Post-Stroke Fatigue: Epidemiology
Post-Stroke Fatigue: Epidemiology
The primary goals of stroke management are to reduce brain injury and promote maximum patient recovery. Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.
Once a patient is medically stable, the focus of their recovery shifts to rehabilitation. Some patients are transferred to in-patient rehabilitation programs, while others may be referred to out-patient services or home-based care. In-patient programs are usually facilitated by an interdisciplinary team that may include a physician, nurse, pharmacist, physical therapist, occupational therapist, speech and language pathologist, psychologist, and recreation therapist. The patient and their family/caregivers also play an integral role on this team. Family/caregivers that are involved in the patient care tend to be prepared for the caregiving role as the patient transitions from rehabilitation centers. While at the rehabilitation center, the interdisciplinary team makes sure that the patient attains their maximum functional potential upon discharge. The primary goals of this sub-acute phase of recovery include preventing secondary health complications, minimizing impairments, and achieving functional goals that promote independence in activities of daily living.
Stroke is the second-ranked cause of mortality in the world and a major cause of disability. Whether ischemic or hemorrhagic, stroke can induce physical disabilities and cognitive, psychological, and behavioral impairments. Poststroke depression is of particular interest. For several decades, fatigue was considered to be a symptom of poststroke depression. However, the fact that depression-free patients frequently complain of fatigue has prompted the examination of “Post Stroke Fatigue” (PSF) as a specific syndrome.
At present, there is no consensual, clear definition of PSF and this is partly because of the syndrome’s complexity. PSF differs from normal fatigue that results from overexertion and is relieved by rest. In fact, PSF is a disease state characterized by a chronic, persistent, excessive lack of energy with an impact on activities of daily living. PSF is generally defined in subjective terms as an overall state of feeling: “a feeling of early exhaustion, weariness, and aversion to effort”. This type of fatigue has been studied with qualitative approaches such as patient interviews and patient questionnaires like the Fatigue Severity Scale (FSS)
Methods
A computer-aided search in Medline was performed on June 6, 2013, which was later updated in October 2013 using the keywords ‘fatigue', ‘stroke', ‘depression', ‘asthenia'.
The search retrieved 69 publications. Two authors read every abstract and obtained the full text of paper that were deemed interesting; reference lists of the retrieved articles were scrutinized for potentially relevant studies.
We excluded case reports, abstracts as well as articles not written in English and articles not published in peer-reviewed journals. Moreover, we also excluded studies having a few patients enrolled.
Overall, 62 articles were read by the three authors in order to provide a narrative review of the epidemiology, clinical characteristics and treatment for post-stroke fatigue.
Epidemiology
Fatigue is among the most prevalent symptoms after stroke and is an important predictor for death after stroke onset. The frequency of post-stroke fatigue ranges from 29% to 77%. This large variability across studies is due to two known reasons. The first reason is that fatigue is difficult to define, characterise and measure. In fact, methodological differences among studies include different definitions of fatigue, different inclusion criteria and different fatigue scales.