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

• Published in: Journal of advanced nursing 2021-04, Vol.77 (4), p.1825-1838
• Main Authors: Su, Ya, Asamoto, Mitsuko, Yuki, Michiko, Saito, Masaru, Hasebe, Naoko, Hirayama, Kengo, Otsuki, Mika, Iino, Chieko
• Format: Article
• Language: English
• Subjects: depression; Fatigue; Health status; Hospitalization; Insomnia; Mental depression; Nursing; Observational studies; Original Research: Empirical Research–Quantitative; Path analysis; Quality of life; Rehabilitation; Research Papers; Sarcopenia; Sleep disorders; Stroke; Survivor
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14731

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. 摘要 目的 分析出院回家后脑卒中后疲劳 (PSF) 相关因素的相互作用, 确定脑卒中后疲劳的预测因素及其对脑卒中幸存者的影响。 设计 一项前瞻性观察研究。 方法 2019年5月至2020年7月, 共招募94名急性脑卒中患者。主要结果是疲劳、抑郁、失眠、少肌症和健康相关生活质量 (HRQOL) , 并在入院时和出院后1个月进行评价。使用疲劳评价量表进行疲劳测量。分别使用医院焦虑抑郁量表——抑郁失眠严重程度指数进行抑郁和失眠评估。使用简易五项评分问卷 (SARC‐F) 测量少肌症, 使用简表‐8评估健康相关生活质量。 结果 急性期脑卒中后疲劳是出院回家后脑卒中后疲劳的独立预测因子。而且路径分析显示, 这种效应既通过急性期脑卒中后疲劳对出院回家后脑卒中后疲劳的直接影响, 也通过与脑卒中前SARC‐F、急性期抑郁和急性期失眠的相互作用的间接影响来介导, 而后者仍是急性期脑卒中后疲劳的独立预测因子。总的来说, 17%的幸存者有持续性脑卒中后疲劳。持续性脑卒中后疲劳与抑郁、失眠、少肌症和较低的生活质量评分显著相关。 结论 可能在急性期发生脑卒中后疲劳,