Predictors and short-term outcomes of post-stroke fatigue in initial phase of transition from hospital to home: A prospective observational study

Risk of sarcopenia among older adults and associated factors in daily life

BACKGROUND

Sarcopenia-associated lifestyle factors are not fully recognised. Community nurses could identify such factors and promote intervention strategies, mitigating the risk of sarcopenia.

AIMS

To investigate the health indicators and lifestyle factors that have an impact on increased sarcopenia risk among older adults in the community.

METHODS

A cross-sectional study was conducted with data collected using a structured questionnaire. The SARC-F questionnaire was used for the risk assessment of sarcopenia. The Barthel index, Fatigue Severity Scale, Visual Analogue Scale and Athens Insomnia Scale were used to assess functionality, fatigue and sleep. The duration of sleep was self-reported. Descriptive statistics and logistic regression were used for the data analysis.

FINDINGS

A total of 100 subjects (median age=72.50 years) were included in this pilot study. Among the participants, 19% were identified as being at risk for sarcopenia. Functionality, fatigue and sleep difficulties predicted the risk for sarcopenia.

CONCLUSIONS

Community nurses could identify older adults at risk of sarcopenia by recognising the associated factors in everyday life.

IMPLICATIONS FOR PRACTICE

Nurses in community settings could contribute to the prevention, early detection, slow progression or even potential reversal of sarcopenia by identifying, evaluating and addressing related factors to sarcopenia in the daily lives of community-dwelling older adults. Conducting routine screenings for muscle strength and function, promoting targeted exercise programmes and providing nutritional guidance to support muscle health can make a significant difference. Nurses and other healthcare professionals can collaborate to develop personalised intervention plans to provide comprehensive care to older adults for mobility and independence.

Prevalence, Trajectory, and Factors Associated With Patient-Reported Nonmotor Outcomes After Stroke: A Systematic Review and Meta-Analysis

Importance

The evidence on nonmotor outcomes after acute ischemic stroke and intracerebral hemorrhage (ICH) is limited and domain-specific. The prevalence, natural history, and factors associated with nonmotor outcomes across multiple domains are unclear.

Objective

To synthesize the published data and to identify the prevalence, natural history, and factors associated with multidomain nonmotor outcome burden in patients with stroke.

Data Sources

A search of PubMed, MEDLINE, EMBASE, and PsycINFO databases between January 1999 to June 2023 was supplemented by search of bibliographies of the key articles.

Study Selection

The analysis included prospective cohort studies that reported nonmotor outcomes across 10 domains: anxiety, depression, fatigue, sleep disturbance, social participation, pain, bladder dysfunction, bowel dysfunction (constipation and fecal incontinence), and sexual dysfunction assessed by patient-reported scales.

Data Extraction and Synthesis

Two reviewers independently assessed studies, extracting baseline data, nonmotor prevalence, and follow-up information. Pooled prevalence of nonmotor outcomes was estimated using random-effects models. Meta-regression models were used to analyze natural history and factors associated with nonmotor outcomes. Subgroup analysis was used to assess prevalence by symptom description within each nonmotor domain. Publication bias and study quality were assessed using funnel plots and the Newcastle-Ottawa scale.

Results

A total of 279 prospective cohort studies met the inclusion criteria (117 440 participants with stroke; median [IQR] age, 65 [59-70] years; 209 of 279 studies with more male than female participants) with a nonmotor outcome follow-up period ranging from 30 days to 10 years after stroke. The most prevalent adverse nonmotor outcomes by pooled prevalence were sleep disturbance (59.9%; 95% CI, 53.9%-63.9%), sexual dysfunction (59.8%; 95% CI, 50.0%-69.5%), constipation (58.2%; 95% CI, 53.9%-62.6%), reduced social participation (56.5%; 95% CI, 52.1%-60.8%), bladder dysfunction (45.9%; 95% CI, 38.0%-53.8%), and fatigue (45.2%; 95% CI, 40.7%-49.5%). Meta-regression analysis showed no significant improvement over time for most nonmotor outcomes, except pain (coefficient = -11.0%; P = .05) and sexual dysfunction (coefficient = -24.1%; P < .001). The heterogeneity ranged between 52% and 98% across all studies. The common factors associated with adverse nonmotor outcomes were female sex, studies with mixed stroke cohort (ischemic stroke or ICH), and older age.

Conclusions and Relevance

Patient-reported nonmotor outcomes were common after stroke. Sexual dysfunction, sleep disturbance, constipation, reduced social participation, bladder dysfunction, and fatigue were most prevalent. These adverse outcomes often persisted over time, especially in women, older adults, and those in studies with mixed stroke cohorts.

Post-stroke fatigue interventions for stroke survivors: A scoping review

Background

Fatigue following a stroke, known as post-stroke fatigue (PSF), is a frequent complication experienced by individuals recovering from a stroke, with its incidence steadily increasing over time. The long-term presence of PSF significantly hinders the rehabilitation process and quality of life for these individuals. However, the most effective intervention strategies for PSF remain unclear. Therefore, it is crucial to implement appropriate intervention strategies at an early stage to prevent and manage PSF, thereby mitigating its negative impacts and promoting recovery in stroke survivors.

Objective

This scoping review aimed to explore and chart the interventions available for managing post-stroke fatigue in individuals recovering from stroke, providing healthcare professionals with evidence to guide the development of optimal treatments.

Design

A scoping review.

Data Sources

This review conducted a systematic search across six databases⎯PubMed, Web of Science, Cochrane Library, Scopus and CINAHL (via EBSCO), and CNKI, for articles published from 10 January 2012 to early May 2024.

Review Methods

This review followed the PRISMA-ScR reporting guidelines. Studies were selected based on the PCC framework, focusing on specific participants, concepts, and contexts. Exclusion criteria included ongoing studies without results, articles without full text, posters, reviews, and protocols. Tables and narrative descriptions were used to present relevant information on the interventions and their outcomes during the review process.

Results

Twenty-seven studies were included, categorizing interventions for post-stroke fatigue into ten types: pharmacological treatments, physical activity, physical therapy, cognitive behavioral therapy, respiratory training, music therapy, mindfulness-based stress reduction, health education management, Traditional Chinese Medicine, and environmental enrichment.

Conclusion

The interventions for post-stroke fatigue have demonstrated positive effects in alleviating fatigue symptoms among stroke survivors. However, some approaches have limitations, and the most effective treatment strategy remains unclear. The multidisciplinary collaboration between nurses and healthcare professionals plays a critical role in managing post-stroke fatigue by providing patients with education on fatigue prevention and treatment, along with personalized care plans, including one-on-one or group interventions. Future research should focus on increasing sample sizes and conducting multicenter trials to identify the most effective intervention strategies for managing post-stroke fatigue.

Fear of disease progression and resilience parallelly mediated the effect of post-stroke fatigue on post-stroke depression: A cross-sectional study

AIMS

To explore the effect of post-stroke fatigue (PSF) on post-stroke depression (PSD) and examine the mediating effects of fear of disease progression (FOP) and resilience between PSF and PSD.

DESIGN

A cross-sectional study.

METHODS

A total of 315 stroke patients participated in the questionnaire survey between November 2022 and June 2023. Data were collected using the General Information Questionnaire, Fatigue Severity Scale, Fear of Disease Progression Questionnaire-Short Form, Connor-Davidson Resilience Scale-10 Item and Hospital Anxiety and Depression Scale-Depression Subscale. Data were analysed by descriptive analysis, Mann-Whitney U-test, Kruskal-Wallis H-test, Pearson or Spearman correlation, hierarchical regression analysis and mediation analysis.

RESULTS

PSF had a significant positive total effect on PSD (β = .354, 95% CI: .251, .454). Additionally, FOP and resilience played a partial parallel-mediating role in the relationship between PSF and PSD (β = .202, 95% CI: .140, .265), and the total indirect effect accounted for 57.06% of the total effect.

CONCLUSIONS

FOP and resilience parallelly mediated the effect of PSF on PSD, which may provide a novel perspective for healthcare professionals in preventing PSD. Targeted interventions aiming at reducing PSF, lowering FOP levels and enhancing resilience may be possible ways to alleviate PSD.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Interventions that tail to reducing PSF, lowering FOP levels and enhancing resilience may be considered as possible ways to alleviate PSD.

IMPACT

This study enriched the literature by exploring the effect of PSF on PSD and further examining the mediating effects of FOP and resilience between PSF and PSD. Findings emphasized the important effects of PSF, FOP and resilience on PSD.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to guide reporting.

PATIENT OR PUBLIC CONTRIBUTION

One tertiary hospital assisted participants recruitment.

Using of Hot Red Bean Bag on the Symptoms of Depression, Sleep, and Fatigue in Stroke Patients

Background

Symptoms of depression, sleep, and fatigue in stroke patients are associated with each other, and intervention development for improving of these symptoms is needed. This study aimed to examine the effects of hot red bean bag on depression, sleep state, sleep satisfaction, and fatigue among Korean stroke patients.

Methods

A quasi-experimental pretest-posttest control group design was employed. The study participants included 57 stroke patients (Intervention: n=28, Control: n=29) in a hospital in Seoul, South Korea from Aug 2017 to Mar 2018. Hot red bean bag, as an intervention, was heated in a 2,450 MHz microwave oven for 3 min, and applied for 30 min at 41±6 °C in the lower limbs of the intervention group for 5 days.

Results

There were statistically significant differences on depression (P<0.001), sleep state (P<0.001), sleep satisfaction (P<0.001), and total fatigue (P<0.001) between the two groups.

Conclusion

Hot red bean bag was an effective intervention for decreasing depression and total/subcategories fatigue, and for improving sleep state and sleep satisfaction of Korean stroke patients. Research on complementary and alternative therapies for stroke patients needs be studied continuously.

Post-stroke fatigue: a review of development, prevalence, predisposing factors, measurements, and treatments

Background

Post-stroke fatigue (PSF) is a ubiquitous and overwhelming symptom for most stroke survivors. However, there are no effective management strategies for PSF, which is partly due to our limited understanding.

Objective

In this paper, we review the development, prevalence, predisposing factors, measurements, and treatments of PSF.

Results

PSF is an independent symptom after stroke, with a prevalence ranging from 42 to 53%, which depends on the selection of measurement tools and stroke characteristics. It is affected by biological, physical, and psychological factors, among which inflammation may play a key role.

Conclusion

Numerous but non-specific evaluation measurement tools limit the management of PSF. In clinical practice, it may be beneficial to identify PSF by combining scales and objective indexes, such as walking tests and electromyographic examinations. There are no evidence-based interventions to improve PSF. However, increasing evidence suggests that transcranial direct-current stimulation and mindfulness-based interventions may become promising treatments. Further studies are urgently needed to better understand the etiology of PSF, thereby providing the basis for developing new measurement tools and targeted treatments.

Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention

Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.

Fatigue Experiences in People With Stroke

PURPOSE

Fatigue is a major symptom in patients with stroke. Because fatigue is an overarching multidimensional phenomenon, it is important to understand how the characteristics of fatigue change over time. The purpose of this study was to explore how fatigue characteristics change over time in patients with stroke.

DESIGN

This study used a mixed-method observational design.

METHODS

This study is a secondary analysis of data from a previous study, the results of which indicated fatigue to be a prominent symptom. Participants in that study were patients with stroke who met eligibility criteria and provided informed consent. This secondary analysis used data from numeric rating scale scores for fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores, fatigue descriptors, and participant comments about fatigue gleaned from transcribed interviews.

RESULTS

Twenty-two patients participated in the study. Thirteen characteristics of fatigue were evaluated. Seven characteristics showed significant improvement ( p < .05) from admission to 1 month follow-up, and six characteristics did not change significantly.

CONCLUSIONS

Fatigue experiences vary over time and have both physical and mental aspects to them.

CLINICAL RELEVANCE TO REHABILITATION NURSING

Nurses may consider providing a quiet environment for physical rest, which may allow the brain to not be distracted by multiple stimuli.

Addressing mood and fatigue in return-to-work programmes after stroke: a systematic review

Introduction

Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue.

Method

Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided.

Results

The search yielded 5 RCTs that satisfied the selection criteria (n = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies.

Conclusion

Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.

Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward

Sato M, Hyakuta T. Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 39-48.

Objective

To clarify the level of awareness of and support for post-stroke fatigue among medical professionals working in recovery phase rehabilitation wards.

Methods

We conducted a questionnaire survey targeting all medical professionals (physicians, nurses, physical therapists, occupational therapists, and speech therapists) working in recovery phase rehabilitation wards of three facilities to evaluate their awareness of post-stroke fatigue and the support they were offering to address this. Quantitative data were subjected to statistical analysis and free description data were subjected to content analysis.

Results

Of the 130 participants, we obtained responses from 94 (collection rate, 72.3%; valid response rate, 100%). Those who felt that post-stroke patients are always tired or tire easily comprised 63.8%. Those who acknowledged the importance of post-stroke fatigue as a problem and that it is an issue that must be addressed comprised 70.2% and 73.4%, respectively. Issues emerging due to post-stroke fatigue were extracted as follows: "Difficulty continuing with rehabilitation," "Decreased drive," "Difficulty with emotional control/depression," "Fewer interactions with others," and "Loss of goals." Support for post-stroke fatigue was offered by 57.4% of medical professionals, most commonly as individual support such as "Ensure rest." The effects of support were described as "Cannot say either way" (44.4%), with 3.7% noting that they were not very effective. Awareness and support rates among therapists were significantly higher than those among nurses.

Conclusions

Post-stroke fatigue is acknowledged by medical professionals as a critical issue that negatively influences the patient's physical, emotional, and daily living functions. Unfortunately, effective support is not currently being offered, demonstrating the need for the development of appropriate interventions.

Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression

BACKGROUND

Depression is the most common psychiatric condition that occurs after cerebrovascular accident, especially within the first year after stroke. Poststroke depression (PSD) may occur due to environmental factors such as functional limitations in daily activities, lower quality of life, or biological factors such as damage to areas in the brain involved in emotion regulation. Although many factors are hypothesized to increase the risk of PSD, the relative contribution of these factors is not well understood.

PURPOSE

We evaluated which cross-sectional variables were associated with increased odds of PSD in our adult outpatient stroke neuropsychology clinic population.

METHODS

The sample included 325 patients (49.2% female; mean age of 59-years old) evaluated at an average of 8.1 months after an ischemic or hemorrhagic stroke. Variables included in logistic regression were stroke characteristics, demographics, psychosocial factors, comorbid medical problems, comorbid psychiatric conditions, and cognitive status. The Mini International Neuropsychiatric Inventory was used to determine DSM-defined PSD and anxiety disorders. A standard neuropsychological test battery was administered.

RESULTS

PSD occurred in 30.8% of the sample. Logistic regression indicated that increased odds of PSD were associated with a comorbid anxiety disorder (5.9 times more likely to suffer from PSD, p < 0.001). Further, increased odds of PSD were associated with a history of depression treatment before stroke (3.0 times more likely to suffer from PSD), fatigue (2.8 times more likely), memory impairment (2.4 times more likely), and younger age at stroke (all p values < 0.006).

DISCUSSION

Results suggest that PSD is likely multifactorial and extends the literature by demonstrating that a comorbid anxiety disorder correlated strongest with PSD. Poststroke screening and treatment plans should address not only depression but comorbid anxiety.

Long-term prognostic significance of sarcopenia in acute ischemic stroke

Because sarcopenia is widely distributed in patients with acute ischemic stroke (AIS) and has not attracted enough attention, this study aims to explore the relationship between sarcopenia defined by temporal muscle thickness (TMT) and physical function and prognosis of patients with AIS. A total of 265 hospitalized nonsurgical AIS patients from 2015 to 2018, with an age range of 28 ~ 92, were analyzed retrospectively. The median value of TMT was used as the risk classification index of sarcopenia. The main results were the relationship between sarcopenia and Essen Stroke Risk Score, National Institutes of Health Stroke Scale, modified Rankin Score, water swallow test, venous thromboembolism assessment of medical inpatients, activities of daily living assessed by Barthel Index, and the relationship between TMT and final survival outcome. The mean TMT of men in the study cohort was higher than that of women. The measured values of TMT among different researchers had good consistency (intraclass correlation coefficient, 0.980; P < .001). After adjusting for confounding variables, logistic regression showed that sarcopenia was associated with Essen Stroke Risk Score (odds ratio, 1.89; P < .05) and Barthel Index (odds ratio, 1.67; P < .05). Kaplan-Meier analysis showed that the survival time of low TMT group was significantly lower than that of high TMT group (36 vs 49 months; P < .001). Multivariate Cox regression showed that there was causal correlation between sarcopenia and patient death (hazard ratio, 3.54; 95% confidence interval, 1.46-8.58; P < .01). As a potential comprehensive index, thickness of temporal muscle can be included in baseline evaluation to show the physical status, stroke recurrence, and survival prognosis of AIS patients.

Predictors and short-term outcomes of post-stroke fatigue in initial phase of transition from hospital to home: A prospective observational study

AIM

To analyse the interactions of associated factors with post stroke fatigue (PSF) after discharge home and determine the predictors of PSF and their impact on stroke survivors.

DESIGN

A prospective observational study.

METHODS

A total of 94 patients with acute stroke were recruited between May 2019 -July 2020. The main outcomes were fatigue, depression, insomnia, sarcopenia, and health-related quality of life (HRQOL) and were assessed at admission and 1 month after discharge. Fatigue was measured using the Fatigue Assessment Scale. Depression and Insomnia were assessed using the Hospital Anxiety and Depression Scale-Depression and Insomnia Severity Index, respectively. Sarcopenia was measured using the SARC-F questionnaire, and HRQOL was assessed using the Short Form-8.

RESULTS

Acute phase PSF was an independent predictor of PSF after discharge home. Moreover the path analysis revealed that this effect is mediated through both the direct effect of acute-phase PSF on PSF after discharge home and through the indirect effect of interaction with pre-stroke SARC-F, acute phase depression, and acute phase insomnia, which remains a separate predictor of acute-phase PSF. In total, 17% of the survivors had persistent PSF. Persistent PSF was significantly associated with depression, insomnia, sarcopenia, and a lower quality of life scores.

CONCLUSIONS

Post-stroke fatigue may occur in the acute phase and persists after discharge, it will not only affect later depression, insomnia, and quality of life, but also sarcopenia.

IMPACT

Acute phase PSF was found to be an independent predictor of PSF after discharge home. In addition, the interaction with pre-stroke SARC-F, acute phase depression and insomnia had an indirect connection with PSF after discharge home, which remains a separate predictor of acute-phase PSF. Thus, early assessment and management of mental status, sleep problems, and sarcopenia during hospitalization might be an important step in post-stroke rehabilitation and home transition.