The Impact Of Poststroke Fatigue In Stroke Inpatient Rehabilitation

BackgroundStroke known as a common cerebrovascular accident, and its high morbidity and mortality brought great burden to society and family, early rehabilitation can effectively reduce the happening of the comorbidities of stroke, promote the recovery of patients with physical and daily life ability. Poststroke fatigue are experienced in the majority of stroke survivors, previous studies have reported the frequency of poststroke fatigue ranged from 29% to 68%. Poststroke fatigue has a negative impact on patients’ physical decondition and psychological impairment, and further studies illustrated it has influence patents’ daily living and social activities.Intensive inpatient stroke rehabilitation is important for enhance functional outcomes, and more liable to fatigue. While there is comparatively little evidence of effective pharmacological or nonpharmacologicaltreatments. To our knowledge, prestroke fatigue, depression and severe physical deconditionhave been identified as independent predictors of poststroke fatigue. Nevertheless, few studies have explored the impact of poststroke fatigue in patients undergoing inpatient rehabilitation. Functional independence measure(FIM) is an international function scale, it can reflect the effect of rehabilitation very well. Therefore, the purpose of this study was to investigate whether poststroke fatigue impact on inpatient rehabilitation progress and identify the related factors that are significantly associated with poststroke fatigue. ObjectiveThis study aimed to investigate whether poststroke fatigue impact on inpatient rehabilitation progress and identify the related factors that are associated with poststroke fatigue. MethodsForty-six stroke patients were recruited in the study(25 males and 21 females, mean age 69.7 ± 11.3 years). The primary outcome measure was fatigue level and functional independence. Fatigue level was evaluated using the fatigue pictogram, functional independence was assessed by Function Independence Measure(FIM). The explanatory outcome included attention, memory, pain, blood biochemistry and hematology data were obtained from medical records. Serum levels of C-reactive protein(CRP) were measured using human CRP immunoassay ELISA kit. Results1. Participant Characteristics: forty-six stroke patients were recruited in the study(25 males and 21 females, mean age 69.7 ± 11.3 years). The majority of participants were ischemia stroke(82.6%).2. Fatigue and Clinical data: the portotion of moderate to severity fatigue level patients was 39.2 percent, the FIM scores on admissions was high at 50.7±18.6, and this statistically significant improved to 75.13±21.04 at discharge(P<0.01). After paired t-test, there was significant difference between the first inpatient week and the third week CRP level(P = 0.019), and the trend of CRP levels was decreasing.3. Correlation between fatigue and variables: Spearman’s correlation coefficient revealed the fatigue level positive correlation with fatigue ability, attention, age and length of stay, and negative correlation with motor and total FIM scores at discharge. The fatigue score was not correlated with the memory, pain score, CRP levels and other variables.4. Functional independence: comparison of motor FIM score at discharge between low(Fatigue level < 3) and high(Fatigue level ≥ 3) levels fatigue was statistically significant(P = 0.048). Also, there was a near-significant difference for discharge total FIM score(P = 0.056). The lower levels fatigue patients had higher admission FIM score and discharge cognitive FIM score, than the high levels fatigue patients, but they did not achieve the statistically significant threshold. Conclusion1. This study indicated that poststroke fatigue has a negative impact on patients’ functional independence, attention and active during rehabilitation process, prolong inpatient rehabilitation time.2. Since fatigue can be a limitation factor of participation in stroke recovery programs and was significantly related to rehabilitation outcomes, healthcare providers should be alert to fatigue and its causative factors during the inpatient rehabilitation.