Patients with Severe Poststroke Fatigue Show a Psychosocial Profile Comparable to Patients with Other Chronic Disease: Implications for Diagnosis and Treatment
Objective. To obtain a psychosocial profile of patients with poststroke fatigue (PSF), which could aid in optimizing treatment strategies. Methods. Eighty-eight outpatients with severe PSF measured with the Checklist Individual Strength-fatigue subscale (CIS-f) and the Fatigue Severity Scale (FSS) were selected. Depression and anxiety, psychological distress, coping, social support, and self-efficacy of this group were compared to reference groups of healthy controls and patients with other chronic diseases. Associations between psychosocial characteristics and fatigue were calculated. Results. Compared to healthy controls, patients with PSF reported more psychological distress, less problem-focused coping, and more positive social support. Minor or no differences were found in comparison with other chronic patients. The CIS-f correlated with somatic complaints and the FSS with cognitive complaints. Conclusion. Patients with PSF show a psychosocial profile comparable to patients with other chronic disease. Implications for diagnosis and treatment are discussed. 1. Introduction In recent years, researchers have become increasingly interested in one of the most common and persisting complaints after stroke, that is, poststroke fatigue (PSF). PSF is best described as a feeling of early exhaustion with weariness, lack of energy and aversion to effort [1] that develops during physical or mental activity and is usually not ameliorated by rest [2, 3]. The percentages of patients reporting fatigue after stroke range from 38% to 77% [4], and these percentages do not seem to decline in the chronic stage [4–6]. Furthermore, PSF appears to be related to higher mortality rates and poorer rehabilitation outcomes [7]. However, the pathogenesis of PSF is still poorly understood and, until now, effective treatments are still lacking [4, 8]. Although the mechanisms leading to PSF are still elusive, its origin is believed to be multifactorial [4]. PSF may be a direct result of organic brain damage [9], as it has often been reported in other types of brain disease, such as traumatic brain injury [10]. However, only a few associations of fatigue with biological markers have been reported in the stroke population [4]. In other words, although stroke severity may play a role, there is little evidence linking lesion size or location to PSF [3–5, 11]. The origin of PSF could also be related to psychosocial factors, which has been the focus of numerous studies (see Lerdal et al., 2009, [4] for an overview). Of all psychosocial factors, the most investigated are depression,
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