Patients experience of cognitive fatigue post-stroke: an exploratory study

Identifying mediators of healthy lifestyle adoption after stroke: a focus group study using a Theoretical Domains Framework guided analysis

BACKGROUND

Lifestyle measures in addition to pharmacotherapy are recommended to optimise stroke secondary prevention. Adopting and sustaining good health behaviours after stroke necessitates ongoing motivation, influenced by complex social and cultural factors. This study analysed stroke survivors' experiences of addressing their lifestyle-related risks through a comprehensive theoretical lens addressing cognitive, affective, social, and environmental influences. Patient and public involvement (PPI) enhanced the research quality and transparency.

METHODS

Eight focus group discussions (N = 35 stroke participants; N = 3 family members/informal carers) were facilitated using semi-structured questions co-developed with a PPI panel. Purposive sampling ensured adequate representation (e.g. urban/rural location and stroke-related disabilities). Data were first coded and categorised inductively and mapped to the Theoretical Domains Framework (TDF) deductively to identify relevant constructs and theories of behaviour-change.

RESULTS

Participants reported risk reducing lifestyle changes as largely self-directed activities they figured out themselves. Their experiences mapped to 10 of the 14 theoretical domains of the TDF. The most reported behaviour-change mediators discussed were in the domains of Knowledge and Social Influences, seen as encouraging change and supporting emotional reactions. Goals were discussed in a limited way indicating underutilisation. Reminders, reinforcements, and rules to observe for maintaining healthy behaviours, mapping to the Reinforcement and Behavioural Regulation domains, were valued constructs. Psychosocial challenges, emotional responses and cognitive difficulties (Memory, Attention & Decision Processes and Emotions domains) were strongly evident, resonating with the experiences of our PPI contributor and interfacing with behaviour change processes and knowledge uptake. Health-beliefs, self-identity and perceived ability to change behaviour were considered to assert both positive and negative influences on behaviours, mapping to Social/Professional Role & Identity, Beliefs about Consequences and Beliefs about Capabilities domains. 'Know how' was highlighted as largely lacking for behaviour change, with the associated theoretical domains Intentions, Skills, Environmental context & resources to encourage skills development and Optimism about change notably absent from discussions.

CONCLUSIONS

The TDF proved a valuable tool to link stroke survivors' secondary prevention experiences and unmet needs with recognised constructs for behaviour-change. Results have important theory-driven implications to guide future interventions designed to support individuals in risk reducing behaviours following stroke.

Functional Recovery in Acute and Subacute Stroke Patients With or Without Post-stroke Fatigue

This study analyzed the impact of post-stroke fatigue (PSF) on functional recovery in acute and subacute stroke patients during inpatient rehabilitation. Medical records of 177 patients were retrospectively reviewed. PSF was assessed using the Fatigue Severity Scale (FSS)-9. Patients were classified into two groups: a PSF group (mean FSS ≥ 4) and a non-PSF group (mean FSS < 4). Stroke severity was measured with the National Institutes of Health Stroke Scale, and functional outcomes were evaluated using Functional Ambulation Category (FAC), Berg Balance Test, Korean version of the Modified Barthel Index (K-MBI), and Mini-Mental State Examination-Korean version (MMSE-K). Statistical significance was set at p < 0.05. The prevalence of PSF was 52.5%. The repeated measures of analysis of variance showed significant "time" effects on FAC (F = 29.726, p < 0.001) and K-MBI (F = 15.348, p < 0.001). A significant "group" effect was observed on MMSE-K (F = 4.571, p = 0.035), and a "time × group" interaction on only K-MBI (F = 4.284, p = 0.041). Multivariable logistic regression analysis showed that improvements in K-MBI scores were independent of initial severity, depression, and age (p = 0.043). PSF affects the recovery of activities of daily living (ADL) in stroke patients, suggesting that regulating early fatigue after stroke positively affects functional recovery.

Vigilant Attention During Cognitive and Language Processing in Aphasia

PURPOSE

Persons with aphasia (PWA) experience differences in attention after stroke, potentially impacting cognitive/language performance. This secondary analysis investigated physiologically measured vigilant attention during linguistic and nonlinguistic processing in PWA and control participants.

METHOD

To evaluate performance and attention in a language task, seven PWA read sentences aloud (linguistic task) and were compared to a previous data set of 10 controls and 10 PWA. To evaluate performance and attention in a language-independent task, 11 controls and nine PWA completed the Bivalent Shape Task (nonlinguistic task). Continuous electroencephalogram (EEG) data were collected during each session. A previously validated EEG algorithm classified vigilant-attention state for each experiment trial into high, moderate, distracted, or no attention. Dependent measures were task accuracy and amount of time spent in each attention state (measured by the number of trials).

RESULTS

PWA produced significantly more errors than controls on the linguistic task, but groups performed similarly on the nonlinguistic task. During the linguistic task, controls spent significantly more time than PWA in a moderate-attention state, but no statistically significant differences were found between groups for other attention states. For the nonlinguistic task, amount of time controls and PWA spent in each attention state was more evenly distributed. When directly comparing attention patterns between linguistic and nonlinguistic tasks, PWA showed significantly more time in a high-attention state during the linguistic task as compared to the nonlinguistic task; however, controls showed no significant differences between linguistic and nonlinguistic tasks.

CONCLUSIONS

This study provides new evidence that PWA experience a heightened state of vigilant attention when language processing demands are higher (during a linguistic task) than when language demands are lower (during a nonlinguistic task). Collectively, results of this study suggest that when processing language, PWA may allocate more attentional resources than when completing other kinds of cognitive tasks.

How do sepsis survivors experience life after sepsis? A Danish qualitative study exploring factors of importance

OBJECTIVE

Sepsis is a condition associated with high mortality and morbidity, and survivors often experience physical and psychological decline. Previous research has primarily focused on sepsis survivors discharged from the intensive care unit (ICU). We aimed to explore and understand the consequences of sepsis experienced by sepsis survivors in general.

DESIGN

A qualitative study inspired by a phenomenological hermeneutical approach was conducted. Data were analysed using systematic text condensation.

SETTING

Patients with sepsis were identified on admission to the emergency department and invited to an interview 3 months after discharge.

PARTICIPANTS

Sixteen sepsis survivors were purposively sampled and interviewed. Among these survivors, one patient was admitted to the ICU.

RESULTS

Three main themes were derived from the analysis: new roles in life, cognitive impairment and anxiety. Although many survivors described a physical decline, they experienced psychological and cognitive impairments after sepsis as the most influential factors in daily life. The survivors frequently experienced fatigue, withdrawals from social activities and anxiety.

CONCLUSION

Sepsis survivors' experiences appeared to overlap regardless of ICU admission or treatment at the general ward. Identifying patients with sepsis-related decline is important to understand and support overall patient processes and necessary in meeting specific needs of these patients after hospital discharge.

Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders

Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.