0.01),respectively.According to the ROC curve,the cut-off value of Chinese version NFI-Stroke is 15 points based on FSS,at which time the maximum Youden index is 0.552,and the area under the curve is 0.852.2.Taking Chinese version of NFI-stroke as the fatigue evaluation standard,the PSF rate was 50.53%.The results of univariate analysis showed that there were significant differences between fatigue group and non-fatigue group in marriage status,personality,cohabitation population,work status,per capita monthly income of the family,recent sleep,recent appetite,self-care status,form of hospitalization,number of medication,physical exercise before stroke.The results of binary Logistic regression analysis showed that recent sleep,self-care status,personality and number of medication were independent influencing factors of PSF.Taking FSS as the fatigue evaluation standard,the PSF rate was 62.46%.The results of univariate analysis showed that there were significant differences between fatigue group and non fatigue-group in age,place of residence,marriage status,personality,cohabitation population,work status,occupational nature,per capita monthly income of the family,recent sleep,recent appetite,self-care status,timely treatment within 6 hours of onset,fatigue lasting for 3 months before stroke,physical exercise before stroke.The results of binary Logistic regression analysis showed that age(≤60),personality,recent sleep(good),self-care status and physical exercise before stroke were independent influencing factors of PSF.3.In this study,the total score of SSCI of 285 stroke patients was 46.46±17.03,28.58±10.82 for internalized stigma and 17.88±7.09 for enacted stigma.Whether based on NFI-Stroke or FSS,there was a statistical difference between the fatigue group and the non-fatigue group in the score of the whole SSCI,internalized stigma and enacted stigma.The score of the whole SSCI,internalized stigma and enacted stigma in the fatigue group was higher than that in the non-fatigue group(P<0.01).The total score of SSCI,internalized stigma and enacted stigma were positively correlated with the NFI-Stroke and FSS(P<0.01).Conclusion:1.The Chinese version of NFI-Stroke shows good reliability and validity,which can be used in the study of Chinese Stroke population.2.Taking Chinese version of NFI-stroke as the fatigue evaluation standard,the recent sleep,self-care status,personality and number of medication were independent influencing factors of PSF.Taking FSS as the fatigue evaluation standard,age(≤60),personality,recent sleep(good),self-care status and physical exercise before stroke were independent influencing factors of PSF.According to the above factors,appropriate management measures can be taken in clinical work to effectively deal with PSF.3.There was a positive correlation between post-stroke fatigue and stigma.The higher the level of stigma,the higher the degree of PSF.It is suggested that attention should be paid to reduce the level of stigma in clinical nursing,so as to alleviate the severity of PSF and promote the recovery and prognosis of patients.