Objective. To evaluate the need for information and treatment of poststroke fatigue (PSF) in community-dwelling patients with stroke in The Netherlands. Methods. Data were obtained from a Dutch internet-based questionnaire. The amount of information received about PSF, self-management and other treatment options, and the perceived need for treatment were scored. PSF was assessed with two Visual Numerical Scales of fatigue severity (VNSF), the Fatigue Severity Scale (FSS7), and by scoring the nature (physical versus mental) and onset time of PSF. Results. Data were available of 538 stroke survivors (mean age 52 years, 45% men, and mean time since onset 2.7 years). Severe fatigue (both VNSF items ≥7; 48%) and severe fatigue impact (FSS7？>？5; 68%) were frequent. Most participants (57%) experienced both physical and mental fatigue. Only 17% of the respondents indicated to have had received sufficient information about PSF and 7% about treatment options, whereas 56% expressed a substantial need for treatment. The need for treatment was moderately associated with fatigue severity and fatigue impact, whereas information status was not related to any demographical, fatigue, or stroke characteristic. Conclusions. PSF is a significant symptom after stroke requiring medical attention and treatment. The results of this survey indicate that patients do not receive adequate information on PSF. 1. Introduction Persisting fatigue is a common and debilitating consequence of stroke even in patients with good recovery [1–4]. Prevalence rates of poststroke fatigue (PSF) are substantial, varying between 38 and 73% [4]. These rates seem to be stable over time, with no marked decline after the postacute stage to even years following the injury [5–9]. As no unequivocal associations with clinical or demographical variables, such as stroke type, age, sex, or education, have been found, all patients who have experienced a stroke may be at risk to develop this symptom [4]. Furthermore, PSF has been found to have a negative effect on quality of life [2, 10], rehabilitation outcomes [11], and even mortality [12–14]. However, PSF is often misdiagnosed [11, 15, 16] and evidence-based clinical guidelines for dealing with PSF are scarce [17, 18]. The pathogenesis of PSF is still poorly understood [4, 12, 19, 20] but believed to be multifactorial [4, 5, 12, 14, 20–22]. Although direct associations with biological markers have been demonstrated only in a few studies [20], the brain damage itself is suggested to be a primary cause for the experienced fatigue [23–25]. Furthermore,
References
[1]
M. H. de Groot, S. J. Phillips, and G. A. Eskes, “Fatigue associated with stroke and other neurologic conditions: implications for stroke rehabilitation,” Archives of Physical Medicine and Rehabilitation, vol. 84, no. 11, pp. 1714–1720, 2003.
[2]
G. E. Carlsson, A. M？ller, and C. Blomstrand, “Consequences of mild stroke in persons <75 years—a 1-year follow-up,” Cerebrovascular Diseases, vol. 16, no. 4, pp. 383–388, 2003.
[3]
J. Bogousslavsky, “William Feinberg lecture 2002: emotions, mood, and behavior after stroke,” Stroke, vol. 34, no. 4, pp. 1046–1050, 2003.
[4]
A. Lerdal, L. Bakken, S. Kouwenhoven et al., “Poststroke fatigue—a review,” Journal of Pain and Symptom Management, vol. 38, no. 6, pp. 928–949, 2009.
[5]
V. Schepers, A. Visser-Meily, M. Ketelaar, and E. Lindeman, “Poststroke fatigue: course and its relation to personal and stroke-related factors,” Archives of Physical Medicine and Rehabilitation, vol. 87, no. 2, pp. 184–188, 2006.
[6]
D. Christensen, S. P. Johnsen, T. Watt, I. Harder, M. Kirkevold, and G. Andersen, “Dimensions of post-stroke fatigue: a two-year follow-up study,” Cerebrovascular Diseases, vol. 26, no. 2, pp. 134–141, 2008.
[7]
S. P. van der Werf, H. L. van Den Broek, H. W. Anten, and G. Bleijenberg, “Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics,” European Neurology, vol. 45, no. 1, pp. 28–33, 2001.
[8]
B. Y. Tseng, S. A. Billinger, B. J. Gajewski, and P. M. Kluding, “Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke,” Stroke, vol. 41, no. 12, pp. 2908–2912, 2010.
[9]
H. Naess, H. I. Nyland, L. Thomassen, J. Aarseth, and K. M. Myhr, “Fatigue at long-term follow-up in young adults with cerebral infarction,” Cerebrovascular Diseases, vol. 20, no. 4, pp. 245–250, 2005.
[10]
I. G. van de Port, G. Kwakkel, V. P. Schepers, C. T. Heinemans, and E. Lindeman, “Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke?” Cerebrovascular Diseases, vol. 23, no. 1, pp. 40–45, 2007.
[11]
M. Bendz, “The first year of rehabilitation after a stroke—from two perspectives,” Scandinavian Journal of Caring Sciences, vol. 17, no. 3, pp. 215–222, 2003.
[12]
G. E. Mead, C. Graham, P. Dorman et al., “Fatigue after stroke: baseline predictors and influence on survival. analysis of data from UK patients recruited in the international stroke trial,” PLoS ONE, vol. 6, no. 3, Article ID e16988, 2011.
[13]
E. L. Glader, B. Stegmayr, and K. Asplund, “Poststroke fatigue: a 2-year follow-up study of stroke patients in Sweden,” Stroke, vol. 33, no. 5, pp. 1327–1333, 2002.
[14]
H. Naess, L. Lunde, J. Brogger, and U. Waje-Andreassen, “Fatigue among stroke patients on long-term follow-up. The Bergen stroke study,” Journal of the Neurological Sciences, vol. 312, no. 1-2, pp. 138–141, 2012.
[15]
N. A. Flinn and J. E. Stube, “Post-stroke fatigue: qualitative study of three focus groups,” Occupational Therapy International, vol. 17, no. 2, pp. 81–91, 2010.
[16]
J. H. White, K. R. Gray, P. Magin et al., “Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: a prospective qualitative study,” Disability and Rehabilitation, vol. 34, no. 16, pp. 1376–1384, 2012.
[17]
E. McGeough, A. Pollock, L. N. Smith et al., “Interventions for post-stroke fatigue,” Cochrane Database of Systematic Reviews, no. 3, article CD007030, 2009.
[18]
A. M. Zedlitz, T. C. Rietveld, A. C. Geurts, and L. Fasotti, “Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial,” Stroke, vol. 43, no. 4, pp. 1046–1051, 2012.
[19]
F. Duncan, M. A. Kutlubaev, M. S. Dennis, C. Greig, and G. E. Mead, “Fatigue after stroke: a systematic review of associations with impaired physical fitness,” International Journal of Stroke, vol. 7, no. 2, pp. 157–162, 2012.
[20]
M. A. Kutlubaev, F. H. Duncan, and G. E. Mead, “Biological correlates of post-stroke fatigue: a systematic review,” Acta Neurologica Scandinavica, vol. 125, no. 4, pp. 219–227, 2012.
[21]
A. Lerdal, L. N. Bakken, E. F. Rasmussen et al., “Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke,” Disability and Rehabilitation, vol. 33, no. 4, pp. 334–342, 2011.
[22]
A. M. E. E. Zedlitz, J. M. A. Visser-Meily, V. P. Schepers, A. C. H. Geurts, and L. Fasotti, “Patients with severe post-stroke fatigue show a psychosocial profile comparable to patients with other chronic disease: implications for diagnosis and treatment,” ISRN Neurology, vol. 2011, Article ID 627081, 8 pages, 2011.
[23]
A. Chaudhuri and P. O. Behan, “Fatigue in neurological disorders,” The Lancet, vol. 363, no. 9413, pp. 978–988, 2004.
[24]
J. Y. Park, M. H. Chun, S. H. Kang, J. A. Lee, B. R. Kim, and M. J. Shin, “Functional outcome in poststroke patients with or without fatigue,” American Journal of Physical Medicine and Rehabilitation, vol. 88, no. 7, pp. 554–558, 2009.
[25]
D. Claros-Salinas, D. Bratzke, G. Greitemann, N. Nickisch, L. Ochs, and H. Schr？ter, “Fatigue-related diurnal variations of cognitive performance in multiple sclerosis and stroke patients,” Journal of the Neurological Sciences, vol. 295, no. 1-2, pp. 75–81, 2010.
[26]
S. Choi-Kwon, J. Choi, S. U. Kwon, D. W. Kang, and J. S. Kim, “Fluoxetine is not effective in the treatment of poststroke fatigue: a double-blind, placebo-controlled study,” Cerebrovascular Diseases, vol. 23, no. 2-3, pp. 103–108, 2007.
[27]
F. Staub and J. Bogousslavsky, “Fatigue after stroke: a major but neglected issue,” Cerebrovascular Diseases, vol. 12, no. 2, pp. 75–81, 2001.
[28]
A. W. Barrit and D. G. Smithard, “Targeting fatigue in stroke patients,” ISRN Neurology, vol. 2011, Article ID 805646, 6 pages, 2011.
[29]
L. Whitehead, “The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures,” Journal of Pain and Symptom Management, vol. 37, no. 1, pp. 107–128, 2009.
[30]
J. H. Vercoulen, C. M. Swanink, J. F. Fennis, J. M. Galama, J. W. van der Meer, and G. Bleijenberg, “Dimensional assessment of chronic fatigue syndrome,” Journal of Psychosomatic Research, vol. 38, no. 5, pp. 383–392, 1994.
[31]
L. B. Krupp, N. G. LaRocca, J. Muir-Nash, and A. D. Steinberg, “The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus,” Archives of Neurology, vol. 46, no. 10, pp. 1121–1123, 1989.
[32]
V. Mathiowetz, K. M. Matuska, and M. E. Murphy, “Efficacy of an energy conservation course for persons with multiple sclerosis,” Archives of Physical Medicine and Rehabilitation, vol. 82, no. 4, pp. 449–456, 2001.
[33]
H. Gonzalez, T. Olsson, and K. Borg, “Management of postpolio syndrome,” The Lancet Neurology, vol. 9, no. 6, pp. 634–642, 2010.
[34]
C. S. Cleeland, T. R. Mendoza, X. S. Wang et al., “Assessing symptom distress in cancer patients: the M. D. Anderson symptom inventory,” Cancer, vol. 89, no. 7, pp. 1634–1646, 2000.
[35]
R. P. C. Kessels, “Patients' memory for medical information,” Journal of the Royal Society of Medicine, vol. 96, no. 5, pp. 219–222, 2003.
