Investigation Of Post-stroke Fatigue In Patients With Acute Stroke And Effect Of Lower Extremity Exercise Training On It

Objective:1.To investigate the incidence of post stroke fatigue and the quality of life in patients with acute stroke,and screen out independent risk factors for post stroke fatigue in acute stage,thus providing in order to provide reference for targeted intervention.2.To study the effects of lower limb excise training on fatigue symptoms,activity capacity,social roles and quality of life of patients with post stroke fatigue,for improving the patients' fatigue related symptoms and the quality of life.Methods:The first part:General clinical data of acute stroke patients who were hospitalized in the Department of cerebrovascular disease in a Tertiary Hospital in Guizhou province from August 2016 to March 2017 were collected.The Fatigue Severity Scale(FSS),Stroke Specific Quality of Life scale(SS_QOL)and National Institute of Health Stroke scale(NIHSS)were used to evaluate the clinical situation of the patients admitted to the hospital for 48 hours.The risk factors and quality of life of patients with post-stroke fatigue were analyzed by Chi square test,rank sum test and logistic regression analysis.The second part:The clinical effects of lower limb exercise training in patients with post-stroke fatigue were validated based on the independent risk factors of fatigue after stroke in the acute stage.From April 2017 to November 2017,patients with acute stroke and acute stroke fatigue who were hospitalized in the cerebrovascular Department of a Tertiary Hospital in Guizhou province were selected as the subjects.The intervention to patients was designed as lower limbs exercise training on the basis of regular rehabilitation training with solely regular rehabilitation training as control.The two groups of patients were trained at the beginning of the second day after admission,once a day,30 min each with a total of 12 days.Basic clinical data of two groups of patients were collected by NIHSS scale and general information questionnaire.SS_QOL scale and FSS scale were used to assess the quality of life and fatigue index before and after intervention in two groups of patients.Results:The first part:1.A total of 130 questionnaires were issued,among which 3 patients were discharged from the hospital due to the change of the condition and 7 questionnaires were not finished completely,thus 120 questionnaires were actually recovered.The recovery rate was 97.69%,and the completion rate was 94.48%.48 females and 72 males were included in the 120 acute stage of first attack patients with an average age of 61.07±13.29.There were 87 cases in cerebral arterial thrombosis and 33 cases in hemorrhagic apoplexy.The lowest score of fatigue index score was 1.67 and the highest one was 6 with a mean 4.33 ± 0.65.The incidence of post-stroke fatigue is 74.17%.2.The patients were divided into two groups according to FSS score: 89 patients in the PSF group(FSS?4)and 31 patients in the Non PSF group(FSS<4).Positive correlations between FSS score and SS_QOL score,FSS score and NIHSS score of patients were showed through Spearman's Rank Correlation Analysis.3.The distribution of the 22 possible factors: gender,age,payment of expenses,admission,work,education,average annual income,severity of admission,stroke type,stroke location,past history,NIHSS score,SS_QOL score were compared between in the PSF group and in the Non PSF group,respectively.The results showed that the distribution of 9 factors-gender,age,educational background,condition severity at admission,language,emotion,activity ability,social role and SS_QOL score-were statistically different in the PSF group with those in the Non PSF group.Progressive logistic regression analysis on the nine factors showed that condition severity at admission,activity ability and social role were independent risk factors for PSF.The second part:1.Two independent sample rank sum tests were used,and the results showed that there was no significant difference between the two groups in general demographic data,clinical disease data(sex,age,educational background,admission method,annual average income,hospitalization insurance,working situation,condition of admission,NIHSS score,types of stroke and the diseased region)and:FSS score,SS_QOL score,activity ability score and social role score before intervention(P>0.05).2.The FSS,SS_QOL,energy,family role,language,self-care ability,activity ability,personality,emotion,social role and thinking score of the two groups of patients in the experimental group and the control were analyzed by repeated measurement of variance analysis.The results showed that the scores of FSS,SS_QOL,activity ability and social role were significantly decreased through lower limb exercise training,and the difference was statistically significant(P<0.05).A simple effect analysis was carried out on the significant indicators of interaction effect.The results showed that there was no significant change in FSS,activity,thinking and personality scores before and after the test in the control group(P>0.05).Conclusion:1.The incidence of post stroke fatigue is high and the quality of life is poor in the acute stroke patients with first stroke,and fatigue severity in patients with acute stroke are significantly correlated with quality of life;Condition severity at admission,activity capacity and social role are independent risk factors for post-stroke fatigue.2.Lower extremity exercise training can relieved the fatigue degree of patients with post stroke fatigue,improve the patient's activity ability and quality of life,and reduce the impact of PSF symptoms on the social role of the patients,as well as strengthen the determination of patients to recover their health;Lower extremity exercise training is simple,safe and inexpensive and can be widely applied to the treatment of PSF patients.