Poststroke fatigue: characteristics and related factors

Background and purpose: Poststroke fatigue (PoSF) is a common, but poorly studied problem. The purpose of the present study was to elucidate the characteristics of and the factors associated with PoSF.

Methods: We studied 220 consecutive outpatients at an average of 15 months after the onset of stroke. The presence of poststroke depression (PSD) and poststroke emotional incontinence were identified with the use of a standardized questionnaire. The presence of PoSF was assessed using the visual analogue scale and Fatigue Severity Scale. The presence of prestroke fatigue (PrSF) was also assessed. The impact of PoSF on patients' daily activities was also assessed using the Fatigue Impact Scale.

Results: One hundred and twenty-five patients (57%) had PoSF, 83 (38%) had PrSF and 53 (24%) had PSD. Thirty-six percent of the patients without PrSF and 50% of the patients without PSD had PoSF. The impact of PoSF on patients' daily activities was more severe in the physical domain as compared with the psychological or cognitive domains (p < 0.01). Multivariate analyses showed that the presence of PrSF (p < 0.01, OR 33.5), high modified Rankin scale (MRS; p < 0.05, OR 3.3), PSD (p < 0.05, OR 2.7) were independently associated with PoSF. Cessation of cigarette smoking (p < 0.05) and the presence of PrSF (p < 0.01) were independently related to PoSF in patients without PSD while decrease in sexual activities (p < 0.05) and the presence of dysarthria (p < 0.05) were related to PoSF in patients without PrSF.

Conclusions: Fatigue is a fairly common sequela of stroke patients, exerting an impact on their daily activities, especially physical ones. PrSF is the most important factor related to PoSF, followed by high MRS and PSD. Nevertheless, the causes of PoSF appear multifactorial. Strategies to improve the PoSF should be individualized according to the causative factors.