Chronic Fatigue After Subarachnoid Hemorrhage Is Not Stable: Evidence From An Ecological Momentary Assessment Study

Abstract

<h3>Research Objectives</h3> To study daily variability in fatigue after subarachnoid hemorrhage (SAH) using the ecological momentary assessment (EMA) method. <h3>Design</h3> Observational study with repeated-measures of fatigue during 7 consecutive days using EMA. <h3>Setting</h3> General community. <h3>Participants</h3> Patients (n=42) with SAH who suffer from chronic fatigue, recruited by their treating physician. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Momentary fatigue on a 1 to 7 scale, assessed 10-12 times per day for 7 consecutive days using the EMA method and average fatigue on a 1 to 7 scale assessed with the Fatigue Severity Scale (FSS). <h3>Results</h3> Mean age of the group was 53.9 years (SD=13.0), 43% male, and mean time post SAH onset was 9.3 months (SD=3.2). All patients completed in total 2872 momentary fatigue questions. Mean momentary fatigue over all days was 3.22 (SD=1.47) and mean FSS score was 5.02 (SD=1.18). Total variance in fatigue (2.21) was explained for 52.3% by between-person variance and for 47.7% by within-person variance. Multilevel analyses revealed that fatigue varied significantly (p<0.001) within the day. Moreover, diurnal patterns of fatigue differed between and within individuals. <h3>Conclusions</h3> Fatigue is often assessed retrospectively with a questionnaire (e.g. FSS), in which daily variability in fatigue is not reflected. This study shows that fatigue after SAH is not stable: momentary fatigue varies over the day and is lower than retrospectively assessed fatigue. In addition, individuals show different momentary fatigue patterns between days. These results imply that fatigue is an ambiguous construct; retrospectively assessed fatigue might not capture all the aspects of fatigue as experienced by patients after SAH. Therefore it should be considered to also take into account EMA measures in the assessment of fatigue, this might provide valuable input to optimize personalized interventions to treat fatigue after SAH. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.